How I help clients with anxiety
Anxiety is one of the most common problems that people bring to therapy. The way I help clients with it isn’t unique or revolutionary, but it is different to the way some therapists work. It’s also different to what clients often expect. So I thought it would be useful to set out my approach here, so that you can see if you think it’s right for you.
What clients often expect, and what some therapists offer, is to learn techniques that help them cope with their anxiety. Breathing techniques, distraction, positive thinking and so on. There’s a place for those techniques, absolutely, but they are not enough on their own. What’s more, using them regularly can make anxiety worse - I’ll explain below.
My approach to anxiety is based on the following:
Anxiety is a normal emotion. We all feel anxious in certain situations - meeting new people, taking exams, presenting in meetings, and so on. Feeling anxious in those sorts of situations doesn’t mean that you suffer from an anxiety disorder; it just means you’re feeling an appropriate human emotion. I’m not saying you shouldn’t bring those anxieties to therapy - that’s absolutely fine. I’m just saying don’t diagnose yourself with a disorder!
Anxiety becomes problematic when it significantly interferes with a person’s ability to go about their daily life; and that happens when the person believes themself unable to tolerate anxiety. This is important. It isn’t just about how easily someone’s anxiety is triggered; it’s also about their ability to tolerate that feeling. If you think I’m feeling anxious and that’s okay, your anxiety is much less likely to escalate than if you think I’m feeling anxious so I’m in danger and need to get away from the thing that’s making me anxious.
There is a learned element to excessive anxiety. I can’t think of a client I’ve seen for anxiety who hasn’t had an anxious parent or two. If your caregivers when you’re very young regularly tell you to be careful, watch out or be on the safe side, you quickly learn that the world is a dangerous place. It doesn’t need to be explicit; it’s just a sense you have that bad things will happen if you’re not on your guard. And most people who have learnt to be anxious don’t realise they’ve learnt it. What we learn from our family when we’re very young feels like truth to us. It can be quite a revelation - and a challenge - to discover that other people don’t see the world the same way.
When I have an anxious client, my way of working includes four strands:
Increasing the person’s tolerance for anxiety. This may involve some psychoeducation around what happens to our bodies when we’re anxious, to help the person recognise the physiological signs of anxiety as just that. Then they are encouraged to sit with those feelings for longer than they would normally. They are in control; they can always choose to do something to alleviate the anxiety.
However, I explain to them that every time they alleviate anxiety (by leaving a social situation, cancelling an interview, not trying a new food, or whatever their trigger is) they reinforce the message that the trigger is something to be feared and avoided. That increases their anxiety about it. This is what I was referring to above about coping techniques actually increasing anxiety. The aim in my approach is not to avoid the trigger, but to gradually tolerate the anxious feelings more and more, so that the anxiety naturally diminishes.
Understanding their experience. Since there’s a learned aspect to problematic anxiety, it can be really helpful for clients to think about where they learned to be anxious. When they see how they were taught to be anxious, they can then entertain the possibility of viewing the world as a less dangerous place.
I also want to hear about their current experience - what is it like for them to live with anxiety? Simply talking about how challenging daily life is, and having a therapist empathise with you, can make it feel easier. Saying out loud how your anxiety impacts you can also be like shining a light on the cost of continuing to live that way. That can be a great motivation for overcoming your anxiety.
Challenging the beliefs behind their anxiety. I explore the specific beliefs behind individual anxieties. We all have an inner voice that lies to us. It does it very fast, and we’re often not conscious of it, but we feel the effects of it. Unpicking what this inner voice is saying is a key part of treating anxiety.
For example, when someone with a fear of speaking in meetings is asked to make a presentation, their inner voice may say things like You’re going to mess it up, Everyone will see you don’t know how to do the job, You’ll get fired, You’ll never get another job, You’ll be worthless. With an inner voice like that, it’s easy to see how being asked to give a presentation could make the person feel really anxious.
I help my clients to identify what their inner voice is telling them, and then to challenge it. By challenging your inner voice repeatedly, you can change what it says and therefore feel less anxious.
Creating back-up plans. I’ve said that I discourage my clients from escaping their anxiety or distracting themselves from it. There’s a caveat to that: knowing you’ve got an escape or a distraction makes it possible for you to tolerate anxiety for longer.
So it can be helpful for us to create plans together, in therapy, for what you can do when the anxiety gets too much. By taking control of the process and increasing your exposure to anxiety gradually, you may well find you don’t need to use these plans, but knowing you have them in your back pocket is a comfort.
If you would like help with your anxiety, I’d love to hear from you. You can book an initial consultation here.