Anxiety isn't always obvious from the outside. Someone can appear confident, capable and comfortable in everyday situations while internally spending a great deal of energy worrying, anticipating difficulties, questioning decisions or trying to make sure that nothing goes wrong.

Sometimes anxiety is connected to particular situations, such as social interactions, relationships, work or conflict, while for others it can be a more constant feeling of unease or apprehension that is difficult to explain. It might involve going over conversations long after they have happened, imagining how something could go wrong before it has even begun, struggling to make decisions or feeling unable to relax even when there is nothing immediate that needs your attention.

Anxiety can also be experienced physically, through tension, a racing heart, changes in breathing, digestive difficulties or a sense of being continually on edge. For some people these physical sensations are particularly frightening, especially when they appear suddenly or develop into panic.

When anxiety begins to shape your life

Anxiety is a natural part of being human, and being able to recognise uncertainty, anticipate difficulties and respond to potential threats can be useful. What can become difficult is when so much of our attention and energy goes towards preventing something from going wrong that it begins to influence what we feel able to do.

Sometimes this happens through avoidance, perhaps turning down opportunities, putting off conversations or gradually withdrawing from situations that feel uncomfortable, even when they involve things we genuinely want to do. At other times anxiety can look almost the opposite, with someone becoming particularly organised, prepared or attentive to other people's needs because making a mistake, disappointing somebody or not knowing what to expect feels difficult to tolerate.

It can affect relationships in ways that are not always immediately recognised as anxiety, such as needing reassurance that everything is okay, feeling unsettled when somebody seems distant, finding disagreement particularly difficult or spending considerable time trying to work out what another person might be thinking.

Over time, life can become organised around avoiding uncertainty or discomfort, and although these ways of coping may bring some relief in the moment, they can also leave less room for spontaneity, enjoyment and the choices we might otherwise want to make.

Understanding your experience of anxiety

There isn't one explanation for why somebody experiences anxiety, and understanding it involves looking at their particular experiences, circumstances and what is happening in their life.

For some people anxiety develops alongside prolonged stress, significant changes or periods of uncertainty, while for others it may be connected to earlier experiences in which being alert to other people's moods, anticipating difficulties or avoiding mistakes felt important. Sometimes patterns of worry, checking, reassurance-seeking or avoidance gradually become familiar ways of managing uncomfortable feelings, even when they no longer seem to be helping.

Anxiety can also exist alongside ADHD, trauma, physical health difficulties or other experiences that affect how manageable everyday life feels. At the same time, not every experience of anxiety needs to be understood through the past, and sometimes there are very real pressures or uncertainties in someone's present circumstances that deserve attention rather than simply being treated as something to overcome.

Working with anxiety in therapy

One of the frustrating things about anxiety is that understanding what is happening doesn't necessarily make it easier to change. In therapy, we can explore what happens when anxiety appears, what you find yourself anticipating or trying to prevent, and the ways you have learned to manage those experiences. This can include looking at patterns of worry, avoidance, self-criticism or the need for reassurance, while also paying attention to how anxiety is experienced physically and what happens when you begin to feel uncertain, exposed or overwhelmed.

Depending on your circumstances, we might work towards feeling more able to make decisions without repeatedly questioning them, having difficult conversations without needing to anticipate every possible response, or gradually approaching situations that have become restricted by fear or avoidance. Sometimes the work involves understanding why particular situations feel so threatening, while at other times it is about developing different ways of responding when anxiety is present.

My approach is integrative, relational and somatically informed, bringing together talking therapy with attention to emotional and physical experiences. The intention isn't to eliminate anxiety altogether, but to help you develop a different relationship with it, so that worry, fear or uncertainty don't have quite so much influence over your choices and everyday life.