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Anxiety is more than just stress; it develops into a pattern that subtly alters how you think, feel, and behave. What begins as simple worry can escalate into irrational fears that seem impossible to overcome. You may start to avoid places, people, or tasks that once felt comfortable. Your mind might leap to worst-case scenarios, and you may find yourself questioning your own reactions, asking, "Is this really dangerous, or is it just me?"

These fears may not always be logical, but they certainly feel real, and they can be exhausting. In this article, we will explore the connection between anxiety and irrational fears, identify symptoms to watch for, and, most importantly, discuss how to break the cycle. If you have ever felt trapped by fear or confused by your reactions, know that you are not alone. At Amae Health, we assist individuals in understanding these patterns and beginning to shift them.

Understanding Anxiety and Irrational Fears

What is Anxiety?

Anxiety is the body’s built-in alarm system, a survival mechanism designed to detect and respond to danger. It activates the fight-or-flight response: heart rate rises, muscles tense, breath quickens. In short bursts, this can sharpen focus and improve reaction time. 

But when anxiety and irrational fears become chronic or misfire in everyday situations, they can overwhelm instead of protect. You might feel on edge without knowing why, or react strongly to things that don’t pose real threats. While anxiety isn’t always visible, it’s deeply physical — rooted in your nervous system and shaped by both biology and experience.

What are Irrational Fears?

Irrational fears are exaggerated or unfounded responses to perceived threats. They can range from specific phobias, like a fear of flying or spiders, to more generalized worries, like the fear of embarrassing yourself in public or losing control of your actions.

What makes these fears irrational isn’t that they feel fake—the feelings are often intensely real—but rather that the perceived danger is out of proportion to the actual reality. These fears are common in anxiety disorders, where cognitive distortions disrupt logical thinking and create a heightened sense of vulnerability, even when you are objectively safe.

The Link Between Anxiety and Irrational Fears

Anxiety primes the body to detect danger - but it doesn’t always get it right. When the brain remains on high alert, even neutral or mildly stressful situations can start to feel threatening. Over time, this misfiring stress response can lead to anxiety and irrational fears, where the mind interprets everyday events as potential threats, reinforcing a cycle of hypervigilance and emotional reactivity.

A systematic review found that people with chronic anxiety show a heightened attentional bias toward threats, especially in verbal form - a pattern that may reinforce anxious thinking and sustain long-term worry cycles.

How Anxiety Triggers Irrational Thinking

Anxiety can hijack your thinking and turn mild concerns into overwhelming fears. It often starts subtly, but the mental patterns it triggers quickly escalate - shaping how you interpret the world around you. This is a key way in which irrational fears develop and take hold.

Research shows that people with high levels of anxiety tend to focus more on perceived threats, especially verbal ones, and have difficulty shifting their attention away from them. This attentional bias reinforces distorted thought patterns and emotional reactivity, making it harder to break the cycle of anxious thinking.

Here's how that cycle unfolds:

• Catastrophizing: The mind imagines worst-case scenarios instantly - turning a small mistake into a life-altering failure in your head.
• Avoidance: To reduce discomfort, you start avoiding triggers, which actually strengthens the brain’s belief that the threat is real.
• Hypervigilance: You stay on high alert, scanning constantly for signs of danger, which keeps your nervous system activated and fragile.
• Thought loops: Anxious thinking becomes repetitive and obsessive, locking you into a story where fear seems justified - even if it isn’t.

Together, these habits create a self-sustaining loop: anxiety leads to fear, fear amplifies anxiety. Breaking that loop starts with noticing the distortion - and gently stepping out of it.

The Effects of Anxiety-Induced Irrational Fears

Irrational fears driven by anxiety can significantly affect daily functioning. These reactions may appear disproportionate, but they often dictate how individuals approach routine situations, decisions, and responsibilities.

Over time, these patterns can limit personal and professional development. Irrational fears may not be grounded in reality, but their influence on behavior and well-being is substantial. Recognizing these patterns is the first step toward regaining a sense of control and flexibility in everyday life.

Recognizing the Symptoms of Irrational Fears

Physical Signs of Anxiety-Driven Fear

Irrational fears often show up in the body, even when there’s no external threat. These symptoms stem from the body’s automatic stress response and can become chronic if not addressed.

