1. What is generalized anxiety disorder?
Generalized anxiety disorder (GAD) is characterized by a high level of anxiety and worry about a number of events and activities, e.g., work or school performance. The anxiety and worry are difficult to control and occur more than days than not for at least six months. Common associated symptoms are: (1) restlessness or feeling keyed up or on edge; (2) being easily fatigued; (3) difficulty concentrating or mind going blank; (4) irritability; (5) muscle tension; and (6) sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). The anxiety, worry, or physical symptoms cause significant distress or interfere with one’s daily life functioning, e.g., professionally, socially.1
2. What is social anxiety, or social phobia?
Social anxiety, also known as social phobia, is characterized by anxiety about being in social situations and exposed to possible scrutiny or negative evaluation by others. Such “social situations” can include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech). One fears acting in a way or showing anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others). As a result, the social situations are avoided or endured with intense fear and anxiety. The fear, anxiety, or avoidance is persistent, typically lasting for six months or more, and cause significant distress or interfere with one’s daily life functioning, e.g., professionally, socially.1
3. What are panic attacks and panic disorder?
A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes. This abrupt surge can come on when one is either in an anxious or calm state. During a panic attack, four (or more) of the following symptoms occur:
- Palpitations, pounding heart, or accelerated heart rate
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed, or faint
- Chills or heat sensations
- Paresthesias (numbness or tingling sensations)
- Derealization (feelings of unreality) or depersonalization (being detached from onself)
- Fear of losing control or “going crazy”
- Fear of dying
*Culture-specific symptoms (e.g., tinnitus (ringing in the ears), neck soreness, headache, uncontrollable screaming or crying) may be seen.
To be diagnosed with panic disorder, at least one panic attack has been followed by one month (or more) of one or both of the following:
- Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, heaving a heart attack, “going crazy”).
- A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations). In extreme cases, agoraphobia can develop in which one is largely home-bound out of fear of bad things happening out in the world.1
4. What are phobias?
Phobias involve fear of a specific object or situation (e.g., flying, heights, animals such as spiders or snakes, receiving an injection, seeing blood). When confronted with the feared object or situation there is almost always an immediate fear or anxiety response that can include a panic attack. As a result, these objects or situations are actively avoided or endured with intense fear and anxiety. The fear, anxiety, or avoidance is persistent, typically lasting for six months or more, and cause significant distress or interfere with one’s daily life functioning, e.g., professionally, socially.1
5. What is depression?
Depression is a disorder characterized by episodes lasting at least two weeks in which there are clear-cut changes in quality of mood, thinking, and key aspects of physical functioning. These changes cause significant distress or impairment in social, work/school, or other important areas of daily functioning. When one is experiencing a major depressive episode, at least five of the common symptoms of depression are present, with one of these being either depressed mood or loss of interest or pleasure in activities one normally enjoys. The other common symptoms of depression are:
- Significant weight loss, or decrease or increase in appetite
- Inability to sleep (insomnia) or sleeping too much (hypersomnia)
- Physical agitation or sluggishness
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Difficulty thinking or concentrating, or indecisiveness
- Suicidal thoughts or behaviors
It is important to note that even if one does not meet full diagnostic criteria for a major depressive episode, i.e., if one is experiencing fewer than five of the above symptoms, it may still be necessary and can be helpful to seek mental health treatment. If one is experiencing suicidal thoughts or behaviors, seeking outside help is always recommended.1
6. What is bipolar disorder?
Bipolar disorder is classified as bipolar I and bipolar II. The primary feature of bipolar I is mania, or at least one manic episode. A manic episode is defined as a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
- Inflated self-esteem or grandiose view of oneself and one’s abilities
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
- More talkative than usual or pressure to keep talking
- Flight of ideas or experience that thoughts are racing
- Distractability (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
- Hyperactive in terms of activity either socially, at work or school, or sexually, or general fidgetiness
- Excessive involvement in risky activities like unrestrained spending, sexual activity, or substance use
As a result of the manic episode, daily functioning is significantly impaired or hospitalization is necessary to prevent harm to self or others, or treat symptoms of psychosis if present. In bipolar I, major depressive episodes are often present but not always. Again, the key feature of bipolar I is mania.
Bipolar II is diagnosed if there are symptoms of a manic episode but they are of lesser severity and shorter duration, constituting a hypomanic episode. In addition to at least one hypomanic episode, there is at least one major depressive episode for a diagnosis of bipolar II disorder to be made.
In bipolar I and typically bipolar II disorder, the first-line treatment is psychiatric medication management, e.g., a mood stabilizing medication. Individual psychotherapy is recommended as well, and often family therapy to ensure additional support for the patient.
7. What is posttraumatic stress disorder, or PTSD?
Posttraumatic Stress Disorder, commonly referred to as PTSD, is considered one of the “Trauma- and Stressor-Related Disorders”1. As the name implies, it occurs after the experience of a traumatic event. The particular type of trauma that typically leads to symptoms of PTSD involves exposure to actual or threatened death, serious injury or sexual violence. PTSD symptoms can be categorized into four different clusters: (1) intrusion symptoms (e.g., recurrent memories, nightmares); (2) avoidance behaviors related to reminders of the trauma; (3) negative alterations in thinking and mood (e.g., self-blame, guilt, emotional numbness); and (4) hyperarousal or increased reactivity (e.g., angry outbursts, sleep disturbance).1
