Anxiety

Anxiety is one of the most common experiences people bring to therapy, and one of the most varied in how it presents. For some it’s persistent worry that doesn’t have a clear object, a background hum of apprehension that’s always present. For others it arrives as panic, as dread before specific situations, as a hypervigilance that makes ordinary interactions exhausting. It can be largely invisible to others while feeling completely consuming from the inside.

What Anxiety Is

Anxiety is the body and mind’s threat response. When something feels dangerous, the nervous system mobilises, increasing heart rate, sharpening attention, preparing the body to act. This is a sophisticated and useful system. The difficulty arises when it activates in situations that don’t warrant it, or when it stays activated long after the immediate threat has passed.

For many people, anxiety is connected to earlier experience. A situation in the present, a presentation at work, a difficult conversation, an unexpected phone call, carries an association with something from the past, often something that happened before the connection became conscious. The nervous system responds to the echo of the earlier experience rather than only to what’s actually happening now. Understanding that connection is often where the most useful therapeutic work begins.

How Anxiety Can Show Up

Anxiety presents differently in different people. Common experiences include:

• Persistent worry that cycles without resolution, returning to the same thoughts or scenarios repeatedly
• A sense of dread or foreboding that doesn’t attach to a specific cause
• Difficulty concentrating, as attention is pulled toward what might go wrong
• Physical symptoms including a racing heart, tightness in the chest, nausea, churning stomach, dizziness, or difficulty breathing
• Trouble sleeping, either dropping off or waking in the night with a mind that won’t settle
• Irritability or emotional reactivity that feels out of proportion to the situation
• Hypervigilance, a constant monitoring of the environment or other people’s responses
• Avoidance of situations, people, or activities that trigger anxiety, which tends to reinforce the anxiety over time

Panic attacks can develop when anxiety becomes acute. These involve sudden and intense physical symptoms that can feel alarming, including racing heart, chest tightness, breathlessness, and dizziness. They are not dangerous, though they can feel that way, and they are treatable.

Anxiety and Avoidance

One of the most common responses to anxiety is avoidance. If phone calls produce anxiety, you stop making them. If social situations feel overwhelming, you decline invitations. If certain topics feel threatening, you steer conversations away from them. In the short term, avoidance reduces anxiety. Over time, it tends to increase it, because it prevents the nervous system from learning that the situation can be tolerated.

This pattern is worth understanding rather than simply pushing through it. Avoidance often has a logic that makes sense in the context of earlier experience, and addressing it effectively usually means understanding that context rather than only targeting the behaviour.

Anxiety and OCD

Obsessive-compulsive disorder shares some features with anxiety but is a distinct presentation with its own specific treatment considerations. If OCD is the primary difficulty, it’s worth discussing this directly when you make contact, as it may benefit from a different or combined approach alongside relational work.

How I Work With Anxiety

From a psychodynamic perspective, anxiety is worth understanding as communication rather than simply as a problem to be managed. It often signals something that hasn’t yet found language, an unresolved conflict, an unmet need, or a threat the nervous system has registered before the conscious mind has caught up. Understanding what the anxiety is responding to, rather than only reducing its symptoms, tends to produce more durable change.

My work with anxiety is relational and psychodynamic, which means I’m interested in the history behind the anxiety as much as its current presentation. We look at what the anxiety is protecting you from, when it first developed, and what conditions allow it to ease. That approach takes longer than symptom-focused work, but what changes tends to hold.

Further Reading

• Herman, J. L. (1992). Trauma and Recovery. Basic Books.
• Jacobs Hendel, H. (2018). It’s Not Always Depression. Bluebird.
• Bowlby, J. (1988). A Secure Base: Clinical Applications of Attachment Theory. Routledge.