Anxiety & Burnout Treatment in San Francisco
Written by: Genesis Javaherian. PMHNP-BC
Last edited: 3/02/26
Anxiety is more than “worrying.” It is a common and treatable mental health condition that can affect how you feel, think, and function at work, at home, and in relationships. With the right support, many people feel significantly better.
In-person at 999 Sutter St, San Francisco &
Telehealth throughout California
✓ Most patients seen within 3–5 days
✓ In-network with Aetna, Cigna, UHC, Medicare & more
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What is anxiety?
Everyone feels anxious sometimes, before a big presentation, a difficult conversation, or an uncertain situation. That kind of anxiety is normal and usually passes. Anxiety disorders are different. They involve fear, worry, or physical tension that is persistent, disproportionate to the situation, and begins to interfere with daily life.
Anxiety is the most common mental health condition in the United States, affecting roughly one in five adults. It is highly treatable, but most people who experience it go years without support. Often because anxiety can feel like a personality trait rather than a condition worth addressing.
Anxiety disorders include several distinct diagnoses. What they share is a pattern of excessive fear or worry that is difficult to control and causes real impairment. The right diagnosis guides the right treatment, which is why a comprehensive evaluation matters.
Quick Takeaways
Anxiety is more than worry. It shows up physically too, in tension, sleep disruption, fatigue, and a racing heart.
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Symptoms that persist for 6 months or more and interfere with daily life may meet criteria for an anxiety disorder.
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Treatment often includes therapy, medication, or both, and the best plan depends on your symptoms and preferences.
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You don’t have to wait. If something feels off, that’s enough reason to reach out.
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Anxiety & Treatment
Common questions about anxiety
Answers written by licensed clinicians, designed to help you understand what you're experiencing and what to do next.
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SYMPTOMS
Anxiety can feel like relentless worry you can't turn off, a sense of impending dread, physical tension and restlessness, a racing heart or shallow breathing, difficulty concentrating, or an urge to avoid situations that trigger the feeling. It can also look like irritability, insomnia, or fatigue that doesn't have an obvious cause. Not everyone with anxiety feels primarily worried — some people experience it almost entirely through physical symptoms, which is one reason it is frequently misidentified as a medical condition before anyone evaluates the mental health component.
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DIAGNOSIS
Anxiety becomes a clinical disorder when it is excessive relative to the situation, difficult to control, and causes meaningful impairment in work, relationships, or daily functioning. A diagnosis is made through a structured clinical conversation using DSM-5 criteria — not a quiz. Common anxiety disorders include generalized anxiety disorder, social anxiety disorder, and panic disorder, each with distinct features. A licensed clinician at Defina Health can evaluate your symptoms and give you a clear picture of what's happening and what treatment options make sense for you.
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Mild situational anxiety often does resolve on its own when the stressor passes. Clinical anxiety disorders, particularly generalized anxiety disorder, social anxiety, and panic disorder, rarely resolve without support. Left untreated, anxiety tends to maintain itself through patterns of avoidance that reinforce the belief that certain situations are dangerous. With treatment, most people improve meaningfully. The longer anxiety goes unaddressed, the more entrenched those patterns can become.
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Panic attacks are sudden surges of intense physical fear — racing heart, shortness of breath, chest tightness, dizziness — that typically peak within 10 minutes. They are frightening but not physically dangerous. Panic disorder is highly treatable with CBT, specifically through a combination of cognitive work and interoceptive exposure that helps the nervous system stop reading normal physical sensations as threats. Medication can also be effective. If you are experiencing panic attacks, let your clinician know at your first appointment — panic disorder responds well to treatment when properly identified.
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It depends on your symptoms and what you're looking for. Therapy is often the first-line recommendation for anxiety — particularly CBT, which has the strongest evidence base. Psychiatry is especially helpful if your symptoms are moderate to severe, significantly disrupting sleep or daily functioning, or haven't improved with therapy alone. Many people with anxiety benefit most from both working together. If you're not sure where to start, a first visit can clarify what level of care fits your situation.
