Anxiety Therapists in New York

Hi ! I am a licensed clinical social worker who has worked in the field of mental health and healing for over 15 years. I love hearing the life stories of others and exploring with them how they can get some healing from life's challenges. I am also big on looking at one's strengths and accomplishments in life. I believe that many people already are on their journey.

Welcome! I’m Kathy Brammer and I have worked as a therapist and counselor for over 20 years, mostly with adolescents and young adults. I believe that it is a privilege to work alongside my clients to help them to cope with difficulties, problem solve, and support them to feel better . In my view, therapy is a kind, supportive partnership, and a source of support and encouragement for every client.

Hello! I am a Licensed Clinical Social Worker with 26 years of experience as a therapist. I have worked with adults, adolescents, and children from various backgrounds in community mental health clinics and private practices. I understand that having the courage to seek help can be challenging. I believe in the importance of establishing a safe therapeutic relationship. I am here to support you by applying my knowledge and expertise to help you identify the core of your difficulties and effectively cope with your challenges. I use evidence-based tools that empower you to improve your overall functioning.

Robyn Houlihan is a Licensed Clinical Social Worker (LCSW) based in New York, with over 20 years of experience in social services. Her career encompasses a broad range of roles, including supportive housing for individuals experiencing homelessness and severe mental illness, mobile crisis response teams, and clinical psychotherapy for both children and adults. Robyn has held positions in direct practice as well as leadership roles, consistently demonstrating expertise in complex clinical and organizational settings. Robyn holds a Bachelor’s degree in Forensic Psychology from CUNY John Jay College of Criminal Justice and a Master of Social Work from Fordham University. She is currently pursuing a Doctorate in Social Work (DSW) at the University of Kentucky, where her research focuses on women in leadership and women’s health. In addition to her clinical work, Robyn runs a private practice dedicated to supporting women’s health and well-being. She also serves as a Senior Social Worker at a community mental health center within a Brooklyn hospital, where she specializes in intake assessments, diagnosis, and crisis intervention. Robyn is an active member of two peer support teams, furthering her commitment to empowering and support health workers and prevention of burnout.

Do you often feel stuck in life? Or have a hard time getting to where you KNOW you can be physically, mentally, or emotionally? Navigating the complexities of life, dealing with anxiety, depression or any other mental health challenges can be extremely tough & take a toll on you functioning at your best. We are taught to just push through & everything will be fine, but you know that this rarely works. So here you are asking the question "Can this person actually help me?" To that question, I want to start by introducing myself. My name is Destiny & have spent my 6+ years career as a Licensed Mental Health Counselor, gaining the passion to facilitate the process of healing and hope to individuals who navigate symptoms of anxiety, depression, & trauma-related issues. I also work well with those in need of support with self-esteem issues, stress, and navigating their spiritual walk. Together, we will foster a mindset of resilience, confidence, and self-compassion, allowing you to navigate life's challenges with grace and authenticity. The journey towards healing & growth, starts & will continue with one step at a time.

Licenses & Training: I hold a Master of Science degree in Clinical Mental Health Counseling from Walden University. I hold a Master of Science degree in Health Education and Promotion from Walden University. I am currently licensed in the state of New York (LMHC) Presently, I work as a Program Director for residential treatment services for clients impacted by substance and mental health challenges. Along with my formal education, I have 23 years' experience working within various modalities, providing me with skills to utilize techniques and interventions from Cognitive Behavior Therapy, Dialectical Behavior Therapy, Cognitive Processing Therapy, Motivational Enhancement Therapy, Expressive Therapy, Solution Therapy, and Motivational Interviewing., etc. Frequently addressed issues in treatment may include anxiety, depression, post-traumatic stress disorder, abuse, life transition problems, general stressors, self-esteem issues, dysfunctional patterns of behavior, etc. I am also a member of the American Counseling Association.

There are times in life when we struggle and feel hopeless. We try our best to be resilient, but sometimes we need help in finding our inner strengths and developing strategies to move forward. I am here to help encourage and support you to break general patterns to move you toward your goals. I work with individuals dealing with anxiety, depression, relationship issues, and life transitions.