Common physical signs include:

• Trembling or shakiness
• Rapid heartbeat or palpitations
• Shortness of breath
• Dizziness or lightheadedness
• Chest tightness
• Stomach discomfort or nausea

When these symptoms appear repeatedly in safe situations, they may point to a pattern of anxiety and irrational fears rather than a physical illness.

Emotional and Cognitive Symptoms

Emotionally and mentally, irrational fears create a cascade of reactions that distort how danger is perceived and processed.

You might notice:

• Intrusive or obsessive thoughts
• Catastrophic thinking (expecting the worst)
• Feeling out of control or detached
• Constant mental “what if” loops
• Difficulty calming down even when safe

This internal noise makes it hard to distinguish real threats from imagined ones, fueling a cycle of anxiety and irrational fears that can feel overwhelming.

Behavioral Patterns to Watch For

Behavior is often where irrational fears become most visible. Many coping behaviors offer short-term comfort but reinforce fear in the long run.

These patterns may include:

• Avoidance – skipping places, people, or situations linked to fear
• Reassurance-seeking – constantly asking others for safety validation
• Checking rituals – re-reading messages, scanning rooms, double-checking locks
• Procrastination – putting off tasks due to vague dread or fear
• Over-control – needing to plan or control every outcome

These patterns are especially common in individuals with high-functioning anxiety, where external calm hides intense internal distress. When these habits interfere with daily life, it’s a sign that anxiety and irrational fears are no longer just occasional - they’re shaping your behavior.

5 Strategies to Manage Anxiety and Irrational Fears

Cognitive Behavioral Therapy (CBT)

CBT is one of the most effective treatments for anxiety and irrational fears. It helps you identify distorted thought patterns and challenge the beliefs that trigger fear responses. By gradually exposing yourself to feared situations and learning new ways to think about them, you reduce the emotional charge behind them.

Therapists may also use tools like thought logs or behavioral experiments to make fear feel more manageable - and less like a runaway train.

Mindfulness and Awareness Techniques

When you're caught in irrational fears, the mind fixates on future threats or past mistakes. Mindfulness brings you back to the present. Techniques like breathwork, body scans, and mindful movement teach you to observe fear without reacting to it.

By building awareness of your internal state, without judgment, you can interrupt automatic responses and shift from panic to presence. This doesn't eliminate anxiety but gives you more space to respond rather than react.

Healthy Lifestyle Habits

Your daily routines shape how your nervous system responds to stress. Sleep deprivation, poor diet, and lack of movement all lower your ability to manage anxiety and irrational fears. Certain nutrient deficiencies can also intensify anxiety-related symptoms like fatigue or restlessness.

Consistent sleep, balanced nutrition, regular physical activity, and reduced caffeine/alcohol can stabilize mood and improve resilience. These changes may seem simple, but over time, they strengthen your foundation — so fear doesn’t take over when life gets hard.

Professional and Peer Support

You don’t have to manage anxiety and irrational fears alone. Talking with a licensed therapist from Amae Health can help unpack the roots of your fear and create a clear path forward. Support groups or peer spaces also offer validation - reminding you that you’re not the only one struggling.

Being seen and heard by others can reduce shame and isolation, which are often amplified by irrational thinking. Connection itself becomes a powerful counterweight to anxiety.

Medication When Necessary

In some cases, irrational fears are too intense to manage with therapy alone. When symptoms interfere with daily life, short- or long-term medication may help balance the brain’s chemistry and reduce overactivation.

This isn’t a quick fix - but for many people, it lowers the background noise enough to make other strategies more effective. Working closely with a healthcare provider ensures that the treatment is safe, personalized, and aligned with your goals.

You Can Break the Cycle

Anxiety and irrational fears don’t have to define your life. With the right support and tools, it’s possible to interrupt the thought loops, ease the physical symptoms, and rebuild a sense of emotional safety.

Whether you're just beginning to notice these patterns or have struggled for years, change is within reach. Healing starts small - with one conversation, one technique, one act of self-compassion.

At Amae Health, we’re here to help you take that first step. Reach out today, you don’t have to face this alone.

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The short answer: for many people, yes. The fuller answer depends on your diagnosis, your history with other treatments, and how your brain responds. That nuance matters because if you are reading this, you have already tried the straightforward answers.

