MARIN CENTER FOR ANXIETY AND BEHAVIORAL THERAPY
Personalized evidence-based therapy for children, teens, and adults
WHAT WE TREAT
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generalized anxiety disorder (GAD)
Worrying
Worrying about daily concerns and having trouble letting them go
Problems handling uncertainty
Jumping to the worst case scenario ("what ifs")
Health worries
Rigid Standards
Perfectionism about school, work, or hobbies
Persistent need to be on time
Over-planning
Indecisiveness
Discomfort
Sleep problems and fatigue
Problems concentrating
Difficulty relaxing/feeling tense
Additional in Children:
Frequent reassurance seeking
“What if” questions
Spending excessive time doing schoolwork
Needing to know what will happen next
Children and adults with GAD worry about a range of topics, such as school, work, personal health, and world events, among other issues. Although everyone experiences some level of worry, in GAD the worries can last for hours and one cannot simply “turn them off,” even with distraction. The worries can be so prevalent that they interrupt the ability to concentrate, sleep, or enjoy things.
Treatment will help to put these worries in the background so you or your child can use your minds for more preferred activities.
Signs of GAD
social anxiety disorder
Avoidance
Problems asserting self (saying "No")
Saying "No" to events or not reaching out to others
Avoiding eye contact
Inhibition
Keeping opinions to self
Extreme shyness
Speaking with a soft voice
Discomfort
Extreme unease with public speaking
Feeling isolated
Negative thoughts about self (“I’m so stupid”)
Physical symptoms,
including panic attacks
Additional in Children:
Parents speaking up for kids in social situations (such as ordering for them at restaurants)
Staying nearby parents at a social gathering
Not asking teachers for help or poor class participation
Staying home on weekends or after school
phobias
Children and adults with social anxiety have worries about saying or doing “the wrong thing” in social situations, leading to embarrassment, humiliation, or other negative consequences. To cope, people with social anxiety often avoid forms of social contact, such as declining invitations to events, holding back in conversations, and staying away from less familiar people.
Social anxiety can make our world feel small and lead to missed opportunities in friendship, dating, and general enjoyment of life. In adults, it can block job promotion and in children, it can impact school performance.
Treatment will help to build self-confidence and enhance connectedness to those around you or your child.
Signs of Social Anxiety
Children and adults with a specific phobia have an intense fear about a specific situation or object, such as heights, dogs, elevators, spiders, the dentist, or the dark.
Although it is common and normal to have some fear about these things, it becomes a phobia when (1) the fear outweighs the true danger of the situation and (2) the fear interrupts one’s routine or enjoyment of life. For example, if a child is afraid of dogs and they cannot spend time at their best friend’s house because they own a golden retriever, this may indicate a phobia.
Treatment will help to empower you or your child face these situations with greater ease.
Examples of Phobias
Dark
Sleeping with overhead lights on
Not going into a dark room alone
Staying inside in the evenings
Insects
Leaving a room if there is a bug inside
Avoiding outdoorsy activities
Requesting others to kill a bug
Vomiting
Not eating certain foods that may lead to vomiting
Going to extreme lengths to avoid germs
Assuming the worst when feeling slightly ill
Injections
Avoidance to go to the doctor and not getting needed treatments
Needing to be held down at the doctors office
Worrying about a shot a week or more before
separation anxiety disorder
Both children and adults can experience separation anxiety. Children may resist separation from parents, even for a short period of time, such as going to bed, school, or friends' houses. Children may also worry that something bad will happen to them or their caregiver or that their parent won’t come back. Adults may struggle to separate from their partner, parents, or children.
Treatment helps parents and children enhance independence while maintaining strong relationships with caregivers.
Signs of Separation Anxiety
Worries
Fear of something bad happening when apart from attachment figure
Problems Separating
School refusal
Following parent around the house
Sleeping with parent
Safety Seeking
Frequent visits to school nurse or counselor
Frequent reassurance seeking ("Will it be OK?")
Excessive texts or calls to attachment figure when apart
Frequent visits to school nurse or counselor
Discomfort
Physical complaints before or during separation
Nightmares
Fatigue for attachment figure
Panic disorder & agoraphobia
People with panic attacks experience a sudden rush of very uncomfortable physical sensations that can be triggered by an event or come out of the blue. These feelings can be so intense that it can feel like we’re dying, losing control, or going crazy. In panic disorder, children and adults become very worried about future panic attacks and may modify their routines to avoid them.
Agoraphobia commonly occurs when people have panic attacks, such that they avoid places that feel unsafe or hard to get out of (such as crowded places).