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Cognitive behavioral therapy (CBT) is the most extensively studied treatment for anxiety and is effective for generalized anxiety, social anxiety, panic disorder, and specific phobias. For moderate to severe anxiety, SSRIs are the most commonly used first-line medications — they are not habit-forming and typically take 4 to 8 weeks to reach full effect. For most people, a combination of therapy and medication produces stronger outcomes than either alone. At Defina Health, your therapy and psychiatry providers coordinate directly so your plan addresses both sides.
10 Common signs of anxiety & When to get help
Anxiety doesn’t look the same for everyone. Some people feel it as constant worry or dread; others feel it as physical tension, restlessness, or a sense that something bad is about to happen. Knowing the signs is the first step toward getting support.
If you’re in crisis right now: Call or text 988 (Suicide & Crisis Lifeline) — free, confidential, 24/7. Or go to your nearest emergency room.
Excessive worry that is hard to control, even when you know it may be disproportionate
Feeling on edge, restless, or wound up most of the time
Fatigue that is not explained by physical illness or poor sleep alone
Difficulty concentrating, or your mind going blank
Irritability or a short fuse that feels unlike your baseline
Muscle tension, jaw clenching, or persistent physical tightness
Sleep problems: trouble falling asleep, staying asleep, or waking up still exhausted
A racing heart, shortness of breath, or chest tightness (not explained by a cardiac condition)
Avoiding situations, places, or people because of fear or anticipated anxiety
Panic attacks: sudden surges of intense fear with physical symptoms that peak within minutes (If you’re experiencing this, please call or text 988 now)
You don’t need to be in crisis to ask for help. If these symptoms have lasted several weeks or more or are affecting your work, relationships, or daily life, a licensed clinician can help you figure out what’s going on and what to do next.
Recognize yourself in these symptoms? A 60-minute evaluation with a trained clinician can help you understand what's happening and what to do next. Most patients are seen within 3–5 days · Insurance verified before your visit
Anxiety evaluation in San Francisco & throughout California
Whether you’re in San Francisco or anywhere in California, Defina offers in-person and telehealth evaluations for anxiety — so you can get answers and start feeling better.
Anxiety vs stress or burnout
Stress and burnout can feel a lot like anxiety, but they are usually tied to a specific situation or period of overload. When the stressor is removed, stress tends to ease. Anxiety is different. A helpful rule of thumb is:
Stress or burnout often improves when the situation changes or you rest
Anxiety can persist even when things are objectively fine, and tends to find new things to attach to
Even if you are not sure what is going on, you can still reach out. You do not need to “prove” you are anxious to deserve care.
Types of anxiety
Anxiety is an umbrella term. Some common forms include:
Generalized anxiety disorder (GAD): excessive, difficult-to-control worry about multiple areas of life, most days, for at least 6 months
Social anxiety disorder: intense fear of social situations due to fear of judgment, embarrassment, or humiliation
Panic disorder: recurrent unexpected panic attacks with persistent concern about future attacks or changes in behavior to avoid them
Specific phobias: intense, disproportionate fear of a specific object or situation
Agoraphobia: fear and avoidance of situations where escape might be difficult, or help unavailable during a panic attack
Anxiety with depression: anxiety and depression frequently co-occur, and treating one without the other often leads to incomplete improvement
This is one reason a proper evaluation matters. The right diagnosis guides the right treatment.
How is anxiety diagnosed?
A clinician diagnoses anxiety through a conversation about your symptoms, health history, and how you are functioning day to day. To be diagnosed with generalized anxiety disorder, for example, excessive worry and related symptoms must be present most days for at least 6 months and cause meaningful impairment. Your clinician may also use a standardized tool like the GAD-7 to measure symptom severity and track your progress over time. Medical conditions such as thyroid dysfunction can also produce anxiety-like symptoms, which is one reason a thorough evaluation matters.
Anxiety treatment options overview
Anxiety treatment commonly includes therapy, medication, or a combination. Many people do best with a plan that matches symptom severity, preferences, and medical history.
For milder anxiety, therapy is often tried first, with medication added if needed
For moderate to severe anxiety, medication is often part of the initial treatment plan
For panic disorder, a combination approach tends to produce the strongest results
It's common to try more than one approach before finding what works best.
Therapy vs psychiatry:
Which do I need?
