Contact Us



You may also contact us via phone or email:

Phone: 858-354-4077


Name *
Phone *
OK to leave a detailed message on this phone? *
How did you find CSAM? *

7860 Mission Center Ct, Suite 209
San Diego, CA, 92108


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.

Blog Awards 1:18.jpg


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


Filtering by Tag: stress and anxiety in san diego

Five Ways Parents Can Help Children with Political Anxiety

Jill Stoddard

Guest Post by Tracy Dunne-Derrell, writer at

One hundred years from now, America in 2017 will exist only in history books. Those future writers will have plenty of material to work with: mass shootings, terrorism fears, international turmoil, and “fake news.” But those facts probably won’t capture the anxiety that’s been generated by these events. A poll conducted earlier this year by the American Psychological Association found more than half of American adults cited the current political climate as a source of stress.  

Children are feeling anxious too. A recent UCLA survey found that 51% of teachers reported more anxiety among their students. As a parent, the past year may have presented you with unique challenges as your children grappled with a range of emotions- from general anxiety to personal stress over the impact potential policies could have on them and their friends. You may have a child who’s finding that current events are causing anxiety, and are struggling to figure out how to best provide support.


As an adult, you might be experiencing negative feelings too, but you have the advantage of being able to channel them productively by contacting elected officials and engaging in activism and service. And you’re more likely to have developed meaningful ways to help yourself get through uncertain, difficult times. But your children might not be able to grasp the concepts that are troubling and confusing to them, and they may lack the skills they need to identify and cope with their feelings. Here are some ways to help them.

1. Listen, but accept that you might not always have good answers. 


As a parent, you may be tempted to help by dismissing and downplaying the concerns and worries of your anxious child. But this approach, while well-intentioned, isn’t helpful. Validating kids’ concerns and making sure they understand that it’s ok to feel what they’re feeling is important.  And unfortunately, you can’t magically erase the sources of stress for them. But you can be a sympathetic ear, and make a point to spend a little time each day talking to them about their concerns. Help them develop coping skills, which won’t eliminate the sources of negative feelings, but will help them learn to work through them. The ability to cope with challenging times is a necessary life skill.

2. Help them take action.

With so much beyond their control, your kids may find themselves feeling powerless. They might want to do something to distract them from their fears and help them feel like they’re contributing to the world in a positive way. Some adults are channeling their concerns into helping others, and there are ways children can do the same. Talk with them about some of the needs they observe in your community, and help them think of ways to address them. Young children can choose items from the grocery store to donate to a local food pantry, while older ones can join service-oriented local organizations, or look for a project to support, like a winter coat drive. Even small actions help students feel like they matter, and lead to a life-long involvement with community service.


3. Connect with the school counselor.

Kids spend a substantial amount of time in school, and their counselors are a valuable resource. School counselors are already trained to help students learn to manage a wide range of situations and challenges. And they’ve got ample materials to help them work with students who are living with political anxiety. Last year the American School Counselor Association published a guide for counselors, with suggestions for supporting children experiencing post-election stress. Sitting down with a school counselor could be a great opportunity for your child to share his or her fears with a trained professional. Ask for ideas and strategies to use at home to talk about current events, and the feelings these events generate.

4. Examine the impact of technology.

News and social media might play a role in fostering negative feelings. Escaping bad news used to be as easy as turning off the television and radio. Now, with 24-hour cable channels, mobile apps, and social media, it’s almost impossible to get a break from current events. Consider the role screen time with televisions and gadgets may be playing in your child’s politics-related stress. Evaluate the amount of time your child spends watching and reading news, and discuss alternative activities which may help them manage their stress.

5. Talk about previous times our country experienced turmoil and got through it.

It feels like we’re going through unprecedented uncertainty, but America has faced crisis before, more than once. Our country has survived wars, recessions, and natural disasters. Your children likely have some awareness of challenging times in our history, but events of long ago probably feel abstract to them; they may not be able to connect past and present. Depending on your age, you may have your own personal stories to share which might resonate with your anxious children and help them feel more optimistic. For example, during the 1970s, Watergate dominated the news, and led to concerns about government. In the 1980s, the Cold War between the United States and the former Soviet Union generated fears as both countries and their allies engaged in an arms race, generating legitimate concerns over the possibility of nuclear war. Share your stories and take this opportunity to talk with your kids about America’s resilience.

