Barb Shepard, LMHC

01/20/2026

2025 and 2026 have brought an incredible surge of research in epigenetics, neurodevelopmental disorders, and the neuroimmune aspects of psychiatry.

This large-scale study examines the role of chromatin in the potential development of OCD and related conditions such as Tourette syndrome. It hypothesizes that a complex interaction between genetic vulnerability (involving many genes), epigenetic mechanisms, and environmental factors (such as stress or infection) contributes to the development of OCD.

My own two cents: therapy will always remain essential. Even when the etiology is largely biological, once behaviors like compulsions, rumination, and avoidance are established, the brain builds entrenched neural pathways that become habitual. Evidenced-based methods such as exposure and Response Prevention are necessary to help rewire these circuits. Even when the medical aspects are treated, the behavioral and neural patterns that have formed often still require treatments like ERP to create lasting change.

That said, it is incredibly exciting to see science advancing toward a clearer understanding of what is happening in the brain, which has historically been relatively mysterious organ compared to other parts of the body. The possibility of interventions that could address shared mechanisms across conditions such as ADHD, Tourette syndrome, OCD, and the immune-related components seen in PANS/PANDAS is especially promising.

If we can move toward treatments that target a component of the underlying biological and neuroimmune processes (rather than continuing siloed care based solely on symptom categories) the potential impact for individuals and families would be truly phenomenal.

Read the study here:

Background Obsessive Compulsive Disorder (OCD) affects 2 to 3% of the population and is marked by intrusive thoughts and repetitive behaviours. OCD is increasingly recognized as a polygenic disorder involving gene-environment interactions, with genetic risk largely driven by common variants and a sm...

01/08/2026

🌟 Upcoming Live Zoom Training: Panic & Health Anxiety 🌟

A practical, skills-focused training for adults, parents, and clinicians looking to strengthen their evidence-based approach to overcoming these symptoms.

👩‍⚕️ Co-led by:

Barb Shepard, LMHC
Michelle Stiles, LMHC
OCD, anxiety, and panic specialists based in Syracuse, NY
Highly practical, real-world strategies you can actually use 🧠✨

What We’ll Cover:

🚫 Common pitfalls in health anxiety (reassurance-seeking, checking, avoidance, etc.)
✅ What actually helps panic & health anxiety from an evidence-based lens
🛠️ Actionable strategies clinicians can use and parents can apply with kids
📄 Take-home resource/handout for ongoing support

Who It’s For:

💬 Clients struggling with panic or health anxiety
🧠 Therapists wanting concrete, effective tools
👨‍👩‍👧 Parents supporting anxious children (strategies for both adults and kids)

Details:

📅 Tuesday, February 3
⏰ 1–2 PM
💻 Live on Zoom (replay available for 30 days)
💲 $50

🔗 Registration link:
https://lnkd.in/eQdbz24e

📲 Connect With Us:
Instagram: |
Websites: barbshepardcounseling.com | michellestiles.com

📧 Email with questions: therapy@barbshepardcounseling.com

12/30/2025

Sharing a piece of my story on Instagram today — why PANS/PANDAS matters so much to me. I hope you’ll give it a watch.


https://www.instagram.com/reel/DS41LFQkQ11/?igsh=MTJtYTgxZTZvdDR4aA

12/17/2025

PANS (Pediatric Acute-onset Neuropsychiatric
Syndrome) made it to Newsweek.

One story at a time is going to change the trajectory of diagnosis and treatment for these kids.❤️

https://www.newsweek.com/girl-9-becomes-different-person-overnight-mom-fights-for-rare-diagnosis-11185463

Her mom Crystal, 30, told Newsweek: "She almost seemed possessed, like something came over her body."

