Anxiety, Panic & Stress-Related

What these have in common

Anxiety, panic, 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 sudden panic, 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, social anxiety, and specific phobias.
• Panic — surges of fear that arrive out of nowhere, often with physical symptoms frightening enough to feel like an emergency.
• 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.)

If what you’re dealing with is intrusive thoughts and compulsions — checking, washing, repeating, or mentally putting things right — that’s covered in more depth on the OCD 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 thoughts that don’t hold up to scrutiny, cognitive restructuring helps you hold them more lightly. Where compulsions are involved, the method is exposure and response prevention.

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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

Is panic dangerous? It doesn’t feel that way in the moment, but no — a panic attack is your alarm system firing hard, not your body failing. Part of the work is testing that out rather than taking my word for it.

Do I have to do exposure? 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.