Boston Evening Therapy Associates was founded in 2007 by Aaron Gilbert, LICSW, to offer effective anxiety therapy and support to individuals seeking relief. With over 30 years of experience, Mr. Gilbert has helped many clients manage anxiety disorders through therapy grounded in trust, empathy, and personal growth.
Anxiety disorders are more common than you might think, affecting 4% of the world’s population.
Recognizing these disorders and understanding their impact is crucial for both those experiencing them and their loved ones.
Mr. Gilbert described anxiety disorders as “having an experience of the world that feels intolerable, believing that it must change, and being unable to do so.”
Occasional anxiety or worry is a natural part of being human, especially in high-pressure moments.
However, the key difference between everyday anxiety and an anxiety disorder is determined by how often you experience it and to what degree it impacts your day-to-day functioning.
In other words, while mild anxiety may show up as nervousness, anxiety disorders persist longer than six months with symptoms such as chronic worry, sleep disturbance, muscle tension, panic attacks, all of which may result in avoiding certain activities and situations altogether.
When anxiety starts interfering with your daily functioning, it may signal that you are struggling with an anxiety disorder.
Mr. Gilbert explains that while all anxiety disorders stem from having an experience of the world that feels intolerable and needing to change, but feeling unable to do so, they manifest in different circumstances.
“The etiology of all of these conditions stems from some combination of genetics, family history, and incidents of trauma,” Mr. Gilbert said.
Mr. Gilbert adds that anxiety often begins with “triggering” events or recurring negative thoughts.
People with Generalized Anxiety Disorder worry excessively about nearly every part of life—social, work, or health—on most days for six months or more.
Physical symptoms include, but are not limited to, difficulty concentrating, muscle tension, and sleep disturbance.
Mr. Gilbert calls generalized anxiety “the most pervasive” because it disrupts nearly every part of a person’s life.
Social Anxiety Disorder causes an intense fear of judgment or rejection in social or professional settings. This fear leads to avoidance or distress that lasts six months or more.
Mr. Gilbert describes Social Anxiety Disorder as pronounced when interacting with others or being in crowds. He added that social anxiety refers to a “specific worry or fear related to either particular relationships, social circumstances, being in the presence of groups, or simply being seen or observed.”
Many people with social anxiety disorder find speaking to a therapist daunting. Remote therapy often lowers the barrier and feels more approachable.
Recurrent unexpected panic attacks mark Panic Disorder. Panic attacks begin suddenly with intense fear, distress, and dread that peak within minutes. A panic attack may include symptoms like rapid heartbeat, sweating, trembling, shortness of breath, nausea, dizziness, or chills. Panic Disorder includes sudden, repeated panic attacks plus ongoing fear of future episodes or behavior changes to avoid them. The fear and behavior changes persist for at least a month.
Mr. Gilbert describes Panic Disorders as “periodic bouts of intense fear which can feel like a life or death circumstance."
Separation Anxiety Disorder involves intense fear about being apart from emotionally close people, especially when that fear is excessive or not age-appropriate.
Symptoms include fear of losing attachment figures, worry about being separated, reluctance to leave loved ones, and even physical issues like stomachaches or panic when separation happens or feels likely.
Separation Anxiety Disorder causes intense fear of being apart from loved ones for at least 4 weeks in youth or 6 months in adults, often disrupting daily life.
Mr. Gilbert described Separation Anxiety as “a specific fear of being cut off from a particular person.”
Phobias are of either specific circumstances, physical items, or both.
Mr. Gilbert explained that one of the most common misconceptions about anxiety disorders is that it is “a form of personal weakness or failing.”
“Being human is hard. Despite our enormous intellect and problem-solving capacity, most of the world's events are beyond our control, a concept that is difficult for modern humans to accept. When there is the perception that things are going badly and we cannot change them, anxiety can arise,” he added.
“In therapy, some form of anxiety is probably the most common presentation. The good news is that most of the time, it is highly treatable with a variety of both psychotherapy interventions and lifestyle changes,” Mr. Gilbert noted.
“When fear or worry starts interfering with daily life, it’s important to seek some form of help,” Mr. Gilbert explains. In other words, if you perceive your anxiety to have adverse effects on your life, seeking therapy is a good next step; however, it's not the only one.
“While psychotherapy is a proven option, it’s not the only one. People who prefer not to pursue therapy can also turn to resources like books, podcasts, or take action by making intentional, meaningful changes in their lives,” Mr. Gilbert adds.
Mr. Gilbert adds that success in treating anxiety often starts with recognizing something is wrong and feeling ready to make a change.
“Success means different things to different people, but often includes the feeling of getting your life back,” Mr. Gilbert said. “A sense of gratitude and regular awareness of calm moments can help strengthen that progress.”
When choosing a therapist for anxiety, Mr. Gilbert suggests that someone with specific training and experience in working with anxiety disorders is essential. Still, a good therapist “must also ‘meet you where you are’ in a non-judgmental, empathic, and deeply connected manner,” Mr. Gilbert says. He emphasizes that good anxiety therapy depends on a kind, present, and insightful therapist who builds a strong, trusting connection.
Cognitive Behavioral Therapy (CBT) is the first-line treatment for anxiety. It helps people challenge distorted thoughts and develop coping skills. These may include relaxation, problem-solving, and exposure techniques. Specific approaches include Exposure Therapy for phobias, panic, and OCD, and Cognitive Restructuring for generalized or social anxiety.
Mr. Gilbert says Cognitive Behavioral Therapy is one of the most common methods used to treat anxiety.
For example, Mr. Gilbert cites Acceptance and Commitment Therapy, Exposure Therapy, and Mindfulness-Based Therapy as highly effective. He also added that, “frequently therapy can be augmented by medications, most commonly in the antidepressant family.”
“Medications for anxiety are often prescribed on a 'PRN' (as-needed) basis, which can be helpful in certain situations but isn’t as effective for long-term management,” Mr. Gilbert explains.
When anxiety seems to have a strong genetic component, antidepressants like SSRIs (Selective Serotonin Reuptake Inhibitors) may offer more consistent, ongoing relief, Mr. Gilbert explains.
Doctors usually start with SSRIs when treating conditions like generalized anxiety, agoraphobia, or social anxiety disorder.
Research doesn’t show that any one SSRI works particularly better than others, but that it is highly individual and dependent on your concerns and goals.
SSRIs usually require several weeks before they start working.
In some cases, medication alone may be enough, but more often, it works best when combined with therapy and healthy lifestyle changes.
Relaxation techniques and meditation are practical tools for managing anxiety. In fact, for mild, everyday anxiety, non-medication strategies are often considered the first line of treatment.
There are numerous resources, including books, websites, and apps (see examples below), that offer relaxation exercises often combined with deep breathing and guided meditation.
Mr. Gilbert recommends mindfulness, regular exercise, early morning sunlight, thought-stopping techniques, and quality sleep as powerful tools for managing anxiety.
For those who are seeking a more personalized approach, mental health professionals can offer guidance in developing these skills.
If you'd like to deepen your understanding of anxiety disorders, Mr. Gilbert recommends these insightful resources:
“Don’t Feed the Monkey Mind,” by Jennifer Shannon – Applies anxiety disorders in clinical and therapeutic settings.
American Psychiatric Association: Anxiety Disorders
American Psychiatric Association: What Are Anxiety Disorders
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