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At The Center for Stress and Anxiety Management, our psychologists have years of experience. Unlike many other providers, our clinicians truly specialize in the diagnosis and treatment of anxiety and related problems. Our mission is to apply only the most effective short-term psychological treatments supported by extensive scientific research. We are located in Rancho Bernardo, Carlsbad, and Mission Valley.

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Read our award-winning blogs for useful information and tips about anxiety, stress, and related disorders.


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Depression: The Autoimmune Disease Of the Mind

Jill Stoddard

Written by Marnie at

Depression: The Autoimmune Disease Of the Mind

I’ve seen so many great tributes to Robin Williams in the past 24 hours. I hope he knows how much he affected others in a positive way. That, despite his inner torment, the fact that he made people laugh was able to penetrate the immense sadness he must have felt and give him some sort of peace … even if only for a little while. In fact, peace is something those of us with depression rarely feel.

I hate the word “depression”.  Frankly, it’s depressing. And I hate the commercials about it. You know those Cymbalta commercials? Depression hurts; Cymbalta can help. They show these scenarios of people having trouble getting out of bed, or not even wanting to play ball with their dogs. The truth is, sometimes depression probably does look a lot like that. But sometimes it looks like Robin Williams. Sometimes it looks like comedy, as that is one of the many coping mechanisms people with depression use. Sadly, with people like Robin, it masks something much deeper and darker. Sometimes it looks like a busy schedule. Sometimes it looks like forgetfulness. Sometimes it looks like the person standing up on the podium, accepting an award. As Glennon Melton from Momastery said in a recent post, “People who need help sometimes look a lot like people who don’t need help.”

A friend of mine recently broke my heart with a Facebook status update that said something about how she has an autoimmune disease and that, while she might look happy and healthy on the outside, the pain can be unbearable. It was such a simple statement and yet really had an impact on me, as my mother has had chronic pain her whole life but, to the outside world, she looks fine. In fact, she’s gotten dirty looks and even comments from people for using her Handicapped placard.

Depression is the same way. It’s an autoimmune disease of the mind. For all intents and purposes, many of us who have it look fine on the outside. We might even be somewhat, if not very, blessed by our life circumstances. Abby Heugel put it perfectly on her recent Scary Mommy post, saying, “These are the times that I should reach out, but the thing about depression is that it comes with the sense that you shouldn’t have it to begin with, that it’s a bunch of self-indulgent navel gazing and not an actual illness like those that everyone can see looking in.”

Despite everything good in our lives, the negative thoughts persist in our minds and hearts. Its attack on ourselves feels silly, embarrassing, ridiculous, hateful, awful, confusing, shameful, and a whole bunch of other emotions. When I’m tired, it attacks the most, sensing the weakness within.

Physically, I’d consider myself one tough mother f*cker. In fact, when I was little, I had an unusually high pain tolerance. I went to bed once on a broken wrist that my parents didn’t even know about until they saw me the next morning with an arm that had swollen to twice its size. I once let a man stand on my fingers at a baseball game until they were completely flattened because I didn’t want to say anything. I sprained my ankle a week before my first marathon but ran it anyway, having to stop and get it taped about three times. And yet the feelings of melancholy can crush me like I’m a cancer-ridden 100-year-old.

I hate saying but the truth is I suffer from depression. Some days are great and others are horrible but, you know what, that’s life. I have to learn to accept myself the way I am and not be afraid to talk to others about it. And if you need someone to listen, I’m your gal. In the meantime, when you’re out and about doing your daily deeds, remember that things are not always as they seem. Be kind. Be gentle. Be aware that others might be suffering beyond belief despite that fancy, new car, perfect hair, or insanely clean house. Give meaningful hugs and warm smiles. You never know what those could do for someone who is feeling at the end of his rope.

RIP, Robin Williams. You were loved.


An Interview with Dr. Scarlet of CSAM: Superhero Therapy

Jill Stoddard

By Lauren Helm, M.A.



In our blog “Modern Metaphor: Tapping into the Power of the Superhero to Turn Struggle into Triumph,” Dr. Janina Scarlet discussed how she uses superheroes and fictional characters in therapy as a way of connecting with values and inspiring healthy psychological change. Read below for an interview with Dr. Scarlet about how she uses modern metaphors in therapy.

CSAM: What inspired you to start incorporating fictional characters in the therapy room 

Dr. Scarlet: I wanted to incorporate fictional characters into therapy because I found that many clients found it difficult to talk about their own feelings or experiences and found it easier to identify with certain fictional characters, which made it easier for them to understand what they were going through. Too often, people who are going through depression, anxiety, trauma, or another difficult experience have no one to talk to and do not believe that anyone can understand their experience. Once they find a person or character they can relate to, they usually feel more understood, and that’s when healing can begin.