Maybe you have been through two or three medications that helped a little, but not enough. Maybe therapy gave you tools, but you still wake up with a tight chest and a mind already spinning. Maybe you feel permanently stuck in fight-or-flight. And trying yet another treatment feels less like hope and more like another chance to be disappointed.

This article is not here to make promises. It is here to give you a clear picture of what TMS therapy for anxiety involves - what the evidence supports, what is still emerging, and whether this might be the right next step for you.

What Is TMS Therapy for Anxiety?

Transcranial magnetic stimulation, or TMS, is a non-invasive brain stimulation technique. A device placed near your scalp delivers focused magnetic pulses that stimulate specific brain regions - no surgery, no anesthesia, no medication entering your bloodstream. You sit in a chair, fully awake, while a coil delivers brief pulses that feel like tapping on your scalp. Afterward, you drive yourself home.

Here is what TMS for anxiety looks like in practice:

• Non-invasive - no needles, no implants, no sedation required
• Outpatient - done in a clinic, no hospitalization
• Session length - typically 20 to 40 minutes
• Course length - 4 to 6 weeks, five sessions per week (20-30 sessions total)
• Common sensations - rhythmic tapping on the scalp, clicking sound, mild scalp pressure

Most people tolerate it well from the first session, and any scalp discomfort typically lessens within the first week.

Why People Consider TMS for Anxiety

TMS therapy for anxiety tends to enter the picture when standard treatments have not worked well enough, or when a person wants an option that does not involve more systemic medication. Common reasons people seek TMS:

• Multiple medications tried with limited or inconsistent results
• Side effects (weight changes, emotional blunting, sexual dysfunction) that were hard to sustain
• Partial response to therapy - better, but still significantly impaired
• Anxiety co-occurring with depression, complicating treatment response
• Preference for a non-medication approach for personal or medical reasons

How Does TMS Help With Anxiety?

Anxiety disorders are associated with an imbalance between brain regions - an overactive amygdala (the brain's alarm system) and reduced activity in the prefrontal cortex, which handles top-down regulation. Think of it as the alarm going off constantly while the manager who silences it is underperforming.

TMS for anxiety targets these circuits directly. By stimulating the dorsolateral prefrontal cortex (DLPFC), it encourages that regulatory region to become more active - helping the brain reduce fear responses and improve emotional balance. It is not adding a chemical; it is nudging specific neural circuits toward healthier patterns.

What Symptoms Can TMS Improve?

TMS works through neuroplasticity - the brain's capacity to rewire itself through repeated stimulation. This is gradual. Most people notice meaningful changes in weeks 3 through 6, not week one. Symptoms people commonly report improving:

• Persistent rumination and racing thoughts
• Sleep difficulties - both falling and staying asleep
• Emotional overwhelm from stressors that feel disproportionately intense
• Physical tension - jaw clenching, muscle tightness, shallow breathing
• Hypervigilance - the persistent sense of being "on" even in safe situations

Individual responses vary, which is why clinical evaluation and ongoing monitoring matter.

Does TMS Help With Anxiety? What the Research Says

TMS is FDA-cleared for major depressive disorder and obsessive-compulsive disorder. It is not yet FDA-approved for generalized anxiety disorder or panic disorder as standalone diagnoses - making its use for primary anxiety off-label, which is legal and common across many areas of medicine.

The evidence picture is more nuanced than a simple approval status suggests:

• Anxious depression - anxiety co-occurring with depression - has strong supporting evidence, with improvements in both symptom clusters well-documented.
• Research on TMS for generalized anxiety, PTSD, and social anxiety is growing, with studies showing meaningful symptom reductions.
• Clinicians regularly observe anxiety improvements in patients treated for depression, confirming real overlap in underlying brain circuits.

The clearest summary: Does TMS help with anxiety? Evidence is strongest when anxiety co-occurs with depression, and increasingly promising - though still emerging - for anxiety disorders on their own.

TMS vs. Medication: How to Choose

Neither TMS nor medication is the right answer for everyone. They work differently, and the better choice depends on your individual history and clinical situation.

Some people use TMS instead of medication. Others add it to an existing regimen to deepen a partial response. The right answer comes from a clinical evaluation - and the team at Amae Health conducts that evaluation before any TMS course begins.

Who Is a Good Candidate for TMS Therapy for Anxiety?