Hi there, I'm Colette. I'm a Licensed Clinical Social Worker. I received my degree from Columbia University. I'm trained in Mindfulness, MBSR (Mindfulness-Based-Stress-Reduction), DBT, and CBT. I've been working in the mental health profession for over 20 years. I help young, middle, and older adults manage life stressors, including, managing work stress, school stress, relationship problems, anxiety, sadness, and grief and loss issues. In sessions, I'm client-centered and will meet you where you are and provide you with compassion and a safe space.

Hello there. I'm Stephanie Campos, a Licensed Clinical Social Worker, and I'm honored to be a part of your journey towards emotional well-being. With over 8 years of experience, my focus is on providing comprehensive and compassionate support to individuals facing various challenges. As a Licensed Clinical Social Worker, my role is grounded in understanding the unique aspects of your situation and tailoring interventions to meet your specific needs. I specialize in mood disorders, anxiety, and depression, utilizing evidence-based practices such as Cognitive-Behavioral Therapy (CBT) to address negative thought patterns and behaviors.

I'm a Licensed Clinical Social Worker (LCSW) based in New York I’m dedicated to empowering clients. I provide a compassionate space for healing and voice. I help clients identify the emotions that keep them stuck. I am here to help you unlock that potential. Together, we will forge a path toward confidence, empowerment, and healthy coping strategies. From age 15, my dedication to psychotherapy became evident. I passionately believe in the transformative power of healing and resilience. My life's mission is to support those navigating trauma, anxiety, significant relationship challenges, and self-doubt.

Overwhelming life experiences? Stop right here. I have a few questions for you. Have you ever felt like throwing in the towel? Like shouting "I give up!" or wanting to trade in your life for a whole new one? If any of this applies to you I am so glad you stopped by my page. I am a dedicated therapist who has been through a thing or two myself. I have a variety of life experiences that make it easy for me to relate to others. I use a trauma informed; strength based; integrative approach. I have been doing this for awhile and still love it! I am a Licensed Clinical Social Worker (LCSW) in the state of New York. Although I specialize in helping people who have experienced trauma; I also really love to help people get organized. I am able to assist with a lot other things as well.

I have over 15 years of psychotherapy experience as an LCSW-R based in NY. I enjoy working with ages 12 and over focusing on life transitions, anxiety related concerns, sports performance, as well as many other areas of need. I want to help clients find the best version of themselves and be able to find success in their treatment goals.

I am licensed marriage and family therapist and credentialed alcoholism and substance abuse counselor. I work with individuals, couples, and families. My approach is cognitive-behavioral strength-based approach. I focus on helping people invalidate negative thoughts and become aware of their strengths in order to improve their confidence and self-esteem. With couples, I focus on assisting with improving communication, developing a better understanding of one another, and compromising.

I am a psychotherapist in White Plains, NY, with a focus on treating individuals, couples, and families. I work as a bilingual school-based clinician with MHA Westchester, based in the North Rockland school system, and an LMFT in private practice at Bridge To Bliss Therapy. I hold certifications from the Center for Practice Innovations at Columbia Psychiatry and NYU Grossman School of Medicine, two prestigious post-graduate programs. In addition, I have training in the Gottman Method for couples. I am certified in Cognitive Processing Therapy (CPT), Integrated Mental Health/Addictions Treatment Training (IMHATT), and Managing & Adapting Practice (MAP).

I have been working with adults for approximately 15 years. On the first visit, my job is to listen to your description of what is going on in your life. What are the stressors, what are the protective factors? Also, what are your strengths and challenges? We then collaborate on what it is that you want to change. We look at behavior/thinking,feeling patterns that may get in the way of a better quality of life. I come from a place of I'm okay and you're okay, meaning that we both have value and mutual respect.

My name is Andrea. I am a Licensed Mental Health Counselor in the state of FL and NY. I have over 10 years of experience working with children and adults in inpatient and outpatients settings, including corrections. I was raised in NY by West Indian (Caribbean)/Asian parents. I then moved to FL where I earned my BA in Psychology and Masters in Mental Health Counseling. My passion is helping others figure out this crazy thing called life, and learn how to live with more satisfaction. My approach to therapy is person centered and may change from patient to patient. This means it will be tailored to each person's specific needs. I enjoy building rapport with my patients to help encourage a healthy therapeutic relationship and allow my patients to feel as comfortable as possible. So whether it's anxiety, depression, or trauma etc., let's figure this out together!