CSAM: How do you use superhero and fantasy characters in therapy? What might you do to help people access their inner superhero while working with them in therapy?

Dr. Scarlet: Usually, I ask the client to tell me if they like comic books, movies, TV shows, etc. and ask which is their favorite and why. Often there’s one or more that people can name and usually there’s a character they feel that they can relate to. We then begin by exploring what the character has gone through, what made them who they are today, and what makes this particular character special to the client. For example, if someone likes Batman, they might like that Batman is a Superhero, that he saves other people, and that he is brave and strong. This allows me to understand what kind of person the client would like to become, to get at their values. We then explore what Batman had experienced (i.e., the death of his parents, the phobia of bats, and years of isolation) and how through the terrible pain he went through he was able to become the Superhero of Gotham that he is today. We then bring it back to the client’s values and identify ways that he or she can begin to take steps to become their own kind of Superhero.

CSAM: Is there any particular issue that you’ve found superhero-therapy to be most helpful for?

Dr. Scarlet: I think that since Superheroes tap into someone’s individual value system, that they can be used for any issue someone is going through.  I believe that the biggest remedy for emotional pain is connection with one’s values and Superheroes and heroes of works of fiction, such as Harry Potter and Frodo, lend themselves very nicely to value identification.  

CSAM: You have training in mindfulness and meditation techniques, compassion and self-compassion, and biofeedback. How might you incorporate a superhero approach when using these interventions in therapy? Do they complement one another?

 Dr. Scarlet: I think that they complement each other very nicely. For most people, what they value is helping others. Unfortunately, often people don’t know how to go about that, feel too depressed to do it, or don’t believe that their efforts matter. In addition, I often find that people burn out when they don’t know how to provide compassion toward themselves. In my “Superhero training” sessions, I teach the clients about Jedi mindfulness, as well as the magic of self-compassion, and the Superhero steps behind being compassionate toward others.

CSAM: How do you think that being a therapist who uses superhero metaphors aligns with your own value-system?

 Dr. Scarlet: The person that influenced me the most was my grandfather. He spent his life helping people every way that he could. He wasn’t only a hero, he was my Superhero. He really inspired me because he showed me that it only takes one person to make a difference. I became a therapist because it was the main way I knew how to help others, and in using superhero metaphors in therapy, I find that I can make therapy more accessible to my clients. 

 CSAM: What kinds of triumphs have you seen people create in their lives when working with you?

 Dr. Scarlet: The bravest people I have ever met are my clients. They are the ones that have been most impactful to me. They face their fears every single day, and just like Batman, they do what they can to fight for what they believe in. I was working with one client with severe PTSD and agoraphobia and I will never forget the day that he was able to step out of his house with me. This person now drives and travels and in my opinion, deserves his own comic book for everything he has been able to overcome.

 CSAM: What can you tell us about the book that you are working on about using superheroes in therapy?

 Dr. Scarlet: The book will be a self-help book, on how to become the Superhero that you would like to be and will specifically focus on overcoming anxiety. It will follow the acceptance and commitment therapy format with a chapter on self-compassion, and will primarily include metaphors from comic books, fantasy novels, science fiction, and TV shows.


More about Dr. Janina Scarlet:

Dr. Scarlet earned her Ph.D. from the City University of New York. Her clinical experience includes using Cognitive-Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) to help individuals with anxiety, depression, chronic pain, sleep, and other mental health and medical conditions, as well as using Cognitive Processing Therapy for PTSD. Dr. Scarlet also has experience working with a variety of mindfulness and meditation techniques, as well as compassion and self-compassion and is certified in biofeedback. In addition, she is fluent in Russian and can conduct therapy with Russian-speaking clients. Finally, Dr. Scarlet is a proud geek and is able to incorporate clients' interests into therapy, including but not limited to Batman, Iron Man, Green Arrow, Harry Potter, Lord of the Rings, Doctor Who, Sherlock Holmes, and many others. She was recently interviewed by an award winning podcast, Geek Therapy, about her use of fantasy and geek culture in therapy. Above all, Dr. Scarlet believes in establishing an active collaboration with a client and working as a team in targeting the presenting problems.

If you'd like to speak with Dr. Scarlet or another professional at the Center for Stress and Anxiety Management, please click here.

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Hypochondriasis is like OCD: Cognitive Behavioral Therapy Can Help

Jill Stoddard

by Lucas Myers


You are patiently explaining to the third doctor that the bruising on your arm is a sure sign of leukemia. Once again, she tells you that the tests all came back negative. You’ve heard it all before. She explains that much like the parasites causing intense stomach pain were just some gas, and the terrible headache in June was not a brain tumor but most likely a sign of dehydration, this is just a normal bruise and should clear up in a few days. You attempt to cap your seething frustration as you push your doctor to try another test. As soon as you get home you make an appointment with another doctor - perhaps this one will help. Welcome to the challenging world of someone coping with Hypochondriasis, sometimes referred to as Health Anxiety or Illness Anxiety. 

