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Josh Spitalnick is a clinical and research psychologist with expertise in treating a variety of anxiety conditions with cognitive-behavioral therapy (CBT) and other evidence-based approaches. In this episode, Josh unpacks the four layers of anxiety—psychological, emotional, cognitive, and behavioral—highlighting why avoidance is the key feature that transforms ordinary worry into disorder. He explains why he continues to treat OCD and PTSD as anxiety conditions despite their DSM-5 reclassification, and he draws important distinctions between worries versus worrying and thoughts versus thinking. The discussion explores health anxiety, illness anxiety, and the impact of modern contributors such as wearables, social media, and the COVID era, while weaving in real-world case studies and Josh’s structured assessment approach. Josh also breaks down evidence-based treatments, from exposure therapy and cognitive-behavioral therapy (CBT) to acceptance and commitment therapy (ACT), along with the role of medication, lifestyle factors, and how shifting from avoidance to committed action can build long-term resilience.

We discuss:

• Josh’s professional background and his holistic approach to treating anxiety [3:00];

• Definition of anxiety and changes in the DSM-5 [5:00];

• The psychological and cognitive aspects of anxiety [10:45];

• Breaking down anxiety symptoms: triggers, fears, and hidden mental rituals [17:00];

• Thoughts versus thinking and worries versus worrying: what constitutes dysfunction [20:15];

• Health anxiety and the limits of medical reassurance: understanding illness anxiety and somatic symptom disorder [24:30];

• Triggering events for health anxiety, symptom fixation, heritability, and the role of nature versus nurture [36:30];

• Historical and modern shifts in health anxiety, from HIV/AIDS in the 1980s to today’s heightened fears of cancer [45:30];

• Modern factors and recent events that have amplified societal anxiety levels [47:15];

• Josh’s approach to patients with excessive health-related rituals and/or OCD using CBT and exposure therapy [54:30];

• Hypothetical example of treating a person with a fear of flying: assessment, panic disorder, and