I’m a Hispanic female, 42 years old. A mom to two special needs children. I have the experience and the knowledge on the concerns I feel comfortable treating. I’m open minded and I include myself in the therapy journey, I speak in the WE not the YOU and definitely not the I. I’m knowledgeable with many different cultures and styles of living. I’m LGBTQ affirming and a vast understanding of neurodivergence. I do my best work when I feel most comfortable and that includes the clothes I wear. I always stay true to my self.

Hello, I'm a Licensed Mental Health Counselor with over 15 years of experience, specializing in Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and person-centered approaches. I work with clients to navigate life's challenges, helping them build resilience and achieve personal growth. My aim is to provide a supportive environment where you can explore your thoughts and feelings, develop effective coping strategies, and make meaningful changes in your life.

Are you feeling anxious or depressed? Do you want to feel better, be less stressed, feel more positive, handle your thoughts and feelings more effectively? If you answered yes to one or more of these questions, I can help. I am a supportive and empowering therapist. I provide a warm and supportive environment that stresses collaboration, mutual respect and trust. If you are you ready to start: developing healthy coping skills, change negative behavioral patterns, improve personal/romantic relationships, work on problem solving techniques and reduce stress. Please reach out so we can discuss how to meet your goals. Our work is empathic, proactive, and collaborative- we are on this journey together. We will make meaning out of hardship and transform crisis into opportunity. I am passionate and committed in helping each person achieve their maximum potential. I am licensed in NY, CT and NJ.

Hello! My name is Gregory Longmore. I'm a Licensed Mental Health Counselor based in Brooklyn, NY. I provide Christian counseling, however I'm able to clinically assess and treat the most common mental health disorders. This means that it's not required that we talk about Christ, or that you are Christian to use my services. Currently I'm offering online services only, through a virtual clinic.

Victoria James is an experienced Licensed Clinical Social Worker, Psychotherapist, Anxiety & Mindset Expert, Wellness Entrepreneur and the Founder of Ever Growth Counseling®, LCSW, PLLC. Ever Growth Counseling was created for busy Young Professional’s, Millennials and Entrepreneurs who are struggling with mental health challenges and in need of support across the states of New York, New Jersey, Connecticut and Florida. Additional services include life coaching, consulting, wellness workshops for businesses, clinical supervision for mental health professionals, business coaching for therapists and wellness professionals who need support with start up or scaling their business. Victoria is a member of the BIPOC community. She is a First generation American born to a multi-racial immigrant family. Victoria can support you around issues related to racial/ethnic identity, challenges of being first generation American or person of color. She has a passion for Mental Health and hopes to destigmatize mental health services in BIPOC communities. Victoria enjoys working with young adults, women in male dominated careers, entrepreneurs, creatives, college students, high achievers, therapists, wellness professionals, lawyers, finance and tech professionals. Her goal is to help people uncover their true potential and lead a fulfilling life. Victoria has over 15 years of experience in the Wellness & Mental Health Field. She completed her Bachelor of Social Work degree at Long Island University, Brooklyn Campus and earned a Masters of Social Work at Stony Brook University. Victoria has worked in a variety of mental health settings including Inpatient Medical Units, ABA Behavioral Therapy programs, Outpatient Mental Health Clinics and Non-Profit Community based programs. She has extensive experience in treating symptom’s related to anxiety, stress, impostor syndrome, depression, burnout, low self-esteem, homelessness, life transitions, child developmental disorders, crisis management, and generational trauma to individuals and families across New York City.

Hi there. I’m Marlene, I am a Licensed Clinical Social Worker based in Florida and licensed in Florida and New York. I work with young and older adults and specialize in anxiety, depression, loneliness, family issues, relationship issues and loss. I utilize Cognitive Behavioral Therapy, Dialectical Behavior Therapy, Strength- Based Therapy and Psychodynamic Therapy to help you make progress and start feeling better. Throughout my over 15 years of experience, I have been fortunate to work with children, and adults including home-bound adults, and seniors. Some of my areas of specialization include mood disorders, anxiety, relationship issues, family issues, working to reduce depressive symptoms and strengthening self-esteem. I am certified in Dialectical Behavior Therapy and a Certified Grief Informed Professional.

