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Anxiety Disorders and Obsessive-Compulsive Disorder
When you join me in therapy, our goal in the first few sessions is to build our relationship and create a space in which you feel safe sharing with me about who you are and what brought you to therapy. People who present to therapy are often feeling some level of anxiety and/or depressed or significantly fluctuating mood, and I always assess for these things, in our conversation and, often, through questionnaires. Of course, everyone presents in therapy with unique histories, challenges, and goals. We’ll collaborate to form a plan for treating anxiety and for addressing other challenges you’re experiencing; I will bring my expertise on mental health and effective treatments and you bring your vital insights about yourself, your preferences, what approaches you think will work best for you, etc. Read this page to learn more about what I typically recommend as part of treatment approaches for a few common diagnoses. You are also invited to schedule a free 15-minute consultation below (or reach out to book an initial full appointment) to learn more about working together.
generalized anxiety disorder
Generalized Anxiety Disorder (GAD) is common (about 3% of American adults experience it each year) and involves frequent worrying and anxiety that have been present for at least 6 months and that make it difficult to function at work, at home, and/or in your relationships. Some possible symptoms of GAD include irritability, muscle tension, difficulty sleeping, trouble concentrating, restlessness, feeling quickly fatigued, etc. Similarly to how I treat Major Depressive Disorder, I typically treat GAD by integrating cognitive-behavioral therapy (CBT) and mindfulness approaches. CBT, among other things, involves identifying unhelpful (and often exaggerated or simply untrue) thought processes that contribute to anxiety and working to change them. For example, you might find that you have a tendency to catastrophize, assuming you’ll face adversity and/or experience negative outcomes. Perhaps every time you go into a presentation at work you think “I’ll perform poorly and I’ll never truly be respected by my peers,” etc. Maybe you have this thought even though you have a history of crushing presentations, getting promotions and accolades, etc. Here’s the thing… feelings aren’t facts. Feeling anxious doesn’t mean you’re in danger or that something bad will surely happen. Perhaps a more true and helpful thought in this situation might be something like: “Although I don’t like giving presentations, I have done well in the past and have thoroughly prepared for this one. I have no evidence that my colleagues don’t respect me. In fact, my boss just told me yesterday I was doing a great job on a project.” There’s more to it than that, but there’s a little intro! Essentially, through CBT we work on addressing how thoughts, feelings, behaviors, and physiological experiences (what you’re feeling in your body) affect each other as a way to alleviate distress and improve functioning. Meanwhile, learning and practicing mindfulness involves fostering increased awareness, curiosity, and non-judgmental acceptance of your experiences. One aspect of mindfulness that I love involves self-compassion and working on accepting yourself as a flawed, but loveable and worthy, human being. Using mindfulness in therapy can also involve guided meditations, which can be very helpful in working on focusing on the present moment and remembering the whole of your reality (which is more than that big ball of anxiety you might be feeling).
social anxiety disorder
Sometimes people have anxiety that is specific to fear of being judged, which leads to avoiding various situations. When this is a frequent experience that is impeding functioning at work, school, home, or in dating or friendships, it could be Social Anxiety Disorder (SAD). I use assessments for SAD in my practice, when applicable, so we can form a better understanding of what specific situations trigger anxiety and what situations you avoid because of discomfort. Here is a common example of social anxiety: “I don’t want to ask a question, because people will think I’m stupid for not knowing the answer, so I’m just not going to ask.” The resultant avoidance, of course, means you don’t get your question answered or your need met. Sometimes people with SAD can identify very specific areas of social anxiety that impact their functioning; for instance, some people feel very uncomfortable eating in front of others and avoid this experience altogether, interfering with their social functioning. If we determine you’re experiencing SAD, we’ll work together to identify things you are currently struggling to do that you would like to be able to do (e.g., ask questions at a store, eat in front of others, ask someone on a date). We will then work on a treatment plan founded in cognitive and behavioral techniques. We’ll identify and tune into unhelpful thoughts that fuel your anxiety and avoidance and come up with more helpful thoughts (that you can believe). But the biggest aspect of SAD treatment is the behavioral technique of exposure therapy. Basically, trying things that make you nervous so you can see they’re not that bad. You might be thinking, “wait a second, are you just going to tell me to go ask someone on a date? If I could do that, I just would.” Of course not! We’ll together to thoughtfully build up to the hardest things, but we’ll start small. Maybe the first thing you practice is asking a stranger who feels non-threatening what time it is. And we build up from there. We might do some sessions for SAD out in the real world (e.g., I meet you at Home Depot and we practice brief social exchanges).