My approach to working with anxiety
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Psychotherapy for anxiety, in person and via telehealth, based in Dupont Circle. Click the Free Consultation button to schedule with Dr. Levine.
My Approach to Anxiety
Every form of anxiety involves both biological and psychological factors.
Anxiety is an umbrella term that covers a lot of variety. But every form of anxiety within that umbrella involves both psychological factors and biological factors which need to be addressed in treatment. When I say psychological factors, I'm also including cultural and social factors, because ultimately those are all mediated through the psychology of individual human beings. On the biological side, there are things like genetics, the biological effects of trauma and stress, and physical tension or chronic pain.
We address the biological side of anxiety directly.
It's important to address these biological factors directly when working with anxiety. We might do that through somatic approaches like breathing exercises and other relaxation techniques, such as progressive muscle relaxation. We might incorporate meditation and mindfulness, or work on improving your sleep habits, or level of physical activity. Medication can also be helpful for the biological aspects of anxiety. While I can't prescribe medication, as I am not a medical doctor or nurse practitioner, I can provide referrals and/or help you work with your prescriber to decide whether it's right for you, and I can help build a treatment plan with them in a collaborative fashion such that whatever you're doing on the medication side complements what we're doing in psychotherapy.
On the psychological side, we begin by building insight.
When working with the psychological aspects of anxiety, as is the case with any mental health concern, I believe it is very important to work with a focus on balancing both insight and action. Insight means developing an understanding of what's causing your anxiety. Internal conflicts, relationship problems, career concerns, problematic thought patterns and beliefs, a lack of clarity about your values, difficulty with transitions, ambiguity and uncertainty, or questions of identity. All of these can conspire to trigger and maintain anxiety, and it's rarely a single cause. It's almost always a combination, and the complexity of that combination can be hard to parse on your own. Part of the reason for this is that, even when we feel we understand the causes of our anxiety, more often than not, there are drivers of anxiety that exist and operate outside of our awareness—that is, unconsciously. When working with me in therapy, we collaboratively build a comprehensive understanding of what is driving and maintaining your anxiety. Without this understanding, any treatment approach is shooting in the dark.
We also work to understand how your anxiety has affected the full picture of your life, and sense of self. Maybe your life has become more and more constricted because of your anxiety. Maybe this constriction causes a sense of shame, or dissonance with your values. Maybe this constricted way of being feels at odds with your sense of who you want to be, or perhaps it makes it hard to know who you are in the first place—to discern what is the anxiety versus the “real you.” When working with anxiety, we don’t simply address your anxiety in isolation. In addition to reducing the anxiety itself, we want to understand the ways it has affected every other area of your life so that you can move beyond symptom management to building a meaningful life worth living.
From insight, we move to action.
Once we've built some understanding of what's going on under the hood of your anxiety, and the ways in which it is affecting all other areas of your life, we move to action: making concrete changes to reduce your anxiety and to address the ways it has affected your life and sense of who you are. This might include specific techniques to confront your anxiety head-on, such as various forms of exposure therapy to build tolerance to things you find anxiety provoking, cognitive therapy to challenge and modify anxiety-provoking thoughts and beliefs, or emotion regulation strategies to bring the temperature down when agitation gets out of hand. We may also use a variety of mindfulness strategies to help you relate to your anxious thoughts, feelings and bodily sensations differently so that they affect you less.
We may also work to address the areas of your life that are causing the anxiety in the first place. This might include things like working towards resolving ambivalence or internal conflict, addressing problems in your relationships, clarifying values, managing career or academic challenges, or addressing existential issues like identity, meaning-making, transitions, and aging.
Reducing your symptoms matters, but it isn't the whole goal.
People are often driven to seek out therapy because of their anxiety symptoms. So of course, we will devote significant time and energy to addressing them. However, I think it's just as important to focus on the ways those symptoms are affecting other areas of your life, and elucidating the underlying issues that may be causing or exacerbating your anxiety. In my experience, when patients focus only on symptom resolution, they're left feeling unresolved. So I'm always an advocate for both: symptom management, and a holistic approach that treats you as an entire human being who is more than the sum of your symptoms, or their absence.