Anxiety Therapy
Psychological therapy for anxiety, worry, panic and overthinking
Psychological therapy for anxiety, worry, panic and overthinking
Anxiety can affect people in very different ways. For some, it means constant worrying and finding it difficult to switch off. For others, it might involve panic, physical tension, avoiding situations, seeking reassurance or repeatedly thinking through things that have already happened.
Sometimes anxiety is obvious. At other times, you may appear calm and capable to everyone around you while experiencing a great deal of worry internally.
I am Dr Aaron Shaw, Chartered Clinical Psychologist, and I offer evidence-informed psychological therapy for adults experiencing anxiety and related difficulties.
Therapy provides a space to understand what may be driving your anxiety, identify the patterns that are keeping it going and develop more helpful ways of responding.
When Anxiety Starts Taking Over
Feeling anxious from time to time is a normal part of being human. Anxiety is one of the ways our mind and body prepare us to deal with potential threat, uncertainty or difficulty.
The problem is not necessarily that we experience anxiety.
The problem is when anxiety starts becoming too frequent, too intense or begins influencing the decisions we make.
You might notice that you:
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spend a lot of time worrying about things that might happen
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replay conversations afterwards and wonder whether you said the wrong thing
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struggle to relax or switch off
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feel tense, restless or constantly on edge
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avoid situations because they make you anxious
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experience panic attacks or sudden surges of anxiety
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worry about what other people think of you
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repeatedly seek reassurance
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prepare excessively because you are frightened of making mistakes
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become very focused on physical sensations or your health
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find uncertainty particularly difficult
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appear confident externally while feeling anxious internally
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feel exhausted from constantly thinking, preparing or anticipating problems
You do not need to experience all of these difficulties for therapy to be helpful.
Sometimes people simply recognise that anxiety is taking up far more space in their lives than they would like.
What Is Anxiety?
Anxiety is part of the body's natural threat system.
When the brain believes something might be dangerous, important or uncertain, it can trigger a range of physical and psychological responses designed to help us respond.
You might notice your heart beating faster, your breathing changing, your muscles becoming tense or your attention becoming very focused on potential problems.
Your mind may also begin searching for answers:
What if something goes wrong?
What if I can't cope?
What if they think badly of me?
What if I've missed something important?
This system can be extremely useful when we are genuinely in danger.
However, our threat system does not only respond to physical danger. It can also respond to uncertainty, social situations, memories, work pressures, relationships, health concerns and imagined future events.
When that system becomes particularly sensitive, anxiety can begin affecting everyday life even when we logically recognise that there may not be an immediate danger.
Why can anxiety be so difficult to break?
People experiencing anxiety are often already trying extremely hard to manage it.
The difficulty is that some of the things that provide relief in the short term can unintentionally keep anxiety going over time.
For example, anxiety might lead you to:
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avoid situations that make you uncomfortable
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repeatedly check things
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seek reassurance from other people
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mentally rehearse conversations or situations
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try to prepare for every possible outcome
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analyse whether you have made the right decision
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monitor physical sensations
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distract yourself whenever anxiety appears
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set extremely high standards so that nothing can go wrong
These responses make sense.
They often develop because they help us feel safer or more in control.
However, if we never have the opportunity to discover that we can cope with uncertainty, uncomfortable feelings or situations that feel threatening, the brain may continue treating those experiences as dangerous.
Part of psychological therapy involves understanding your particular anxiety cycle rather than simply trying to remove anxious thoughts or feelings.
Anxiety can take many different forms
Anxiety is not one single experience.
People often come to therapy with a mixture of difficulties rather than one clear diagnosis.
Excessive worry
You may find yourself constantly thinking ahead, anticipating problems and trying to work out what might happen.
One worry can quickly lead to another, making it difficult to ever feel that everything has been dealt with.
Read more: Understanding Worry
Panic and physical anxiety
Anxiety can sometimes arrive very suddenly.
A racing heart, dizziness, changes in breathing, feeling detached or experiencing other strong physical sensations can themselves become frightening.
