Anxiety Disorders

Anxiety can be physically, emotionally, and psychologically draining. Our minds and bodies are hard-wired, from an evolutionary perspective, to make us feel anxious when there is a danger or threat nearby. Anxiety is a key emotion necessary for our survival.

In terms of an evolutionary perspective, our ancestors were glad they had anxiety so that their fight-or-flight system would get activated and help them run for safety when a tiger was coming after them. Fortunately, today we don’t have as many loose tigers roaming the streets. Yet, our minds and bodies still react in a similar ways to non-life threatening sources (work deadlines, relationship troubles, etc).

There are many types of of anxiety disorders and the most recent edition of the Diagnositic & Statistical Manual (DSM5) lists three separate categories of Anxiety Disorders. The first, termed Anxiety Disorders, includes:
  • Weight gain
  • Generalized Anxiety Disorder
  • Panic Disorder
  • Social Anxiety Disorder
  • Specific Phobias
The other two categories within the overall category of Anxiety Disorders are: Obsessive-Compulsive Disorders and Trauma and Stress-Related Disorders which are covered in the tabs to the right.

Generalized Anxiety

Do you find yourself constantly worrying about a number of different things in your life? Do you find it hard to control the worry? If so, you may be suffering from Generalized Anxiety Disorder (GAD). Individuals who suffer from GAD often experience the following symptoms:
  • Restlessness
  • Easily fatigued
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Insomnia or difficulty sleeping well


Treatment for GAD includes Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT). Both of these treatments target unhelpful thought patterns and provide clients with new skills for managing their worry and anxious thought patterns. Behaviorally, these treatments also work on helping individuals manage physical anxiety symptoms, with treatment including the following:

  • Psycho-education for how Generalized Anxiety Disorder (GAD) is formed and maintained in the individual
  • Breathing retraining and relaxation training
  • Restructuring unhelpful thoughts and distorted thought patterns or working on mindfulness-based approaches to disengage from unhelpful thought patterns
  • Behaviorally turning the focus to living a life consistent with values
  • Occasionally treatment will involve scheduling “worry time,” problem-solving, and scheduling time to engage in pleasurable activities

Panic Disorder

Have you ever had spells or attacks when you suddenly felt anxious, frightened, or uneasy to the extent that you began sweating, your heart began to beat rapidly, you were shaking or trembling, your stomach was upset, or you felt dizzy or unsteady, as if you would faint? If so, you may have suffered from a panic attack.

Panic attacks include having a number of physical symptoms such as the following:
  • Shortness of breath
  • Shaking hands
  • Feel flushed and hot in the face
  • Dizziness
  • Feeling like you’re having an out of body experience
  • Mouth gets dry
  • Muscle tension
  • You feel like you’re going crazy, that you are losing control, or that you might die
  • Feeling nauseated
  • Tightness in the chest
Panic Disorder is when individuals have these types of panic attacks out of the blue in unexpected ways. They worry about when they might have another panic attack, and alter their behavior because of having had a panic attack.

Associated with panic attacks and Panic Disorder is Agoraphobia where sometimes individuals will avoid situations in which they fear there won’t be an easy way to escape if they have a panic attack (i.e., being on a train/metro or avoiding being in the midst of large crowds).


Our therapists use Cognitive Behavioral Therapy (CBT) to treat panic disorder. This entails the following:

  • Psycho-education about how panic disorder is formed and maintained in individuals
  • Acceptance-based approach to physical sensations
  • Mindfulness meditation, defusion, and contacting the present moment
  • Breathing and relaxation training
  • Graded exposure to feared situations
  • Cognitive restructuring or reframing unhelpful or distorted thought patterns
  • Interoceptive exposure: exposure to bodily sensations that are feared or avoided

Social Anxiety Disorder

Do you get nervous or anxious in situations where you might be negatively evaluated such as meeting new people, giving a speech, calling someone on the phone, ordering off a menu at a restaurant or being around others who might be observing you in some way?

Are you worried people will think of you if they see you becoming anxious (seeing you sweat, shake, or get red in the face)? Do you worry about not knowing what to say to people in social situations … not knowing what to talk about?

Do you feel extremely anxious before having to speak in front of others? Do you avoid face-to-face interactions through the use of technology? You may be struggling with Social Anxiety Disorder.

Social Anxiety Disorder affects nearly 15 million adults in American. Often individuals suffering from Social Anxiety Disorder will develop such a strong fear of certain social situations where they might be evaluated negatively that they avoid them all together.

This is more debilitating than just being shy. Social Anxiety Disorder can negatively impact one’s life. 

Examples and ways in which social anxiety disorder can impact one’s life include:

  • Turning down a job promotion because it requires public speaking
  • Avoiding or turning down invitations to socialize and build relationships because
  • Of the anxiety leading up to social events
  • Being isolated and feeling lonely because of avoidance of social situations in which there is fear of being embarrassed

Social Anxiety Disorder can lead to other problematic disorders such as substance use disorders, depression, loneliness, and even difficulty getting a job because of fears and anxiety around interviewing.