Hi! I'm a Licensed Clinical Social Worker based in New York City. I received my Masters in Social Work from Adelphi University in Garden City and have been practicing for over 10 years. I have experience working with adults , adolescents, children, families and couples. I have a deep passion with improving their outlook on life obstacles.

Hi, I am a licensed therapist based in New Jersey. I received my master's degree from Fordham University. I have been working with adults who suffer from depression, anxiety and loss for the last 9 years. I provide a safe judgment free environment for you to discuss your problems. My passion is helping is helping others heal and find solutions.

Providing therapy, being a listener and helping others in essence found me. I did not initially plan to become a therapist but I am so happy and proud I did. I receive joy from being able to find the right words and work through the issue with my client. Therapy is a very important tool, whether it is intensive treatment or being a supportive ear. I have worked in the helping field for over 20 years. Beginning my career with developmentally delayed, then preventive services, foster care, Autism spectrum and currently providing child and adult psychiatric services. I enjoy the reward of helping! I am licensed to provide treat in New York and Georgia.

Hello. I'm a Licensed Clinical Social Worker living in New Jersey . I received my Masters from Fordham University Graduate School of Social Work. I have over 20 years of clinical experience. My practice is centered on working with individuals who struggle with anxiety, burnout and depression. We work together as a team to create a plan that best work for you.

Welcome! I'm a licensed mental health counselor based in New York. I'm also a Credentialed Alcoholism and Substance Abuse Counselor and Licensed Art Therapist. My practice is primarily psychodynamic while incorporating elements of cognitive and behavioral therapies as needed to assist in restructuring self-defeating patterns. My role is to travel your path with you, to create a space and relationship that is welcoming and safe.

Hello, my name is Janet Pierre-Toussaint.My ideal client is someone who is seeking growth and self-awareness, struggling with anxiety or life transitions. They need support in building emotional resilience and healthier coping mechanisms. Their goal is to lead a more fulfilling life by understanding their emotions, improving relationships and gaining confidence in their ability to navigate challenges. Open to vulnerability and potential uncomfortable feeling that comes with growth. Seeking therapy to better understand themselves and to develop skills for lasting change. Taking the first step in seeking care can be hard, but together we'll build the tools you need to start living the life you truly deserve.

Hi! I’m a Licensed Clinical Social Worker (LCSW) based in the state of New York. I received my Masters Degree from the University of New Hampshire and have been practicing for 7 years. I work with adults struggling with various life stressors, transitions, and diagnosed mental health conditions such as anxiety and depression. My goal is to help you process, heal, and become the you that you have thought you could only imagine.

I am a Clinical Therapist with over a decade of experience in counseling, leadership, and mentoring. I have my Masters in Clinical Social Work and specialize in Trauma and PTSD, Relationships, Grief and Loss, Life Transitions, and mood-related concerns. I work with clients from all age groups, focusing on finding practical and meaningful solutions for difficult situations. I offer a strengths-oriented and trauma-informed perspective grounded on various therapeutic techniques. I am very aware of the dynamics culture, gender, and other external factors play on our life choices. Treatment is approached holistically and includes all the different pieces of who you are so that change can be meaningful and long-lasting. As a Certified Christian Counselor, I have experience integrating faith with clinical treatment. I believe spiritual and emotional wellness go hand-in-hand and actively work towards bridging the gap between spirituality and mental health. For my clients who identify as Christian, we will focus on spiritual growth alongside of developing clinical skills. Therapy is tailored to your specific needs and filled with compassion and respect. I aim to create a challenging yet encouraging space so my clients feel empowered as they work towards healing and growth. Let's get a session scheduled and discuss your needs. I am looking forward to meeting you and being part of your journey.

I am Ayana Foluke McKanney, a seasoned Clinical Social Worker and Life Coach with over 26 years of experience in both public and private sectors, helping individuals and families navigate life’s most challenging circumstances. I hold clinical social worker licenses in New York (#098940) and Rhode Island (#ISW04317). I believe that obstacles are opportunities for growth, and I support my clients in reflecting on their experiences, safely processing their feelings, and then choosing empowered ways to move forward. I specialize in supporting individuals as they heal, build fulfilling careers, navigate family dynamics, and create a life of balance and purpose.

I am a licensed clinical social worker and integrative mental health therapist. What does that mean? I work holistically and believe truly in the "mind body" connection when working with my clients to find healing and their individual path forward. I also am a firm believer in practicing what I preach. In my every day life I use a ton of integrative and mindfulness tools to support my own self care and need for balance.

