Anxiety

Are you feeling anxious? If you are reading this it’s likely that either you or someone close to you is struggling with anxiety. You may be asking yourself whether it’s worth getting help for. I’m a psychologist in London experienced in treating anxiety.  I can help you work out how big a problem anxiety is going to be for you, what to do to overcome it, and how long treatment is likely to take.

The good news is that there are now a number of effective psychological treatments for anxiety. They generally involve seeing a therapist for between 5 to 20 sessions depending on the size and type of problem. Although treatments vary depending on the kind of anxiety you’re facing, they all involve discussing your anxiety with me, carrying out exercises, setting goals, and planning how to manage anxiety between sessions.

Read on to find the different explanations of anxiety and what they mean for treating anxiety.  Then find out the main types of anxiety, how common they are, and how I can help you to overcome them.

Explanations

Problems

Explanations 

Anxiety has causes at several levels.  By considering the causes of anxiety at those levels, you can understand better how I can help you reduce anxiety in therapy.

Evolutionary

In the primitive world where mankind evolved, detecting nearby threats was a matter of life and death. Even if the rustle of a bush was only occasionally a hungry predator, that vigilance and anxiety response kept our ancestors alive. Anxiety remains useful now when it motivates us to get away from real dangers. But the world has changed, and our bodies continue to react as though we were in that primitive world even when we are not.  When anxiety affects our ability to work, socialise, or go out, then it is no longer helpful.  Fortunately, I can help you in therapy to learn to override your more primitive motivations with rational thought and to control your behaviour in the face of anxiety until the primitive part of your brain learns that it’s safe. ^Top

Social

We live in a society where fear sells products and incites people to support political causes. So it’s in the interests of marketeers and politicians to tell us how unsafe we are. And we want to know: we find headlines of new threats and dangers exciting.  But the availability of all these scare stories makes us overestimate the likelihood of threats occurring: we don’t hear about all the times when all was well and nothing happened! News about diseases adds to health anxiety, news about the economy adds to Generalised Anxiety, news about violent crime adds to agoraphobia, and news of traumas adds to PTSD.   I can help you in therapy to put these fears into perspective. ^Top

Group

We learn a lot about what’s dangerous from the groups we’re members of: Our “tribe” tells us who the enemy is.  Our family shares stories of dangers. Our peers face some dangers and worry about others. Our employer bombards us with safety messages.  Our friends send us messages of upcoming threats.  Then those groups tell us how we should respond to threats. And they suggest what will happen to us if we don’t respond as they would wish.  We believe them because being ousted from our group is a scary prospect.  In therapy I can help you reconsider the messages you’ve received and make your own decisions. ^Top

Interpersonal

We get anxious about the relationships that are important to us, and we learn to manage those relationships to contain our anxiety.  Past relationships can set us up for fears in current relationships. We feel mistrust and paranoia.  So may react, by concealing our fears or by going “over the top”. We may play subtle mind games with others to manage our anxiety, which end up damaging our relationships.  In therapy I can help you learn to identify the games you play and find more straightforward ways to get the support you need. ^Top

Individual

Anxiety is above all a problem for us as individuals, and it is at this level that most of the work in therapy for anxiety occurs. First in therapy I will help you examine the individual experiences, recent and past, which trigger your anxiety. You’ll learn to change or get used to those triggers and the memories associated with them.  Second we uncover and challenge the beliefs and thoughts (“cognitions”) which those trigger experiences have evoked in you.  Third, in therapy, we look at the motivations and feelings which follow on from your thoughts and beliefs.  You’ll practice calming those feelings, or changing your priorities so that you can accept unwelcome motivations and feelings more easily.   Fourth, we’ll review the strategies with which you’ve tried to manage anxiety in the past.  Many people avoid what makes them anxious. Step by step we’ll help you to learn to approach and problem-solve anxiety-provoking situations. Fifth, in therapy we’ll look at the behaviours which anxiety has provoked from you, and work to introduce new and more constructive behaviours. ^Top

