Anxiety and Counseling


Carlos Durana Ph.D., M.Ac. offers counseling and therapy in Reston, Virginia, Washington, DC, and Bethesda, Maryland.

Body & Mind – Anxiety

Welcome!  I’m Beverly Jones, your host, and I’m speaking today with Dr. Carlos Durana.

Dr. Durana is the founder of A Caring Approach, a psychotherapy, counseling, and complementary medicine practice in Reston. He’s a clinical psychologist and counselor with over 30 years of experience, and also has a background in complementary medicine. Dr. Durana also has counseling practices in Bethesda and Washington, DC.

Dr. Durana: Thank you for being here. It’s always wonderful to be with you. Bev: Today we’ll be talking about anxiety, which is another huge topic. We pick some pretty meaty ones, I think. Dr. Durana, we all deal with worry and anxiety, they’re just a part of life. Do you think some forms of anxiety actually help us get things done on a daily basis?

Dr. Durana: Yes, I think mild worry and anxiety and even fear are important in how we deal with challenging or difficult situations. Those are necessary things. They help us plan, and get ready, just in case something happens, we want to be ready. But when it becomes excessive, then it becomes problematic, and then when it’s over a period of time, excessive and long, then it becomes an issue, then it starts to affect us. It may affect our relationships, it may affect our job performance. Or our health, even.

Bev: So how do we know when it’s excessive?

Dr. Durana: Well again, if it’s something that is starting to affect us — how we deal with others, if it’s starting to affect our job, how we perform. In terms of our own personal health, if things start to worsen. Or not concentrating well. Starting to have maybe certain physical symptoms. Those are some of the ways when we then need to start paying attention, and perhaps get some counseling or therapy at that point.

Bev: I see. So are there a variety of ways in which anxiety can be manifested in our lives? How do we see it?

Dr. Durana: Yes, certainly, and I’ll be brief with this but it’s important to address some of the different types. In generalized anxiety disorder, there’s excessive attention to worrying and thoughts and feelings. We become overly concerned, overly attentive. So for example, if you have a physical symptom, all of a sudden, you start to pay a lot of attention to it, and the next thing you know you think you’re having a heart attack, for example, if your chest is tight and so on.

We have social anxiety, where then we are afraid of being judged or evaluated negatively by others. We can have phobias of different kinds, where we are afraid of different things to the point where we avoid those things, you know, getting on an airplane, for example, and so on.

We can have panic disorders, where we may have panic attacks, that can be very disabling. Obsessive-compulsive disorder, where there are uncontrolled thoughts with behaviors. We can also have anxiety that’s related to having a traumatic event in our lives. We can have anxiety that’s related to certain drugs that we might be taking, or substance abuse. We can have anxiety that might be related to certain medical disorders. Those are some of the ways that anxiety can display itself.

Bev: So if we feel that anxiety is a problem for us, what steps can we take? How can we get help for these issues?

Dr. Durana: Well, as I said, once they become more problematic, if we’ve gone to a medical doctor just to make sure that we don’t have a physical symptom that really needs to be addressed, then we may want to visit a qualified psychological professional, psychotherapist, counselor, and so on, someone that has had experience in this realm, that can help.

Bev: I know you’ve listed some examples on your website, of clients who have had issues with anxiety and you were able to help them with different tools and things like that, but I think that you may have also had an experience yourself with anxiety.

Dr. Durana: Oh, certainly, certainly, and I’ll be glad to talk about that. I’ve had numerous experiences with that… (laughs)

Bev: You mean psychotherapists have issues with anxiety too?

