Conditions we treat Anxiety and panic
Help with anxiety in Tempe, AZ
Anxiety is the most common reason people call us, and most of them have been putting off the call for months. This page is a plain description of what it looks like and when an hour with somebody is worth it.
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- First visit
- Usually within 3 to 5 business days
- Where
- In person in Tempe or by video anywhere in Arizona
- Free consultation
- 15 minutes by video with our front desk. Request a consultation and we call you back to arrange it.
What it looks like day to day
Anxiety does not always look like panic. More often it looks like a day that is fine from the outside and exhausting from the inside. Some of what people describe:
- Rehearsing conversations before you have them, then replaying them after
- Checking things you already know you checked
- Saying yes when you meant no, because no felt like a confrontation
- A body braced for something it cannot name: jaw, shoulders, stomach
- Tiredness that sleep does not fix
- Avoiding the thing, then dreading the avoidance
- Or the wave that arrives with no warning and feels entirely physical
Some people get the physical version, some get the thinking version, most get both in different weeks. This is not a checklist and you do not have to match all of it.
Why the precautions stop working
Anxiety is a forecast. Fear in front of a real threat is useful, and it switches off when the threat does. Anxiety is that same response running on a prediction instead of an event. Your heart rate climbs for a meeting that has not happened yet. That is not a malfunction; it is what a body correctly does when it has been told something dangerous is coming. The fault is upstream, in the forecast, and the forecast is the thing that never gets corrected.
It never gets corrected because you almost never arrive at the feared thing without a precaution in place. You over-prepare. You sit near the door, keep your phone in your hand, take the longer route with fewer left turns, bring the friend, arrive twenty minutes early, rehearse the first sentence. Then it goes fine, and the relief is credited to the precaution. What your nervous system learns is not that the meeting was survivable. It is that the meeting was survivable because you sat near the door. So the door seat stops being optional, and the conditions attached to ordinary activities accumulate. Each one is small and individually reasonable, which is why nobody ever questions them, and why a life narrows without any decision being made to narrow it. These are called safety behaviors, and they are the most under-reported part of anxiety, because from the inside they look like being organized.
Panic has a second loop on top of that one, and it is why a single panic attack becomes a condition. In panic the feared thing is not the situation. It is the sensation. The hammering heart, the tight chest, the hands, the feeling that the room has gone slightly unreal. And the conviction that arrives with it: you are having a heart attack, suffocating, losing your mind, or about to humiliate yourself. The first attack is a false alarm. What turns it into a disorder is the fear of the next one. That fear produces monitoring, and monitoring supplies the sensations it is scanning for. Then the place it happened becomes the place it happens, then anywhere far from an exit, and the map shrinks from the outside in.
This is why the forecast cannot be argued down. It was not built by argument and it does not revise that way. It was built by experience, and only experience revises it. So the work is graded approach, which most people expect, and one part they do not: the precaution comes off. A test you pass with the door seat and the phone and the script in place teaches nothing, because the credit goes to the precaution again. Dropping them is the uncomfortable half and the half that changes the forecast.
If you want a single question to hold this against, it is not how bad the worry feels. It is whether you can name something you have stopped doing: a drive you no longer make, a meeting you send an email about instead. That list is the cost, and it is what a plan gets measured against.
Ready to talk it through? It takes a few minutes to request an appointment.
What the first appointment involves
What it covers
Sixty minutes, in a private room at our Tempe office or by video. Most of it is spent on the part you have probably never been asked about.
It covers six things. What you avoid outright, named one at a time and not summarized as "social things" or "driving." The precautions you take when you cannot avoid it, which nobody volunteers, because each one looks like ordinary preparation — where you sit, what you carry, who comes with you, how early you arrive, what you rehearse. Whether there are panic attacks, and if there are, what you believed was happening at the time: heart attack, suffocation, losing control, humiliating yourself. The body, asked separately from the thoughts: what hour it peaks, how long the bracing lasts once it starts, and whether sleep breaks at the beginning of the night or the end. What has narrowed, in concrete terms: the route, the meeting, the number of people you can be in a room with, the distance from home at which it starts. And what else is in the picture, because anxiety sits on top of something else more often than it arrives alone.
You will also be asked whether your thyroid and your heart have been checked recently. Several physical conditions produce symptoms indistinguishable from anxiety, and if that work has not been done your clinician will name who does it, so that nothing gets planned around the wrong cause.
What you leave with
A written list of your own safety behaviors, ranked by how hard each one would be to give up. Most people have never seen theirs written down, and the length of the list is the point at which the accumulation becomes visible.
A first step defined by which precaution comes off, not by which situation you enter. You have already entered plenty of situations with the precaution in place and it taught you nothing. The step is small enough that you would put money on doing it, and you pick it yourself.
A plan for a panic attack that is not leaving the room. Three parts: staying where you are long enough to find out that it ends without your help, dropping whatever you normally do to stop it, and knowing in advance that the peak is short and the fall happens on its own. Your clinician walks through it with you while you are calm, because nobody learns a new response mid-attack.
And the order of treatment in writing, if there is more than one thing in the picture, with the reasoning for that order. Anxiety sitting on low mood is approached differently from anxiety sitting on a long-standing attention difficulty, and you should know which case you are being treated as.
How we approach it
These are the approaches our clinicians are trained in and use for anxiety. Which one you get is a conversation, not an assignment.
Cognitive Behavioral Therapy
Identifying the thoughts and beliefs connected to your anxiety, and examining them during sessions.
Exposure and Response Prevention
Approaching the thing you have been avoiding, in a graded order you agree on, without the check or the reassurance that usually follows.
Dialectical Behavior Therapy
Practicing skills for managing intense emotions, tolerating distress, staying present, and navigating difficult situations.
Trauma-Informed Therapy
Exploring anxiety with attention to past experiences, current triggers, personal boundaries, and your sense of safety.
Solution-Focused Therapy
Identifying current concerns, discussing practical next steps, and building on the strategies and strengths you already use.
What does not vary: in the first session your therapist tells you what they would try and how the two of you would know whether it is working. If it is not working, you change it.
Where people start
Individual Therapy
Sixty-minute sessions with the same clinician every time. Practical work on the parts that an assessment alone does not fix.
See therapy and costPsychiatric Evaluations
A sixty-minute appointment with a psychiatric provider at our Tempe office. You leave with a diagnosis, a plan, and the reasoning behind both.
See evaluations and costThree questions we get about this
Is this just stress, or is it anxiety?
That distinction matters less than you would think, and it is not something you have to settle before you call. The useful question is whether it is running more of your life than you want it to.
Will talking about the panic make it worse?
It is the most common worry people bring to a first session, and it is worth saying out loud in the first ten minutes. Your therapist will tell you what they are going to do and why, and you set the pace.
What if my anxiety is about something real?
Plenty of it is. A job that is genuinely precarious, a parent who is genuinely ill, money that is genuinely short. Therapy does not require you to decide the worry is irrational.
Related concerns
The first step is yours to pick.
A few minutes now, a short phone call within one business day, and a confirmed date on the calendar. You will know what it costs before you commit to anything.
Monday to Friday, 8am to 5pm · Saturday, 9am to 2pm