
Effectively managing your anxiety might start with smart, personalized medication strategies
Living with Anxiety
Anxiety
Anxiety disorder is a mental health condition that causes people to feel excessive worry, fear, or nervousness, even when there’s no real danger.
While everyone feels anxious from time to time, people with anxiety disorders experience these feelings in a way that is life disrupting, everyday.
It can affect your thoughts, emotions, and even physical health, causing symptoms like a racing heart, sweating, or difficulty sleeping.
Forms of Anxiety
Anxiety can present itself in many forms.
Comprehensive list provided for clarity and completeness.
- Generalized Anxiety Disorder – The most common form of anxiety, involves excessive worry about a range of everyday issues – work, health, finances, relationships… This ongoing anxiety can lead to restlessness, fatigue, difficulty concentrating, and trouble sleeping, making it hard to relax or simply enjoy life.
- Panic Disorder – The sneaky version of anxiety, Panic is marked by unexpected and intense panic attacks, which often feel overwhelming and frightening, frequently with no clear trigger. Can include a racing heart, chest pain, shortness of breath, or dizziness, leaving one fearful of when the next attack might occur. If you have had a panic attack, you know how deblilitating it can be.
- Social Anxiety Disorder – Most of us have social anxiety to some degree… but the disorder goes beyond feeling shy or nervous – it involves an intense fear of social situations where one worries of being judged, embarrassed, or rejected. It often disrupts daily life, leading to avoidance of events like parties, public speaking, or even casual conversations – which can make forming relationships or pursuing opportunities challenging.
- Phobias – Phobias are more than just your common fears – they involve an intense, overwhelming and often irrational sense of dread when faced with specific objects or situations, such as flying, snakes, or small spaces. Phobias can lead to avoidance behaviors that impact daily life. Even if one knows logically that their fear is out of proportion to the actual risk, the intensity of the inner experience often promotes avoidant behaviors.
- Obsessive-Compulsive Disorder (OCD) – Involves persistent, intrusive thoughts (obsessions) that can cause significant anxiety, leading to the performance repetitive actions or rituals (compulsions) to reduce those feelings. These behaviors, like excessive handwashing or checking, can interfere with daily life and are sometimes challenging to control, even when the person recognizes they’re unnecessary.
- Post-Traumatic Stress Disorder (PTSD) – is a severe form of anxiety that can develop after experiencing something deeply traumatic, such as violence, accidents, or natural disasters. It often causes symptoms like vivid flashbacks, difficulty sleeping, and heightened alertness. PTSD is intrusive and can be intense, which often interferes with daily life and relationships.
Untreated Anxiety
Anxiety disorders are very common.
About 19% of adults in the United States experience anxiety each year.
Only about 37% of people with anxiety get help.
For those with any of the anxiety disoders listed above the common themes are social isolation and disruption to your life.
Untreated anxiety can feel isolating and overwhelming. We often struggle to concentrate, avoid social events, or feel trapped by our own thoughts and fears.
Managing the anxious internal state can be exhausting, increasing the risk of depression and substance abuse.
blog article: When to Seek Help for Anxiety
Living with Someone who has Anxiety
Supporting someone with anxiety can be both rewarding and challenging. Anxiety affects not only the person experiencing it but also the dynamics of their relationships. Family and friends can sometimes face moments of confusion, helplessness, or frustration, especially if they don’t fully understand what anxiety entails or how it feels.
It’s important to recognize that anxiety isn’t just ‘nervousness’ or something that a person can simply ‘snap out of’. Reactions to stress, social situations, or daily tasks might seem exaggerated to others, but the feelings are very real and overwhelming to someone with anxiety.
Someone with anxiety may avoid certain situations, struggle to express their feelings, or react in ways that feel unpredictable. This can make friends and family feel unsure of how to help.
Loved ones may experience a mix of emotions – compassion, frustration, or even guilt if their support doesn’t seem to alleviate the anxiety. It’s common for those close to someone with anxiety to feel exhausted, especially when the anxiety leads to frequent reassurance-seeking or impacts daily routines.
Education is key in these situations. Learning about anxiety can help those close to understand that one doesn’t ‘choose’ to feel this way. Patience and empathy are important, but it’s also vital to set boundaries and maintain self-care. Again, education is key.
Supporting someone with anxiety shouldn’t come at the cost of your own mental health. Encouraging them to seek treatment, like therapy or medication, can be a huge step toward improvement.
Living with Anxiety
There are two views of anxiety… the external, observational view and that which is managed internally.