Dr. Durana: Oh, of course, for the most part. I think, well, everyone has had anxiety in one way or another throughout their lives. And then there are different degrees of anxiety. But let me give you an example. Because I think this example illustrates how, without seeking help, I was able to deal with this problem. And then of course I did seek counseling help with other concerns. But when I was about six or so, I lived in Havana, and I was a city boy. And we had never gone to the beach. And I remember driving with my family, going over this hill, and all of a sudden this incredible view as I’m going over the hill, and looked to the left, and saw the ocean in the middle of summer. It was incredible. The water was blue, the sky was clear, the sand was white, beautiful, beautiful. We got to the beach, got into our swim clothes, and you could smell the water, the sand, ah, amazing. And we started to walk into the water, and then all of a sudden my father picked me up and threw me into the deep water. Okay? Now, I got my head out of the water and I didn’t know what was happening, I was panicking, my mother was freaking out, and you know, in my father’s mind, this was a way of showing me how to deal with deep water, that I would sink or swim and deal with that. Now for me, it was “he’s trying to kill me.” Now I had a history with him when I was about three or four, there were several incidents where I did think he was going to kill me. So at this point, you know, I felt very overwhelmed, I felt “I can’t breathe — I’m gonna die.” But then he came and he took me out.
We didn’t go to the beach very often after that, for different reasons — we were working class and so on — but when I left the country, I was sent out to live with my sister when I was about 13 or so. And then I was living with my brother in law who was an outdoorsman, and he had a boat and we used to go fishing, and we did a lot of things in New Orleans, down in the bayous in the
gulf. And I realized that I needed to learn to swim. I didn’t know how to swim. And I still had that fear about it. And so, I ended up, I remember, going to a YMCA and taking a class. And this is the thing with any fear, any anxiety, sooner or later, it’s best if you gradually expose… we have this term, “exposure therapy” in psychotherapy, you expose yourself to the situation in one way or another. But generally we do that and we prepare. Counselors and psychotherapists prepare the client with certain techniques, and I’ll talk a little further later about the techniques — I use breathing techniques, and how do we talk to ourselves, for example. Because if I’m telling myself “I can’t cope with this — I’m not going to be able to do it, I’m going to fail” and so on, then I’m not going to learn. There are certain ways of thinking that are going to disable me from coping and dealing with this problem. So what I was doing was a kind of exposure. I’m taking a class, I’m taking a class in the swimming pool at the YMCA, and gradually I learn to swim, and I realize that I can float! Amazing! (laughs) And then gradually you go into the deeper part of the water and the teacher is showing you how to do that and so on, and then you’re in the deep water and you’re swimming, and then you dive into the water, so you’re gradually exposing yourself into the thing that you’re avoiding.

And there’s also a certain kind of social support which is nice. The teacher is there, there are other people learning this, there are people who are older, and they have this issue, they’re afraid of the water. They don’t know how to swim. And so, instead of feeling like a failure, I’m feeling a little more competent, and I gradually become even more competent in this. And I’m feeling better about myself, that I can actually do this. I don’t become graceful, but at least I can swim, I can float, I can…

Bev: You won’t drown.

Dr. Durana: I’m not going to drown, and so on, you see? So those are, in essence, some of the therapy methods in dealing with anxiety or phobias and so on, that we have to work with. We have to work with our thinking. The beliefs that we have. The attitudes that we have that may be disabling us, that may be counterproductive. If I’m thinking that I’m not capable, that it’s always going to get worse, which is very common with anxiety, you may start to feel maybe something physical, “Oh my God, it’s going to be a heart attack,” so we catastrophize, for example. Or it’s going to get worse — we’re fortune telling into the future. Or we minimize ourselves — “I’m not capable of this” — doing something well — to take care of myself. Those are negative thoughts and attitudes that we need to work on in therapy to transform, because they will impair us in dealing and exposing ourselves to what we need to do to overcome this problem.
So what other techniques do we use? Like I said, the exposure, we call this in the cognitive behavioral therapy world, working with the negative thoughts and the beliefs and all that, and we develop better ways of coping in terms of our thinking and behaving and so on. Then there are mindfulness techniques that are very important. I think of the idea of mindfulness that is becoming more prevalent now in our culture, meditation, it’s this ability to tap into an aspect of our being that, it’s kind of like the center of a hurricane or cyclone or a storm, it’s just a calm place inside from which we can stand back and get a better perspective. And really look at ourselves and actually realize that we are not all of those thoughts that we identify with. Or those sensations, or those feelings that are there that if I’m feeling anxiety or some sort of panic, then I’m incapable or then it’s going to get worse or then I’m not going to be able to cope with it, and so on and so on, see? So it teaches you to stand back from that, and to see that that is not, like that example I was giving with myself, “wait a minute, I can gradually develop some skills here so that I can cope with this.” So that whole idea of mindfulness in counseling is very important.
I also find that, what I do is I call this therapy more grounded mindfulness because I work with that sense of your feet on the ground. And with many forms of anxiety, it’s very important to bring the body into it. Bring physical disciplines that are not just physical but you’re entering it through the body, whether it be yoga or tai chi or qi gong or some other form of physical exercise for strengthening, or martial arts or different kinds of things that give us resources, you see. Because what we’re talking about is developing resources within. We also have outer resources where we get support from others and all that, that’s very important. But this idea of developing these resources internally that we don’t even realize that we have them. And the body and the energetics of our bodies are extremely important, and then how we cope with what we’re having to deal with. And it’s very important with anxiety problems and traumas and so on, to tap into that kind of resource.

Bev: Could it even be as simple as developing a daily walking practice? I know I go for a morning walk…

Dr. Durana: A sense of conscious walking, you’re sensing your feet as you’re walking, and you’re working with your breathing, you know? And if your mind starts to get overly active, to learn to witness it and not get overly involved with it, step back from it. Sometimes it’s helpful to use what is called a repetition or sometimes it’s called a mantra, a word or two that you can use as you’re walking, so that then that allows you to disengage from the thoughts. It helps you get to that place of, that quieter place inside. So that conscious walking becomes then even more holistic or more comprehensive or more…

Bev: Even more healing.

