Anxiety
Anxiety
Anxiety is one of the most common reasons people come to therapy, and one of the most varied in how it presents. It might be a constant low-level hum of worry that never quite switches off. It might be panic attacks, social anxiety, health anxiety, or a persistent sense that something bad is about to happen even when nothing in the present moment justifies it. It might show up in your body, in your sleep, in the way you avoid certain situations or push yourself relentlessly to stay ahead of it.
Anxiety is not a personal failing or a sign that something is fundamentally wrong with you. It is a signal, and it usually has meaning. The nervous system learned to stay alert for a reason, often in environments where there was genuine unpredictability, threat, or a need to monitor carefully. When those conditions no longer exist, the alertness can persist anyway, because the body doesn’t automatically update its threat assessment when circumstances change.
How anxiety shows up
Anxiety takes many forms. Some people experience it primarily in their thoughts: repetitive worry, catastrophising, difficulty switching off, or a sense of dread that has no clear object. Others feel it physically: a tight chest, shallow breathing, a churning stomach, difficulty sleeping, or a persistent sense of being unable to settle. Many people experience both.
Common presentations include:
- Generalised anxiety, a persistent background of worry that attaches to whatever is available
- Panic attacks, which can feel alarming and disproportionate, particularly the first time
- Social anxiety, a fear of how you come across or of being judged, evaluated, or exposed
- Health anxiety, a preoccupation with physical symptoms or illness
- Performance anxiety, in professional, creative, or relational contexts
- Anxiety connected to specific triggers, which often have roots in earlier experiences
Avoidance is one of anxiety’s most reliable companions. When something produces anxiety, the instinct is to withdraw from it, which can provide short-term relief but tends to entrench the anxiety over time and gradually narrow the life around it.
The roots of anxiety
Anxiety is rarely just a chemical imbalance or a habit of thought. It usually has roots. Early relational experiences, particularly those that were unpredictable, critical, or unsafe, teach the nervous system to remain vigilant. Attachment patterns formed in childhood shape how much threat you perceive in the world, how safe it feels to need things, and how much of yourself you allow to be visible.
This is why anxiety that doesn’t respond to symptom-management approaches often does respond to longer-term relational therapy: because the work addresses the layer where the pattern actually lives rather than only its effects.
How I work with anxiety
My approach is psychodynamic, which means I’m interested in what your anxiety is responding to and where it comes from, as well as how it affects your daily life. We pay attention to the patterns that run through your relationships and your history, and to what happens in the room between us, because anxiety often shows up in the therapeutic relationship too and becomes available to work with directly.
This is not a quick-fix approach. But the changes it produces tend to be lasting rather than situational, because they reach the source rather than managing the surface.
Further reading
- Emotional Inheritance — Galit Atlas
- First, We Make the Beast Beautiful — Sarah Wilson
- Dare — Barry McDonagh
- Anxiety UK: anxietyuk.org.uk
Samantha Merry is a BACP Senior Accredited Psychotherapist in private practice in Bromley, South East London, and a doctoral researcher at the University of Chester.
