Anxiety

Anxiety is a condition involving the mind (e.g. worry), the body (e.g. racing heartbeat, shortness of breath, sweating, muscle tension, digestive disturbances), and behavior (e.g. avoiding the trigger, trying to think happier thoughts). It tends to be self-reinforcing, meaning that the behaviors developed to try to manage the anxiety actually end up feeding the anxiety cycle.

My primary modality for treating anxiety is an evidence-based treatment called Acceptance and Commitment Therapy (ACT). The goal of ACT isn't primarily to reduce or eliminate anxious thoughts and feelings, which often backfires, but rather to change one's relationship to them in service of living a rich and meaningful life. There are several components to treating anxiety with ACT:

1. Acceptance
   Clients learn to make room for anxious thoughts and feelings rather than fighting, suppressing, or avoiding them. The premise is that struggling against anxiety often amplifies it and drives avoidance behaviors that constrict life to being rigidly focused on managing anxiety rather than living.

2. Cognitive defusion
   Instead of disputing the content of anxious thoughts (as in traditional CBT), clients learn to "unhook" from thoughts, noticing them as mental events ("I'm having the thought that...") rather than literal truths that must be acted upon.

3. Present-moment awareness
   Clients learn mindfulness-based attention to the here-and-now, since anxiety often lives in anticipated future threats.

4. Self-as-context
   Developing a sense of self that observes thoughts and feelings without being fully identified with them. This is sometimes called "the observer self".

5. Values clarification
   Identifying what genuinely matters to the client (relationships, work, health) as a compass for behavior, as opposed to anxiety-driven avoidance goals.

6. Committed action
   Behavior change aligned with values, even in the presence of anxiety — often looking similar to exposure work, but framed as "willingness to feel anxious in service of what matters" rather than "reducing anxiety through habituation."