What anxiety actually looks like

Anxiety is not one thing. People describe it in very different ways, and part of what makes it hard to talk about is that it does not always look like fear.

It can be constant low-level tension that never quite resolves. It can be a mind that will not stop working over the same problem at two in the morning. It can be physical before it is anything else: a tight chest, a churning stomach, shallow breathing, exhaustion that sleep does not fix.

It can also arrive in short, overwhelming episodes. Panic comes with a genuine conviction that something is badly wrong, and it is frightening precisely because it feels physical rather than psychological.

For some people it attaches to something specific: flying, health, social situations, work. For others it attaches to nothing in particular and simply follows them around.

Why anxiety becomes self-sustaining

Anxiety is uncomfortable, so we manage it. We avoid the thing. We check. We over-prepare. We reassure ourselves, or ask someone else to.

Each of those brings relief, which is why we keep doing them. But the relief arrives before you ever find out whether the thing you feared would actually have happened. So the fear is never disconfirmed, and the belief that you only coped because you avoided gets stronger. The anxiety tightens rather than loosens, and the life around it gets smaller.

This is usually the point at which people come to therapy. Not because the anxiety is new, but because the accommodations it demands have become too expensive.

How I work with anxiety

I work in two directions at once.

The practical part addresses what anxiety is doing to you now: how to interrupt a panic response, how to reduce avoidance at a pace you can tolerate, how to work with the thinking patterns that keep worry running. This draws on cognitive behavioural techniques and mindfulness, both of which have a solid evidence base for anxiety.

The other part asks a different question. What is this anxiety about. Anxiety is frequently a reasonable response to something that has not been faced or has not been said, and it usually has a longer history than the current episode suggests. Managing the symptom without ever asking that question tends to produce relief that does not last.

Which of these dominates depends on you, and we work it out together.

What to expect

Sessions are 50 or 75 minutes, in Wimbledon or online. We begin with a free fifteen-minute conversation.

Weekly works best, particularly at the start, though fortnightly is workable if that is what fits your life.

Many people notice a difference within the first month, particularly with panic. Anxiety that has been present for years usually takes longer, and it is more honest to say so than to promise otherwise.