Lillian is not only a Licensed Clinical Social Worker (LCSW) based in New York, New Jersey, and Connecticut. She is also proud member of the New York Chapter of the National Association of Black Social Workers, Inc. (NABSW). With various years of experience working in a variety of different mental health settings, including outpatient, inpatient and addiction. She utilizes a strength-based perspective offering a holistic approach that includes a traditional therapeutic process, anti-oppressive/liberation, meditation/mindfulness and self-care practices to promote healing and attainment of maximum potential. Lillian received her bachelor’s degree from Herbert Lehman College, City University of New York, in Social Work. She also earned a master’s degree from the Adelphi University School of Social Work. As an ally who stands in solidarity with refugees and immigrants of any status, Lillian incorporates cultural sensitivity into her work to accommodate different values and attitudes of various cultures and diverse populations.

I am a New York State Licensed Mental Health Counselor and Credentialed Alcohol Substance Abuse Counselor and EMDR trained. I help individuals to develop solutions to the many problems that life can present. In addition to owning my private practice, I currently work as a counselor in an outpatient clinic in the addictions field. I have experience working in residential settings, school counseling, inpatient mental health and chemical dependency, PROS and outpatient chemical dependency.

Hi, My name is Dr. Sister Marian Mikhail Doctorate of Min., L.C.P.C. Advanced, PhD Clinical Pastoral Counseling, M.Div., LMHC, LPC, M.A. Rel. Ed. I am a licensed therapist in New York and New Jersey with 5 years of professional work experience. I have experience in helping clients with stress and anxiety, coping with grief and loss, motivation, self-esteem, and confidence, & career difficulties. I believe in treating everyone with respect, sensitivity, and compassion.

Hi! I am a Licensed Mental Health Counselor (LMHC & LPC) based in Connecticut. I support my clients through life’s inevitable stressors and help them to understand themselves better, all while maintaining a culturally sensitive and empathetic approach so you may feel most supported. I have experience in working with anxiety, adjustment, trauma, anger management, depression, relationship issues, life transitions, and in providing career and academic guidance. It is my aim to bring compassion, insight, and everyday coping tools to my work with you; using an integrated approach of person centered therapy, cognitive-behavioral therapy (CBT), and mindfulness practice. Therapy can be a challenging yet life-changing process. If my approach resonates with you, I encourage you to reach out. Taking that first step is often the hardest!

Hello there! I am a Licensed Clinical Social Worker (LCSW) based in New York, Massachusetts and Georgia. As a therapist, I find my work fulfilling and believe that it is my calling to help my clients in the therapy space. I hold a Master's degree from New York University (NYU) and have been practicing for 20 years. My areas of expertise include helping women who are struggling with trauma, depression and anxiety to overcome their struggles and realize their full potential.

Hi! I'm a licensed clinical social worker, licensed to practice in New York, Virginia and Florida. I acquired a master’s degree in social work from Columbia University and have a master's degree in psychology from NYU. I have been practicing for 16 years working with clients experiencing a wide range of issues that may include one or more of the following: low self confidence, relationship issues, anxiety/overthinking, depression, coping with life changes as well as parents facing challenges with their children. I believe in treating everyone with respect, sensitivity, and compassion. I will tailor our sessions to meet your unique and specific needs. My approach pulls from many different therapy styles blended with a direct, no-nonsense approach. I am here to support you in taking the steps towards building a more peaceful, fulfilling and authentic life.

Hi there, I’m Carrie! I’m a Licensed Clinical Social Worker with 9 years of experience helping individuals navigate life’s ups and downs. I’m passionate about creating a safe, supportive space where you can be yourself and feel truly heard. I specialize in working with young adults facing trauma, stress, life transitions, anxiety, depression, family challenges, low self-esteem, and relationship or friendship struggles. My approach is compassionate, nonjudgmental, and centered on your needs and pace. In our sessions, we’ll work together to better understand what you’re going through, make sense of your experiences, and build tools to support emotional well-being. Whether you're processing past pain or just trying to figure out the next step, I’m here to walk alongside you as you move toward healing and self-discovery.