TMS therapy for anxiety tends to be most appropriate for people who:- Have tried at least one medication without adequate relief

• Experience anxiety that co-occurs with depression
• Cannot tolerate medication side effects, or have medical reasons to avoid certain drugs
• Want a non-systemic option alongside existing therapy
• Are stable enough for outpatient treatment and can commit to 4-6 weeks of sessions

Who Should Avoid TMS?

TMS is not appropriate for everyone. It is generally not recommended for people with:

• A history of seizures or epilepsy
• Metal implants near the head or skull (cochlear implants, certain aneurysm clips)
• Active mania or a mixed mood episode
• An acute psychiatric crisis requires a higher level of care

If any of these apply to you - or if you are unsure - a clinical consultation will give you a clear answer. Do not self-screen out; let a qualified clinician assess your situation. You can also read about how anxiety-related conditions present and are evaluated on the Amae Health blog.

What to Expect During TMS Treatment

Treatment Schedule and Session Length

A standard TMS for anxiety course runs five days per week for four to six weeks - 20 to 30 sessions total, each lasting 20 to 40 minutes. Some accelerated protocols compress treatment into fewer weeks; your provider will recommend the right approach.

What It Feels Like

You will feel a rhythmic tapping on your scalp and hear a clicking sound from the device. Some people experience mild scalp tenderness or a light headache in the first sessions - this typically fades within the first week. You stay fully alert and leave without any restrictions.

Side Effects and Safety

TMS has a well-established safety profile. Common minor side effects:

• Mild headache during or after sessions
• Scalp tenderness at the coil site
• Mild fatigue, particularly early in treatment

Serious adverse events are rare and monitored by clinical staff. Unlike ECT, TMS does not affect memory or cognition. Most people drive themselves to every session.

TMS Therapy for Anxiety at Amae Health

If you have made it this far, you are weighing a real decision. Whether TMS therapy for anxiety is right for you depends on your full history, current symptoms, and goals.

At Amae Health, TMS is integrated into a broader psychiatric care plan, coordinated with therapy, medication management (if applicable), and ongoing clinical oversight. Clinicians conduct a thorough evaluation before recommending TMS, monitor progress throughout, and adjust the plan as needed. If TMS is not the right fit, you will know that clearly, along with a better picture of what is.

Getting started is simple:

1. Schedule a consultation - call 1-888-860-2825 or use the Amae Health contact page to arrange your initial psychiatric evaluation.
2. Complete your clinical evaluation - a clinician reviews your treatment history, current symptoms, and contraindications to determine whether TMS therapy for anxiety is appropriate.
3. Begin your individualized plan - if TMS is recommended, your schedule is set, and your care team stays involved throughout.

You do not have to keep cycling through treatments without a real clinical partner. Reach out to Amae Health in LA and take the next step toward a less anxious life.

When life throws challenges our way, we all react differently. Some of us might feel sad or worried, while others may show their stress through changes in behavior. Adjustment disorder is a condition that happens when someone has trouble coping with a stressful life event. When this struggle shows up mainly as problematic behaviors rather than just feelings, doctors call it adjustment disorder with disturbance of conduct.

This article will help you understand this condition, how to recognize it, and what help is available. Amae Health has been working with patients nationwide for many years, and we know better than anyone how to convey information in simple, understandable language.

Understanding Adjustment Disorder

Adjustment disorder is a mental health condition that develops when someone has difficulty coping with a stressful event or life change. These difficulties start within three months of the stressful event and don't last longer than six months after the stress has ended.

How strongly it affects your life makes this condition different from everyday stress. The emotional or behavioral symptoms are more severe than expected and can seriously impact your daily activities, work, relationships, or school performance.

There are several types of adjustment disorders, depending on the main symptoms:

• With a depressed mood (mainly feeling sad)
• With anxiety (mainly feeling nervous)
• With mixed anxiety and depression (both feelings together)
• With disturbance of conduct (mainly behavioral problems)
• With mixed disturbance of emotions and conduct (both feelings and behaviors)

What Does "Disturbance of Conduct" Mean?

When doctors talk about adjustment disorder with disturbance of conduct, they're referring to a specific way that stress shows up in a person's behavior. Unlike other types of adjustment disorder, where feelings like sadness or worry are the main symptoms, this subtype is recognized by changes in how someone acts.