12/15/2025

Brilliant webinar on the latest PANS/PANDAS research, highlighting key research that could help bridge the gap between what is well established in neuroscience and what has yet to be fully translated into clinical care:

https://www.pandasppn.org/neuroimmune-epigenetic-webinar/

“Scientific understanding of immune–brain interactions has significantly advanced in the last decade, but translation into clinical care is lacking.”
—Dr. Russell Dale

🧬 Dr. Dale shared over a decade of work in epigenetic neuroimmunology, emphasizing immune–brain cross-talk, microglia as immune cells of the brain (~10% of brain cells), and gene–environment interactions. Many patients have normal MRI, CSF, and bloodwork, yet show meaningful clinical response to anti-inflammatories, antibiotics, and IVIG. Dale's research focused on this question: one disease or a clinical syndrome with complex, individualized biology? The findings point to the latter.

🧬 Research from Columbia and Stanford continues to clarify the role of blood–brain barrier disruption and neuroinflammation. Dr. Jennifer Frankovich highlighted emerging evidence linking autoimmunity with OCD, eating disorders, and arthritis, reinforcing shared immune-driven mechanisms across these presentations.

🧬Clinical takeaways:
-Evidence of strep (throat culture or titers in blood) are often missed due to timing, making PANS more clinically useful than strict PANDAS criteria
-Children with PANS are often highly sensitive to psychotropics Neuropsychiatric symptoms may respond to very low-dose D2 blockade (e.g., risperidone), clonidine or guanfacine, and SSRIs for OCD—started low and escalated slowly
-Recovery requires rehabilitating the brain, not just symptom suppression: CBT, ERP, SPACE, parent management, plus PT, OT, and speech therapy when indicated

As both a mother and clinician who has witnessed PANS firsthand, I am committed to ensuring this condition is acknowledged and appropriately addressed in clinical care. We all share a responsibility to keep our understanding of the neuroimmune system aligned with the latest research, and I am passionate about championing this in both the clinic and the community.

This webinar explores the latest research on PANS and PANDAS. The session examines the roles of neuroimmune and epigenetic factors in children, and discusses whether these conditions are best

12/05/2025

PANS/PANDAS Training for Mental Health Clinicians

February 27 | 10 AM – 12 PM | 2 CEs

I’m excited to share an introductory CE training I’ve been developing on PANS/PANDAS—conditions that can cause sudden-onset OCD, tics, eating restriction, anxiety, and dramatic behavioral changes.

Families often describe it as “my child went to bed one kid and woke up another.” Despite how acute and debilitating these symptoms can be, access to informed medical and psychological care is limited. Advocacy and increased training on these disorders is essential to help families receive proper assessment, diagnosis, and treatment.

Training Includes:

-Definitions: PANS vs. PANDAS
-Differentiating from non-PANS OCD & neurodevelopmental disorders
-2025 research updates: immune dysregulation, neuroinflammation, RNA sequencing
-Evidence-based interventions: ERP, SPACE, DBT crisis strategies
-ARFID/eating restriction within PANS presentations
-Scope of practice & referral pathways with medical teams
-Worksheets & flowcharts for assessment, referral, and treatment planning

Why this training matters:

-Families often come to therapists first
-Proper rule-outs are essential, even when it’s not PANS
-Coordinated mental health + medical care is critical when it is PANS

CE Information:

-2 CEs for NYS LMHCs, LMFTs, LCSWs, LMSWs, LCATs & Psychologists
-Provided through Hudson Valley Professional Development
Register here: https://www.eventbrite.com/e/panspandas-an-evidence-based-approach-for-mental-health-professionals-tickets-1976257528467

I hope to see you there!

For more PANS/PANDAS resources, visit: barbshepardcounseling.com

10/20/2025

A lot has been going on lately in my mental health counseling practice, and I realized it might be time for a little reintroduction!

Hi, I’m Barb! I’ve worked in the helping profession since 2010 and specialize in anxiety and OCD across the lifespan. I love my job 💛

While most of my practice focuses on non-PANS cases of OCD, I’ve also developed a subspecialty in PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and its subset, PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection) that I’m starting to talk about more.