Biological

The biological basis of anxiety is in our neurology and the chemicals which the brain releases to create the anxiety response. Our neurology varies with our genes and our life experience.  Some people are born with a genetic predisposition to anxiety, but whether that turns into an anxious personality depends on what happens to them and how they’re taught to deal with it.  Some people get diseases which change their neurology and their metabolism to activate the anxiety response.   Still others take medications and recreational drugs which trigger an anxiety response.  Psychiatrists are expert at identifying diseases and drug responses which enhance anxiety.  My role as a therapist is to help you change your neurology by retraining your brain to respond with less anxiety to the things which threaten you. In studies, brain scans have shown that therapy helps the brain grow new neural pathways which underpin new behaviours. ^Top

Anxiety Problems

Each person’s problem with anxiety is unique, because each person and each life is unique. However science has uncovered seven major types of anxiety, called anxiety disorders or diagnoses.  Your anxiety problem is likely to be made up of one or more of these disorders, and an important element of successfully treating anxiety problems is for the therapist to work out how the disorders combine to create the problem.  I can do this work with you in therapy.  Read on to find a brief description of each disorder, how common it is, what therapy works best for it, and how easy it is to treat:

Phobia

  • Phobias are excessive fears of particular objects or situations. Common phobias include fear of flying, insects such as spiders, snakes, socialising, blood, heights, enclosed spaces, animals, and medical procedures.
  • A person with a phobia will experience symptoms of anxiety or panic when exposed to the feared object or situation, and will try to avoid contact with it.   They may realise that their fear is exaggerated but be unable to face the feared object.  The fear then starts to constrain where they can go and what they can do, to the point where it can threaten relationships, jobs, and health.
  • Up to 11% of people will suffer from a phobia at some point in their life, with most cases developing between the ages of 7 and 14.
  • The treatment of choice for most phobias is Cognitive Behavioural Therapy (CBT)  which includes gradually getting the person more comfortable with the situation or object they fear (called graded exposure), in a way that lets them learn that their anxiety and symptoms will reduce the longer they stay in the fear situation. In studies, between 70 and 85% of people have significantly improved after an average of 5 sessions, making phobias one of the easier and faster problems to treat. Without treatment, only about around 30% of people will recover naturally, and many who recover also relapse, so you would be more than doubling your chances of overcoming your phobia by getting this treatment. ^Top

Post Traumatic Stress Disorder (PTSD)

  • PTSD is the medical name for the anxiety which can develop after we experience an event which is so frightening that we think that we or people with us are in danger of ceasing to exist.  The threat can be to our life or our selfhood.  Common causes of PTSD include being a witness or victim of war, violence, natural disaster, sexual abuse, rape, road traffic accidents, medical operations, injury, or bullying.
  • Common symptoms of PTSD include re-experiencing the traumatic event through flashbacks or nightmares, which can lead us to avoid places, people, events, or items which remind us of the event. Depression and insomnia are also common symptoms that many sufferers experience.
  • Between 2 and 10% of people will suffer from PTSD at some point in their lifetime, with approximately 3% in the UK suffering from it in any week.
  • Currently, the psychological treatments recommended for PTSD by the National Institute of Clinical Excellence are either Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) or Eye Movement Desensitization and Reprocessing (EMDR). In studies, these treatments help about 50-70% of people recover over an average of 9 sessions. The studies estimate that you’re likely to be better off than 74% of people with the same problem who didn’t have treatment. ^Top

Obsessive Compulsive Disorder (OCD)

  • OCD is the medical name for a pattern of obsessions and compulsions which significantly reduce a person’s ability to function in everyday life.  Obsessions are thoughts and impulses which a person considers intrusive or inappropriate, and which cause them distress or anxiety. Compulsions are repetitive mental or behavioural actions which a person performs in response to the obsession to reduce distress or ward off a feared event.
  • Around 3% of people will suffer from OCD some time in their lifetime, with the majority of cases developing in early adolescence/young adulthood (13-24 yrs).
  • Currently, the most effective treatment for OCD is Cognitive Behavioural Therapy (CBT) combined with Exposure and Response Prevention (ERP).  In studies, 75% of people who have these treatments are significantly improved or recovered after an average of 20 sessions. Without treatment, only 40% of people with OCD eventually recover, and many of those who recover subsequently relapse, so getting treatment for OCD almost doubles your chances of recovering from it. ^Top

