Guide
Anxiety is a normal reaction: it prepares the body to face a danger. It becomes a problem when it goes off too often, too loudly or in response to dangers that aren’t really dangers.
Anxiety is an alarm: it prepares the body to face a danger. In some people, the alarm becomes too sensitive and goes off when there is no real danger.
A little theory · Anxiety disorders are the most common psychological problems: around one person in three will have one during their life. They combine a vulnerability (genes, temperament, experiences) with factors that keep fear going, above all avoidance (Craske and Stein, 2016).
The circle that keeps it going
A trigger (a situation, a thought) brings up alarm thoughts (“what if…?”), sensations in the body (racing heart, shortness of breath, a knot in the stomach) and the urge to protect yourself: avoiding, checking, asking for reassurance. In the moment it brings relief. But that relief prevents you from discovering that the danger doesn’t happen, or that you can face it. Next time, the alarm goes off again.
What helps, according to research
- Understanding your own circle, starting from concrete situations.
- Gradually reducing avoidance and safety behaviours, exposing yourself step by step to what you fear.
- Stepping back from anxious thoughts instead of arguing with them endlessly.
- Carrying on doing what matters, even with some anxiety.
A little theory · CBT is the most studied psychological treatment for anxiety. A meta-analysis of placebo-controlled trials confirms its effectiveness across the anxiety disorders studied (Hofmann and Smits, 2008).
The sensations aren’t dangerous
The sensations of anxiety are unpleasant but, in a healthy person, they aren’t dangerous. If you have a medical doubt (chest pain, dizziness), see a doctor first.
When to ask for help
If anxiety stops you doing important things, lasts for weeks or disturbs your sleep, CBT (including third-wave CBT) is one of the best-evaluated treatments.
Watch: short videos
- What is the Cycle of Anxiety?, by Therapist Aid: the avoidance circle.
The videos open on YouTube. They complement this guide and are no substitute for support.
Worksheets to practise
- 06 · Understanding my anxiety · The cycle of trigger, thoughts, body, behaviours (psychoeducation)
- 07 · The observation diary · Noting moments of anxiety and rumination throughout the week
- 08 · The map of my avoidances · Spotting avoidance and safety behaviours
- 09 · The ladder of small steps · Building a gradual exposure plan
- 12 · Examining a worry · Probability, severity, resources: bringing the fear back to its real size
Sources
Clark, D. A. & Beck, A. T. (2010). Cognitive Therapy of Anxiety Disorders: Science and Practice. Guilford.
Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 19(1), 6-19.
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T. & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.
Craske, M. G. & Stein, M. B. (2016). Anxiety. The Lancet, 388(10063), 3048-3059.
Hofmann, S. G. & Smits, J. A. J. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. The Journal of Clinical Psychiatry, 69(4), 621-632.
These worksheets do not replace therapy. If you are in distress or having suicidal thoughts, call your local emergency number (112 in Europe; 3114 in France, free, 24/7).
