Therapy for Anxiety

Anxiety is one of the most common issues I see in my therapy room.  I also know that the idea of therapy in itself can be anxiety-inducing, so as part of my About Therapy series, I wanted to write something about therapy for anxiety.

Psychotherapy is incredibly effective for anxiety, although it can take a long time as there are lots of steps to take and the work can involve much un-picking.

In this article, I explain what anxiety is, how it becomes problematic, and the process of therapy for anxiety.  And I start with a quick note about my relationship with anxiety.

Anxiety and Me

Anxiety is part of me and has been problematic at times.  Through therapy, I managed to understand its root causes, and heal from events in my history which then allowed me to change my relationship with it.  I now recognise anxiety as part of human experience, and when I feel it I take it as a signal to self-soothe, then examine what’s happening, and work out if it’s in the “Bucket of Reasonable Concern” (I’ll say more about this later), or a reaction that’s more about ancient scars than real-life events.  Once I’ve done that, I can take rational, mitigating actions.

What’s Anxiety?

Anxiety is a normal human response just as, for example, hunger is.  Where hunger is a signal to eat, anxiety is a signal that alerts us to a perceived threat, telling us that action is required to mitigate the apparent danger.

You’ll no doubt have heard about “Fight or Flight” response which has been extended to include “Freeze, Flop”.  Those 4 automatic responses are our brains’ response to danger. They bypass the parts of our brain that can make sense of things and make rational decisions.  Which in evolutionary terms make sense: if we’re in imminent danger, there’s no time for thinking, we need to act immediately.

What’s the difference between Worry, Anxiety and Panic Attacks?

Worry and anxiety are similar to each other.  Essentially anxiety is a more extreme version of worry, which is a fear about events that are happening in the future.

Panic attacks are more extreme still.  They are usually really scary – heart racing, shortness of breath, feeling nauseous, and light-headed or faint are all symptoms.  The first time it happens can feel like a heart attack, impossible to believe it’s mental-health related.  You may even believe you’re about to die.  I know when it first happened to me I dissociated for a few moments – my brain sort of switched off and it felt like my head was buzzing.

Here’s the link to Mind’s website where you can read their description:

https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/about-anxiety/

What Causes Anxiety?

In general, problematic anxiety is caused by difficult historic events.  That can be one big single incident, but often it is repeated unacceptable small actions or experiences that on an individual basis would probably be easily forgotten or dismissed. 

For example, if as a child your parent was prone to outbursts of anger, it makes sense that you would develop a strategy to be on high alert, ready for danger which may appear at any moment when you are near them – anger from adults is really scary for a child.  That strategy is unlikely to have been consciously made, but an instinctive survival technique that kept you safe at the time.  As an adult, that may then manifest as a tendency to be on high alert with everyone, or particular groups such as men or women in general, people in positions of power, or even people with a particular physical appearance.

Anxiety can also relate to challenging current events or situations, such as an unhealthy relationship, when you have tough decisions to make, or significant difficult events are happening around you. 

When is Anxiety Problematic?

Anxiety becomes problematic when it persists, is all-consuming, and stops us living our lives to the full.  That’s where therapy for anxiety can help.

It can be difficult to understand for anyone who hasn’t experienced it.  We all feel worry, but on the whole we have strategies to manage it, rationalise our thoughts and carry on with our lives.  It’s important to try to understand that for problematic anxiety, the “fight-flight” response renders out of action the parts of our brain that can rationalise.

The “Bucket of Reasonable Concern”

I started using this phrase “Bucket of Reasonable Concern” after a client used it.  It’s a perfect way to describe those situations where anxiety or worry is rational.  For example if you’re feeling anxious about the results of medical tests, someone you know does not hold the same values as you, or if you’re preparing for a particular exam that your future depends on, then it’s perfectly reasonable to worry.

Therapy for Anxiety

So how does therapy for anxiety work? (By the way, I use “therapy” and “psychotherapy” interchangeably to mean the same thing.)

There are 5 main tasks in the therapy work, which you’ll read in a moment, but the most vital element that must be in place before those tasks can be successful is for the client to feel psychologically safe.

Psychological Safety: the Science Bit

Now I’m not a neurobiologist, but that hopefully means I can explain what I learned in my training in reasonably plain English!

When our fight-flight response (the “limbic system”) is active, the thinking bits of our brain that can rationalise, give meaning to what’s happening and explain in words (e.g. the pre-frontal cortex, hippocampus) are effectively switched off.  They are relatively slow to work, and when we’re in danger we don’t have time to do any thinking.  That’s why when we’re highly anxious or in panic, attempts by those around us to tell us why we’re wrong to worry don’t make things any better at that time.

So in order for those “thinking” parts of our brain to do their work, to accurately make sense of what is happening (or what’s happened in the past), we need to be self-regulated.  That means we have been soothed, our limbic system has calmed down to a greater extent, and our thinking brain has switched back on.

That’s why working with an accredited psychotherapist for anxiety can be so helpful.  If you feel comfortable with them, you know they are trained so can work with anxiety, you’ll feel increasingly relaxed in their company, and as time progresses you’ll be able to perceive the lack of judgment, and you’ll know you don’t have to be concerned with their thoughts and feelings.

