Anxiety is a natural part of life and can motivate us to maximise safety or prepare for difficult tasks like exams or public speaking. The issue is when anxiety and worry dominate so much they feel uncontrollable and prevent you from enjoying or doing things that matter to you. Eg, if worrying so much about family means they have to adapt to help you. Or if you are anxious about work, you might spend lots of time checking things or redoing them and feeling overwhelmed. With severe anxiety, people may experience physically debilitating panic.. Long-term, anxiety can lead to physical difficulties such as tension, stomach problems and headaches from chronic stress. Sometimes there isn’t a specific fear but just a general sense of dread or feeling that something bad will happen.

NICE-recommended CBT for anxiety targets the worry directly and ‘what if…’ thinking. It might use experiments to test out anxious predictions or exposure approaches to face avoided situations or imaginal approaches for deeper fears. Problem-solving techniques can help or relaxation training, as well as starting to do meaningful things that anxiety has disrupted. These treatments can powerfully break down and overcome anxieties that are often perceived as impossible at the start.

ACT also uses these techniques, but puts extra emphasis on stepping back from the anxiety and observing it and connecting to actual experience in the present. Anxious distress often centres on the past events or future fears. It may be that developing and practicing more mindful ways of being can offer relief from some of that inner turmoil.

Most of us have some fears. Common ones include spides, snakes, other animals, heights, needles (or blood injury) and confined spaces. Sometimes they are just instinctive and it’s likely we’ve evolved to react to some potential dangers. In some cases, people have had bad past experiences which leads to developing a strong fear response or association, which amplifies over time.

Many people have phobias which don’t bother them too much and therefore aren’t worth working on. However they can become more of a problem, if the distress and avoidance strategies start to have a significant impact on your life and interfere with things you enjoy. In some cases, a significant change might also make it more problematic. For example, a fear of needles might be totally manageable until a new health condition requires regular testing.

Treatments for phobias include CBT for graded exposure – i.e. facing the fear in small manageable steps to build confidence and systematically reduce anxiety. Alternatively EMDR, targets the fear imaginally to resolve it.

ACT approaches can be really helpful in focussing on tolerating unwanted thoughts, feelings and sensations in response to fears and focussing on what valued things you want to move towards.

Anxiety about your health can look a lot like general anxiety but with a focus on extreme fears around getting ill. Like all anxieties, in moderation it can help to focus us and motivate healthier behaviours. But it can become intolerable when it starts to dominate and you spend lots of time checking and researching your health. You might notice that you are withdrawing from things you used to value e.g. people who fear having a sudden collapse might stop exercising, socialising or going out at all and start planning for all the health disasters they imagine.

If really health anxious you might seek lots of doctors appointment and tests, due to feeling so awful, or you might avoid medical contact altogether. In some cases, however it’s necessary to rule out medical problems first before focussing on the anxiety itself.

And health anxiety is obviously much harder if you are living with a long-term condition or have watched family members suffer with severe illness and it maybe.helpful to disentagle what is good self-care and what is unhelpful monitoring and build a confident approach. Both ACT and CBT are great approaches to work with this and have a good evidence base.

OCD is a well-known mental health problem but it can be misunderstood as excess cleanliness or high standards. In reality the obsessions can cover a wide range of intrusive thoughts, images or fears covering many possible themes eg morality, responsibility, unwanted sexual thoughts, fears of contamination or harm etc. People may respond to these with rituals, compulsions or checking behaviours to try and feel safer, get rid of thoughts or prevent feared outcomes. It is possible to have just the obsessions or just the compulsions but they most commonly come together. In its most severe form OCD can become really disabling as the compulsions become ever more demanding and the OCD becomes a more bullying force in their lives.

Exposure and Response Prevention is a CBT approach strongly recommended by NICE with a robust evidence base. It involves mapping out all the OCD fears, avoidance strategies and rituals which maintain the problem and facing them (the exposure bit) in a graded way to gradually overcome the urges (the response prevention bit) and reduce the fears. It’s a powerful and effective approach but needs a fair bit of commitment. Although you will build up the approach gradually allowing time to build trust in the process and your therapist. Challenging associated beliefs can add to treatment in complex cases and build motivation and flexibility to face fears. ACT and Mindfulness approaches can also be extremely helpful in learning to tolerate difficult feelings and urges and experientially trying different ways of responding.

Social demands are increasingly complex and hard to navigate. We’re evolved to live in smaller communities where fitting in is important for survival, but now come into to contact with hundreds and thousands of people in our schools and workplaces, towns and cities, who often have very different perspectives and expectations. And online socialising comes with a whole host of additional pressures. It would be rare to be consistently confident in all these different social areas and we probably all have difficulty at times. Social anxiety (or phobia) goes beyond this to having constant fear of other people’s judgments or judging yourself harshly in a social context. There might be embarrassment concerns, such as blushing or sweating that take hold and things you do to try and manage these. Sometimes there’s severe worry before or after social events and memory distortions or intrusive imagery – seeing yourself in an unreasonably negative light. Frustratingly, the anxiety can bring on a whole range of physical anxiety responses (ie stomach problems, shaking or the very sweating or blushing that you were concerned about in the first place). It’s possible to work on these difficulties and steadily build confidence in relating to people differently and becoming more accepting of yourself.

Both CBT and ACT have lots of evidence of helping with social anxiety or phobia.

When anxiety is really high you can experience a severe physical panic response. This can be extremely scary and sometimes people think that something is really wrong and fear dying. This can be really undermining if it happens often and for no obvious reason. It can include:

racing heartbeat

feeling faint, dizzy or nauseas

sweating, hot flushes or chills

chest pain

fast or difficult breathing

trembling and shaky limbs

dry mouth or choking sensation

numbness, pins & needles or tingling

a feeling of dread or a fear of dying

a churning stomach

feeling like you're not connected to your body