Understanding your anxiety is already the first step to easing it
Anxiety is not a character flaw: it is an alarm system that has become too sensitive. Here I explain how it works, why it sometimes settles in for the long term and what research says about what helps.
What is anxiety?
Anxiety is part of everyday life. It is a response that anticipates a threat, real or imagined, and prepares the body to react. It becomes a problem when it appears too often or too strongly, without a real danger to justify it, and starts to weigh on your work, your relationships or your daily life.
It shows up on three levels at once
What you think
Worries that keep coming back, expecting the worst, the feeling of losing control. This is the cognitive level.
What you feel in your body
Palpitations, muscle tension, rapid breathing, a knot in your stomach, tiredness. This is the physiological level.
What you do
Avoiding certain situations, seeking reassurance, putting things off, checking again and again. This is the behavioural level.
The three levels influence each other: an almost imperceptible physical sensation can trigger a catastrophic thought, and that thought increases the body’s activation even more.
When anxiety becomes a problem
Diagnostic manuals describe several anxiety disorders. You don’t need a label to ask for help, but knowing them helps you understand what you are going through.
Generalised anxiety
Excessive worries that are hard to control, about many topics, present most days for months, often with tension, tiredness, irritability and sleep problems.
Panic attacks
Sudden, intense fear that peaks within minutes, with palpitations, a feeling of choking or dizziness. The problem arises when you live in fear of them coming back.
Social anxiety
Intense fear of situations where you may be observed or judged, such as public speaking or speaking up in meetings.
Specific phobias
A disproportionate fear of something specific: flying, lifts, injections, certain animals…
Agoraphobia
Fear of places where it would be hard to get out or to get help if you felt unwell: public transport, crowds, going out alone.
To give you an idea: each year, about 11% of adults have at least one panic attack, and between 7 and 9% have a specific phobia.
Why does anxiety persist?
The avoidance cycle
One of the best-established ideas in psychology is that anxiety is maintained mainly by avoidance. When you avoid what frightens you, anxiety drops straight away, and that relief pushes you to avoid again next time.
Something frightens you
A situation, a physical sensation or a thought.
Anxiety rises
The body activates and the mind expects the worst.
You avoid or escape
You leave, you don’t go, you put it off or you seek reassurance.
Immediate relief
Anxiety drops… but the fear stays intact and comes back stronger.
The problem is that avoidance prevents you from finding out that what you fear does not happen, or that you could cope with it. In psychology this is called negative reinforcement. For example, someone who is afraid of driving may think “I don’t have accidents because I don’t take the car”, and their fear is never put to the test.
Worrying can also work as a form of avoidance: it feels as if you are doing something to prevent the worst and, when the worst does not happen, the worry is reinforced.
And why does it start? Most often, several elements combine: a certain biological sensitivity to stress, experiences lived as unpredictable or uncontrollable, and direct learning (what happened to us) or indirect learning (what we saw or heard).
What research says about what works
Division 12 of the American Psychological Association rates psychological treatments according to the support they receive in studies. For anxiety, these stand out:
Cognitive behavioural therapy (CBT)
For generalised anxiety and social anxiety. It combines techniques to change what you do (exposure, skills) and what you think (cognitive restructuring, problem solving).
Exposure therapy
For specific phobias. It involves gradually and safely approaching what frightens you, for long enough for the fear to lose its strength.
Acceptance and commitment therapy (ACT)
For mixed anxiety conditions. It helps you live differently with difficult thoughts and emotions and steer your life towards what matters to you.
These ratings are reviewed regularly against increasingly demanding criteria, so they may change with new studies.
The relationship matters too
Techniques are not everything. Some authors estimate that specific techniques account for about 15% of improvement in therapy, and so-called common factors, such as a trusting relationship with the therapist, for about 30%. These estimates are still being studied, but they underline something important: feeling heard and understood is part of the treatment.
How we work on anxiety
Assessment
We talk about what you are going through and, when useful, we use validated questionnaires (for example the STAI, the BAI or the PSWQ for worry). This gives us a starting point and lets us track your progress.