Treatment helps one cope with physical sensations by showing that they are stronger than the feelings, and that you or your child does not need to be paralyzed by them.
Signs of Panic Disorder & Agoraphobia
Panic Attacks
Racing heart & shortness in breath
Sweating and/or shaking
Numbness or tingling
Choking feelings
Tunnel vision, dizziness, and/or feeling detached
Worry
Fears of dying, losing control, or going crazy during panic attack
Worries about if and when next panic attack will occur
selective mutism
Selective mutism is a condition most typically seen in young children, and it is characterized by a child being unable to speak in specific settings, despite ability to communicate effectively in more comfortable settings. Selective mutism is an anxiety disorder that is often seen in children who are beginning school or entering a novel social setting.
Treatment is designed to help children “find their voice” and gain greater comfort across a variety of settings.
Signs of Selective Mutism
Avoidance
Inability to speak in certain social situations or setting, though the child has the ability to speak in comfortable settings with familiar people
Social shyness
Worry
Elevated anxiety around unknown individuals
Fear of social embarrassment
Worry related to going to school or extracurricular
obsessive compulsive disorder (oCd)
Children and adults with OCD can experience a range of unwanted thoughts, urges, doubts, or images ("obsessions"). Although everyone experiences obsessions from time-to-time, people with OCD are very distressed by their thoughts and struggle to distract themselves from them.
To cope with obsessions, people get in patterns of compulsive behaviors, such as excessive cleaning, counting, checking or arranging/organizing. The compulsions give temporary relief but they come at a price. Obsessions usually come back, leading to a stressful and time consuming cycle.
Treatment will help break the cycle and find better ways to cope with distressing thoughts.
Signs of OCD
Obsessions
Having "sticky" thoughts and trying to get rid of them
Need to follow a routine/getting upset if it’s disrupted
Excessive superstitions
Urge to tap or touch things
Disruption
Losing productivity at work or school
Arguments with family members over compulsions
Rituals take up hours a week
perfectionism
Perfectionism is not a psychological disorder but it can significantly disrupt our daily routine. Although striving for high standards is often a favorable trait, perfectionism may actually make us less productive, less happy, and less fulfilled in our lives. Perfectionism differs from high standards in that we are setting standards that are inflexible and very hard to achieve, standards that define our self-worth, and standards that sacrifice other important areas of our lives (such as time with friends or family).
Treatment will help to strike a balance of flexibility and achieving important goals.
Signs of Perfectionism
Hard to Achieve Standards
Needing to get all A’s in school
Very high standards in work, athletics, art, or other leisure activities
Getting upset over small mistakes
Disruption
Giving up social plans to do work
Problems making decisions
Procrastinating
Excessive worry about the future
disruptive behaviors
In addition to anxiety treatment, we provide services to help parents manage difficult behaviors, such as problems with following directions, arguing, and temper tantrums. These behaviors are not specific to any psychological domain and can occur within the context of anxiety, depression, ADHD, Autism, or another condition.
Treatment will teach parents proactive approaches and practical tools to reduce problematic behaviors.
Signs of Disruptive Behaviors
In Children:
Talking back
Hitting or kicking
Yelling or whining
Excessive fighting with siblings
Refusal to promptly follow directions (chores, homework)
In Caregivers/Adults:
Repeating the same direction over and over
Trying a number of tools that don’t seem to work
Feeling burnt out
Always “putting out fires”
Using punishment or raising your voice more than you’re comfortable with
Other CONCERNS
Sleep problems, picky eating and compulsive behaviors (such as hair pulling and skin picking) can be a consequence of anxiety or separate issues. Regardless of the source, they can be highly disruptive to the individual and those around them.
Treatment will help individuals and family members gain greater awareness of behavioral patterns and learn ways to better manage these issues.
Other Issues We Treat
Sleep Problems
Problems falling asleep independently
Getting out of bed multiple times at bedtime
Going into parents' room in the middle of the night
Waking up too early
Picky Eating
Refusal to try new foods
Eating only certain types of food (e.g.; only certain textures or colors or only a specific type of food)
Frequent arguments around meals
Needing foods prepared a "certain way"
Parents making different meals for different children
Hair Pulling, Skin Picking & Nail Biting
Hair pulling, leading to bald spots, or patches of missing hair on eye lids, eye brows, or elsewhere
Skin picking or nail biting resulting in infection, bleeding, or irritated skin
Taking efforts to concealing habit (such as wearing long-sleeves)
Minimal awareness or feeling out of control
Wetting Issues
Wetting clothes or bed beyond what is expected given the child's age
Wetting in certain settings