I find the last 2 – knowing you won’t be judged and not worrying about me the therapist – can be the hardest for clients to achieve, particularly if they have a tendency to assume others judge them negatively.  Your relationship with an accredited psychotherapist is in-and-of-itself part of the therapeutic work as you spend time with someone you know is non-judgmental.

Tasks of Therapy for Anxiety

So on to the therapeutic tasks:

1. In-the-moment strategies
2. Uncovering the root cause
3. Healing past trauma
4. Exposure therapy
5. Changing your relationship with anxiety

In-the-moment strategies

This is working out what steps to take when a sense of wobble, anxiety or panic is happening.

It’s important to know that any attempts to rationalise, make sense of what’s going on are unlikely to work at this time.  It’s about soothing, which you may be able to manage yourself, or you may need the help from others.

The usual go-to techniques to learn are as follows.  All of them are additionally helpful if a loved one or close friend does them with you:

1. Breathing out – our bodies are short of oxygen, and we’re so busy trying to get oxygen in that we forget to breath out. I’ve created a helpful video to guide you through.
2. 3 things exercise – identify 3 things you can see, hear, smell, touch, and maybe even taste.
3. Visualise – an exercise to identify the shape and feel of your anxiety.
4. Hugs – perhaps the easiest of all! This wouldn’t be with me (it’s ethically problematic), but asking a loved one (best if negotiated beforehand) to hug you releases oxytocin and other hormones that sooth.

Uncovering the Root Cause

This is where we go into your history.  You may not know why you’ve ended up with problematic anxiety, although I often find clients have theories that are on the right track to discovery. 

I sometimes find that clients feel embarrassment or shame that their experience on the face of it seems so apparently trivial compared to the experience of others.  However, when we examine it we find it makes perfect sense and isn’t actually so trivial.

I have to say that sometimes anxiety is due to current circumstances.  If you’re in an unhealthy relationship, have challenging decisions to make, or significant difficult events are happening around you, then anxiety is a normal response.  In those circumstances being able to talk about it along with some other strategies will help you through difficult times.

Healing past trauma

Sometimes uncovering the root cause and understanding the underlying cause is enough to heal. 

Often though, there’s a little more work to be done.  Depending on your therapist, their model of working, and what works for you will govern how that’s done.

I often find using visualisation to go back to the events and change the narrative, or working with the wounded parts in the present day is incredibly powerful for some clients.  If visualisation is uncomfortable for you, describing how things could or should have been different, being heard and understood is the approach I take.

Exposure therapy

Exposure therapy is usually considered in the context of phobias, although the same principles can be applied to anxiety.

Setting boundaries, asking for what you’d like, having difficult conversations, accepting complements, entering social situations are examples of skills relating to reducing anxiety that are important to learn. 

I ask clients to identify what would be the smallest challenge they can set themselves so that whilst it might be a challenge, it’s only a little anxiety-provoking so feels do-able. 

As time goes on, as you have those successes, and recognise (“integrate”) them, you grow in confidence and anxiety reduces.

Your psychotherapist will help you identify those small steps across a whole heap of topics, and encourage you to keep at it.

Changing your relationship with anxiety

This is the one I always struggle to explain to clients when they begin working with me.  It’s because I know that when you feel riddled with awful anxiety, the idea that one day you might see it as friendly seems ridiculous.

Once you understand your anxiety more, and have healed from your past then a) anxiety responses are likely to be reduced, and b) when you do feel anxious you’ll be able to understand it as a call to action – to self-sooth, or know it’s in the “bucket of reasonable concern”.

I really do see my anxiety now as a signal, telling me things aren’t quite right.  It can signal where being the authentic me doesn’t work in the environment I find myself in, or where I’m open to potential rejection, so I can self-sooth then act accordingly.

The quest for authenticity is a whole separate article (yet to be written!).

When will I know we’re done?

Knowing the time to end therapy is almost as important as knowing when to start.  If you have supportive, understanding family and friends it’s likely to be sooner than if you have fewer trusting relationships.

I find working with anxiety is rarely just a few sessions.  Regular reviews of how it’s going, working out a frequency and intensity that works for you are important as we progress.  After an initial few weeks, moving to fortnightly or monthly is often an option with me, especially if finances are tight.  Some clients choose to continue every week for an extended period, whilst others opt for the occasional check-in as they start to feel they’re making significant progress on their own.

Ready for therapy for anxiety?

Most therapists offer a free initial consultation.  This is important so you can get a sense of who they are, and if you can imagine yourself opening up to them. 

The most anxious and confusing time can be when you’re about to contact a therapist then waiting for that initial consultation.  Once you’ve had that initial chat, your therapist will hopefully have helped you feel calmer on that call / in that meeting, and will have provided you with some idea of what to expect giving you at least a little sense of hope that things can change with their help.

I offer a free 10-minute telephone consultation, and usually I set aside a little more time than that just in case it would be helpful for us to talk a little longer.  If you’d prefer it in person, contact me and I’ll get you booked in.  How you get in touch with me to book that initial chat is down to you: you can book online, text, telephone or email me – whichever is your preference – my contact details are below.  

Online booking: Book here

Call or text: 07968 767 232

Email: michelle@counsellingwestbridgford.co.uk

If you’d like to check my credentials, here’s the link to my profile on the UKCP’s Find A Therapist: Michelle Briggs (psychotherapy.org.uk)

If you’d like to explore my website further, here are a few links that you might find helpful: