Anxiety therapy in California — for the alarm that stayed on.
Online anxiety therapy in California for adults in their 20s and 30s. For the overthinking, the racing thoughts, the night dread, and the performance anxiety that passes for ambition.
Anxiety is your threat-detection system firing when there's no threat in the room. In small doses it's useful. It's the part of you that prepares, double-checks, and cares how things go. The trouble starts when the alarm stays on after the moment has passed, and you start living with it in two places at once, your body (shallow breath, a tight jaw, nights spent staring at the ceiling) and your thoughts (the what-ifs, the replays, the rehearsals for conversations that may never happen). Good anxiety therapy works on both, and, for the anxiety that keeps coming back, on what's underneath them.
What anxiety is.
Anxiety is an alarm that got very good at its job and never got the memo that it can stand down. It's a working system that was left on, and it tends to be exhausting more than it's dramatic. Most of the people we see for it are tired long before they're scared.
Danielle, who reviews this page, has OCD herself and knows this territory from the inside: "I know the kind of mind that asks what if and won't accept a maybe." Over time, a mind like that quietly takes over rooms in your life. Sleep. Weekends. The drive home. Conversations you used to enjoy. Much of the work is taking those rooms back, one at a time.
Anxiety also tends to pass itself off as productivity, high standards, or being "the responsible one," which is part of why people carry it for years before calling it what it is.
The three doors out of the spiral.
A lot of anxiety advice works on only one thing, often your thoughts and sometimes your breathing. In our practice we describe three doors out of an anxiety spiral. Each one opens onto a different part of the problem and is useful at a different moment. A common reason people decide "nothing works" is that they keep trying the wrong door first.
1. The body door. In the middle of a spike, the fastest way out tends to run through your body: a long exhale, cold water on your face, a walk around the block. Anxiety is a nervous-system state, and the nervous system answers physical signals faster than it answers arguments. This door doesn't solve anything on its own. It gets you calm enough to reach the next one.
2. The thought door. Once the spike has eased, you can look at the thought itself. Anxious thinking leans on a few familiar moves: catastrophizing, mind-reading, all-or-nothing, predicting the future with total confidence and no evidence. Arguing with the thought usually makes it louder. Naming the move it's making, and answering with something more accurate, tends to quiet it. This is where CBT lives, and where most day-to-day relief starts. One exception: if the worry is OCD, answering it can turn into reassurance, which keeps the loop going. That's why OCD gets a different approach.
3. The root door. After a few weeks of noticing your pattern, a different question tends to show up: what has this alarm been protecting me from? The answer often goes back further than the current situation. This is where attachment work, Internal Family Systems and, when trauma is involved, EMDR come in. Plenty of people stop at the second door and call the anxiety handled. For some of them, it comes back a few months later in a different outfit.
Doors one and two tend to get your evenings back. Door three is what helps the change last.
How it shows up.
Some of the ways anxiety tends to show up for the people we work with:
- Lying awake while your mind runs the next day, or the last ten years
- Replaying conversations for hours, sure you said the wrong thing
- Rereading a text before you send it, then again after
- Performance anxiety that looks like drive from the outside
- A body that's always braced, with tight shoulders, shallow breath and a stomach in knots
- Panic that comes out of nowhere, with a racing heart and the certainty something is wrong
- Quietly avoiding things you used to do easily, without quite knowing why
If the loop mostly finds you at night, Danielle wrote about that in The 12 a.m. spiral, and about why "facts, not feelings" can backfire in The facts you're using to argue with your feelings. If the overthinking is about a decision you can't make, Julia wrote The decision you can't make. If your mind won't clock out after work, Jasmeet wrote The you that can't turn off at night.
The forms it takes.
Anxiety isn't one thing, and the version you're carrying shapes the work:
- Generalized anxiety: a steady hum of worry that attaches to whatever's nearby
- Performance and high-achiever anxiety: the fear of not being enough, dressed up as standards
- Social anxiety: the post-game analysis of every interaction, and the certainty you were judged
- Panic attacks: sudden surges of fear, often with physical symptoms that feel like an emergency
- Health anxiety: trouble trusting your body's ordinary signals
- Relationship anxiety: the what-if loop about the person you love, covered on our relationship anxiety page
- OCD-spectrum anxiety: worry that demands a compulsion before it lets go, covered on our OCD page, because it needs a different treatment
How therapy helps.
Anyone who cares about things will feel some anxiety, and you probably wouldn't want to lose that entirely. What you can have is an alarm that goes off when it should and settles when it's done. The goal isn't to silence the what if. It's to stop letting it run the place.
