What is anxiety?
Anxiety can come in several forms and can affect the sufferer in different ways. For example, GAD (Generalised Anxiety Disorder) is a chronic condition resulting in rumination and worrying; Panic Disorder, is more of a sudden and intense feeling of terror, often accompanied by a racing heart (inducing panic attacks); Social Anxiety Disorder, is a fear of being judged or scrutinised by others in social situations; and Phobias are an extreme and irrational fear of specific things such as animals, situations or events, e.g. spiders or flying.
While some level of anxiety, or what we call in CBT 'healthy anxiety', is a normal part of everyday life as it can be an important 'radar' to tell us about potential threats to ourselves or others, issues can arrive when our sympathetic nervous system is too activated for too long. This can result in chronic conditions which may need interventions such as therapy, and in some instances medication. It is good to reflect on the fact that when we have something stressful happening in our lives or fear for a future event, it means we care, but there are levels of anxiety which we can tolerate, and those we can’t.
As a CBT/EMDR therapist, I typically see clients when the level of anxiety goes beyond a 6/10 level which leads into 'unhealthy anxiety'. The effects of such ‘turned up’ anxiety can be having extreme symptoms like the ones above. Anxiety as a theme is usually a ‘future threat’ of something that may happen, such as giving a presentation at work, a health issue, or debt worries. It often involves the fear of something catastrophic happening, or a fear of being judged as not being good enough. Thus, a threat to the physical self or a threat to the ego. It could also be about past ruminations such as ‘did I say the right thing? Did I make a fool of myself?’
How I can help
Because life is often uncertain, talking things through with a therapist can really help. As someone who is actively engaged as being on your side, but is also neutral observer, I can help break down the issue and help you with the way ahead. Here, it can be helpful to analyse your thoughts, beliefs, and behaviours around the issue, and change negative thinking to a more productive way of thinking about things.
Therapy provides a safe and structured space to understand what is maintaining your anxiety and develop practical ways of responding differently. Using CBT, we can explore the connection between your thoughts, emotions, physical sensations, and behaviours. Together, we can identify patterns that may be keeping anxiety going and develop more balanced and helpful ways of thinking and responding. EMDR can also be particularly helpful when anxiety is linked to past experiences, distressing memories, criticism, humiliation, or traumatic events that continue to influence how you feel in the present. Thus, rather than simply managing symptoms, our work sessions would aims to understand the underlying causes of anxiety and build lasting confidence in your ability to cope with life's challenges.
Example: giving a presentation at work
A lawyer has been asked to give a presentation in front of her bosses.
- Thought (Cognition): “I am going to screw this up. I’m a terrible speaker. Everyone is going to judge me and think I am not good enough. I may get fired!”
- Feeling (Emotion): Panic, anxiety, shame, depression.
- Behaviour (Action): Avoids thinking about the presentation, procrastination, sleeplessness.
Therefore, for someone terrified of giving a talk at work the following week, they may not be sleeping well, they may be distracted and their heart rate has increased. They constantly think about the ‘activating event’ and image themselves giving a bad presentation and everyone laughing at them or thinking ‘well, this is crap, this person is a crap speaker!’. When they imagine this, they start to sweat and think ‘I am a terrible speaker, everyone is going to judge me negatively’. This may result in them calling in sick and avoiding the presentation all together.
Therapy is a good way of understanding what is going on and changing thoughts, beliefs and behaviours to achieve a more positive outcome. A key aspect of this is to note down any negative thoughts of ‘what you are telling yourself’? In the sessions we can then reframe these thoughts to be ones that are more realistic. We will look at how you feel about giving presentations, what your experience of giving presentations has been in the past, your parents’ attitudes to you giving presentations, any trauma around speaking generally in your life so far. Through this analysis it can be understood that what you are experiencing is a normal reaction to abnormal thoughts and beliefs from childhood or events in the past, or low self-esteem. Within the sessions we create a new plan to deal with the event in a more productive way that is accepting and compassionate towards yourself and others. Simples!