How To Tell If You’re Experiencing An Anxiety Attack in Washington DC

Worried woman: Psychotherapy for anxietyAnxiety (or panic) attacks are — well — they’re awful.

Anxiety attacks are periods of intense anxiety, or panic that often occur suddenly, and with no warning. They affect the mind, but more so the body, and can cause extreme fear for the sufferer — especially those who’ve never before experienced such a thing — as the symptoms mimic those of other, more severe maladies.

What is an anxiety attack?

To use the more technical term, a panic attack can be best described as severe dread or distress, often attended by painful physical symptoms that can include dizziness, sweating, a racing heart, chest pain, shaking, or numbness. And then there’s what’s going on inside the mind.

A typical anxiety attack will last five to 10 minutes, during which the sufferer will experience extreme thoughts that might lead them to believe they are going crazy, or that they’re dying — none of which is true.

What causes an anxiety attack?

Stress. Remember, last week, when we talked about stress, its effects on the body, and the subsequent ‘fight or flight’ response? The same concept applies here. Stress can lead to panic, which leads to a chemical reaction in the body, which leads to feelings of anxiety and apprehension.

Panic attacks often seem to come out of nowhere, but they can be triggered: By a lack of sleep; by traumatic life events, such as loss; by drugs, alcohol, or caffeine; or by specific chemical and hormonal imbalances.

If you believe you may be experiencing an anxiety attack, take a deep breath, and know that anxiety attacks are highly treatable.

take our anxiety quizSince most symptoms of a panic attack mirror those of a heart attack, most first-time sufferers end up in the emergency room. It’s always a good idea to rule out any physical conditions that might be causing the symptoms of an anxiety attack. Once you’ve determined that what you experienced in Washington DC really was a panic attack, a few simple lifestyle changes — such as adequate sleep, exercise, and the basic skills of mindfulness (detailed below) for as little as 10 minutes per day — will greatly reduce the severity of, or eliminate panic attacks altogether.

What is the best way to treat an anxiety attack?

The physiology of stopping an anxiety attack is incredibly simple yet profoundly elusive in a moment of panic. The scientific reason for a panic attack is this: Your brain and body’s natural defense system — the stress response — shifts into high gear.

See? Simple. Yet complicated.

If you were running away from your neighbor’s pit bull, the major stress chemicals, adrenaline and cortisol, would be needed to help you leap over the chain-link fence fast enough to avoid a nip from the dog. If you were a zebra, once the threat was gone you would mindlessly resume your activities of munching grass.

Zebras don’t get ulcers (or have panic attacks), because they have no prefrontal cortex — that part of the human brain which imagines or re-lives the experience of stress. When your thinking cortex hasn’t hijacked your body, your parasympathetic nervous system naturally kicks in, to soothe and calm your body with just the right cocktail of chemicals.

This is called the relaxation response.

The solution to a panic attack is already inside of you.

Comforted yet? We’re getting there.

You are not defective; your mind and body are not betraying you.

In fact, the opposite is true. Your mind and body are functioning perfectly during a panic attack — perfectly in response to stress, real or imagined.

Researchers and psychotherapists in Washington DC have uncovered the antidote to disorders of the mind and body caused by anxiety and fear:

A simple skill called mindfulness.

How simple is mindfulness? In the most basic form, mindfulness is the focusing of your attention with the goal of diminishing simulation.

To enhance the effect of mindfulness and engage your relaxation response fully, deepen and slow your exhalation and pull your next breath in deeply using rise of your belly to expand the bottom lobes of your lungs. For eight breaths focus only on the sounds of your breath, the feeling of your belly rising and the sensations everywhere in your body — without judgment or analysis.

Simply begin to notice what you are feeling.

Eventually your mind will quiet itself, and begin to wander less. Through the practice of mindfulness, you will learn how to not jump on the endless freight train of thoughts produced by your wonderful and imaginative neocortex, so you can remain still, calm and at peace.

