Anxiety is not one problem. Constant worry, panic attacks, dread before social situations and fear about your health can all feel like "anxiety", but they are maintained by different patterns, and they respond best to different versions of CBT. Getting that distinction right at the start makes treatment shorter and more effective.
I am a BABCP-accredited CBT therapist with more than ten years of clinical experience. Many of the people I see with anxiety are high-functioning: capable, conscientious, and outwardly doing well, while privately spending a great deal of energy holding things together.
Types of anxiety I treat
Generalised anxiety and chronic worry
Worry that moves from one topic to the next, feels impossible to switch off, and often comes with tension, poor sleep and irritability. Treatment focuses less on the content of each worry and more on how worry works: the beliefs that it's useful or uncontrollable, difficulty tolerating uncertainty, and the habits that keep it going.
Panic attacks and panic disorder
Sudden surges of fear with racing heart, breathlessness or dizziness, often followed by fear of the next attack. CBT for panic targets the misreading of bodily sensations as signs of danger, and the safety behaviours that stop you discovering they aren't. It is one of the most effective treatments in the whole field.
Social anxiety
Fear of being judged, of saying the wrong thing, or of others noticing your anxiety. This is often accompanied by intense self-monitoring during conversations and a long post-mortem afterwards. It is common in people whose work requires presenting, leading or networking, and it is very treatable. I explain how it works in more detail in Social anxiety: more than shyness.
Health anxiety
Persistent fear of having or developing a serious illness, with checking, searching online, seeking reassurance from doctors, or avoiding medical information altogether. The relief from reassurance rarely lasts, which is a clue to how the problem is maintained.
Phobias
Specific fears such as flying, needles, vomiting or driving, which can restrict life far more than people expect. These usually respond to a relatively short, focused course of exposure-based treatment.
Anxiety also overlaps with other areas I work with. Repetitive, sticky intrusive thoughts may point to OCD. Anxiety that began after a frightening event may be better understood as trauma. Anxiety that is bound up with relentless standards often comes with perfectionism and, eventually, burnout.
Why anxiety persists
Most anxiety is kept going by things that make sense in the moment: avoiding what you fear, checking, seeking reassurance, over-preparing, or relying on subtle "safety behaviours" to get through. Each of these lowers anxiety in the short term. The cost is that you never get to find out that you could have coped without them, so the fear stays intact and life gradually narrows around it.
What CBT for anxiety involves
- A clear assessment. Working out which kind of anxiety is in charge, and what keeps it going for you specifically.
- A shared formulation. A map of the cycle that you can use, not just a diagnosis.
- Behavioural experiments. Planned ways of testing the predictions anxiety makes, rather than arguing with them. This is where most of the change happens.
- Reducing avoidance and safety behaviours, at a pace we agree together.
- Working on worry and self-criticism directly, where they are part of the picture, including low self-esteem that often sits underneath.
- Relapse prevention, so you leave able to recognise early signs and respond on your own.
Sessions are 50 minutes, usually weekly, and most courses of CBT run between 8 and 20 sessions depending on the problem and your goals. CBT is active: between-session practice is part of the treatment, and it's a large part of why the results tend to last.
Online or in person
I see people online across the UK and in person on Thursdays at The Re-mind The Body Centre in Queen's Park, North West London, close to Kilburn, Maida Vale, Kensal Green and West Hampstead. CBT for anxiety works well in either format. For social anxiety and panic, we will often plan experiments that take place out in the world between sessions anyway.
Is this the right service for you?
I work with adults (18 and over) on a private, self-pay basis. If you're unsure whether what you're experiencing is "bad enough" for therapy, that hesitation is very common among the people I work with, and it isn't a reason to wait. The first session is an assessment: you'll come away with a clearer understanding of what's going on and what treatment would involve, whether or not you decide to continue.