How I Can Help You

I specialize in cognitive-behavioral therapy (CBT) for adults with anxiety and related problems, especially:

If you have Panic Disorder you may suffer repeated and sudden attacks of intense terror or apprehension that make you feel like you are dying or going crazy – for no apparent reason. Symptoms can include racing heart, shortness of breath, chest pain, lightheadedness, numbness or tingling in limbs, feelings of unreality, stomach or bowel symptoms, sweating, trembling or choking.
When panic attacks or other symptoms lead to significant avoidance, Agoraphobia may develop, in which you fear having a panic or other symptoms in a place or situation from which escape might by difficult or embarrassing. These situations include crowds, certain buildings, being alone, being far from home or a trusted person, or traveling by car, bus or airplane.  The cost of agoraphobia can be a very restricted lifestyle.
If you have a Specific Phobia you may suffer from an intense fear reaction to a specific object or situation, such as vomit, spiders, dogs, heights, water, air travel, or closed-in spaces. You recognize that your level of fear is irrationally inappropriate to the situation. Such intense fear can lead to avoidance of common, everyday situations, and can interfere with your life.
If you experience a Medical Phobia you suffer from fear of blood, injections, doctors, dentists, or medical procedures. The anxiety you experience may keep you from attending doctor or dentist appointments, having blood work done, visiting hospitals, getting flu shots or other inoculations, or donating blood. You may also avoid pursuing pregnancy or a career in medicine, nursing, etc. Fainting is a common feature of these phobias.
If you are struggling with Social Anxiety Disorder you may have become excessively self-conscious, and you persistently desire to avoid one or more situations involving social interactions. Commonly feared situations include public speaking, meeting new people, writing or performing in front of others, being at parties, dating, speaking to people in authority, eating in public, having conversations, talking on the phone, e-mailing or posting on-line, using public restrooms, or disagreeing with others. People with social anxiety worry about being judged by others or behaving in a way that might cause embarrassment or ridicule. Physical symptoms such as blushing, shaking or sweating can increase the fear of humiliation or embarrassment.
If you have Obsessive-Compulsive Disorder (OCD) you are plagued by intrusive, persistent and recurring thoughts, images or impulses (obsessions) that may seem senseless or distasteful. Typical obsessional topics concern disease, dirt, disorder, sex, religion or violence. These unwanted thoughts may lead you to perform a ritual or routine (compulsions) to try to neutralize, suppress or reduce the distress caused by the obsession. Common compulsions include repetitive hand washing, excessive cleaning and arranging, checking door locks and other objects, ritualistic counting, repeating phrases, and rereading.  Significant avoidance can result from OCD.
If you worry all the time, you may suffer from Generalized Anxiety Disorder. In this condition, people experience excessive, unrealistic worry that often feels uncontrollable. The constant worry may concern topics such as financial problems, loved ones, school, career, health, etc. This worrying leads to a number of unpleasant symptoms including restlessness, fatigue, problems with concentration, insomnia, muscle tension, irritability, and abdominal upset.
If Health Anxiety (also known as Illness Anxiety Disorder) is a problem, you suffer from fears of being seriously ill, or even terminally ill, when no symptoms of serious illness exist. You may misinterpret normal bodily sensations or physical symptoms as being dangerous and life threatening. Reassurance from friends, family, medical tests or health care professionals may provide temporary relief, but the fears return anyway. You may make many unnecessary visits to the doctor or undergo unnecessary medical testing and procedures, or even avoid contact with health care providers for fear that you will receive bad news.
 Body-Focused Repetitive Behaviors (BFRB’s) include Excoriaton (Skin-Picking) Disorder, compulsive nail biting, biting the insides of the cheeks, lip picking, blemish squeezing, nose picking, etc. Although lightly regarded as “nervous habits” by many, they can have serious negative impacts upon you, such as intense shame, scaring, depression and social isolation.
Trichotillomania or Hair-Pulling Disorder, is the recurrent pulling out of one’s hair, resulting in noticeable hair loss. Hair might be pulled from the scalp, eyebrows or eyelashes, among other areas. If you have “trich,” you may or may not experience strong urges to pull, which you cannot resist. Episodes are followed by such feelings as gratification, relaxation, relief, guilt, shame or depression. You may avoid activities that you fear will reveal your hair loss or go to great lengths to conceal bald spots, using scarves, wigs, makeup, clothing, etc.
Body Dysmorphic Disorder (BDD) is characterized by having a distorted perception of one’s appearance, leading to agonizing shame and despair. It is generally diagnosed if you are extremely critical of your physique or body-image, despite the fact there may be no noticeable disfigurement or defect. If you suffer from BDD, you may anxiously focus upon monitoring and hiding the aspect of appearance (e.g. skin, hair, nose) that you view as ugly. This can lead to social avoidance, compulsive reassurance seeking, unnecessary surgeries, etc.
Insomnia is one of the more troubling experiences for depressed or anxious patients. If you have problems falling or staying asleep, or experience non-restorative sleep that occurs on a regular or frequent basis, you may have Chronic Insomnia. Insomnia can affect not only your energy level and mood, but also health. Fortunately, a course of CBT, without the use of drugs, can be quite effective in controlling insomnia problems.

I can also help you with:

  • Discontinuing Psychiatric Medication
  • Reducing shyness and social isolation
  • Managing clinical depression
  • Cultivating self-esteem, optimism and psychological resilience
  • Developing assertiveness and social skills
  • Overcoming procrastination, perfectionism and self-criticism
  • Maintaining a healthy life style (e.g., exercise plans)
  • Improving time management
  • Improving self-care
  • Achieving and maintaining weight loss (including use of “The Beck Diet Solution”)
  • Integrating spirituality and faith into your counseling
  • Navigating life transitions and loss
  • Controlling “shy bladder syndrome” (Paruresis)
  • Learning improved stress management skills
  • Clarifying values, direction, purpose and life goals

Please feel free to call me at 206-285-0900 or email me at if you have a question or wish to schedule an appointment.

All material provided on this website is for informational purposes only. Direct consultation of a qualified provider should be sought for any specific questions or problems. Use of this website in no way constitutes professional service or advice. David J. Kosins, Ph.D. © 2021