Have panic attacks become a frequent, maybe even debilitating part of your life?

You may have panic disorder — and you’re not alone. Nearly six million American adults suffer from panic disorder. One of Washington DC’s leading psychotherapy and anxiety counseling practices, Keith Miller Counseling & Associates, can help you unlock the potential of your mind and body’s relaxation response.


Call 202-629-1949

Rediscover Your Passion for Life: Consider Psychotherapy in Washington DC

Montgomery County Mental Health

For months now, you’ve just not felt like yourself. Everyday activities have become a struggle, and your loved ones have started to comment on how it seems you’re lacking that joie de vivre — that exuberant passion for life you’ve always had.

You’re not sure what’s wrong, and you’re not sure how to make it better.

May I suggest you consider counseling?

Therapy can help. The wisdom and guidance of a professional psychotherapist in Washington DC can help you onto a path of self-discovery, and toward more effective methods of dealing with depression, stress, and anxiety.

Anyone suffering from, or anyone who thinks they might be struggling with moods that feel out of balance or unwanted behaviors can benefit from seeking professional help. Unfortunately, however, a lot of people harbor misconceptions regarding counseling — and you’re just not sure if psychotherapy in DC is right for you.

Let me be the first to tell you:

It is.

Psychotherapy in DC is right for you.

That being said:

Psychotherapy in DC is not… just common sense.

As a professional psychotherapist in Washington DC, this is an argument I hear a lot. “Therapy is pointless because all therapists do is rehash common knowledge.” Sure, many of the concepts we discuss during psychotherapy sessions at Keith Miller Counseling & Associates make sense: They’re meant to. But they’re not common. Because they’re specific to you.

Psychotherapy is a safe place — your place to work with a trained expert who’s focused only on you; and whose mission is to understand, and help you reach your goals.

Psychotherapy in DC does not… make you weak.

Here’s another big one. A lot of people believe that admitting to and seeking the help of a therapistis a sign of having a character flaw or is a sign of weakness. Neither of these assumptions are true. In fact, the opposite is true.

Having the mental fortitude to recognize that you can, and should be a better, stronger, more confident version of yourself is a sign of strength, not weakness.

Psychotherapy may be… necessary even when you have great friends.

Your best friend has a great shoulder for crying on. Her love and support is undeniable, and you can talk to her about anything. Your relationship with your Washington DC psychotherapist will be different, for a number of reasons.


Therapists are trained professionals, and devoted years of their lives to learning and practicing how to diagnose and treat cognitive, emotional and behavioral issues.


Relationships are give and take; you’ll talk about you for a while, and then your friend will want to talk about herself. The expert, licensed psychotherapists at Keith Miller Counseling & Associates (in Washington, DC & Bethesda, Maryland) devote 100 percent of their time and energy to you.

And hey, you know what they say:

What happens in psychotherapy… stays in psychotherapy.

Contact Keith Miller Counseling & Associates today, and let’s discuss how psychotherapy in Washington DC can help unburden you from stress, anxiety, and depression and let you feel more joy in life.


Call 202-629-1949

The Right Couples Therapist CAN Save Your Marriage

dc mindfulness couples coaching“No one — not rock stars, not professional athletes, not software billionaires, and not even geniuses — ever makes it alone.” ―Malcolm Gladwell, Outliers: The Story of Success

When you’re searching for a couples therapist in Bethesda, how do you know whom you can trust? Without knowing, you could hire a highly trained and well-intentioned therapist… who might ultimately make your relationship worse.

Did you know that most universities that train therapists don’t offer a single course in couples therapy? And yet, if you look through an online therapist directory like PsychologyToday.com you’ll notice that most advertise themselves as specialists in couples therapy. Something is seriously wrong with this picture.

