31/07/2026
Why anxiety therapy does not always work, and four great questions to ask yourself to begin breaking the cycle
Have you had counselling or CBT for anxiety, kind of understood how the anxiety sustains itself and works, and yet found that the anxiety itself did not really change?
This is something I hear quite often. Anxiety is one of the most common complaints people seek me out to help with.
People often describe negative self-talk, catastrophising or avoiding things. They will often know that their thoughts are irrational or that their behaviours do not truly serve them. Some clients can trace their problems back to childhood. They may feel the anxiety clearly in the body, or describe it as a background sense of uncertainty or even dread.
All of this can be useful. But understanding anxiety is not always the same as changing it.
The difficulty is that anxiety rarely exists only at the level of thought. It can become woven into the way a person experiences themselves and the world, and on some level it is often a felt sense in the body. The nervous system remains on alert, while the mind continually searches for what might go wrong. Certain feelings become difficult to tolerate.
Avoidance is a common attempted solution which, unfortunately, gradually narrows life. Confidence declines, and eventually the person may no longer trust their own ability to cope. In this way, anxiety can become a downward spiral.
Someone may know intellectually that they are safe while their whole system continues to prepare for danger. This is utterly confusing until they learn that the rational mind and the nervous system can function as two relatively independent systems, often with different agendas.
This is why I often work with anxiety on several different levels.
There is the thinking itself. Some thoughts need to be questioned, while others need to be interrupted rather than endlessly analysed. Anxiety has a way of turning thought into a form of compulsive problem-solving, as though one more hour of thinking might finally produce complete certainty.
There are also the emotions beneath the thinking. Anxiety can keep us in the head because being in the head feels safer than meeting fear, grief, anger, shame or helplessness directly. Learning to experience emotion without either becoming overwhelmed by it or immediately trying to get rid of it can be an important part of recovery. But there is an art to this. It is not simply a question of endlessly diving into emotion.
Then there is identity.
Many people with chronic anxiety have gradually come to see themselves as fragile, unsafe, incapable or fundamentally less able to cope than other people. Treatment therefore needs to involve more than calming down. It may also involve rebuilding self-trust, self-esteem and a sense of personal strength. In fact, a damaged sense of identity, driven by limiting beliefs, is often one of the main drivers of the anxiety itself.
The body matters too. A nervous system that has been rehearsing danger for years does not simply relax because it has been given a convincing explanation. It needs repeated experiences of becoming activated and then discovering that nothing catastrophic follows. This is where new learning begins to take place. In recent years, neuroscience has contributed a great deal to our understanding of how these patterns can be changed and how the nervous system can learn greater safety.
The same is true of avoidance and reassurance. They can bring relief in the moment, but they often strengthen anxiety over time. Every time we escape a situation, check again, seek reassurance or wait until we feel completely safe, the brain receives the message that danger was present and that the protective behaviour saved us.
A useful exercise is to pause when anxiety appears and ask four questions:
What is my mind predicting right now?
What am I feeling in my body?
What am I doing to try to make myself safe?
What would I do differently if I trusted that I could cope with the discomfort?
The final question is usually the most important. As simple as these questions are, they may take several minutes to answer honestly. That process itself can begin to interrupt the anxiety pattern.
The answer does not need to be dramatic or earth shattering. It might mean waiting a little longer before seeking reassurance, staying in a situation for another few minutes, sending the email without checking it repeatedly, or allowing a feeling to be present without immediately trying to suppress it.
These small moments matter because they begin to create a different kind of evidence.
The first piece of evidence may simply be that, once you connect with yourself more fully, the anxiety either reveals itself more clearly or, in many cases, begins to settle. We learn to allow emotions to move through us, and we begin to discover that we can deal with the uncertainty of life without needing to control everything or feel completely safe first.
This is the kind of work that may be needed when counselling has brought insight, or CBT has helped with certain thoughts, but the deeper pattern remains.
Anxiety can be complex. Effective treatment often needs to be equally comprehensive, working with thought, emotion, the body, behaviour, identity and the deeper expectations through which a person has learned to experience life.
My approach to helping people with anxiety is drawn from many different modalities, including Acceptance and Commitment Therapy, hypnotherapy, transformational coaching, Focusing, neuroscience-informed approaches and trauma-informed psychotherapy.
Contact me to discover more: [email protected], or send me a direct message.