Understanding what keeps it going
We identify your triggers, your thoughts, your physical reactions and above all what you do to protect yourself, which is often what maintains the problem.
A tailored intervention
Depending on the case: gradual exposure to what you avoid, work on thoughts, diaphragmatic breathing, problem solving or ACT tools such as acceptance and cognitive defusion.
Consolidating and preventing relapse
We review your progress, you practise between sessions and we prepare how to respond if anxiety comes back.
The aim is not to remove uncertainty from your life, which is impossible, but to learn to live with it more flexibly.
What you can start today
Get moving
Physical exercise is associated with lower anxiety. Guidance from the literature: moderate intensity, from 20 minutes to an hour, at least three times a week, breathing harder but without exhausting yourself.
Practise your breathing when calm
Diaphragmatic breathing helps regulate activation. Practise it first at quiet moments; once you have mastered it, it will be easier to use when anxiety arrives.
Notice what you avoid
For one week, note the situations you avoid or put off because of anxiety. It is valuable information to start working with.
Lean on the people close to you
A good social support network acts as a buffer against anxiety.
Gonzalo Garzo
Clinical psychologist · CBT, ACT, DBT and EMDR
I have been a clinical psychologist since 2018, and I am also an anthropologist. For years I combined psychology with management positions (see my LinkedIn profile), before dedicating myself fully to clinical work.
I work with an integrative approach: third-wave CBT (ACT, DBT, mindfulness) and EMDR, adapted to each person’s needs.
I have lived in several countries and I work in English, French or Spanish, online or in La Rochelle.
Frequently asked questions
Is it normal to feel anxious?
Yes. Anxiety is a useful response that prepares us for threats. It becomes a problem when it is very frequent or intense, does not match a real danger and limits your life.
Do I need to know why my anxiety started?
Not necessarily. In many cases, what matters most for getting better is understanding what keeps it going today. That said, if your history helps you understand it, we explore that too.
How many sessions will I need?
It depends on each person and on the type of anxiety. Some specific problems, such as certain phobias, can improve in a few sessions if you practise between them; structured programmes for generalised or social anxiety often last several months. We discuss it together after the assessment.
What about medication?
The treatment of anxiety is first and foremost psychological and, in some cases, it is combined with medication. If you need it, prescription is a matter for your doctor or psychiatrist.
Can we work online?
Yes. Online therapy allows us to do the same work (assessment, explanations, exercises and follow-up) without you having to travel, and in your language. We plan exposure exercises together so that you can do them in your own environment, between sessions.
Shall we talk?
Sources
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
- Society of Clinical Psychology, APA Division 12 (2016). Treatment Targets: Generalized Anxiety Disorder, Social Anxiety Disorder, Specific Phobias, Mixed Anxiety Conditions.
- Caballo, V. (Dir.) (2002). Manual para el tratamiento cognitivo-conductual de los trastornos psicológicos, vol. 1. Siglo XXI.
- Vallejo, M. and Comeche, M. (Coords.) (2016). Lecciones de terapia de conducta. Dykinson.
- Sandín, B. (2008). Teorías sobre los trastornos de ansiedad. In Belloch, Sandín and Ramos (Eds.), Manual de psicopatología, vol. II. McGraw-Hill.
- Ruiz, M., Díaz, M. and Villalobos, A. (2013). Manual de técnicas de intervención cognitivo conductuales. Desclée de Brouwer.
- Fernández-Álvarez, H. and Opazo, R. (2004). La integración en psicoterapia: manual práctico. Paidós.
- Márquez, S. (1995). Beneficios psicológicos de la actividad física. Revista de Psicología General y Aplicada, 48(1), 185-206.
- Orozco, W. N. and Baldares, M. J. V. (2012). Trastornos de ansiedad: revisión dirigida para atención primaria. Revista Médica de Costa Rica y Centroamérica, 69(604), 497-507.
This page is for information only and does not replace a professional assessment.