Therapy in San Francisco

Licensed Psychotherapist

870 Market Street, Suite 1021
San Francisco, CA 94102
(415) 680-0180

Psychotherapy and Counseling
for Individuals and Couples

Therapy for Anxiety

"Do the thing we fear, and the death of fear is certain"
-- Ralph Waldo Emerson

With all types of anxiety people experience feelings of nervousness, apprehension, fear, or worry. The anxiety may occur without an obvious cause, or it may occur based on a real situation, but may be out of proportion to what would normally be expected.

Severe anxiety can have a serious impact on daily life. Some common symptoms of anxiety include: excessive worry, restlessness, muscle tension, increased heart rate, difficulty concentrating, fatigue, irritability, sleep disturbance, avoidance, and stomach upset.

Therapy has been helpful for many people with anxiety. In therapy we will explore your specific triggers and practice anxiety-reducing techniques, along with receiving the necessary support to bring peace to your life again.

There are many different classifications of anxiety. Here is a simplified overview of the various different anxiety disorders.

  • Generalized anxiety is when a person has excessive anxiety or worry about a variety of events and circumstances. The worry is often excessive and feels uncontrollable.
  • Specific anxiety is when a person has a fear of flying, animals, heights, blood, water, etc.
  • Social anxiety occurs when a person has an overwhelming fear of one or more social or performance situations.
  • Post-Traumatic Stress Disorder is diagnosed when a person is exposed to a traumatic event in which they felt their life or someone else's life was threatened and they suffered intense fear or helplessness in response to this event. The person may then re-experience the event by having intrusive thoughts, flashbacks, dreams, and a persistent, overactive physiological response in which they cannot relax.
  • Obsessive-Compulsive Disorder is diagnosed when a person has persistent intrusive thoughts or an overwhelming urge to perform certain actions such as excessive hand washing, counting rituals, or checking behaviors.
  • Panic Disorder is when a person suffers unexpected and repeated episodes of intense fear with multiple physical reactions including increased heart rate, sweating, chills or hot flashes, trembling, shortness of breath, chest pain, feeling of choking, stomach distress, dizziness, feeling of losing control, and/or a fear of dying.

When anxiety is present there are both physiological symptoms that occur in the body and psychological symptoms that happen in the mind. These two factors influence each other; therefore it is important to treat both in order to get relief from anxiety. I help treat the physical symptoms by teaching relaxation and sensory interventions, while psychological symptoms are treated by psychodynamic and cognitive-behavioral therapy techniques.

Although anxiety can be debilitating, research has shown that anxiety can be successfully treated with cognitive-behavioral therapy interventions. There is hope.

Here are some tips that may help you deal with anxiety symptoms:

1. Accept Uncertainty:

  • Anxiety can be caused by not knowing what the outcome of something will be. It is very important to not think of the worst possible outcome as this is often not the case and you will likely be causing yourself unnecessary worry. It is best to think that whatever the outcome, you will problem solve and handle it. If, however, you don't handle the situation in a way that produces the best outcome for you, you will likely learn something new from the experience. In addition, we often learn and grow more from situations in which we make mistakes.

2. Practice Relaxation Techniques:

  • Progressive muscle relaxation-This technique involves tensing each muscle group for three seconds and then releasing the muscle group in your body. As your body relaxes, your mind will follow. Start with your facial muscles and move to your toes.
  • Deep breathing-When you're anxious, you breathe faster and this hyperventilation causes symptoms such as dizziness, breathlessness, lightheadedness, and tingly hands and feet. These physical symptoms can be frightening, leading to further anxiety and panic. When you breath inefficiently, you don't get enough oxygen to your brain so you may become more anxious, irritable and/or confused. But by breathing deeply from the diaphragm, you can reverse these symptoms and calm yourself down. Breathe in and count to five in your head and exhale out to the count of five. Repeat 3-5 times.

3. Avoid Caffeine, Alcohol, Tobacco, and Sugar (CATS):

  • Stop drinking or cut back on caffeinated beverages, including soda, coffee, and tea. Caffeine can increase anxiety, interfere with sleep, and even provoke panic attacks. If you get tired mid-day, don't drink caffeine; try drinking water and walking fast for 10 minutes to pick up your energy level.
  • Alcohol temporarily may reduce anxiety and worry, but it actually causes anxiety symptoms to increase as it wears off. Drinking for anxiety relief also starts you on a path that can lead to alcohol abuse and/or dependence.
  • Nicotine is actually a powerful stimulant, even though it may seem like cigarettes are calming. Smoking leads to higher, not lower, levels of anxiety.
  • Sugary snacks and desserts cause blood sugar to spike and then crash, leaving you feeling emotionally and physically drained. Eat something healthy, like a piece of fruit or bag of pretzels when feeling tired or craving something sweet.

4. Go towards your fear or anxiety:

  • Many times avoiding doing something that is important can cause anxiety to increase. Make a plan to get started on what you are avoiding and follow through. Break the task up into small parts and get started on the first part. After you finish that, you may be motivated to take on more.
  • Pay attention to how you feel after you complete the task or situation. Your anxiety may increase in the short term when you are initially confronting a task or situation however, it is likely that once it is over, you may feel less anxious overall and you may feel relieved or proud versus anxious.
  • Pay attention to how avoiding the task or situation is affecting you. Many times people think they are taking a break from something when avoiding it, when really the unfinished business is always on their mind. After you make a plan, take action sooner rather than later.
  • Sometimes people with anxiety may act impulsively without thinking to get relief from their overwhelming feelings. This will decrease anxiety initially, but then increase anxiety in the long term. This is why it is important to notice your feelings and tolerate the anxiety without acting out impulsively. Help decrease your anxiety by making a plan for dealing with the issue and then act.

5. Challenge your anxious thoughts:

  • People with anxiety often have automatic negative thoughts that contribute to increasing anxiety levels. When these thoughts occur you need a specific plan to deal with them. Many times it is helpful to ask yourself the following questions to reduce your anxiety:
  1. Whatís the evidence that the thought is true? That itís not true?
  2. Is there a more positive or realistic way of looking at the situation?
  3. Whatís the probability that what Iím scared of will actually happen?
  4. How will worrying about it help me and how will it hurt me?
  5. What would I say to a friend who had this worry?

6. Practice Visualization:

  • Visualization is particularly helpful with social anxiety difficulties. If you are anxious about an upcoming social event or performance, visualization can help prepare your body and mind for the event. Practice visualizing yourself in the specific situation for at least five minutes daily for at least three days prior to the event. Imagine how you want to appear. For example, imagine smiling, greeting people with good eye contact, being confident, etc.
  • Anticipate your specific automatic negative thoughts that may come up during the event. Practice challenging these with more realistic thoughts prior to the event so you are better prepared. Imagine yourself doing this at the event and being successful.

One of the most important, empowering things you can do for yourself is to take control of your situation and reach out for help. Please call me. We can talk to see if you would like to make an appointment and begin to make positive changes in your life. You don't have to suffer alone. Help is available.