Many people benefit from both, but here is a simple guide:
Therapy may be a good first step if you want help with:
Patterns of anxious thinking or avoidance
Worry spirals, catastrophizing, or reassurance-seeking
Social anxiety, performance anxiety, or specific fears
Coping skills, grounding techniques, and nervous system regulation
Processing past experiences that contribute to current anxiety
Psychiatry may be especially helpful if:
Symptoms are moderate to severe and disrupting daily life
Sleep, concentration, or functioning is significantly affected
You have tried therapy but still feel stuck
You want to explore medication options or have medication questions
Anxiety is accompanied by depression or other co-occurring conditions
If you are not sure, you do not have to figure it out alone. A first visit can clarify what level of care fits best.
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Therapy (talk therapy) for anxiety helps you understand the thought patterns and behaviors that maintain anxiety and develop practical tools to interrupt them. Over time, most people learn to experience anxiety without being controlled by it. Therapy can help with persistent worry, avoidance, panic attacks, social anxiety, sleep disruption related to anxiety, and the underlying beliefs that fuel the cycle.
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Our therapist may use one approach or a blend, based on your goals:
Cognitive Behavioral Therapy (CBT): The most extensively studied treatment for anxiety. CBT identifies the distorted thought patterns that drive anxious feelings and teaches concrete skills to challenge and reframe them. Exposure-based components help patients gradually face feared situations and reduce avoidance.
Exposure and Response Prevention (ERP): Particularly effective for OCD and specific phobias. Involves gradual, structured exposure to feared thoughts or situations without engaging in avoidance behaviors.
Acceptance and Commitment Therapy (ACT): Focuses on reducing the struggle against anxious thoughts and feelings and building a life aligned with personal values, even in the presence of anxiety.
Mindfulness-Based approaches: Help patients develop awareness of anxious thoughts without becoming fused with them — creating space between the trigger and the response.
Somatic approaches: Address the physical component of anxiety through breathwork, body awareness, and nervous system regulation techniques.
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Your first session will focus on understanding your history and goals. Depending on your symptoms and the approach, you may begin working on specific skills relatively quickly. Most people with anxiety notice meaningful improvement within 8 to 16 sessions, though this varies. Sessions are typically 50 minutes, weekly or biweekly. Your therapist will adjust the pace based on your progress and comfort.
Therapy for anxiety
Psychiatry for anxiety
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Your psychiatric provider will conduct a thorough evaluation of your symptoms, health history, and how depression is affecting your daily life. From there, they can diagnose, recommend treatment options including medication, and screen for overlapping conditions like anxiety, bipolar disorder, or trauma-related symptoms that are often missed without a proper assessment.
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Antidepressants are commonly used for anxiety. They work by changing how the brain produces or uses certain chemicals involved in mood and stress.
A few things patients often want to know:
How long do antidepressants take to work? It can take time, often 4 to 8 weeks, and sleep or appetite may improve before mood improves.
Will I be monitored? Yes. Follow-up is important to adjust dose, address side effects, and track progress.
Do I have to be on medication forever? Not necessarily. Many people use medication for a period of time while they stabilize and build other supports. Your plan should be individualized.
If you are under 25 or starting or changing a medication dose, your provider may recommend closer monitoring early on.
The goal is always the lowest effective dose with the fewest side effects and your input matters throughout.
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Our first appointment is typically 60 minutes. Your provider will take a full history, ask about your symptoms, how they developed, what you've tried, and how anxiety affects your daily life. If medication is recommended, they will explain the options, likely effects and side effects, and what to monitor. Follow-up appointments are typically 30 minutes and include a GAD-7 check-in to measure how your symptoms are actually responding to treatment.
Wondering if you might have anxiety?
Take this 1 min anxiety screener
This questionnaire is not intended to replace professional diagnosis. It is not monitored in real time and responses are not added to a patient profile.
Source: Generalized Anxiety Disorder 7-item Scale (GAD-7), Spitzer et al.
Therapy and psychiatry in one place. If you benefit from both, your therapist and psychiatric provider share clinical notes and coordinate your plan directly. No repeating your story at every appointment.
