CBT for Anxiety London
Anxiety Therapy in London
- Do you experience physical sensations of anxiety?
- Does the presence of your anxiety symptoms cause you discomfort or worry?
- Do you worry about your symptoms showing up when you have a presentation to give, are taking public transport, or are away from home, etc?
- Has your anxiety ever come on out of the blue and caught you off guard?
- Do your anxiety symptoms cause you concern when you can’t find an explanation for them?
If you answered “yes” to the above questions, CBT for Anxiety can help you.
What Is Anxiety?
Anxiety is the physiological response to a feared situation. Most of us have experienced mild to moderate anxiety at some point in our lives-either before an exam, a work interview, or a dentist appointment! Anxiety symptoms can feel very unpleasant-even when mild, but they are understandable, given the above situations.
Anxiety is an understandable physiological response to stressful or fearful situations. It is our built-in threat detection system and it helps protect us from physical danger, i.e., it helps us jump back off the road when we see a speeding car come towards us, and it helps us run quickly if we are being chased by a criminal. In these situations, anxiety is welcome! Without our built-in survival mechanism, we would be toast!
Fight or Flight
I’m sure you’ve heard of the fight or flight response, right? But what does it really mean and what does it have to do with anxiety?
The fight or flight response is how your body prepares itself for action when you are afraid. It is your body’s instinctual response to fear and is how your body’s automatic response to a threat stimulus prepares you to either fight or flee danger.
The fight or flight response includes physiological changes in the body including:
- Rapid breathing which allows more oxygen to your muscles to help you fight or flee
- Heart beats faster and harder allowing blood to be pumped around the body more readily
- Blood pressure rises
- Muscles tense up preparing you to jump into action
- Sweating more – fight or flight generates heat
In fact, even now, the fight or flight response would be perfectly appropriate if you stepped out onto the road and realized a car was speeding towards you; the increase in adrenaline would allow you to move out of the way quickly. You probably wouldn’t question the physical symptoms experienced at the time because they would help protect you from being run over.
However, the problem with the anxiety response is that it can’t differentiate between a real physical threat (i.e., “I’m about to be run over by a car”) and a psychological threat, i.e., “I’m about to speak at an important event” and so it sometimes signals danger when there is none. There is nothing inherently dangerous about public speaking, other than the fear of feeling anxious, and the fear that others may notice.
When Anxiety Misfires
Our anxiety response can misfire when it perceives a danger when there is none. For example, there is a difference between a physical danger (as in the speeding car example and the escaping a criminal example) and social situations that our minds tell us are dangerous, but really aren’t.
The problem is that anxiety kicks in whenever you think you are in danger. “Think” is the key word, because thinking something does not necessarily make it true. I may think it is going to rain later, but it may not. Just because we think something will go wrong, doesn’t mean that it will. And just because we may think we are in danger, doesn’t mean that we are. And this cannot be more true when it comes to social and performance situations.
Can you think of a social or performance situation where you felt anxious, in the absence of a physical threat? Do any of the following ring true for you?
Have you ever felt anxious:
- In a supermarket
- Lying in bed
- On the train
- Driving on the motorway
- At a social event
- Standing up in front of a crowd and speaking/presenting
Are any of the above situations objectively dangerous? No. So the question is why do you feel so anxious in these situations?
When Anxiety Behaves As A False Alarm
If you think about your anxiety response as your body’s smoke detector, like all smoke detectors, they can go off even when there is no real danger.
When you experience anxiety in situations where there is a real physical threat, anxiety can be very helpful, as discussed above. It warns you that a physical danger is present and that you need to run or escape in order to stay safe. In these physically threatening situations, it would be very helpful to experience anxiety-the rush of adrenaline, the increased heart rate, etc. which would spur you into action.
However, in modern times, the anxiety response, and all of it’s unpleasant symptoms has become an overdeveloped response to psychological/social (rather than physical) threats, and it can cause a lot of problems when it presents itself when it is not welcome!
Anxiety symptoms become a problem when they are severe, and they interfere in your daily life. An example of this would be if you had severe anxiety before a work presentation, such that you had to pull out at the last minute. Or, you decide not to pull out but all the while you’re giving your presentation, you are unable to focus on anything other than your bodily symptoms, which inevitably impedes your performance.