What are the causes of Social Anxiety Disorder?

Our knowledge of Social Anxiety Disorder and what causes it can be summarized as a mix of social, environmental, and biological/genetic factors. Typically social anxiety disorder emerges around age 13 and can affect individuals well into adulthood.


The good news is that we have very effective evidence-based treatment for social anxiety disorder.

Our psychologists are trained in Cognitive Behavioral Therapy (CBT) for Social Anxiety Disorder. In this treatment we will help clients learn to manage their anxious thoughts in a way that improves their emotional response. The behavioral aspect of treatment will include relaxation training to manage the physical response of anxiety and also exposure therapy which will involve practicing approaching situations that clients are avoiding, now with new tools to use to help cope in the moment.

Specific Phobias

Have you ever experienced any strong fears? For example, of heights, insects, animals, dirt, attending social events, being in a crowd, being alone, being in places where it may be hard to escape or get help?

Treatment for specific phobias using evidence-based treatment is highly effective. Primarily, our therapists will use a cognitive behavioral therapy (CBT) approach with an emphasis on exposure therapy. Patients work with the therapist on getting practice slowly and gradually with their biggest fears.

Common phobias include the following:
  • Snakes
  • Elevators
  • Insects
  • Heights
  • Needles/Injections
  • Vomiting
  • Flying
  • Dogs
An example of how exposure therapy may work for one of these phobias includes creating a hierarchy of situations that increasingly produce more and more anxiety. For instance, on a scale of 0-10 for someone who has a fear of needles/injections, seeing a picture of a needle may produce a rating of a 2 out of 10 for anxiety. Seeing a picture of someone get a shot and blood coming out might be a 5. Actually getting a shot may be a 10 out of 10. Our therapists will help you work up the hierarchy of anxiety-producing scenarios to help you eventually overcome your fears.

Obsessive Compulsive & Related Disorders

The Diagnositic & Statistical Manual (DSM5) lists three separate categories of Anxiety Disorders. Obsessive-Compulsive Disorders include:
  • Obsessive-Compulsive Disorder
  • Body Dysmorphic Disorder
  • Excoriation Disorder (skin picking)
  • Hoarding Disorder and
  • Trichotillomania (hair pulling)
The other two categories within the overall category of Anxiety Disorders are: Anxiety Disorders specific to this category and Trauma & Stress-Related Disorders which are covered in the tabs to the left and right, respectively.

Obsessive Compulsive Disorder (OCD) is a debilitating disorder when clients are suffering from unwanted, intrusive thoughts, and/or engaging in compulsive behaviors such as cleaning, checking, or counting.

Exposure & Response Prevention (ERP) treatment is extremely effective and is the best evidence-based treatment we have for the treatment of OCD. We strongly recommend working with one of our psychologists trained in ERP if you have OCD. Common obsessions and compulsion symptoms are listed below:


Excessive or ritualized hand-washing, bathing, or grooming, excessive cleaning of household items, excessive measures to remove contaminants

Excessive checking of the stove, locks, appliances, checking that there was not harm done to another person, making sure nothing terrible has happened or will happen, excessive checking to make sure mistakes were not made

Re-reading or re-writing, repeating daily activities (i.e. going up and down the stairs 4 times before leaving the house)

Needing to count steps, needing to count the number of times a behavior was performed, doing a checking compulsion a certain number of times

Excessive need for order or special arrangement of items

Mental Compulsions
Feeling the need to neutralize obsessions by compulsively bringing to the mind a specific number, image, or word

Miscellaneous Compulsions
Excessive list-making, asking for reassurance to ensure something was or wasn’t done, needing to touch, tap, or blink a certain number of times


Violent images, fear of saying inappropriate or obscenities, fear of acting on harmful impulses (i.e. knocking someone over on the metro platform, stabbing someone), fear of hurting others because of carelessness, fear of being responsible for terrible things happening (fire, burglary)

Concern with dirt and germs, fear of contaminating others, concerns about getting ill because of being contaminated, forbidden or unacceptable sexual thoughts/images/impulses, sexual worries about children or incest, worry about acting in sexually inappropriate ways towards others

Obsessive thoughts about the need for things to be symmetrical


What is exposure and response prevention (ERP)?
Exposure and response prevention therapy falls under the umbrella of Cognitive Behavioral Therapy (CBT).

ERP is by far the most effective treatment we have to treat obsessive compulsive disorder (OCD). Patients suffering from OCD often have thoughts, images, objects, or situations that create great anxiety. There is often a desire to escape whatever might be triggering anxiety through compulsive behaviors. Compulsive behaviors often give patients a temporary sense of relief.

