Anxiety, panic attacks, phobias

What happens in anxiety

Anxiety is useful in itself: it mobilises the body ahead of a real threat. It becomes a problem when it switches on without a threat, does not switch off in time, or is triggered by your own thoughts.

The key mechanism that maintains anxiety disorders is avoidance. You avoid a situation, the anxiety quickly subsides, and the brain concludes: “the danger was real, avoidance saved me.” Next time the fear is stronger and the list of avoided situations is longer. That is how anxiety grows, even when nothing bad is happening.

What CBT does

Therapy acts on this mechanism directly.

We work out how your anxiety is built. Not “you are too anxious a person”, but a concrete map: which situations trigger the anxiety, which thoughts appear, what you do next and how that affects the next time.

We work with thoughts. We do not replace “bad” thoughts with “good” ones — that does not work. We learn to test catastrophic predictions against real material: what you predicted, what happened, how accurate the forecast turned out to be.

Graded exposure. The main tool in anxiety. Together we build a ladder of situations — from mildly anxiety-provoking to frightening — and work through it step by step, staying in the situation long enough for the anxiety to come down on its own. No “shock therapy”: you set the pace.

We remove safety behaviours. Often a person already enters difficult situations, but with a safety net: a pill in the pocket, headphones, the habit of staying near the exit. These small things preserve the belief “I only coped because of that” — and the anxiety remains.

We learn to handle bodily symptoms. In panic we work separately on the reaction to the heart pounding and the shortness of breath itself: we go through what is happening in the body and train tolerating those sensations without fear.

How long it takes

Panic disorder and specific phobias — often 8–16 sessions. Social anxiety and generalised anxiety disorder — usually longer, 16–30 sessions. The first changes are usually noticeable before the work is finished.

When a doctor is needed

Some conditions — hyperthyroidism, anaemia, heart rhythm disorders — produce symptoms that resemble anxiety. If you have not had a check-up, it is worth having one. In severe anxiety, medication support can be helpful: that is for a psychiatrist to decide, and psychotherapy combines well with it.