Can Anxiety Be Helpful?
Helpful and unhelpful anxiety
Anxiety can be adaptive and helpful when it is mild (but strong enough to motivate us), as in the following examples:
- Studying for an exam
- Preparing a presentation for work
- Taking our driving test
- Going on a first date
- Meeting our future in-laws for the first time
But anxiety can also be maladaptive and unhelpful when it is so strong in severity, that it causes us to either avoid the above situations, or the symptoms are so severe that they impede our performance in these situations.
What are the symptoms of anxiety?
Anxiety symptoms can be broken down into three parts:
- Physiological-the physical sensations we experience in our bodies
- Cognitive-the thoughts we have either in anticipation of a situation, or during the situation
- Behavioural-the behaviours or actions we carry out (or avoid) to help us feel safe and less anxious
Physiological symptoms of anxiety:
- Heart palpitations
- Dizziness/light-headedness
- Butterflies in the stomach
- Tightness in chest
- Restlessness
- Feeling hot/sweating
- Shortness of breath
- Feeling like you are suffocating/not getting enough air
Cognitive symptoms of anxiety:
- “I am going to have a heart attack“
- “I am going to pass out”
- “I am going to vomit”
- “I am going to make a fool of myself“
- “I am going crazy”
- “I am losing control”
Behavioural symptoms of anxiety:
- Engaging in safety-seeking behaviours, i.e., always carrying a bottle of water with you; sitting/standing near an exit; never venturing far from home
- Avoidance of situations that you predict will cause you anxiety
- Seeking reassurance from others
How Do I Know Which Anxiety Disorder I Have?
It’s the thought that counts
What do I mean by “it’s the thought that counts”? When an individual comes for therapy because they feel anxious, a CBT therapist’s first task is to understand which anxiety disorder they are presenting with.
There are different anxiety disorders and the treatment for each one is different. And so before treatment can begin, it is important that we have a shared understanding of which one fits your symptoms.
Anxiety symptoms include thoughts, behaviours and physiological sensations. The thoughts that you have when you feel anxious, as well as the anticipatory thoughts that you have before you feel anxious, are clues to which anxiety disorder you might have.
For example:
“I’m going to pass out because I feel dizzy”
“What if something bad has happened to my partner/sister/daughter/friend (because they are late)”
“I am going to stumble over my words/they will notice me shaking/I will make a fool of myself”
The Fear of Fear-When Anxiety Causes Anxiety
Anybody who has experienced the physical symptoms of anxiety, knows how unpleasant these symptoms can feel, and how they can impact wider mental health. Therefore, it is understandable that you would develop a fear of anxiety itself. We call this the fear of fear.
The first panic attack, or the first bout of severe anxiety, can feel very scary. When you are in the throes of your first panic attack or anxiety attack, it’s easy to jump to the worst conclusion and think “I’m going to die”; “I’m going to pass out”; “I’m going to have a heart attack” or “I’m going crazy”. This is a common experience for people with an underlying mental health condition such as an anxiety disorder. This experience prompts a lot of people to go to the Accident & Emergency department, only to be told “there is nothing physically wrong with you”.
That reassurance can go a long way, in the short-term, but each subsequent occasion when your anxiety symptoms are at their peak, the same catastrophic thoughts occur.
Why does this happen? Why does your brain think the worst? Because of the way anxiety feels. And guess what? When your brain tells you “I am going to die/have a heart attack/lose my balance/stop breathing”-you will feel anxious! Anybody would.
However, the symptoms you’ve experienced don’t mean any of those things, and they are not dangerous, despite the sensations mimicking symptoms of physical health problems, like heart problems, balance problems, respiratory problems, etc. Anxiety is not the same as an actual physical health problem. That’s great news! Because if you can learn how to think differently, and respond differently to your anxiety, it will have less of a hold on you and your quality of life will improve.
The anxiety equation
One of the main reasons you feel anxious in situations where there is no real threat is because you are overestimating the likelihood of danger, and underestimating your ability to cope in the so-called ‘dangerous’ situation. This is what cognitive-behavioural therapists refer to as the anxiety equation (or anxiety formula).
What is CBT for Anxiety?
CBT for Anxiety is an evidence-based talking therapy, proven effective in helping individuals like you learn how to manage their anxiety symptoms and improve overall mental health.