For instance, if someone has a great fear of getting sick because of germs, they may often engage in excessive hand washing to be able to escape the fear. This pattern of feeling anxious and engaging in compulsive behaviors to escape feeling anxious is reinforced over time and can result in psychological distress. Often OCD symptoms can be greatly life-interfering causing problems in relationships and work-related responsibilities.

In ERP treatment, our trained psychologists work with clients to confront that which they are avoiding (the exposure part of ERP) and help them to stop engaging in the compulsive behaviors (the response prevention part of ERP). For instance, a psychologist on our team may work with a patient who has germ-related OCD and have them touch door handles around our building without then washing their hands. With repeated exposure to doing this type of exercise, the mind begins to learn that you can be exposed to germs on a door handle everyday, not wash your hands, and nothing terrible happens. As the mind begins to learn this, psychological distress is reduced and OCD symptoms decrease.

OCD is complex and can take on many different forms. Many patients are apprehensive about engaging in this form of treatment. Our compassionate therapists are here to help. Call or email us today to get help from our psychologists who are experts in using Exposure & Response Prevention for OCD.

Trauma & Stress-Related

The Diagnositic & Statistical Manual (DSM5) lists three separate categories of Anxiety Disorders. Trauma & Stress-Related Disorders include:
  • Acute Stress Disorder
  • Adjustment Disorder
  • Post-Traumatic Stress Disorder (PTSD)


Many of our clients come to us feeling a little lost as they are transitioning to a different part of their life. In the DSM-V there is a diagnosis called Adjustment Disorder which is often accompanied by symptoms of anxiety and depression.

We are here to help whether it is getting out of a long-term relationship or marriage, adjusting to marriage, moving to a new city, starting a new job, mourning the loss of someone special, being diagnosed with a new medical condition, raising a child for the first time, or wanting to make a career change.

Below are some common complaints clients have as they are going through a life transition or struggling with adjustment disorder:

Depression Symptoms
When life transitions happen, there can be symptoms of depression that come up such as difficult getting motivated, trouble concentrating, feeling sad, feeling a lack of interest in activities one used to enjoy doing, struggles with sleep, feeling hopeless, or feeling fatigued.

Anxiety Symptoms
There can also be symptoms of anxiety that come up such as worrying constantly, struggling with feelings of inadequacy, feeling restless or jittery, experiencing your heart racing more, having sweaty palms, and having trouble focusing or concentrating.

Eating Disorder Symptoms & Weight Changes
When experiencing stress, loneliness, or grief during a transition period, it’s not uncommon for someone to turn to food for comfort. This can lead to emotional eating, binge eating, weight gain, or often not eating enough at all and losing significant amounts of weight.

Insomnia or Hypersomnia
Sometimes adjustment periods and transitions in life lead to difficulty sleeping or sleeping too much.

Nutrition & Physical Activity
During life transitions, normal routines around making good, nutritious food and engaging in physical activity can be disrupted. Two things that can often be tied to good mental health can begin to be pushed to the bottom of the “to-do” list during adjustment periods and transitions which can often lead to increased problems with sleep, depression and anxiety symptoms.

Substance Use
Occasionally when struggling with a new phase of life, the stress will be so great that clients find themselves turning to drugs or alcohol to cope and temporarily escape the emotional pain they may be feeling.

Relationship Deterioration or Loneliness
During life transitions and adjustments, there can be a desire to isolate or irritability that leads to problems in intimate or family relationships. Alternatively some clients often move to the Washington DC metro area wanting to connect with others and struggle with feeling lonely and disconnected, not quite sure how to navigate making new friends as an adult.


Our therapists at Mind Body Health are trained in treating Post-Traumatic Stress Disorder (PTSD) and other trauma-related concerns.

Have you ever had nightmares or flashbacks as a result of being involved in some traumatic or terrible event? For example, warfare, gang fights, fire, domestic violence, rape, incest, car accident, being shot or stabbed?

If you have ever been exposed directly or indirectly to actual or threatened death, serious injury or sexual violence and persistently have intrusive thoughts, nightmares, flashbacks, or emotional or physical distress when confronted with reminders of the trauma, then you may be suffering from PTSD.

Often after trauma, clients may find themselves struggling with the following:

  • Avoiding thoughts or feelings associated with the trauma or reminders of the trauma
  • Difficulty remembering aspects of the trauma,
  • Having overly negative thoughts about themselves or the world
  • Blaming themselves for what happened
  • Increased isolation
  • Increased symptoms of depression or negative affect
  • Irritability
  • Aggression
  • Difficulty concentrating
  • Exaggerated startle response
  • Difficulty sleeping


Our providers are trained in evidence-based treatments including cognitive processing therapy, prolonged exposure, and cognitive behavioral therapy for trauma. Trauma recovery often requires talking about the trauma that occurred, and helping clients to restructure the cognitive thoughts that developed after the trauma and the physiological ways in which the body responds to certain stimuli after the trauma. Such work is not easily done by oneself, thus we encourage working with one of our trained therapists to help in the recovery process.