We tend to start with the body, because most spirals have a physical signature (a tight chest, held breath, a bracing in the shoulders) long before they have words. From there, CBT helps interrupt the thought loops, and mindfulness puts a little space between the trigger and the spiral. Then, at whatever pace makes sense, we go underneath, into where the anxiety learned to live and what it's been trying to protect. For the neuroscience of why the brain's alarm fires too often, and how therapy recalibrates it, see Why Therapy Works.
None of this happens on a deadline. We want to understand what's going on before we ever ask you to do something hard, and anything that involves facing a fear happens at a pace you can tolerate. It's slow, kind work, and it holds up.
Who does this work.
Anxiety runs through almost everything we treat, so every clinician here works with it. Each of them comes at it from a different angle, listed below.
Danielle Miller, AMFT (CA #144995). Reviews this page. Her focus is the anxiety that loops, including the OCD-spectrum version where the worry demands a compulsion before it lets go. Previously an OCD Exposure Coach at Psychological Care and Healing Center (PCHC), a Los Angeles treatment center providing partial hospitalization, intensive outpatient and residential care. Member of the International OCD Foundation (IOCDF). About half her caseload is OCD. Gentle and body-aware; ERP, ACT, CBT, somatic and mindfulness.
Elaina Envia, AMFT (CA #149268). Works with anxiety where it lives in dating, self-worth and the after-image of every interaction: the text you reread eleven times, the date you replay on the drive home. Previously a therapist at Claris Health and a social worker at New Dimensions FFA, a foster family agency, which gave her real experience with attachment disruption. Warm, direct, honest. CBT, attachment and solution-focused work.
Fidel Quintanilla, AMFT (CA #125756). High-achiever anxiety and men's mental health are his named specialties. Previously Assistant Program Director for the treatment of Families, Couples, OCD and Depression at PCHC, where his caseload included C-suite executives at Fortune 500 companies and public figures. Adjunct faculty at Pepperdine University for 5+ years and a member of the International OCD Foundation (IOCDF). Direct and present-focused; CBT, ACT, EMDR, EFT and mindfulness.
Marjolaine Bernstein, AMFT (CA #164685). Works with women's anxiety in particular: the over-functioning, the perfectionism, and the mental load that can pass for simply being capable. Member of the International OCD Foundation (IOCDF). ERP, CBT, mindfulness and attachment-informed work.
Julia Melvin, AMFT (CA #137797). Uses Internal Family Systems for overthinking and self-criticism, the versions of anxiety that argue both sides of every decision EMDR-trained, for anxiety that turns out to be carrying something older. IFS, EMDR, attachment, CBT and mindfulness.
Nazzi Vazira-Bhullar, LMFT (CA #102581). 15 years in practice, with particular depth in anxiety inside women's lives and relationships, including South Asian women. Adjunct faculty at Pepperdine University for 10 years. Solution-focused, warm and unhurried; CBT, attachment, EFT and mindfulness.
Molly Binenfeld, LMFT (CA #151728). Sees anxiety in early adulthood and college-to-adulthood transitions, including the high-functioning version that tips into burnout. Currently Clinical Director and Senior Primary Therapist at an intensive outpatient program for college students focused on primary mental health, with specialty-level training in DBT and in assessing suicidality.
Jasmeet Bhullar, LMFT (CA #117019). Founder and Clinical Director, 15+ years in practice. Works with anxiety in professionals and leaders, and with the version that goes back further than the current situation, through a Bowen Family Systems lens. Adjunct faculty at Pepperdine University for over 10 years and a member of the International OCD Foundation (IOCDF). CBT, attachment, EFT, existential and Bowen Family Systems.
All associates are supervised by Jasmeet Bhullar, LMFT #117019.
Because we don't solicit client testimonials as a policy, the voices below come from former graduate students of Fidel and Jasmeet, who both teach at Pepperdine. What they describe is the same presence our clients meet in session.
"Taking his course helped me learn how to advocate for myself professionally and personally, and I was so grateful to learn more about salary negotiation, scheduling self-care, and trusting your judgment in the room with clients." Casey Moore, MFT Trainee on Fidel Quintanilla, AMFT
"Fidel managed to accomplish something rare in a university classroom: to teach the material in a practical methodology while actually caring about his students." Javeed Kassam, MFT Trainee on Fidel Quintanilla, AMFT
"In this class, you will gain the knowledge necessary to enter the field confidently and competently." Margy McCallum, MFT Trainee on Jasmeet Bhullar, LMFT
Our approach at Align.
We match the approach to the anxiety, drawing on CBT, ACT, ERP, IFS, attachment work, body-based practices and, where it fits, EMDR. Anxiety is often an old strategy for staying safe that has outlived its usefulness, and the work is helping it retire.
Every clinician at Align holds a Master's in Clinical Psychology with an emphasis in Marriage and Family Therapy from Pepperdine University, and the whole team trains together in weekly supervision. Sessions are weekly, 50 minutes, held entirely online on a HIPAA-compliant platform, with a California-licensed therapist who's yours alone. $200 per session, out-of-network, with monthly superbills.