Cognitive behavioural therapy (CBT) is recommended by the National Institute for Health and Care Excellence (NICE) for the treatment of panic disorder and generalised anxiety disorder, as well as other mental health conditions. It involves a variety of cognitive and behavioural strategies designed to support people experiencing anxiety and depression and other mental health problems .Our work will primarily involve:
Developing a shared understanding: of which anxiety disorder you have.
Is it panic disorder, social anxiety, generalised anxiety disorder or another type of anxiety disorder?
Cognitive Restructuring: I will help you to de-catastrophize the symptoms you experience so that you can remain calm while experiencing them.
Reducing safety behaviours: learning to reduce your safety behaviours will help you discover that you can face your feared situation without anything bad happening.
Exposure: Facing your fears (whether this is an external trigger like a supermarket or an internal one like your own bodily sensations) is a key component of CBT for anxiety. Facing, as opposed to avoiding your feared situation, whilst at the same time abandoning any safety behaviours, will result in a reduction of anxiety, because you will get to test out your catastrophic predictions that “something bad will happen” and discover for yourself that nothing bad does happen, and whatever does happen-you will cope just fine.
CBT will equip you with the thinking skills you need to combat your unhelpful thoughts, in particular you will learn how to think differently about your symptoms (the physical sensations). We will take the fear out of them so that you can learn that anxiety symptoms aren’t dangerous despite how they make you feel.
The first step is to figure out, together with your therapist, which type of anxiety disorder you may have. The type of anxiety disorder you have will dictate the therapeutic strategies your therapist will teach you.
The above example highlights that a trigger can either be internal (your own bodily sensations) or external (something outside of you, i.e., being far from home, in a crowded place, etc). The meaning you attach to the trigger is what leads to the intensity of bodily symptoms. You might say to yourself “I don’t like this”, or “something bad is going to happen”. You perceive the trigger as a threat, and as something dangerous, and this perception leads to a state of fear and apprehension, which is usually accompanied by an intensification of bodily symptoms and sensations.
These bodily sensations are usually interpreted in a catastrophic manner (“my heart racing means I am going to have a heart attack”), which leads to greater fear and, in turn, an even greater intensification of physical symptoms, and voila! You are caught in a vicious cycle of anxiety!It is at this point in the cycle that you might seek escape or help because things feel so awful. It’s not uncommon (especially when suffering with panic disorder, generalised anxiety, or any other anxiety disorder involving panic attacks) for the sufferer to call the emergency services (999) because they actually believe they are having a heart attack or dying. Other help-seeking behaviours include sitting down, seeking reassurance from a loved one, always travelling with a bottle of water, or simply leaving and going home.
Do you still have questions or concerns about CBT for Anxiety?
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I don’t want anyone to know I’m seeing a CBT therapist for anxiety.
The only time I would need to disclose that you are seeing me is if you were an imminent risk to yourself or to others (see FAQS #8 & #9 for more information).
If I attend during the day, won’t I feel worse when I go back to work? I’ll need to be able to concentrate back at the office.
This is an understandable concern, but most of my clients actually feel that they are able to return to work feeling more positive. They feel pleased that they are taking charge and tackling their problems.
Sometimes, however, sessions can feel emotionally draining, and it can be a good idea to leave yourself some time to process the session and prepare yourself mentally before you return to work. I recommend stopping off at a coffee shop en route back to work to give you time to reflect and regroup before returning to work.
Do you have more general questions about CBT?
Won’t facing my fears make me feel worse?
Sometimes exposure sessions can feel challenging because you are being asked to face the very thing you are afraid of.
In CBT for Anxiety, you will not be thrown in at the deep end-I promise! We will spend the first few therapy sessions developing a shared understanding of your difficulties. You will then learn CBT skills to help you manage your anxiety. You will be equipped to succeed! And, we will always work together at a pace that feels comfortable to you.
What does CBT for anxiety cost?
Are you ready to take the first step?
If you are ready to address your anxiety problem, and learn how to manage your anxiety symptoms better, or if you still have questions about CBT for Anxiety, please email me or contact me through my contact form to schedule a free of charge preliminary phone consultation. I look forward to hearing from you!
CBT sessions can help with the following problems