"Conduct" in this context means behavior that affects others or breaks social rules. A disturbance of conduct involves acting out in ways that might violate the rights of others or go against major age-appropriate social norms or rules.

It doesn't mean the person is "bad" or deliberately causing problems. These behaviors are symptoms of difficulty adjusting to stress, just as fever is a symptom of infection, not a sick person's choice.

Common Signs and Symptoms

Key Behavioral Signs

People with adjustment disorder with disturbance of conduct typically show changes in their behavior rather than just in their mood. These changes usually start within three months of a stressful event.

Common behavioral signs include:

• Acting aggressively toward people, animals, or property
• Breaking rules at home, school, or work that they used to follow
• Arguing more frequently with family members, teachers, or supervisors
• Skipping school or work
• Ignoring previously respected boundaries
• Taking risks they wouldn't normally take
• Stealing or damaging property
• Having sudden outbursts of anger that seem out of proportion
• Deliberately annoying others
• Refusing to comply with reasonable requests

Impact on Daily Life

Adjustment disorder symptoms can significantly affect many areas of a person's life:

• Relationships: The behavioral changes can strain relationships with family members, friends, romantic partners, and colleagues. Arguments may increase, and others might start avoiding the person because of their unpredictable behavior.
• School or Work: Performance often suffers as the person may skip classes or shifts, have trouble concentrating, or get into conflicts with teachers, classmates, or coworkers. Grades might drop, or work quality may decline.
• Legal Consequences: Some behaviors associated with disturbance of conduct might lead to legal problems, especially if they involve breaking laws, damaging property, or aggressive actions.
• Self-Esteem: As problems mount in different areas of life, the person might feel worse about themselves, creating a cycle where stress leads to problematic behavior, which creates more stress.
• Physical Health: The ongoing stress and behavioral issues can affect physical health, leading to problems like headaches, stomach troubles, or sleep difficulties.

It's important to remember that these impacts aren't happening because the person chooses to be difficult. They're struggling with a genuine adjustment problem that needs understanding and proper support.

Causes and Triggers

Adjustment disorder with disturbance of conduct doesn't have a single cause. Instead, it develops from a combination of factors:

Stressful Life Events. The most obvious trigger is exposure to a stressful situation or significant life change. It might be:

• A major loss (death of a loved one, divorce, job loss)
• A significant transition (moving, changing schools, retirement)
• A sudden change in health (diagnosis of a serious illness)
• Family conflicts or domestic problems
• Financial hardships
• Workplace stress or academic pressure

Personal Vulnerability. Not everyone who faces these stressors will develop an adjustment disorder. Personal factors that might increase risk include:

• Previous mental health challenges
• Childhood experiences of trauma or instability
• Limited coping skills
• Lack of strong support systems
• Certain personality traits

Environmental Factors. The context in which the stress occurs matters too:

• Cultural factors affecting how stress is perceived and handled
• Availability of social support
• Concurrent stressors happen at the same time.
• Economic resources available to cope with challenges

Diagnosis and Assessment

Getting an accurate diagnosis of adjustment disorder with disturbance of conduct involves a thorough evaluation by a mental health professional, typically a psychiatrist, psychologist, or clinical social worker.

The Assessment Process:

• Clinical Interview: The professional will talk with you about your symptoms, when they started, recent life events, and how your functioning has changed.
• Medical History: A review of your physical health and any medications you take helps rule out medical causes for behavioral changes.
• Psychological Evaluation: You might complete questionnaires or assessments to measure your symptoms and their severity.
• Collateral Information: With your permission, the clinician might speak with family members, teachers, or others who have observed your behavior changes.
• Differential Diagnosis: The clinician will consider whether your symptoms better match other conditions.

Treatment and Management

Therapy Options

The good news about adjustment disorder with disturbance of conduct is that it responds well to treatment, especially when started early. Amae Health offers some main treatment approaches:

Cognitive-Behavioral Therapy (CBT): This approach helps identify and change unhelpful thought patterns contributing to behavioral problems. CBT teaches specific skills for:

• Managing anger appropriately
• Solving problems more effectively
• Communicating needs without aggression
• Recognizing triggers for disruptive behavior

Individual Psychotherapy: Regular sessions with a therapist provide a safe space to process feelings about the stressful event and learn healthier coping strategies.