Sessions are available in English, Spanish (Fidel Quintanilla), Farsi (Nazzi Vazira-Bhullar), and Hindi and Punjabi (Jasmeet Bhullar).
Who we work with.
Adults in their 20s and 30s, of any gender, anywhere in California. High-achievers whose anxiety hides inside their ambition. People who've read the books, downloaded the apps, done the journaling, and still can't get their mind to stop running at midnight. People who look fine from the outside and haven't felt fine in a while.
What we don't do.
We provide weekly outpatient therapy. If anxiety or panic has reached the point where you can't get through the day, can't leave the house, or are having thoughts of harming yourself, a higher level of care may be the right first step, and we'll say so on the consultation call and help you find it. We don't prescribe medication, and we don't work with children or adolescents.
If you are in crisis: call or text 988 for the Suicide and Crisis Lifeline, available 24/7. If you or someone else is in immediate danger, call 911. Align does not provide emergency or after-hours crisis services.
Anxiety therapy: common questions.
How do I know if I have anxiety or just stress?
Stress usually has an address. It's tied to a deadline, a move, a hard week, and it eases when that thing passes. Anxiety tends to outlive its cause. It spreads to whatever is nearby, it shows up in your body (a tight chest, a stomach that won't settle, sleep that won't come) even when nothing is wrong right now, and it keeps asking "what if" after the answer has arrived. If the worry has stayed after the reason left, it's worth a conversation.
Can anxiety be treated with online therapy?
Yes. Studies comparing online and in-person CBT for anxiety have generally found similar results, and the other approaches we use translate well to video. Some people find it easier to do this work from their own couch, especially when getting to an appointment is part of what makes them anxious.
What are the three doors out of an anxiety spiral?
In our practice we describe three doors, each working at a different layer. The body door: settling your nervous system with breath, movement or temperature, which is usually the fastest relief in the first few minutes. The thought door: spotting the pattern the worry is using (catastrophizing, mind-reading, all-or-nothing thinking) and answering it with something more accurate. The root door: asking what the alarm has been protecting you from, which often goes back further than the current situation. Each one works on a different timescale, and trying the wrong one first is a common reason people decide nothing helps.
What happens in the first anxiety therapy session?
Mostly, we get to know your anxiety. When it shows up, what it says, what it feels like in your body, what you've already tried, and what you'd like to be different. We'll ask about sleep, work, relationships and anything you're avoiding. By the end you should have a rough sense of which door we're starting with, and often one small thing to try before the next session. You don't need to arrive with it all figured out. Plenty of people start with "I just can't turn my brain off."
How long does anxiety therapy take?
It depends on the anxiety and on what's underneath it, and we don't put a number on it up front. The body and thought tools often start helping before the deeper work does, and the deeper work is what helps the change last. After the first few sessions, we'll tell you what we're seeing.
Do I need medication for anxiety?
Not necessarily. Many people manage anxiety well with therapy alone, and for some, medication alongside therapy works best. We don't prescribe, but we're glad to coordinate with a psychiatrist or your primary care doctor if medication is part of your care.
Can I do anxiety therapy in Spanish, Farsi, Hindi or Punjabi?
Yes. Fidel Quintanilla offers sessions in Spanish, Nazzi Vazira-Bhullar in Farsi, and Jasmeet Bhullar in Hindi and Punjabi. For some people, the family and cultural sides of anxiety are easier to talk about without having to translate.
More resources.
- The 12 a.m. spiral, Danielle Miller, AMFT: on the night version of the anxiety loop
- The facts you're using to argue with your feelings, Danielle Miller, AMFT: on why "facts, not feelings" backfires for reassurance-seeking anxiety
- The decision you can't make, Julia Melvin, AMFT: on overthinking and the parts that argue both sides
- The you that can't turn off at night, Jasmeet Bhullar, LMFT: on the executive mode that won't shut off
- The masculinity you can't put down, Fidel Quintanilla, AMFT: on the anxiety underneath high-achieving men's operating systems
- National Institute of Mental Health: research and information on anxiety disorders
- American Psychological Association: on anxiety and when to seek help
If you're in crisis, please don't use this page as your point of contact. Call or text 988, or go to your nearest emergency room.
Related specialties.
- OCD & intrusive thoughts: the thought that demands something before it lets you go
- Relationship anxiety: the what-if loop about the person you love
- Burnout: the exhaustion sleep doesn't touch
- Depression: the flatness that can show up alongside long-term anxiety
- People-pleasing: where the anxiety turns into an automatic yes
- Trauma: when the alarm is responding to something that already happened
- All topics & patterns: the full list of what we work with