We track real progress. At every follow-up, we use the GAD-7 — the same validated tool as the screener above to measure how your symptoms are actually changing. You can see your own trajectory over time.
UCSF-trained, evidence-based care. Defina was founded by Genesis Javaherian, PMHNP-BC, a UCSF-trained psychiatric nurse practitioner and former Behavioral Health Commissioner for the City and County of San Francisco. This is a practice built by clinicians who have worked inside San Francisco's mental health infrastructure.
In-person and telehealth. See us at 999 Sutter St or connect by secure video anywhere in California.
Why Defina for anxiety?
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Yes — therapy is one of the most effective treatments for depression and is recommended as a first-line option for mild to moderate symptoms. Cognitive behavioral therapy (CBT) has the strongest evidence base, but interpersonal therapy and psychodynamic approaches are also well-supported. Many people experience significant improvement within 8 to 16 sessions, though this varies depending on symptom severity and personal history.
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Not necessarily. Medication is one option, not a requirement. For mild anxiety, therapy alone is often sufficient. For moderate to severe anxiety, antidepressants — particularly SSRIs — are frequently recommended alongside therapy because the combination tends to produce better outcomes than either alone. The right approach depends on your symptoms, history, and preferences. A psychiatric evaluation can help clarify whether medication makes sense for you.
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Please reach out now. Call or text 988 (Suicide & Crisis Lifeline — free, confidential, 24/7), or go to your nearest emergency room if you are in immediate danger. Thoughts of self-harm are a signal that you need support sooner rather than later — not something to wait out alone. If you are not in immediate crisis but these thoughts are present, let your clinician know at your first appointment.
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Yes. Telehealth therapy and psychiatry for anxiety have strong clinical evidence behind them and produce outcomes comparable to in-person care for most people. Telehealth removes barriers; commute, scheduling, stigma, that often delay people from getting help. At Defina, we offer telehealth across California, so you can access care from wherever you are.
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Very commonly. Anxiety and depression co-occur in roughly half of all cases, and treating one without addressing the other frequently leads to incomplete improvement. Anxiety also commonly co-occurs with OCD, PTSD, ADHD, and chronic pain conditions. This is one reason a comprehensive evaluation matters. At Defina Health, your provider screens for related conditions during the initial assessment so that your treatment plan addresses the full picture.
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Recovery timelines vary depending on the type of anxiety disorder, symptom severity, and how long anxiety has been present. Many people notice meaningful improvement within the first 4 to 8 weeks of treatment. Fuller improvement — where anxiety no longer significantly interferes with daily life — often takes 3 to 6 months. Some people continue with periodic check-ins or maintenance therapy to prevent recurrence. Research consistently shows that people who engage in treatment recover faster and are less likely to relapse than those who do not.
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Defina Health offers anxiety treatment in San Francisco at 999 Sutter Street, near Union Square and Lower Nob Hill. We also offer HIPAA-compliant telehealth throughout California. We are in-network with Aetna, Cigna, United Healthcare, Magellan, Anthem (Carelon Network Partner), and Medicare. Most patients are seen within 3 to 5 business days of submitting their intake form.
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For mild to moderate anxiety, therapy alone — particularly CBT — is often sufficient and is the recommended starting point in most clinical guidelines. For moderate to severe anxiety, or anxiety that has been present for a long time without meaningful improvement, adding medication management significantly increases the likelihood of recovery. Anxiety and depression frequently co-occur, and when they do, treating both through a coordinated plan tends to produce better outcomes than addressing them separately or sequentially. At Defina Health, if you are working with both a therapist and a psychiatric provider, they share clinical notes and coordinate your care directly — so your treatment plan reflects the full picture rather than two disconnected services running in parallel.
FAQs about anxiety
Medical disclaimer
This page is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. If you have concerns about your mood or mental health, we encourage you to schedule an appointment with a licensed clinician — at Defina or elsewhere.
References and resources
National Institute of Mental Health (NIMH). Anxiety overview, symptoms, and treatments
Spitzer RL, et al. A brief measure for assessing generalized anxiety disorder. Archives of Internal Medicine, 2006. (GAD-7 source)
988 Suicide & Crisis Lifeline. Free, confidential crisis support 24/7