People may then begin worrying about whether those sensations will happen again.
Social anxiety and fear of judgement
You may spend a lot of time thinking about how you come across to other people.
This can involve worrying before social situations, feeling self-conscious while they are happening and replaying conversations afterwards.
Health anxiety
Physical sensations or changes in the body can become a significant source of worry.
You might frequently check symptoms, search for information, seek reassurance or struggle to feel reassured even after receiving medical advice.
High-functioning anxiety
Not everyone experiencing significant anxiety looks anxious from the outside.
Some people respond by working harder, becoming extremely organised, preparing excessively or trying to make sure they never make mistakes.
From the outside, this can look like coping extremely well.
Internally, however, it can feel exhausting.
Read more: What Is High-Functioning Anxiety?
Perfectionism and anxiety
Having high standards is not necessarily a problem.
Difficulties can arise when your sense of safety or self-worth becomes dependent on meeting those standards.
Fear of mistakes, criticism or disappointing other people can then create considerable anxiety.
Read more: Why Am I Such A Perfectionist? When High Standards Become A Problem
Work-related anxiety
Responsibility, deadlines, difficult relationships, uncertainty and high expectations can all contribute to anxiety at work.
Sometimes people find that work continues occupying their mind long after the working day has finished.
How can psychological therapy help with anxiety?
Therapy is not about trying to eliminate every anxious feeling.
Anxiety is a normal human emotion, and experiencing some anxiety is unavoidable.
Instead, therapy can help you develop a different relationship with anxiety so that it has less control over your behaviour and decisions.
We might work together to understand:
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what tends to trigger your anxiety
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the thoughts and predictions that appear when you feel threatened
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how your body responds
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what you tend to do when anxiety appears
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whether avoidance, reassurance, checking or overthinking are keeping the cycle going
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how earlier experiences may have shaped the way you respond to threat or uncertainty
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what helps you feel safer in the short term but may be maintaining anxiety over time
Once we understand these patterns, we can begin experimenting with different ways of responding.
The aim is not simply to provide techniques.
It is to help you develop a clearer understanding of yourself and practical psychological skills that you can continue using outside therapy.
What happens in anxiety therapy?
First, we understand what is happening
The first stage of therapy involves building a detailed understanding of the difficulties you have been experiencing.
We might explore when anxiety tends to appear, what was happening when it became more difficult and how it currently affects your work, relationships, confidence or everyday life.
There is no expectation that you arrive already knowing why you feel anxious.
Making sense of that is part of the therapeutic process.
We develop a shared understanding
Clinical psychologists often refer to this as a psychological formulation.
A formulation brings together your current difficulties, experiences, thoughts, emotions, behaviours and circumstances to help us understand why a particular pattern may have developed and what is keeping it going now.
Rather than simply asking:
“What anxiety disorder do you have?”
we are also interested in:
“Why does anxiety work this particular way for you?”
We begin making changes
Once we understand the pattern, therapy becomes increasingly practical.
Depending on your difficulties, this might involve learning to respond differently to anxious thoughts, reducing avoidance, experimenting with uncertainty, changing patterns of reassurance or checking, developing emotional regulation skills or working with particularly strong self-critical beliefs.
We work towards maintaining progress
An important part of therapy is helping you understand what has made a difference.
Towards the end of therapy, we can identify the psychological skills and insights that have been most useful and consider how you can continue applying them in the future.
My approach to anxiety therapy
There is no single psychological therapy that is right for every person experiencing anxiety.
My approach is therefore integrative and formulation-led.
This means that rather than starting with a predetermined therapy programme, we first develop an understanding of your particular difficulties and then consider which psychological approaches may be most helpful.
Depending on your needs, therapy may draw upon approaches including:
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Cognitive Behavioural Therapy (CBT)
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behavioural approaches and exposure-based techniques where appropriate
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compassion-focused approaches
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mindfulness and acceptance-based approaches
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work focused on self-criticism and perfectionism
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emotional regulation strategies
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psychological approaches for understanding the impact of earlier experiences
We will discuss the rationale for anything we work on together so that therapy feels collaborative rather than something simply being done to you.