Living with anxiety while maintaining relationships can be a constant challenge. Anxiety often promotes overthinking simple conversations or interactions, which can lead to tension with a partner.
Anxiety can frequently motivate one to repeatedly seek reassurance, not because they doubt their loved one, but because their mind is overwhelmed by intrusive “what ifs.”
Within family dynamics, anxiety may drive one to avoid gatherings or seem distant. This is not out of a lack of care, but because social interactions can feel draining or overwhelming, especially when faced with questions or attention.
In the workplace, those with anxiety may struggle to balance their responsibilities while managing internal worries. They may spend excessive time perfecting emails or replaying interactions, worrying they made a mistake or gave the wrong impression. These behaviors often go unnoticed by colleagues, who may misinterpret them as insecurity or lack of effort
Anxiety takes different forms but touches every relationship in our lives.
Treatment
When it comes to treatment, there’s no one-size-fits-all approach – it often takes a combination of therapy, medication, and lifestyle changes to see meaningful progress… but be assured positive change is attainable.
Each individual’s experience with anxiety is unique, so finding the right mix of treatments may take some time. Therapy, such as CBT, is a cornerstone for addressing the thought patterns and behaviors that fuel anxiety, while lifestyle changes like regular exercise, mindfulness, and proper sleep can provide additional support.
In many cases, medication can play an important role in treatment. For some, anxiety is deeply tied to biological factors, like brain chemistry or genetic predispositions, that can’t always be addressed with therapy or lifestyle changes alone.
Medications like SSRIs or anti-anxiety drugs can reduce symptoms to a manageable level, making it easier for individuals to fully engage in therapy and their daily lives. While not everyone needs medication, it’s a tool that has helped countless people regain control and reclaiming their sense of self again.
With proper care, anxiety is manageable.
Whether it’s through therapy, medication, lifestyle adjustments, or a combination of all three, there is relief ahead.
Taking control of your anxiety means taking back the moments that matter
Birch Grove Mental Health
we are not just anxiety specialists…
other conditions we treat
Bipolar Disorder – Mood swings, irritable, impulsive
- Manic episodes of high energy, grandiosity, risky behaviors
- Hypomanic episodes of less severe mania & elevated activity
- Depressive episodes characterized by sadness & apathy
- Mixed episodes include both mania and depression
ADHD – Inattention, hyperactivity, impulsivity
- Difficulty staying focused or on-tasks
- Hyperactivity includes constant movement, fidgeting
- Impulsively or hastily acting without thinking
- Difficulty with detail resulting in careless mistakes
Depression - Sad, fatigued, unmotivated
- Persistently low or depressed mood
- Loss of interest or pleasure in activities once enjoyed
- Significant changes in appetite or weight
- Sleep disturbances such as too much or too little sleep
Trauma – Nightmares, hypervigilance, flashbacks
- Intrusive, distressing flashbacks of the traumatic event
- Avoid people & situations that remind you of the trauma
- Persistent negative emotions, feeling detached from others
- Easily startled, feeling on edge, or difficulty sleeping
Thought Disorders – Disorganized, paranoid, delusional
- Disorganized thinking, incoherent speech.
- Loose associations by jumping between unrelated topics.
- Tangentiality through inclusion of irrelevant information.
- Incoherence (word salad), illogical word combinations
Obsessive Compulsive Disorder (OCD) – Checking, counting, germaphobic
- Compulsive repetitive behaviors or rituals
- Repeatedly intrusive disturbing or unwanted thoughts
- Obsessive, recurrent urges or anxiety causing mental images
- Avoid situations that trigger obsessions or compulsions
Panic Disorder – Intense, sudden fear
- Panic attacks episodes of intense fear & discomfort
- Symptoms include palpitations, sweating, trembling
- Fear of future attacks creates worry of more attacks
- Avoids places where previous attacks occurred
The stuff of life
- Stress Management
- Life Transitions
- Relationship issues
What patients say about us…
My teen son has started seeing Sunami for several months. It’s been great to see and hear his trust in her grow. We are building a toolset that my son can practice and use. It takes a village; happy and relieved to have found Sunami for my son’s mental health journey.
I’ve had nothing but positive experiences with my provider at Birch Grove. Sessions start on time. They get back to me promptly if I ever need anything. They had emergency coverage the one time I was struggling and my provider was on vacation. Highly recommend.
This practice has been so helpful for my whole family. They have been so flexible with appointments and are always responsive. Our NP is very knowledgable and caring. Highly recommend!
Meet The Team
We are a team of psychiatric nurse practitioners united by a shared passion for making a difference in the lives of those facing mental health challenges.