OCD is a core symptom of PANS, but unlike the traditionally recognized form of OCD described in the DSM-5, PANS-related OCD is an abrupt-onset medical condition involving immune system dysfunction that requires specialized medical treatment in addition to therapy.

Syracuse’s first ever participation in World PANS/PANDAS Awareness Day made me feel like we really could change lives of PANS/PANDAS families in Syracuse and NYS!

The outpouring of support and interest in learning about these disorders was astounding and gave the families who attended so much hope for change.

I’ve recently updated the PANS/PANDAS section of my website, which now includes:
▫️overview of PANS/PANDAS symptoms
▫️photos from Syracuse’s first-ever participation in World PANS/PANDAS Awareness Day
▫️resources from trusted organizations like International OCD Foundation
▫️research links for clinicians who want to learn more

Learn more here: https://barbshepardcounseling.com/pandas-pans/

Another thing I’ve got in the pipeline is a CEU training for New York State counselors, social workers and psychologists coming up in February (stay tuned for details). I have a stack of 30+ research articles on PANS/PANDAS and its implications for clinical practice sitting on my desk and I can’t wait to share this with fellow mental health professionals.

Together, I truly believe that we as a community bring more awareness, compassion, and action to families affected by PANS/PANDAS. 💚

10/14/2025

✨ Another week, another important awareness week — OCD Awareness Week! ✨

The average time it takes to receive an accurate OCD diagnosis is 14 years.

That’s why awareness and education are so crucial — and why I’m proud to see landmarks across the country lighting up this week in recognition, thanks to the incredible work of the International OCD Foundation (IOCDF). 💙

OCD (Obsessive Compulsive Disorder) is often misunderstood. Many think only of excessive handwashing or cleanliness, but OCD can show up in so many ways:

🌀 Postpartum mothers with terrifying, unwanted (egodystonic) intrusive fears of harming their babies

🌀 Adults replaying moments on the road, convinced they hit a pedestrian after a bump

🌀 People rereading texts repeatedly for fear of offending someone or asking for excessive reassurance that no one is mad at them

🌀 Avoiding car rides, school, or certain foods due to fears of vomiting (emetaphobia)

🌀 Magical thinking — “If I don’t do this exactly right, something bad will happen.”

OCD doesn’t just affect individuals — it impacts entire families through constant reassurance seeking and accommodating rituals.

But here’s the hopeful part: OCD is highly treatable.

💪 The gold-standard treatment, Exposure and Response Prevention (ERP) therapy, is backed by decades of research and real-life success. Every day in my practice, I see people reclaim their lives through effective, evidence-based care.

Let’s keep spreading awareness so more people can get the right diagnosis, the right treatment, and their lives back. 💙

To learn more about OCD treatment, visit iocdf.org or barbshepardcounseling.com

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The mission of the International OCD Foundation is to help those affected by obsessive compulsive disorder (OCD) and related disorders to live full and productive lives. Our aim is to increase access to effective treatment through research and training, foster a hopeful and supportive community for....

10/11/2025

Here are a few more shots of the National Grid Building lit up GREEN for World PANS/PANDAS Awareness Day! 💚

Families, children, teachers, and local OCD and pediatric mental health providers gathered downtown to raise awareness for PANS & PANDAS. Some families traveled from over an hour away for this meetup — highlighting how isolating these disorders can be for parents and the immense need for support and community for these families.

Several of these families travel out of state to get care and pay out of pocket for these providers. Parents quit their jobs to care for their children and homeschool them due to the severity of symptoms. The financial and emotional strain for these caregivers is astronomical. Many PANS/PANDAS kids have been hospitazed for a range of reasons: life-threatening ARFID requiring feeding tubes; aggression so severe that it cannot safely be managed at home; and other immune-related conditions that can lead to serious physical health complications. What sounds like an impossible nightmare is the daily reality for most of these families as they break the bank to seek care.