Exchange the ‘D’-word for the ‘T’-word: Therapy

Some time ago, I found myself standing in your shoes. My marriage of 14 years was strong — unbreakable, we thought — but the pressures of raising children while maintaining two separate careers had slowly whittled away the cushion of goodwill and gratitude my wife and I once had in reserve. There was almost nothing left of our connection to one another. With weary hearts and hushed voices, we spoke of the ‘D’-word, in the way Harry Truman must have talked about the atomic bomb. Neither of us could really fathom divorce. We hated the idea of thrusting such a burden onto the shoulders of our grade school-aged kids. Getting a divorce went against everything we believed. And yet the pain of our disconnection had become so unbearable that we wanted relief — at almost any cost.

You might feel the same way we did: You’ve hit a point in your marriage that you’d do anything to stop the constant arguments, the misunderstandings, the power struggle. Your energy is sapped, your values compromised; the only thing you know for sure anymore is that this isn’t how two people in love should act toward one another.

But, listen. My biggest fear then is still my biggest fear today. Too many couples rush to divorce, and those who don’t, those who realize the potential benefits of couples counseling rush through the process of selecting the right therapist.

How to Choose the Right Couples Therapist

I operate a busy practice with offices in Washington, DC and Bethesda, Maryland, where we average more than 100 phone calls per month from people seeking therapy. Unfortunately, the majority of those contacting us seem to be seeking immediate help, with no questions asked. It feels much like someone calling 9-1-1: “My house is burning down. Send help immediately.”

I wish it were that simple; if it were, we could dispatch a few trained personnel with top-of-the-line equipment to put out the blaze. But couples therapy as a profession is a specialty that requires advanced training and years of supervision to master. Finding a couples therapist who can help, and won’t hurt your marriage is more like choosing a heart surgeon than calling on your local fire department.

When my wife and I needed help, I knew exactly how to navigate the maze of confusing language, and I was able to decode the alphabet soup of therapist credentials to focus on finding a therapist trained to use the most sophisticated and effective models for helping couples. We were lucky. Once we were matched with a therapist who could speak the “attachment language” of our relationship, she got to work with us, and was confident in her abilities — just like you’d expect from a great surgeon. Ten minutes into our first session, we felt better. Methodically, she helped us stop the bleeding, and together, we sewed the threads of our relationship back together. Her ways were compassionate, and direct; she saved our marriage.

The Right Couples Therapist Can Save Your Marriage

Here I am, a well-respected couples therapist, standing up to say that my marriage suffered. This is not something I am ashamed to admit, and in fact, it is my hope that my experience on the other side of the couch will inspire you to seek the help your marriage needs.

The process of finding a great couples therapist is a daunting one, one that’s nearly as important as the marriage-saving lessons learned, and one that very few people — and therapists, alike — choose to talk about. For that reason, I wrote a book: Love Under Repair: How to Save Your Marriage and Survive Couples Therapy (available for purchase on Amazon.com now), a clear and personal guide, start to finish, through the process of finding a great couples therapist and succeeding at a full-out relationship repair operation. When your relationship is struggling, you don’t have time to experiment.

Love Under Repair brings to life the “Big Three” methods of couples therapy today: Emotionally Focused Therapy for Couples; the Gottman Method Couples Therapy; and Imago Relationship Therapy.

In addition to helping you find the couples therapist that’s right for you, Love Under Repair will also address:

  • How to get effective professional help and avoid the money pit of therapy
  • Why a common treatment for couples in distress is damaging for relationships
  • How to use health insurance to pay for couples therapy
  • Why attachment-based couples therapy can transform your love
  • Three alternatives to couples therapy that can have a big impact on your relationship

If you still have questions about finding a great couples therapist, or if there’s anything about searching for help that has left you confused, contact me, or visit Keith Miller Counseling in Washington, DC or Bethesda, Maryland.

The time to save your marriage is now.

Our psychotherapy fees start at $175 per hour (psychiatry fees start at $200 for 30 minutes).
We do not accept insurance, meaning we are not "in-network" with any health plans.
However, many of our clients submit claims to their out-of-network health insurance and receive 40-60% reimbursement.