Sunami Gurung
CT, MA, NH, NY, RI, VT
Psychiatric Nurse Practitioner

Natasa Ristivojevic
MA, NH
Psychiatric Nurse Practitioner

Salma Trainor
MA, NH
Psychiatric Nurse Practitioner

James Quackenbush
MA, NH, NY
Psychiatric Nurse Practitioner

Juliana S Pires
CO, CT, MA, NH, NY, OH, OR, RI, UT, VT
Psychiatric Nurse Practitioner

Erin Savage
MA, NH
Psychiatric Nurse Practitioner
Sunami Gurung
Psychiatric Nurse Practitioner
Approach
- Person-centered approach
- Tailored treatment plans
- Evidence-based medication management & psychotherapy
Clinical interests
- Depression & Anxiety
- Bipolar disorder
- OCD
- Trauma & PTSD
- ADHD
Languages
- English
- Nepali
- Hindi
Locations
- MA, NH, NY
Salma Trainor
Psychiatric Nurse Practitioner
Approach
- Passion for supporting others
- Empathic relations is foundational
- Collaborative and inclusive
Clinical interests
- OCD
- Depression
- Anxiety
- Bipolar disorder
Languages
- English
Locations
- MA & NH
Natasa Ristivojevic
Psychiatric Nurse Practitioner
Approach
- Wholistic approach prioritizing human connection
- Evidence-based interventions
- Judicious medication management
Clinical interests
- Psychotic disorders
- Mood disorders
- Substance use
Languages
- English
- Serbian
Locations
- MA & NH
James Quackenbush
Psychiatric Nurse Practitioner
Approach
- Collaborative focus on goals and you
- Evidence-based planning
- Empowering you toward well-being
Clinical interests
- Depression & Anxiety
- PTSD
- Borderline
- Personality disorder
- Bipolar disorder
- Schizophrenia
Languages
- English
- French
Locations
- MA, NH, & NY
Juliana S Pires
Psychiatric Nurse Practitioner
Approach
- Medication management
- Coping skills development
- Empathic listener, genuine, honest
Clinical interests
- Depression & Anxiety
- Bipolar disorder
- Schizophrenia
- Trauma & PTSD
- ADHD
Languages
- English
- Portuguese
Locations
- CO, CT, MA, ME, NH, NY, OH, OR, RI, UT, VT
Erin Savage
Psychiatric Nurse Practitioner
Approach
- Compassionate & empathic listening
- Tailored treatment to goals
- Utilize cognitive behavioral therapy & coping skills development
Clinical interests
- Depression & Anxiety
- Bipolar disorder
- schizophrenia
- Trauma
Languages
- English
Locations
- MA, NH
Insurance, payments, costs, locations