Providing support for anxious kids is challenging, but it is possible. As a parent, you know your child better than anyone, and are the best person to help them manage stress and anxiety. However, if you need some outside support to help your child, you can check your child’s school for resources, and reach out to outside resources, like local therapists, as well.


If you or someone you love might benefit from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at

Hey Siri, I’m Feeling Anxious: Apps for Anxiety

Jill Stoddard

by Annabelle Parr

There seems to be an app for everything these days. Smartphones have become like little pocket genies – your wish is its command. Whether you want a date, a ride, or help with a physical or mental health concern, your smartphone claims to have you covered. 

Recently, there has been a surge in apps claiming to help calm anxiety. Some offer mood tracking, others offer guided breathing and meditation, still others allow you to track your thoughts, claiming to utilize CBT methods to help you reframe unhelpful ideas. While technology can be a powerful tool, it’s important to think critically about how we use it and the effect it can have before we rely on it too heavily.

What does the data say about anxiety apps?

Depression and Anxiety: The official journal of the ADAA recently published a study conducted to assess commercially available anxiety apps. Researchers analyzed 52 anxiety/worry relief apps that purportedly use psychological techniques. They discovered that 67.3% of the apps were developed without any input from a healthcare professional, and only 3.8% of them had been rigorously tested.

So the people developing anxiety apps may not actually know much about anxiety, and they almost certainly don’t know if their app will really help you.

Authors of the study concluded that while apps have the potential to broaden access to mental health resources, there is currently a major lack of data regarding the efficacy and effectiveness of the available options. As such, the application space has yet to reach its full potential in helping people with anxiety.

What if an anxiety app is helping me?

Of course, the issue here is a lack of data. You may have found an anxiety app that does help you to manage your worry throughout the day. Guided meditations, breathing exercises, and journaling our thoughts and feelings can certainly be useful.

Should I ask Siri or a professional?

However, an app does not replace professional treatment. If you are dealing with anxiety that is impairing your ability to function in your day to day life, it’s important to seek professional guidance.

Human connection is important for our mental health.

Furthermore, while apps may one day prove to be a useful anxiety management tool, they will never replace the human connection that takes place in the context of therapy. In fact, it is actually the therapeutic relationship itself that is the most important aspect of therapy – it accounts for around 30% of the variance in treatment outcome, which is significantly more than any other factor, including the specific techniques used by the therapist (like CBT or mindfulness). This means that who your therapist is, how you relate to them, and the relationship you share is the most helpful part of therapy. An app will never be able to offer this relationship.

Technology may help us manage anxiety, but it may also be a source of anxiety.

Finally, when considering anxiety apps, it is important to note that according to the APA, smartphone use has been linked to higher stress levels, particularly in those who check their phones constantly.

Given the rapid development of technology and its ever broadening influence in our lives, it is important that we stay curious and aware of the potential it has to both help and hinder us, particularly when it comes to something as important as our mental health.


If you or someone you love might benefit from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at


American Psychological Association (2017). Stress in America: Coping with Change. Stress in America™ Survey.

Sucala, M., Cuijpers, P., Muench, F., Cardos, R., Soflau, R., Dobrean, A., Achimas-Cadariu, P., & David, D. (2017). Anxiety: There is an app for that. A systematic review of anxiety apps. Depression and Anxiety: The official journal of ADAA, 34(6). 518-525. 


Older Adults Afflicted with Depression, Stress and Anxiety

Jill Stoddard

Image source:

Image source:

As the baby boomer generation ages, many more begin to experience the physical and mental challenges that inevitably accompany the aging process. The prevalence of mental illness has been found to increase with age. Research indicates that 20 percent of the American population over 55-years-old is afflicted by at least one mental disorder (APA, 2012). Furthermore, nearly 70 percent of those in long-term care facilities display psychological and behavioral challenges (APA, 2012). However, less than three percent of individuals in late adulthood have reported that they seek psychological treatment. Thus, there are likely many individuals within this population who have never sought treatment who could truly benefit from it.

