What these have in common

Anxiety, obsessive-compulsive difficulties, and stress-related problems can look very different from the outside, but they share an engine: a threat system that has become too sensitive, and the things we do to feel safer that quietly keep it that way. Whether it shows up as worry, as intrusive thoughts, or as feeling overwhelmed after a hard stretch, the work has a common shape — find what keeps it going, and change that.

The forms it takes

Anxiety — generalised worry that won’t switch off, panic that surges out of nowhere, social anxiety, and specific phobias.
Obsessive-compulsive difficulties (OCD) — unwanted intrusive thoughts, images, or urges, and the compulsions (checking, washing, repeating, mentally “putting right”) meant to neutralise them.
Stress-related — acute stress, and adjusting after a difficult event or change. (For ongoing work stress and burnout, see Work Stress & Burnout; for trauma or PTSD, the Trauma & PTSD page.)

Why it keeps going

Most of this is held in place not by the thoughts themselves but by what they make you do — avoid, check, seek reassurance, over-prepare, neutralise. Each works for a moment, and teaches the alarm that the danger was real, so it fires again next time. That loop, not your character, is what treatment targets.

How CBT works with it

CBT is usually the first tool. Early on we build a collaborative formulation — a shared map of your particular loop: triggers, thoughts, feelings, and the safety behaviours that keep it turning. From there the work is practical and testable. Behavioural experiments check what anxiety predicts against what actually happens; graded exposure loosens avoidance. For OCD specifically, the method is exposure and response prevention (ERP) — facing the trigger while resisting the compulsion, so the obsession gradually loses its grip. For thoughts that don’t hold up to scrutiny, cognitive restructuring helps you hold them more lightly.

When CAT is the better route

Sometimes this isn’t a single present-day loop but a pattern — the same dread, or the same need to control, reasserting itself across years and relationships, tied to how you learned to keep yourself safe a long time ago. When it’s that woven into how you relate to yourself and others, CAT fits better. We name the pattern as reciprocal roles, and early on I write you a reformulation letter — an account, in your own story, of how it formed and what keeps it going. The choice between CBT and CAT is made together, at the first session. More on how I work.

What treatment looks like

Most courses run between 8 and 24 sessions — often around 16 — weekly to begin with. In the first session we work out what’s keeping it going and which route fits. By around the fourth, you’ll usually have tried things between sessions and started to see the loop move. By the end, the aim is that you can do for yourself what we’ve been doing together. It isn’t instant, and I won’t pretend it is — but it’s structured, and you’ll always know what we’re doing and why.

Common questions

Are intrusive thoughts dangerous? No. Intrusive thoughts are common, and having one doesn’t mean you’ll act on it. OCD treats the meaning you attach to the thought, not the thought itself.

Do I have to do exposure or ERP? Nothing happens that you haven’t agreed to. It’s graded and collaborative — we go at a pace you can stand, not one imposed on you.

Is online as effective as in person? For most of this work, yes. Some people prefer being in the room — we can do either, or a mix.

What if I can’t even say what’s wrong? That’s common, and it’s part of the work. Whether through a CBT formulation or a CAT reformulation, finding the shape of it is the first thing we do together.

Anxiety, Obsessive-Compulsive & Stress-Related