8. What are “the baby blues” versus postpartum depression?
“The baby blues” are common right after giving birth: 75-80% of new moms will experience them. The baby blues looks like mild depression mixed with happier feelings. Typically they begin 2-3 days postpartum and last no more than two days to two weeks. Common symptoms include: sadness/crying spells, feeling overwhelmed, feeling nervous/anxious, trouble coping, trouble sleeping, and fatigue/exhaustion. Postpartum depression (PPD) is less common—15% of women develop PPD and 10% experience depression in pregnancy. In PPD, symptoms include those in the baby blues, plus more serious ones: e.g., anger, fear, and/or feelings of guilt; thoughts of inadequacy as a person/mother; appetite changes; cloudy thinking/trouble making decisions; feeling isolated from others or disconnected from the baby; possible suicidal thoughts. It is obviously of the utmost importance to seek help as soon as possible if you are experiencing any symptoms of PPD, or if the baby blues don’t go away within two weeks.2
9. What is obsessive-compulsive disorder, or OCD?
OCD is characterized by the presence of obsessions, compulsions, or both. Obsessions are defined by:
- Recurrent and persistent thoughts, urges, or images that are experienced, at some point during the disturbance, as intrusive and unwanted, and that in most individuals cause significant anxiety and distress.
- The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by:
- Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
- The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Finally, the obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause significant distress or interfere with one’s daily life functioning, e.g., professionally, socially.1
10. How do I know when it’s time to see a therapist?
There is not a one-size-fits-all answer to this question. However, typically a person decides it is time to seek professional help when she feels increasingly overwhelmed and does not see a clear way out of this situation using her usual resources and coping mechanisms. In some cases the person may not be as aware that she could benefit from seeking outside help as those closest to her are. The most obvious situation in which seeking professional help is recommended is when any safety concerns are present, as in the case of suicidal thoughts and any attempts, and other high-risk behaviors, like self-injury and severe drug and alcohol use.
11. Why can’t I just talk to a close friend?
Relying on the support of close, trusted friends can certainly be a helpful coping strategy when you are feeling stressed out or overwhelmed. However, sometimes it is more beneficial to speak to someone who has the training and experience to help you deal with a particular problem. Friends are usually well-intentioned but often are unable to take as objective a perspective as a trained therapist can. When speaking to a professional confidentiality is also guaranteed. Further, you don’t have to worry about your relationship getting negatively impacted in some way as you potentially do when you open up to a friend or family member about a particular problem. For example, once you start feeling better you could start avoiding your confidant so you are not reminded of that difficult time in your life.
12. How does therapy work?
Generally speaking, therapy works by providing new perspective and ways to deal with the issues with which you’ve been struggling. The unique qualities of the therapeutic relationship or environment, e.g., confidential, non-judgmental and supportive, promote healing and growth as you feel more comfortable sharing your innermost thoughts and feelings. Further, therapy can instill hope and confidence that your life can improve as you begin to see your issues as more manageable and gain new tools and coping strategies.
13. Don’t you get tired of listening to people’s problems all day long?
My answer is rarely. A large part of my extensive training as a therapist is in how to set healthy, appropriate boundaries with clients that will facilitate growth and positive change. When I first sit down with someone who has sought out my therapy services, I experience a real sense of hope as this person has taken the first and often most difficult step to getting a handle on that with which they’ve been struggling. I agree with therapist Mary Pipher when she says, “I’m not listening to people’s problems, I’m listening for solutions.”3 Another essential aspect of my work is self-care; as therapists, if we’re not taking care of ourselves, then we’re not in a position to be taking care of others’ mental health needs. Therefore, I make it a priority to try to practice regular self-care and live a healthy lifestyle.
14. Can you prescribe medication?
No, I cannot. Medical doctors and psychiatrists specifically most commonly have the training and experience to be able to safely and effectively prescribe psychotropic medication. I can facilitate a referral to a psychiatrist if needed.
A note on the use of therapy in addition to medication management: Engaging in therapy and gaining new tools and coping strategies can enhance the effects of medication. This experience can also be helpful in preventing relapse if you and your prescribing provider decide at some point that you no longer need medication.
15. What is a Psy.D., versus a Ph.D., versus a MFT, versus a MSW? How do I know which type of therapist I should see?
Therapists with Psy.D. and Ph.D. degrees are all considered psychologists. Psy.D. stands for “Doctorate of Psychology” and Ph.D. stands for “Doctorate of Philosophy.” In their purest forms, Psy.D. programs tend to be more geared towards training practitioners or therapists, while Ph.D. programs in clinical psychology tend to be more geared towards training researchers and academics. However, some Psy.D. programs tend to be more research-oriented than others while some Ph.D. programs tend to be more practice-oriented than others. The overall quality of programs can also vary; e.g., typically the highest quality, most reputable programs are accredited by the American Psychological Association (APA).
“MFT” stands for Marriage and Family Therapist and “MSW” stands for Master of Social Work. A main distinction between these providers and Psy.D.’s and Ph.D.’s are level of training; masters versus doctoral. Key differences between MFT’s and MSW’s are type of educational experience and practical requirements for licensure, i.e., number of supervised training hours needed.
One recommendation for deciding which type of therapist to see is to inquire further about his or her training, experience, and specialty areas and base your decision on what seems like the best fit for your particular situation. Personality fit is another consideration, but you likely will have to meet with the therapist face-to-face before you can decide whether or not you are a good match in this regard.
16. Do you take insurance?
I do not take any insurance. But depending on your particular insurance provider, you may be able to receive some reimbursement for services if you have out-of-network mental health coverage. It is recommended to contact your insurance carrier to inquire further. I can provide appropriate documentation of services, like an invoice or super bill, to submit to your insurance provider for reimbursement purposes.
1American Psychiatric Association. (2013). Desk Reference to the Diagnostic Criteria from DSM-5. Washington,
DC: American Psychiatric Publishing.
2Postpartum Support International literature
3Pipher, Mary. (2003). Letters to a Young Therapist. New York, NY: Basic Books.