Anxiety therapy in Seattle and Edmonds, for a mind that won't stop

The students I saw in Baltimore were rarely only students. Many worked full shifts before evening classes. Some were raising children. A good number were the first in their family to attempt college, so nobody at home could tell them what office hours were for or what to do when a financial aid check came late.

They were anxious, and often for good reason. If a broken-down car means a missed exam, and a missed exam puts a scholarship at risk, then lying awake about the car is a fairly accurate read of the situation. Calling that a disorder, or handing the person a worksheet about catastrophic thinking, would have been insulting.

So I learned to start with one question: how much of this fear fits the life you're actually living? Some of it always does. That part needs to be taken seriously, sometimes with plain problem-solving. The rest is the anxiety that keeps running after the danger has passed, or that was learned so long ago it now treats a calendar reminder like an emergency. Therapy is mostly for that second layer. In my experience you can't reach it honestly until the first layer has been acknowledged.

I still work that way. A fair amount of the anxiety I see now is a reasonable response to an unreasonable job, a parent's diagnosis, a rumored layoff. When I think that's what's going on, I'll say so.

Moving my work to the Seattle area changed what anxiety looks like from my chair. In Baltimore the pressure was usually out in the open: rent, rides, childcare, a semester that could fall apart over one bad week. Here it's more often hidden behind a good salary and a composed face on a video call.

Underneath, it sounds the same. The belief that safety depends on staying ahead of every possible problem is identical whether it belongs to a nursing student working nights or a product manager on her third reorganization. That belief is usually old. Your nervous system learned at some point that vigilance was the price of feeling safe, and it never got the message that it's allowed to stop.

This is also why reassurance wears off so fast. You settle one worry and another takes its seat, because the worry was never the engine.

It isn't a formal diagnosis, and frankly I have mixed feelings about the term, because it so easily turns into a compliment. "High-functioning" describes how your anxiety looks to your employer. It says nothing about your evenings.

The people it fits over-prepare for ordinary things, like a routine meeting or a call with a friend. Rest makes them more anxious than work does. Success feels provisional, as if one mistake would reveal they were never as capable as everyone assumed. Friends call them calm, and they don't recognize the person being described.

It's hard to get help for because it works. The vigilance built the career and the household that runs on time, and asking it to ease up feels like risking all of that. Part of my job is to show you, slowly and with evidence from your own life, that the competence belongs to you and doesn't depend on the fear.

It often surfaces on Sunday evenings, which I wrote about in the Monday scaries. If you hold yourself to a standard nothing ever meets, therapy for high achievers speaks to that directly. And if you're wired and running on empty at the same time, burnout therapy may be the better place to begin.

A panic attack is a surge of fear that climbs to its peak within minutes. Your heart pounds, your breath goes short and high, your hands tingle, the room goes unreal, and you're sure you are dying or losing your mind. Then it passes and leaves you wrung out. If the symptoms are new or come on with exertion, see a doctor first.

One attack, or a few during a terrible month, doesn't mean you have panic disorder. The disorder is what grows around the attacks: weeks of dread about the next one, and a life rearranged to prevent it. You stop running because a fast heartbeat feels risky. You take side streets instead of the freeway, and you sit near the exit. Some attacks wake people out of sleep, with no dream to blame.

What I pay most attention to is that list of things you've stopped doing. Each one brought relief, and the relief taught your body the danger was real. We take them back gradually, at a pace you set, until a racing heart is just a racing heart again.

I don't open by arguing with your thoughts. Most anxious people already know their fears are out of proportion. They could recite the counterarguments in their sleep (and often do, at 2am). Knowing hasn't helped, so I'm not going to spend our early sessions repeating it back to you.

I'm also wary of a plan built only on coping skills. I teach a few, and they matter. But if the whole treatment is managing symptoms more efficiently, you've been given a lifetime of homework.

And I'm careful with reassurance, including my own. If I tell you the email was fine, you'll feel better until the next email. I'd rather help you get used to not knowing for a while, which is less pleasant in the moment and lasts much longer.