Why work with a Clinical Psychologist?
Clinical Psychologists undertake extensive doctoral-level training in psychological assessment, formulation and therapy.
Rather than being trained in only one therapeutic approach, Clinical Psychologists are trained to draw upon a range of psychological models and adapt therapy according to the needs of the individual.
For anxiety, this can be particularly useful because two people experiencing similar symptoms may have arrived there for very different reasons.
My role is therefore not simply to apply a particular technique.
It is to understand the wider psychological picture and work with you to develop an approach that makes sense for your circumstances.
You don't need to know exactly what kind of anxiety you have
People sometimes delay seeking support because they are unsure whether their difficulties are "serious enough" or whether they fit a particular diagnosis.
You do not need to diagnose yourself before coming to therapy.
You may simply know that:
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you are worrying much more than you would like
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you are avoiding things because they make you anxious
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your mind rarely seems to switch off
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you are becoming exhausted from trying to stay in control
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anxiety is affecting your relationships, work or quality of life
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the strategies you normally use are no longer helping
An initial conversation can help us think about what you are experiencing and whether psychological therapy might be useful.
Anxiety therapy face-to-face and online
I offer individual psychological therapy for adults experiencing anxiety.
Face-to-face appointments are available on weekday evenings in Bristol and on Saturdays in Cheltenham. Online appointments are also available across the UK.
If you are looking specifically for face-to-face support, you can also visit my local anxiety therapy pages for further information about appointments in your area.
Using private health insurance
I am recognised by a number of private medical insurers, including AXA Health, WPA and Vitality.
If you are hoping to use private health insurance to fund psychological therapy, your insurer may ask you to obtain authorisation before beginning treatment.
I have created a separate guide explaining how private health insurance appointments work and what information you may need before booking.
Related anxiety resources
You may also find the following articles helpful:
Understanding Worry
Why does the mind keep returning to the same worries, even when thinking about them does not seem to help?
What Is High-Functioning Anxiety?
Some people experiencing anxiety appear highly capable and successful externally while feeling very different internally.
Read What Is High-Functioning Anxiety?
More resources exploring perfectionism, self-criticism, people-pleasing, confidence and anxiety will be added to this section over time.
Frequently Asked Questions
How do I know whether my anxiety is bad enough for therapy?
There is no particular threshold you need to reach before seeking psychological support.
If anxiety is causing distress, taking up a significant amount of your time or influencing how you live your life, it may be worth exploring.
Therapy can also be useful before difficulties become severe.
Do I need an anxiety diagnosis?
No.
Many people begin therapy without having received a formal mental health diagnosis.
The first stage of our work is understanding what you have been experiencing rather than expecting you to arrive with a particular label.
What happens during the first appointment?
The first appointment gives us an opportunity to explore what has brought you to therapy, what you would like help with and some of the experiences that may be relevant.
We can begin developing an understanding of the difficulties together and discuss what therapy might involve.
You will also have an opportunity to ask questions and decide whether working together feels right for you.
How many sessions will I need?
There is no fixed number that is appropriate for everyone.
Some people come to therapy with a relatively focused difficulty, while others want to understand longer-standing patterns that may take more time to explore.
We can discuss this together and review progress throughout therapy.
Can anxiety therapy take place online?
Yes.
Online psychological therapy can work well for many anxiety difficulties and allows me to work with adults throughout the UK.
Whether online or face-to-face therapy is most appropriate can be discussed during your initial consultation.
What if I don't know what is causing my anxiety?
That is very common.
You do not need to understand where your anxiety comes from before starting therapy.
Part of our work together can involve making sense of when the difficulties developed, what might be contributing to them and what is maintaining them now.
Can I use private health insurance?
I am currently recognised by AXA Health, WPA and Vitality.
Insurance policies vary, so you should confirm your individual level of cover and obtain any necessary authorisation from your insurer before treatment begins.
If you are looking for anxiety therapy, you can view support options in your area or get in touch to arrange an initial consultation.