A high co-occurrence rate has been identified between physical health problems and mental health problems. Unfortunately, many physicians fail to notice their patients’ anxiety and depression (Alexopoulos, 2005). As a result, an appropriate diagnosis may be overlooked and associated symptoms may be left untreated.

 Suicide Risk

 Older adults have the highest risk of suicide when compared to all other age groups (Connell, Chin, Cunningham, & Lawlor, 2004). In fact, they are two times more likely to commit suicide in comparison to the general population. Both social factors, such as isolation, and the prevalence of psychological disorders, highly impact the rate of suicide within this population (Alexopoulos, 2005). Thus, if the symptoms of mental disorders are unnoticed and left untreated, they may lead to fatal consequences. Research has shown that approximately 75 percent of older adults who have committed suicide have met with their doctor within the last month (APA, 2012). Thus, it is necessary for everyone, including physicians, to be aware of this high risk age group, so that proper precautions can be taken to prevent suicide and improve overall mental health care.

Potential Signs of Depression in Older Adults

 Here is a list of possible signs of depression in older adults according to the National Alliance on Mental Illness (NAMI, 2013, para. 3): 

  • Memory problems
  • Confusion
  • Social withdrawal
  • Loss of appetite
  • Weight loss
  • Vague complaints of pain
  • Inability to sleep
  • Irritability
  • Delusions (fixed false beliefs)
  • Hallucinations
  • Persistent and vague complaints
  • Help-seeking
  • Moving in a more slow manner
  • Demanding behavior


 While the prevalence of mental health problems is higher in older adults, the good news is that there are evidence-based treatments that can help. Cognitive behavioral therapy (CBT) has been demonstrated to be effective in relieving the symptoms associated with stress, anxiety, and depressive symptoms. In fact, structured therapies, such as CBT, have been found to be as “effective as antidepressants for moderate depression and may be more effective in reducing recurrence” (Ell, 2006, para. 12).

 If you know anyone who suffers from symptoms of depression, anxiety, or stress, please encourage them to seek professional support. If you are in the San Diego area and would like to speak to a professional at CSAM who specializes in CBT for older adult stress, mood, and anxiety problems, please contact us.



 Alexopoulos, G. S. (2005, June). Depression in the elderly. Lancet, 365(9475), 1961-1970. Retrieved from

 American Psychological Association. (2012). Growing mental and behavioral health concerns facing older Americans. Retrieved from

 Connell, H. O., Chin, A. V., Cunningham, C., & Lawlor, B. A. (2004, October 16). Recent developments: Suicide in older people. BMJ, 329(7471), 895-899. Retrieved from

 Ell, K. (2006, July). Depression care for the elderly: Reducing barriers to evidence based practice. Home Health Care Serve Q, 25(1-2), 115-148.

 NAMI. (2013). National Alliance on Mental Illness. Retrieved from




Part 2: Thriving through the Embrace of Life: Learning to Open through the Pain

Jill Stoddard

Part 2

Thriving through the Embrace of Life:

Learning to Open through the Pain

By Lauren Helm, M.A.

In the first segment of our blog on learning how to thrive, we explored the role that suffering may have in preventing or blocking our ability to live a valued, full life. Part two continues our discussion of thriving versus suffering, and introduces an alternative approach to responding to emotional or physical pain or discomfort.



“Human beings, we have dark sides; we have dark issues in our lives. To progress anywhere in life, you have to face your demons.” – John Noble 

It can be said, in a sense, that in running away from our pain, we are metaphorically running away from our demons. These demons appear large, menacing, and powerful. They wave their limbs in frightening gestures, and offer deafening roars or shrieks when we move close to them. Our instinct is to flee – to run and escape these frightening beings – for fear that irreparable harm will come our way.  However, our constant attempts to hide away from painful events leads to the cycle of suffering that prevents a thriving, full life. Thriving is not happiness without pain. To thrive is to experience the full range of what it means to be human, and to consciously move forward on a path that is in alignment with who you want to be, and with what is important to you. Life is made up of the “good” and the “bad,” or the “pleasurable” and the “painful,” but focusing on removing the bad or the painful is likely to also prevent you from experiencing the beautiful , the awe-inspiring, and the heart-warming types of life experiences.


Sometimes it just takes a little willingness to open up to all that life has to offer, even when there is pain involved. This may take a certain degree of faith or bravery, because actively taking steps forward into valued territories often entails some degree of risk. There is risk in opening up to vulnerable but deep love, there is risk in pursuing an education or career path that inspires you but has no guarantees, and there is risk in boldly moving forward when there will likely be a certain level of pain (and growth) in doing so. Openness to the fullness of life on some level requires an acceptance of all that comes with it – the ups and the downs. In fact, an embracing of the twists and turns of life may very well be what leads to the transformation and growth that fosters thriving and well-being. Remember, pain in and of itself is not the problem. Suffering-caused by efforts to avoid pain- leads to the seemingly inescapable vortex of pain, and is a beast that feeds itself through escalating distress and avoidance. It requires extensive time and energy to maintain, and yet convinces us of its necessity. However, paradoxically, the way out of suffering is in “embracing the demons.” The alternative to suffering is thriving, an embracing of life.


Metaphorically, this cycle is like feeding a hungry tiger. Dr. Russell Harris, an ACT practitioner, explains how this works: “You discover a baby tiger in your house, and it’s cute and cuddly, so you play with it. Then it gets hungry, and restless, and irritable, so you feed it – and it settles down. But over time, the more you feed that tiger, the bigger it grows - and the more food it needs, and the more aggressive it gets when it’s hungry. Now it’s not cute anymore; it’s scary.  And you spend more and more time feeding it, because you’re terrified that if you don’t, it’ll eat you! But the more you feed it, the bigger it gets” (Harris, 2007).

Acceptance and Commitment Therapy (ACT) is an empirically supported treatment that teaches clients to reduce suffering and truly thrive.  ACT is an experiential therapy and so relies on the use of metaphors and experiential exercises to facilitate learning in an experienced way. Metaphors can help us to really connect with concepts and ideas so that we can begin to apply these concepts; so that we can begin to more openly experience difficult life events, instead of automatically avoiding them. So that we can thrive.  Another commonly used metaphor in ACT that illustrates this point is the Chinese Finger Trap Metaphor. The more that you struggle with, and try to escape the finger trap by trying to pull your fingers out of the trap, the tighter the trap becomes. The struggle to control the situation and escape makes it worse. Instead, the way out of the trap is to yield, and bring both fingers closer together within the finger trap. And then it loosens, and you are set free.  Similarly, in the ACT Quicksand Metaphor, the cycle of suffering is represented by the experience of being in quicksand. If you struggle and try to fight your way out of quicksand, you sink more quickly. The way out of quicksand is to make as much contact with the sand as possible, lying on your back, and in doing so, you rise to the surface.

It is through the willingness to make full contact with life, the embracing of the many possible experiences that make us human, that we thrive. There is richness and fullness of life to be found when we creatively choose to embody meaningful living. We can start this process by letting go of trying to control the pain, and committing to act in ways that allow us to thrive.


Clinicians who wish to incorporate metaphors and experiential exercises into their therapy practice can check out Dr. Jill Stoddard’s The Big Book of ACT Metaphors here.



If you'd like to speak with Dr. Stoddard or another professional at the Center for Stress and Anxiety Management for help learning about how to “embrace your demons,” please click here.

Follow us! Subscribe to the CSAM RSS feed, and follow us on Facebook or Twitter (@CSAMSanDiego).




Harris, R. (2006). Embracing your demons: an overview of acceptance and commitment therapy. Psychotherapy in Australia, 12(4), 70.

Harris, R. (2007). Acceptance and Commitment Therapy (ACT) ADVANCED Workshop Handout. Retrieved from:

Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. New Harbinger Publications.



Tags: anxietyanxiety therapyacceptance and commitment therapyACTstress and anxiety in san diegoCenter for Stress and Anxiety Managementmental healthemotion regulation,anxiety disordersfulfillmentsufferingthrivingpainpersonal values

Why Adult Learning Anxiety is like Learning to Fish in Phoenix:

Jill Stoddard

5 Tips and 6 Resources for Adult Students

by Lucas Myers


In difficult economic times, many adults are returning to school in order to seek out new opportunities or transition into a second career. This can prove to be a tremendous challenge. Have you ever heard the saying “You can’t teach an old dog new tricks”? There may be a grain of truth to the saying but take it with a grain of salt. In this case you might say two grains are better than one. Knowing about the challenges facing an adult learner and having a plan to overcome them is the ticket to success.

Yes, as we age learning becomes more difficult and can become more anxiety provoking. Adults may be even more sensitive to failure in learning situations than children. Often, previous negative experiences with education may contribute to self-doubt and fear surrounding ability. Adults returning to school or any in-depth learning project are likely to feel that they are in unfamiliar territory in spite of education level or socioeconomic status. Frequent sources of adult learning anxiety may include feeling intimidated by unfamiliar new technology, out of place in online learning environments, a lack of confidence in rusty study skills, and concerns related to how school will impact already hectic schedules and limited finances. Returning to school later in life can make an adult as nervous as a fish on Friday.

However, regardless of the challenges that face adult learners, their differences create areas of opportunity in which they excel. A key to success in learning is the source of motivation. It is widely believed that motivation that is inspired by external factors, or extrinsic motivation, is much less powerful than motivation that comes from someone’s internal needs and desires. This intrinsic motivation is particularly important to create the best results with adult learners. Experts believe that adults are strongly motivated to learn in areas that are relevant to their growth in society, social roles, addressing life crises, and managing transitional periods. What I'm telling you is this: no amount of nagging and cajoling will get an adult to hit the books, but if you have an iron clad argument for how education will help him get a raise, a promotion, a new career, a tax break, or a hot dinner, you may find yourself a star pupil.

Unlike young learners who are focused on a postponed application of knowledge (e.g. “I'm going to be an ocean explorer one day”), adults’ time perspective has changed to one of immediate applications (e.g. “I want fish for dinner tonight”). This involves a shift from subject-oriented learning (i.e. marine biology) to problem-oriented learning (i.e. feeding the kids). Research supports the perspective that adults undertaking an educational project hope to solve a problem rather than learn about a subject. Because adult learners will engage better with material that they can relate to their own experiences, they will also learn faster and better. If the educator and learner are able to integrate new and difficult concepts with helping present and future personal experiences, the learner will maximize her chances for success. During transitional periods of life, adults who find themselves in need of knowledge in service of family life or new job skills are triggered to initiate learning. In other words, adults ask of their education “Hey Bub, what have you done for me lately?” Does what you're learning apply to your life now? Learning to fish doesn't help you much in downtown Phoenix, but a hungry man on a lifeboat in the middle of the Pacific is a motivated fisherman.

As a rule, adults are inclined to devote energy and engagement to the quality and quantity of learning that they see as the most immediately beneficial to their future (after all, finding an air conditioner is probably more important than fishing if you live in Phoenix). Therefore, it is vital that an adult learner feel empowered in influencing learning goals to ensure that his or her goals meet specific needs in his or her life. Because adults tend to have a broad base of experience, they are usually well equipped to identify what they need to learn. For most, there are responsibilities that will compete for time and attention. Does the average person need to know the migration patterns of salmon? No. Do they need to know how to bait a hook? Maybe. Do they need to put dinner on the table for the kids tonight? Absolutely. Part of setting goals must then be balancing the expenditure of time with the importance of completing educational objectives.

What can you take away from this for those who are seeking out a new degree, certification or career training? 

  • Caution them that they may feel more challenged by learning than they once did and it is normal to feel anxiety about returning to school. Many adult students incorrectly believe that they do not have the study skills that are necessary to be successful. The truth is that most adults in their forties and fifties possess about the same level of learning ability as they did in their twenties and thirties. In fact experts agree that if there is an age limit on learning performance it is unlikely to be seen before the age of seventy-five. “Bill, you're never too old to learn to fish”.

  • Remind adult learners often to think about their motivation for seeking education and to focus on how it will have direct and immediate impacts on helping them to achieve their goals. Reflecting on what new knowledge will bring to a student’s life, particularly the hows and whys, is a great way to inspire dedication and focus. If the rewards are seen as valuable enough then sacrifices will be borne more willingly and easily. “Bill, your kids are gonna love them fishsticks and tonight we're gonna have the best darn Cajun-style Catfish you ever tasted!”