I am a Licensed Mental Health Counselor licensed in New York and Florida. I am also a certified New York MASTER CASAC and a Florida MCAP. I have been in the field since 2014 and I help those who struggle with substance use, anxiety, day to day life, returning from incarceration/military into the community, mood swings, and depression. I can help you reach your goals at you own pace through guidance and positive reinforcement. I look forward to watching you grow and succeed

I am a licensed clinical psychologist. I have worked with clients presenting with a variety of therapy concerns. I work with clients on helping them identify the concerns they would like to work on. We come up with therapy goals to help address those concerns. We discuss how to address those goals and how to prioritize those goals so that we can work on things in a manageable manner.

Hi! My name is Lisa Eipp and I am a Licensed Mental Health Therapist. I have a School Counselor's degree from Syracuse University along with my licensure for Mental Health. I retired from the public school system in 2023 and I have been in private practice for over 25 years. I feel absolutely blessed to have this opportunity to share your journey.

As a seasoned LCSW with 18+ years of experience, I offer a holistic approach to therapy that honors the interconnectedness of your mind, body, and soul. Through collaborative exploration, we can work together to create a path towards healing and transformation in a supportive and non-judgmental environment. Building strong therapeutic relationships is foundational to my approach, as it fosters trust and facilitates meaningful change. My passion lies in empowering clients to achieve greater independence and well-being. I equip them with practical skills and tools they can utilize beyond therapy, fostering lasting growth. Drawing upon diverse experiences both personally and professionally, I possess strong cultural competency. This allows me to connect with clients from various backgrounds and understand their unique perspectives. Moreover, I am dually licensed in New York and Florida, providing flexibility to serve clients across state lines.

My name is Madeline Almonte, and I am a Bilingual Licensed Mental Health Counselor from New York with extensive experience in educational and therapeutic roles. My Mental Health practice is named THRIVE Wellness & Coaching, LLC, because my vision and approach emphasizes inspiring and guiding clients to THRIVE in life by realizing their true potential through self-reflection and tailored strategies. I work to enhance self-esteem and confidence, alleviate anxiety and depression, and address the impact of traumatic experiences. By focusing on positive development and personal growth, I aim to empower individuals to achieve their aspirations and thrive in all aspects of their lives. Let’s THRIVE together!

I am an LCSW licensed in NY and GA. I graduated from CUNY Hunter College School of Social Work and enjoy working with children/youth and adults. I have experience with play therapy techniques, CBT and solution focused techniques. I believe in clients becoming empowered and utilizing your skills to navigate life successfully. Please feel free to reach out for a free consultation call!

Hey! Hi! I'm a queer, Caribbean-American Licensed Mental Health Counselor based in New York. I received my Masters from the Alliance University (formerly Nyack College) and have been practicing for approximately 3 years, but I've been in the Mental Health/Healthcare field for approximately 10. I help teens and adults who struggle with LGBTQ+ issues, Depression, Anxiety, Stress Management, and Grief become the best version of themselves.

Hi! I am a Licensed Clinical Social Worker--I hold over 13 years of experience facilitating change and transformation. I am passionate about working with individuals who have experienced childhood trauma. I am trained in NARM- which is a holistic approach that incorporated a mind body connection. I am currently completing the NARM master level training. I am mother to two creative, funny and resourceful adolescents. In my free time I enjoy reading, hiking and playing pickleball.

My name is Kathryn Vetrano, a therapist for over eight years who specializes in treating both biologically female adolescents and adults of color, dealing with mood disorders, borderline, personality disorder, and depression. I use a dialectical, behavioral approach to treat emotion, dysregulation, harmful coping skills, having trouble navigating relationships, and to cause an increase in quality of life. I work with clients to improve their emotional reactions to real life situations.

Hello! My name is Jada and I am a Licensed Mental Health Counselor in the state of New York and a Licensed Professional Counselor in New Jersey. I hold my Masters in Mental Health Counseling and been practicing psychotherapy with individual, couples, and families for many years in private and community settings. I use a multitude of therapeutic modalities to ensure client’s treatment is being individualized.

Hello. Great to meet you! I am a psychotherapist who works with teens, families and adults. Providing psychotherapy treatment that offers you support; helping you improve your relationships, reduce stress, depression, anxiety and acute/chronic mental health distress. I have worked with a wide variety of individuals, families and couples to find their path to wellness and reducing acute distress.