Dr. Durana: Yes, more healing. And then you start to notice more, as you’re doing that. You quiet down, and then you enjoy the walk more, the endorphins kick in, and you start to feel better, you start to listen to things more clearly, the smells, maybe the visuals, the birds, the green, the trees, or if you’re in the city you feel like you’re more in that center of the storm a bit more rather than being taken over by the noise and all of that. So those are all very important practices.
We even want to pay attention to our nutrition, because when we’re dealing with anxiety, in general, we have to pay attention to our blood sugar. We can get anxious if our blood sugar’s not right, for example. It drops too much, and so on. And that can create physical symptoms that mimic anxiety and that can turn into anxiety. And so we want to pay attention to good nutrition to support ourselves, again, on that physical or energetic level.
Another thing that is important is how do we deal with that critical part of ourselves? That can be very problematic. Like self-judgments. Also dealing with how we are affected by people’s perceptions. For many people with anxiety, they don’t like to upset other people. They have a great deal of concern about what other people think of them, to “be nice” and so on. And that is a dimension that needs to be addressed very often as well.
Another thing that is very important is if we’re having a physical symptom or a physical illness, what is the relationship? In another podcast that we did on the mind-body connection, and maybe an example would illustrate this, someone that I dealt with who had Meniere’s Disease — that involves dizziness and ringing in the ears, and other kinds of symptoms. And particularly the ringing was very problematic for this person because there was this fear that “it’s going to overwhelm me, it just might drive me crazy, I might even commit suicide because I just can’t
stand it, I just won’t be able to cope with it if it gets worse” and so on. And “this illness is gonna progress, and I’m gonna get worse and I don’t know if I can deal with this and take this.” And so, that was part of the anxiety there, with that physical problem or illness. And one of the things that I worked with was with the breathing, the grounding, that ability to go into that calm inner space, and then to expose him to, gradually, in small amounts, to the ringing itself. Because there’s a tendency, you see, the relationship to the ringing is “oh it’s awful, it’s horrendous, it’s like an enemy, it’s like something that’s overpowering me” and so I have to just not even approach it, get away from it. The problem is the more I get away from it, it’s there, it’s going to be there, and sometimes then it can get stronger if I’m more tense. And so, in therapy, by introducing this person to that grounded and calm, mindful space, to small amounts of listening to the ear ringing — and the idea that I suggested to him, “what is it like when you’re hearing cars outside, and there’s noise?” We could hear that from our room where we were working, and sometimes I had him pay attention to that. And sometimes I would have him pay attention to the ringing itself in small amounts, and starting to see that that ear ringing was just like another kind of sound, like cars or something like that. Rather than something that is going to be so threatening and horrendous that “I can’t cope with it,” but gradually easing into that, and accepting that it was there. And as he was able to do that more and more, realizing that “this is not going to kill me,” that he could cope with this and gradually learn to feel better rather than just feeling horrible.

Bev: I have something that’s probably trivial. But I am deathly afraid of spiders, and they cause me great anxiety. We have a house, a cabin in the mountains, and whenever we go, the first thing I’m thinking when I open the front door is that all these spiders are going to come jumping out at me. Which of course they don’t! But I feel that anxiety, and the thought of exposure therapy — that makes me even more anxious (both laugh). So that’s very trivial in comparison to what some of your other clients face, but I bet a lot of people are afraid of things…

Dr. Durana: Oh yes! Snakes, spiders, closed rooms, airplanes, many many phobias that people have, yes. And one of the ways that may be helpful initially is to take time to learn about spiders. Take time to maybe watch some documentaries that really highlight the beauty and the amazing nature of spiders and what they do, their function, and so on. That would be a gradual way of exposing yourself and appreciating what a spider is.

Bev: Perhaps I’m doing a little bit of that because they create these amazing webs outside of our house, and I know they’re eating all of the harmful bugs around our house. That’s as far as I’ve gotten. (laughs)

Dr. Durana: And you might read Charlotte’s Web (laughs).
Bev: Okay, there you go (laughs), I can do that!

Dr. Durana: So that’s a starting point. Then there are other things that you can do further on, but I would say start with that.

Bev: Okay, okay.
I know that this is a, this actually is a big issue for so many of us. And I know that people might want to talk to you and get in touch with you to talk more about anxiety or about other issues in their lives in your counseling practice in Reston, Bethesda, and Washington, DC. And they can reach you on your website at
Thank you for sitting with me and talking with me today about anxiety, Dr. Durana.

Dr. Durana: Well thank you, it’s been a pleasure.