One of the unique challenges for PANS/PANDAS and is frequently told “this disorder isn’t real.” This couldn’t be further from the truth, as there are decades of studies validating the legitimacy of these disorders, including a groundbreaking study published just this last August studying epigenetic and gene regulation related to PANS. Stanford and Mass General, two world-renowned medical institutions, both have dedicated PANS/PANDAS teams.

These families are in the fight of their lives as their kids deteriorate with physical, mental health, and behavioral symptoms — and then have to prove that this diagnosis exists in the first place.

Syracuse’s recognition of World PANS/PANDAS Awareness Day is a huge step forward in getting these families the support and care that they deserve, and I was blown away by the local support. Thank you to everyone who shared posts on social media, brought flyers to your workplaces, lit up your porch lights green, and talked about PANS yesterday. This is how it all happens, one conversation and act of advocacy at a time.

To learn more about PANS/PANDAS, here are some incredible resources to get you started:

https://iocdf.org/pandas/

https://aspire.care/

https://www.pandasppn.org/

https://barbshepardcounseling.com/pandas-pans/



syracuse.com CNYCentral.com NewsChannel 9 International OCD Foundation

10/10/2025

More professional group photos to come in a few days — but here are a few shots of the National Grid Building lit up GREEN for World PANS/PANDAS Awareness Day!

Families, children, teachers, and local OCD and pediatric mental health providers gathered downtown to raise awareness for PANS & PANDAS — the first event of its kind here in .

I was blown away by the local support. Thank you to everyone who shared posts on social media, brought flyers to your workplaces, lit up your porch lights green, and talked about PANS yesterday. This is how it all happens, one conversation and act of advocacy at a time. I am truly grateful.💚

Syracuse Celebrates World PANS/PANDAS Awareness Day CNYCentral.com Syracuse, New York syracuse.com

09/30/2025

🌍💚 World PANS/PANDAS Awareness Day is coming up on October 9th—and I’m so excited to share that the National Grid Building in downtown Syracuse, NY will joining over 100 other monuments worldwide by lighting up GREEN in support!

This visible show of support means so much to families walking the difficult road of PANS and PANDAS. These conditions can be incredibly disruptive for kids, impacting their ability to go to school, eat, sleep, or even leave their mother’s side without intense anxiety or distress.

Thanks to several groundbreaking studies published just in the last few months, we are gaining a clearer picture of the immune and infectious triggers that can cause these sudden-onset symptoms. But as with many areas of medicine, it takes time for new research to make its way into everyday clinical practice.

That’s why awareness and advocacy are so important. Families need support from providers, educators, and their communities at large. Every step toward visibility is a step toward better outcomes for these kids.

I’m so grateful to National Grid for joining this campaign and helping bring attention to something so important to many families in the Syracuse community.

To learn more about PANS/PANDAS and how you can take part in World PANS/PANDAS Awareness Day, visit the ASPIRE website:

https://aspire.care/

Dedicated to improving the lives of children and adults affected by PANS/PANDAS and other immune-related encephalopathies

07/15/2025

Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)—and its subset, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)—are clinical diagnoses estimated to affect about 1 in 200 children.

These conditions cause the sudden onset of obsessive-compulsive disorder (OCD) along with symptoms such as food restrictions, tics, aggression, and behavioral regression. They profoundly impact not only the child’s development—but the well-being of the entire family.

Thanks to emerging research and advocacy, awareness of PANS/PANDAS is growing, helping families access needed support. Leading centers like Massachusetts General Hospital and Stanford Children’s Health now offer dedicated PANS programs.

In February 2025, the American Academy of Pediatrics released a clinical report officially recognizing PANS as a legitimate diagnosis—a major milestone for families navigating this complex and often misunderstood condition.

I’ve recently updated my website to include an overview of PANDAS/PANS and therapeutic treatment approaches to support affected children and families.

https://barbshepardcounseling.com/pandas-pans/

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One morning, you woke up to a child you didn’t recognize. The confident, happy and curious child you once knew changed almost overnight into someone you barely recognized. Suddenly, they became ter…