ADDITIONAL TIP: One way to stay motivated is to seek out a mentor, someone who is a little farther along the path to her educational and career goals that can share inspiration, advice, and support.

An adult learner must actively look for ways to manage stress. Going back to school, and learning new skills, especially when added to adult responsibilities like caring for a family and paying bills, can be a major source of stress. Like all stress, it is important to be aware of how going to school is going to impact your life, and to make a plan to maintain balance. 

  • Self care such as diet, exercise, and sleep are particularly important to achieving this balance. 

  • Making time to participate in activities that one enjoys is a great way to relieve tension (like fishing!).

  • Reconnecting with friends and family ensures that the busy schedule of an adult student doesn’t lead to isolation and becoming overwhelmed. 

With the many demands facing an adult learner it can be tempting to put his personal needs on the back burner and it is particularly important to remember that self care is not just a momentary impulse now but it part of the journey to a successful education experience and therefore it is an investment in the future.

So why IS adult learning anxiety like learning to fish in Phoenix? They both give you something to do but they don't put dinner on the table.

Adult students, remember: 

  1. Relate lessons to your life to remain motivated.

  2. Remember motivation to increase engagement and focus. 

  3. Maintain balance; take time to care for yourself now so you can be successful later. 

  4. If you are finding yourself feeling alone and overwhelmed reach out to a friend, teacher, adult family member or classmate. 

  5. If anxiety has become too overwhelming, don’t be afraid to ask for help.

If you are suffering from stress or anxiety and would like to speak with a professional, please contact us at the Center for Stress and Anxiety Management at or by dialing 858-

BONUS: Learning Resources for Mature Students

Learn 2 Type ( – In order to write, you must possess basic typing (or keyboarding) skills.  Learning to type faster will help you compose your thoughts more quickly, saving time and making you more efficient!  Learn 2 Type is an excellent typing tutor and is free to use.

The Purdue OWL (Online Writing Lab) ( – This is the most famous writing website I have found.  You will find help with APA formatting, avoiding plagiarism, grammar, mechanics, etc.

Daily Grammar ( – Provides a great refresher of basic grammar rules.

The Oatmeal ( – A website that offers humorous and strange examples to help you remember grammar concepts.  The lessons on using an apostrophe and a semicolon properly are my favorites.

Guide to Writing a Basic Essay ( – Steps you through the writing process. 

James ESL Free English Lessons  ( – James has had over 7 million people watch his videos.  Scroll through his lessons and find the one that will be most helpful to you!


Brookfield, S. (1985). Self-directed learning : from theory to practice. San Francisco: Jossey-Bass.

Cross, K. (1981). Adults as learners. San Francisco: Jossey-Bass.

Darkenwald, G., & Merriam, S. B. (1982). Adult education: Foundations of practice. New York: 

Harper & Row.

Jones, H. E, & Conrad, H. (1933). The growth and decline of intelligence: A study of a 

homogeneous group between the ages of l0 and 60. Genetic Psychological Monographs, 

13, 223-298.

Kidd, J. (1973). How adults learn. New York: Association Press.

Knowles, M. (1980). The modern practice of adult education : from pedagogy to andragogy

Wilton, Conn. Chicago: Association Press Follett Pub. Co.

Knowles, M., Holton, E. & Swanson, R. (2011). The Adult Learner : The Definitive Classic in 

Adult Education and Human Resource Development. Amsterdam Boston: Elsevier.

Knox, A. B. (1977). Adult development and learning. San Francisco: Jossey-Bass.

Maxine E. Rossman and Mark H. Rossman. (1990). The Rossman Adult Learning Inventory: 

Creating awareness of adult development. New Directions for Adult and Continuing Education.

Smith, J., & Baltes, P B. (1990). Wisdom-related knowledge: Age/cohort differences in response 

to life- planning problems. Developmental Psychology, 26, 494-505.

Tags: anxietyCBTanxiety therapy san diegofeartherapystress and anxiety in san diegoCognitive Behavioral TherapyCBT San Diegotherapy in san diegoresolutionsacademic stressAdult Leaning Anxiety