Hypochondriasis, estimated to be affecting 1-7% of the population, causes a person to dread that she has, or is going to have, a terrible disease or physical ailment. This person may constantly monitor her vital signs, and see minor changes in her body as “symptoms” of something far more ominous. She may “hop” from doctor to doctor, reading obsessively online about disease and seeking validation and treatment by demanding unneeded tests. Negative tests may bring some temporary reassurance, but this typically wears off quickly, only to be replaced by more illness fears. 

Those suffering from Hypochondriasis may believe that their excessive worrying is protecting them. They may believe that any discomfort or imperfection of body functioning is a sign of serious illness. Perhaps they sense that any doubt or uncertainty demands thorough investigation. Often they may scour the Internet until they find “proof” that the symptom they are concerned about is associated with a debilitating or deadly disease, such as cancer.

While hypochondriasis might seem funny or eccentric at first, those who have had or known someone with hypochondriasis tell a different story. The obsessive check-ups, monitoring, research, and fear can demand an enormous time investment and stress academic, professional and social relationships to the breaking point. Hypochondriasis can cause a person to become so obsessive that it appears to share similarities with Obsessive Compulsive Disorder (OCD). In particular both diseases share the feature that the more an individual attempts to address their fears (by checking, washing, doctor hopping, etc.), the more intense those fears tend to become. An important difference that distinguishes the two is that while someone with OCD may live in terror of getting a disease, someone with Hypochondriasis lives with the fear that they already have it.

Recommendations to those with Hypochondriasis include sticking to one doctor, avoiding Internet searches about illnesses, keeping active, and stopping self-checks. Of course making these changes is often very difficult to do without help, especially because the very nature of Hypochondriasis is the lurking sense that diagnosis of disease is just one doctor away. The nightly news often offers headlines that read as confirmation of a new health threat and a bombardment of well-meaning public health messages could leave anyone on high alert. However, WebMD is not the answer so where else can someone turn who is struggling with hypochondriasis?

The first step is education about the condition. Understanding hypochondriasis is crucial to gaining the power to change and sticking with a treatment plan. Make sure that a licensed or supervised psychologist is part of the healthcare team. Not only do they have the expertise to diagnose Hypochondriasis, but research has equipped them to to treat it. Due to the many similarities between OCD and Hypochondriasis, strategies developed to treat OCD have been found to be highly effective when adapted to the treatment of Hypochondriasis. According to recent studies by Harvard University and the Mayo Clinic, the most effective treatment is Cognitive Behavioral Therapy (CBT). 

CBT is designed to help identify and change the behaviors that maintain and worsen anxiety and other symptoms of hypochondriasis. Sometimes it may include exposure therapy-- confronting fears little by little until they lose their power. For example, if someone is terrified that they have cancer, they may visit a cancer hospital. Another technique, cognitive restructuring, teaches clients to challenge the validity of their health related fears. An approach that borrows from Mindfulness-Based CBT, is to learn non-judgmental acceptance of unpleasant thoughts. From a mindfulness perspective this discomfort is normal, and distress arises from the persistent attempts to control or escape discomfort.

Over the course of therapy, which is often as short as 16-20 sessions, clients learn to use these tools to challenge their health related anxiety as well as the behaviors that they have been using to cope with those fears. If you would like more information on Hypochondriasis or Cognitive Behavioral Therapy, click here to contact us.


Leahy, Robert L. “Are You a Hypochondriac?” Retrieved October 9th 2013 from:

Haupt, Andrea. “How to Cope with Hypochondria” Retrieved October 9th 2013 from:

Hypochondria / Health Anxiety |Symptoms and Treatment. Retrieved October 9th 2013 from:

What is Acceptance and Commitment Therapy?

Jill Stoddard

By Lucas Myers and Jill Stoddard, Ph.D.


Perhaps you've come across Acceptance and Commitment Therapy (ACT) online or even on our website. Maybe you have encountered it through the popularity of Mindfulness, a “hot topic” in psychology and self-help with strong ties to Buddhist traditions. You may have read, or heard an anecdote about how ACT is helping normal people everywhere to cope with anxiety, depression, and stress. So what is ACT?

