Anxiety

How It Tends to Show Up

• Your mind runs through everything that could go wrong, and reassurance only helps for a few minutes.
• Panic arrives without warning. A racing heart, a tight chest, and the conviction that something is medically wrong.
• You rehearse conversations before they happen and replay them afterward.
• You have had the tests, the results were normal, and the symptoms in your body are still there.
• You have quietly stopped doing things. Driving on the highway, flying, speaking up in meetings, going anywhere you could not easily leave.
• You are tired in a way that sleep does not fix, because being on guard all day is work.
• From the outside you look like you are doing fine. Holding that together is part of what is wearing you out.

How Anxiety Keeps Itself Going

Anxiety usually rests on a belief that something bad is about to happen. If people saw me struggle, they would think less of me. If I stop checking, something will slip through.

A belief like that changes what you notice. You scan for the threat, so you find it. What you notice shapes what you think, what you think shapes what you feel, and what you feel shapes what you do. For most people, what they do is avoid.

Avoidance works, briefly. It also confirms the belief, because you never find out what would have happened. Repeated often enough, it stops being something you do and starts to feel like who you are: an anxious person, with a life that has been getting smaller.

The sequence also runs the other way. What you do reshapes what you believe, which is why acting differently, even before you feel ready, can change the belief itself. Treatment works on that sequence at more than one point.

Anxiety Conditions Treated

Generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobias, illness anxiety disorder, and somatic symptom disorder, where physical symptoms and worry about them have taken over. Anxiety also travels with trauma and with OCD. Part of a careful evaluation is working out which one is driving things, because the treatment differs.

What Treatment Looks Like Here

Therapy for anxiety is active. It draws on cognitive behavioral therapy and on exposure, the same principle behind ERP for OCD. You approach what you have been avoiding, in steps you agree to, and learn through direct experience that you can tolerate the discomfort and that what you feared does not happen. The goal is not to wait until the anxiety disappears, but to build confidence that you can handle it.

Alongside that, insight-oriented work looks at where the underlying belief came from. Anxiety often makes more sense once you understand what it was originally protecting you from.

Appointments are long enough to do this work and manage medication in the same visit.

If you already have a therapist you trust, that work can continue. Many of my patients have their own therapist, and I coordinate directly with them so care stays aligned. My role is to support that relationship, not replace it.

Medication

Medication can be highly effective for anxiety, and using it well is a core part of my daily work. The right medication at the right dose can quiet the physical alarm, improve sleep, and make it possible to do the things anxiety has been keeping you from.

I usually use medication and therapy together, because for many people the combination works better than either one alone. Medication lowers the intensity. Therapy changes the pattern underneath it. Some people do well with therapy alone, and that is an option too.

Whatever we choose, you will understand what each medication is for, what to expect from it, and how we will know it is working. We make the decision together after a full evaluation, and we adjust it carefully as your needs change.

Adolescents

Anxiety often first appears in the teenage years, as school avoidance, stomachaches and headaches with no medical cause, perfectionism, fear of being judged, or pulling away from friends. I work with adolescents age 14 and older. With teenagers, parents are usually part of the plan, because well-meant accommodation at home can keep anxiety going.