Generalised Anxiety Disorder

  • Generalised Anxiety Disorder (GAD) is the medical name for excessive and uncontrollable fear or worry about a range of things, such as relationships, work, health, and finances. People suffering with generalised anxiety disorder tend to spent a lot of their time feeling on edge, restless, tense, or irritable, can find it hard to concentrate, often tire easily, and have poor sleep.
  • About 6% of people will suffer from GAD at some point in their life, and the problem develops on average in a person’s 20s (27 for men, 20 for women).
  • Currently, the most effective psychological treatment for GAD is Cognitive Behavioural Therapy (CBT). In studies, this helps around 60% of people recover or feel significantly better after treatment over an average of 13 sessions. So according to the studies, if you have treatment, on average you’ll be better off than 76% of similar people who didn’t have treatment. ^Top

Health Anxiety – linked to Health Problems page

  • Health Anxiety the fear of having or getting a serious illness when the medical evidence says otherwise.
  • People with health anxiety think harmless sensations such as a sore throat are symptoms of a serious illness which will kill them or ruin their life.  The only thing stopping them from panicking is that their death is not imminent.
  • When they have health anxiety people either avoid seeing the doctor in case their fear is confirmed, or they get multiple medical examinations and tests which produce null results, that fail to reassure them for long.
  • Around 5% of people will suffer from severe health anxiety some time in their lives. A number of treatments, including Cognitive Behavioural Therapy (22) and Mindfulness-Based Cognitive Therapy (23) have been shown to help significantly for health anxiety.  I also find that people feel better when they learn in therapy to savour the moments they have, accept life’s inherent uncertainty, and focus on building things which will outlast them. ^Top

Social Anxiety

  • Social Anxiety is a fear of social interactions and being evaluated on one’s performance. People suffering from social anxiety fear that they will say or do something embarrassing. They often worry that people will notice them sweating, blushing or shaking.
  • Most people feel anxious in some social situations, and some people are naturally shy, but people who suffer from social anxiety also either avoid social situations or perform inadequately in those situations as a result of their anxiety.
  • Between 2-4% of people will suffer from social anxiety at some point in their lives, and the problem tends to develop somewhere between childhood and adolescence.
  •  Cognitive Behavioural Therapy (CBT) for social anxiety is highly effective, and in studies 85% of people with social anxiety significantly improve after treatment.  Without treatment, only around 35% of people naturally recover, so more than double your chances of recovering from social anxiety by seeking therapy. ^Top

Panic and Agoraphobia

  • Panic is a rapid increase of anxiety, combined with unpleasant sensations such as sweating, dizziness and a racing heart, which lead a person to believe that they are about to catastrophically cease to function or even die.  Individual panic attacks tend to last from one to about 10 minutes, but panic can continue at a lower level for hours, as one panic attack succeeds another.  
  • Panic attacks can seem to come “out of the blue”, or they may be triggered by particular situations. Sufferers often worry about when they will another attack, so they remain vigilant for symptoms and avoid trigger situations.  Unfortunately this pattern of vigilance and avoidance only makes it more likely they will have another panic attack.
  • Panic and avoidance of trigger situations can lead to Agoraphobia, where a person’s life becomes significantly restricted by being unable to stay in places associated with panic.
  • Up to 7% of people will suffer from panic or agoraphobia in their lifetime, and it tends to develop in a person’s late 20s to early 30s.
  • Thankfully, panic and agoraphobia respond well to Cognitive Behavioural Therapy (CBT), and in studies, up to 85% of people who seek treatment significantly improve or recover after an average of 12 sessions.  Only 30 to 41% of people eventually recover without treatment, so by seeking psychological therapy for your panic attacks, you could be more than doubling the chances of recovering and leading a more normal life again. ^Top

How successful am I?  Read what some of my clients say about me here. Or if you or someone you’re close to has a problem with anxiety, why not contact me using the form on the right, and we can arrange a time to discuss the difficulty, and how I can help.
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