Family Therapy: Since disturbance of conduct affects relationships, involving family members can be beneficial. Family therapy can:

• Improve communication patterns
• Help family members respond effectively to problematic behaviors
• Address family dynamics that might be maintaining the problem
• Teach everyone skills to support recovery

Group Therapy: Meeting with others facing similar challenges can reduce feelings of isolation and provide opportunities to practice new social skills.

Medication: While medications aren't usually the first treatment for adjustment disorder, in some cases, they might be prescribed to address specific symptoms like severe anxiety, insomnia, or impulsivity.

Supporting Long-Term Recovery

Beyond formal treatment, several strategies support ongoing recovery:

• Stress Management: Learning and practicing stress reduction techniques like deep breathing, progressive muscle relaxation, or mindfulness meditation.
• Lifestyle Adjustments: Regular physical activity, adequate sleep, and a healthy diet can improve mood regulation and reduce stress.
• Building Support Networks: Strengthening connections with supportive friends and family members provides emotional resources during difficult times.
• Developing Coping Skills: Working on problem-solving abilities, emotional awareness, and communication skills creates resilience for future challenges.
• Environmental Changes: When possible, modifying or removing ongoing sources of stress can reduce symptoms.

When to Seek Help

It's essential to reach out for professional help if you notice these signs in yourself or someone you care about:

• Behavioral changes that persist for several weeks after a stressful event
• Actions that are causing problems at school, work, or in relationships
• Aggressive behavior that could harm the person or others
• Declining performance at school or work
• Withdrawing from previously enjoyed activities
• Getting into legal trouble
• Using alcohol or drugs to cope with stress
• Expressing hopelessness or having thoughts of self-harm
• Behavioral problems that don't improve despite your best efforts to help

Early intervention for adjustment disorder with disturbance of conduct can prevent symptoms from worsening and reduce the risk of long-term consequences. Remember that seeking help is a sign of strength, not weakness.

How Amae Health Can Help

At Amae Health, we understand that facing an adjustment disorder can be challenging, but you don't have to go through it alone. Our compassionate team specializes in supporting people through difficult life transitions.

Our approach to treating adjustment disorder with disturbance of conduct is personalized, comprehensive, and evidence-based. We offer:

• Expert assessment and diagnosis by experienced mental health professionals
• Individual therapy using proven approaches like Cognitive-Behavioral Therapy
• Family therapy to strengthen your support system
• Skills-based groups focused on anger management and stress reduction
• Coordination with schools or workplaces when helpful
• A warm, welcoming environment where you'll feel understood and respected

Our goal is to help reduce symptoms and empower you with tools and strategies that will serve you long after treatment ends. We believe in building resilience to help you navigate future challenges more effectively.

Frequently Asked Questions

What is the difference between adjustment disorder with disturbance of conduct and conduct disorder?

A specific stressful event triggers adjustment disorder with disturbance of conduct and typically lasts less than 6 months. Conduct disorder isn't linked to a specific stressor, develops more gradually, and tends to persist much longer with more serious violations of others' rights.

How long does adjustment disorder with disturbance of conduct last?

Adjustment disorder symptoms typically resolve within 6 months after the stressful situation ends. With proper treatment, many people see improvement much sooner.

Can this condition resolve without treatment?

Mild cases of adjustment disorder may improve independently, especially with good social support and after the stressful situation resolves. Professional help can speed recovery and prevent complications.

What are the most effective treatments for this subtype?

Cognitive-behavioral therapy and psychotherapy focusing on coping skills and addressing problematic behaviors are most effective. Family involvement in treatment often improves outcomes, especially for children and teens.

Is medication necessary for managing conduct-related symptoms?

Medication is not usually the first-line treatment, but might be prescribed temporarily in some cases. It's typically only considered for specific symptoms like severe anxiety or sleep problems.

When should someone seek professional help?

Professional help should be sought when behavioral changes after a stressful event interfere with daily functioning or cause relationship problems.

Can adults also experience adjustment disorder with disturbance of conduct?

Yes, adults can experience adjustment disorder with disturbance of conduct. In adults, the symptoms might appear as workplace conflicts, reckless behavior, or legal problems that weren't present before the stressful event.

Is this condition considered a mental illness or behavioral issue?

Adjustment disorder with disturbance of conduct is classified as a temporary mental health condition that affects behavior in response to stress. With proper support, most people return to their usual functioning without long-term mental health concerns.

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