You may know that you’re worrying more than a situation calls for. You’ve thought it through, reminded yourself that things will probably be fine, and tried to focus on something else. But your mind keeps returning to it, and your body doesn’t seem convinced.
Or perhaps anxiety shows up before you have much opportunity to think. Your stomach tightens, your heart pounds, or you suddenly can’t find the words you had a moment ago. Something you wanted to do starts to feel like something you need to escape.
It can be frustrating to understand what’s happening and still feel unable to change it. If you’ve already tried advice, breathing exercises, or talking yourself through it, you may wonder what therapy could offer.
When preparation becomes a spiral
In Inside Out 2, Anxiety arrives with plans. She wants to help Riley anticipate difficult situations, prepare for them, and avoid getting hurt. There’s something useful in that. Thinking ahead can help us study for an exam, prepare for an interview, or consider how to handle a difficult conversation.
But Anxiety keeps going. More possibilities need accounting for. More things could go wrong. Her efforts to protect Riley become increasingly frantic, until Riley is overwhelmed by the very emotion trying to help her.
Disney/Pixar. This embedded player connects to Disney’s video service. Watch on Disney Video.
You don’t need to have seen the movie to recognize that shift. You may start by thinking through a problem and find yourself caught in a spiral that leaves you less able to deal with it.
Anxiety has a useful role in our lives. The difficulty comes when it becomes persistent, disproportionate, or so demanding that it begins making decisions for us.
You cancel something you had been looking forward to. You put off applying for a job because you’re already imagining everything that could go wrong. You spend an evening reviewing a conversation that seemed perfectly ordinary to the other person.
Even when you manage to do what you need to do, the effort can leave you exhausted.
Understanding what happens for you
When I work with someone who is struggling with anxiety, I want to understand their particular experience. What brings it on? What do they find themselves expecting? How does it affect their body? What do they do to get through it, and how well does that work?
Two people can both describe themselves as anxious while facing quite different difficulties. One may be preoccupied with making mistakes. Another may be frightened by physical sensations. Someone else may feel responsible for preventing anything bad from happening to the people they love.
The circumstances matter too. A difficult workplace, financial strain, illness, or an uncertain relationship may involve real problems that need attention. We need room to understand those realities alongside your responses to them.
Physical symptoms also deserve to be taken seriously. New or concerning symptoms may need medical assessment. Working on anxiety should not require you to dismiss what is happening in your body.
Understanding these pieces helps us decide where to begin.
How CBT can help
I often use cognitive behavioral therapy, or CBT, when treating anxiety. We look at the connections among what you’re thinking, what you’re feeling, and how you respond.
Suppose you’re anxious about speaking in a meeting. You may expect that you’ll lose your train of thought, sound unprepared, and change how your colleagues see you. You rehearse repeatedly, monitor every word, and eventually decide to stay quiet.
Staying quiet may bring relief. But it also leaves you without much opportunity to discover whether your prediction was accurate—or whether you could manage an imperfect moment better than you expected.
In therapy, we can examine that process together. How likely is the outcome you’re imagining? What would it mean if you did stumble? What happens when you judge yourself by a standard you wouldn’t apply to anyone else?
We can also consider something practical to try. That might mean contributing one thought in a meeting and then reviewing what actually happened, including how you handled it.
The work needs to be manageable and relevant to you. We choose steps together, learn from your experience, and adjust. Insight matters, but so does having opportunities to respond differently in everyday life.
If repeated analysis is a large part of your anxiety, you may also recognize yourself in Why Can’t I Stop Overthinking Even When I Know I’m Doing It?.
Where mindfulness practice fits
Mindfulness can help you become more aware of what is happening without immediately getting pulled into everything your mind is telling you.
You might notice a thought about failing, the tightening in your chest, and the urge to leave. With practice, there may be a little more room to recognize those experiences and decide what to do next.
That distinction matters when anxiety itself has become frightening. You notice a sensation, worry that it means you’re becoming anxious, and then become more anxious as you watch for further signs.
Trying urgently to make the feeling disappear can become another exhausting struggle. Mindfulness offers a way to practice staying present with your experience while responding with less judgment and more flexibility.
This takes practice, and we can adapt it to what is useful for you. Your mind wandering does not mean you’re doing it wrong. Feeling anxious during a practice does not automatically mean it has failed. We would talk about what you notice rather than treat calmness as a test you have to pass.
When EMDR may be useful
Sometimes past experiences are relevant to the anxiety someone is having now. An earlier experience of being hurt, humiliated, frightened, or helpless may be important to understanding a present reaction.
Depending on your history and what we’re working on, I may suggest considering EMDR as part of treatment. We would discuss why it might fit, what it involves, and whether you feel ready for that work.
This doesn’t mean that every anxiety problem has a hidden traumatic cause or that everyone needs EMDR. The approach should follow an understanding of you and your needs. You can read more about it on the EMDR therapy page.
What if you’ve already tried things that haven’t helped?
Some people come to therapy wanting practical help because sympathetic listening hasn’t been enough. Others have been given techniques before they felt anyone understood what they were dealing with.
Both concerns deserve attention.
If you’ve tried therapy, mindfulness, or coping strategies before, I’d want to hear what that experience was like. What helped, even somewhat? What felt unhelpful or difficult to use? What did you need that you weren’t getting?
We can use that information to make decisions about our work. You can also tell me when something I suggest doesn’t seem useful or when you don’t understand where we’re going. You don’t have to protect me from that feedback. It helps us work together.
Where medication can fit
I’m not a prescriber, and medication is typically not my first recommendation when someone comes to me for help with anxiety. My work focuses on psychotherapy and the changes we can support through that process.
For some people, however, medication can be very helpful. It may be worth discussing with a prescriber as part of considering the available treatment options.
I partner with prescribers to provide collaborative care when appropriate and with your permission. Questions about medication, side effects, or changes to a prescription belong with the professional providing that medical care.
You’re welcome to bring your preferences and concerns into the conversation. Considering medication doesn’t mean you’ve failed at therapy, and receiving psychotherapy doesn’t commit you to taking medication.
What progress might look like
The changes that matter will depend on what anxiety has been making difficult for you.
You might spend less time rehearsing conversations or checking whether something is wrong. You may find yourself accepting an invitation, speaking more freely, sleeping more easily, or recovering sooner after an anxious moment.
Sometimes progress begins with doing something important while still feeling some anxiety. Over time, you may develop more confidence in your ability to handle uncertainty, discomfort, or an outcome you wouldn’t have chosen.
We would pay attention to those changes together. If the work isn’t helping, that deserves discussion too.
I provide online psychotherapy for adults in Massachusetts and Maine. If anxiety has been limiting your life, we can begin with what has been happening for you and what you would like to change. Getting Started explains how to take that first step.