ACT is a type of psychotherapy that helps people to accept difficult inner experiences, like negative thoughts and uncomfortable feelings, instead of trying to suppress or avoid them. Why, you might ask, would I want to accept feeling badly? Because pain is universal. There is not a human on the planet that has not or does not experience difficult thoughts and feelings. ACT (informed by Buddhism and other traditions) suggests that pain is not the problem. Rather, it is our attempts to avoid or eliminate pain that cause true suffering. We call this pursuit of pain relief “experiential avoidance.” Take the person who uses alcohol or drugs to cope with upsetting experiences by numbing himself to avoid the unpleasant feelings that follow. While this might work in the short term, the substances ultimately don’t “fix” the pain and, in fact, lead to more suffering when relationships, work, and other areas of functioning are negatively impacted. In a less extreme example, consider a person who feels self-conscious about her appearance or intelligence and avoids dating for fear of rejection. Again, this may bring some protection from feelings of vulnerability, but it doesn’t solve the self-consciousness. Worse, it prevents the possibility of having a loving relationship even if this is something that's personally important.

So why would you want to accept difficult feelings? Because experiential avoidance often doesn’t work, frequently makes things worse, and typically comes at the cost of pulling you away from the things that matter most. , The alternativeis acceptance. ACT focuses on teaching acceptance of internal experiences in the service of moving toward a life that is guided by values—a life that is characterized by meaning, fulfillment, and vitality.

While there are many different strategies employed to create meaningful change, ACT focuses on building three main skills:

  1. Defusion - distancing and letting go of unhelpful beliefs, thoughts and memories

  2. Acceptance - acknowledging painful feelings, sensations, and urges and allowing them to pass without struggling to avoid or eliminate them

  3. Contact with the present moment - being present in the here-and-now and engaging each moment with openness and curiosity

These skills enable a person to fundamentally change his or her relationship with painful thoughts and feelings, freeing him up to make valued choices. Examples might include spending time with friends and family, pursuing a hobby or career, expanding one's skills, or contributing to one's community, just to name a few.

Defusion involves recognition that thoughts and feelings that are sometimes overwhelming are often passing images or irrational statements we tell ourselves. Learning to step back and observe thoughts as entities separate from ourselves reduces the degree to which we allow ourselves to get “hooked” by their content, or mistake thoughts as facts. Defusion allows us experience thoughts as just words, and words as sounds and syllables instead of meaningful truths we must pay attention and react to. Defusion practices allow thoughts to come and go, passing like leaves floating down a stream. The leaves have no power over the stream.

Acceptance, also called Willingness, begins with recognition that our reactions to distressing thoughts and feelings can be changed. Five strategies for acceptance include:

  1. Giving oneself permission not to be perfect

  2. Acknowledging weaknesses 

  3. Acknowledging an unpleasant thought or feeling instead of running from it 

  4. Letting feelings and thoughts pass without giving in to the compulsion to act on them

  5. Letting go

Contact with the present moment, sometimes referred to as “mindfulness” involves non-judgmental, present focused awareness of both internal and external events. ACT encourages people to check in with themselves and question their responses to life's challenges in each moment. Mindful attention is given to awareness of thoughts, emotions, and physical sensations. Increasing awareness of experience can lead to better mastery of one's reactions to the problems and difficulties that life brings. Energy that would otherwise be invested in avoiding unpleasantness can then be invested in actions that change life for the better. An individual can learn to get in touch with his deepest values and allow this knowledge to act as a guide to a rich and meaningful life.

A unique and even fun aspect of ACT is its reliance on the use of therapeutic exercises and metaphors to help clients experientially derive meaning from the treatment concepts that are presented. . For example: your therapist might play a little game of “Simon Says” with you. But in this version of the game, Simon represents your mind commanding you to act in a certain way. You hear those commands but then DO whatever you want! If Simon says, “raise your hand,” you can hop on one foot instead. The idea is to experientially “get” that you don’t have to obey Simon any more than you have to listen to what your mind is telling you. You might also hear an ACT therapist say, “don’t believe this is true because I’m saying it is so; what does your experience tell you?” Your ACT therapist wants you to learn by experience.

ACT is often summarized using two simple acronyms. The core causes of many problems are represented by FEAR:

Fusion with your thoughts

Evaluation of experience

Avoidance of your experience

Reason-giving for your behavior

As an alternative to these behaviors, ACT!

Accept your reactions and be present

Choose a valued direction

Take action

Acceptance and Commitment Therapy is generally a short-term treatment. With the help of a good therapist, anyone can learn to accept the pain and stress of life, as it comes and goes, to make room for a new commitment to values and living a life with purpose and meaning.

In addition to its widespread use for anxiety and depression, ACT has been adapted to effectively treat substance abuse, body image issues, PTSD, chronic pain, tinnitus, smoking, borderline personality disorder, and others.

If you would like to learn more about ACT contact us.


Acceptance and Commitment Therapy. Retrieved from:

Hayes, Steven. ACT. Rectribed Sept 23from:

Serani, Deborah. Two Takes on Depression: Acceptance and Commitment Therapy. Retrieved  from: and-commitment-therapy

Stoddard, Jill. Introduction to Acceptance and Commitment Therapy [Powerpoint Slides]. Retrieved from personal correspondance September 28, 2013.