Costs
Evaluation $300
Follow-up $180
Payment Options
Zelle/Venmo
Major Credit Cards
Anxiety does not define you,
your resilience does
Why Birch Grove Mental Health?
Our team of Psychiatric Nurse Practitioners are passionate about supporting individuals affected by mental illness
Through effective and practical medication management, we see victories every day
In Person Sessions
MA & NH
You-Centered
Prioritizing your Care, Progress, and Wellbeing
Your Goals
Personalized Treatment Plans
Telehealth
Flex to your schedule and life
Your Voice Matters
Collaborative Decision Making
You Have a Life
Flexible hours and ways to connect
FAQs
Benefits of Online Psychiatric Treatment?
- Easy scheduling: Book appointments at your convenience without the need to commute.
- Support when you need it: Access professional care from the comfort of your home.
- Privacy and flexibility: Maintain confidentiality while receiving care tailored to your schedule.
How long does the appointment last?
- Initial appointments are typically 60 minutes
- Subsequent appointments are 30 minutes or more – durations vary based on need
How will I know where to start my online session?
Once we confirm your appointment date & time, the link to your session room will be forwarded via email.
What types of therapy do you offer?
We provide individual therapy for children, teens, adults, and older adults. Our approaches include Cognitive Behavioral Therapy (CBT), Motivational Interviewing, and Solution-Focused Brief Therapy (SFBT).
Where do you offer services?
We provide services in:
In-person & telehealth
- Massachusetts
- New Hampshire
Telehealth only
- Rhode Island
- Utah
- Maine
- Ohio
- Vermont
- New York
- Colorado
- Connecticut
What can Birch Grove psychiatric nurse practitioners diagnose and treat?
We provide care for a wide range of mental health concerns, including:
- AnxietyDepression
- Bipolar Disorder
- ADHD (Attention Deficit Hyperactivity Disorder)
- Stress management
- Behavior Issues
- Mood Disorders
- Medication Management
- Thinking Disorders
- Weight Loss
What meds do autonomous psychiatric nurse practitioners prescribe?
Autonomous psychiatric nurses, or advanced practice psychiatric nurses (APRNs), can prescribe a variety of medications to treat mental health conditions. These include:
- Antidepressants: For depression and anxiety disorders (e.g., fluoxetine, sertraline).
- Antipsychotics: For schizophrenia and bipolar disorder (e.g., risperidone, olanzapine).
- Mood stabilizers: For bipolar disorder (e.g., lithium carbonate).
- Anxiolytics: For anxiety disorders (e.g., alprazolam, lorazepam).
- Stimulants: For ADHD (e.g., methylphenidate, amphetamine/dextroamphetamine).
These medications help manage symptoms and improve the quality of life for individuals with mental health conditions.
What are your hours of operation?
Telehealth and in-person appointments hours are
Mon-Fri, 6:30am – 6:30pm
What is the cancellation policy?
You can reschedule or cancel your appointment with at least 24 hours’ notice to avoid cancellation fees.
What should I expect from the scheduling process?
Our scheduling process involves a few simple steps:
- Contact us via the Get Started button
- Complete intake forms via our secure patient portal.
- Add payment information: To confirm your appointment, you will need to add your payment information to the portal. This information is securely stored and only accessible to you via your personal login and password.
- Submit insurance information: If applicable, we will need to verify your insurance information to ensure that we can process your payment and accept your coverage.
- Choose your provider and appointment time: Once your forms and payment are completed, you can select your preferred provider, date, and time for the appointment.
- Appointment confirmation: After all forms are filled out and payment is processed, we will confirm your appointment.
Are your providers licensed to prescribe medications?
Yes, all of our providers are fully licensed and able to prescribe both controlled and non-controlled medications as part of a comprehensive treatment plan.
How can a parent or guardian schedule an appointment for a minor?
Parents or guardians can schedule appointments for their children by contacting us through the Get Started link at the top of the page. Parental consent will be required before the first session.
Anxiety, Depression, OCD, ADHD, Bipolar, thought disorders, panic, trauma