Tag: anxiety

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What happens when anxiety leads to avoidance

Anxiety is unpleasant and distressing with symptoms including:

  • Feeling light-headed 
  • Feeling nauseous
  • Sweaty face, armpits, and palms
  • Knot in the stomach
  • Racing heart
  • Tight chest

Anxiety comes along when the amygdala (a small almond-shaped part of the brain) interprets a “threat” and begins preparing the mind and body for “fight-or-flight” in order to survive. 

We need this system to function so that we can keep ourselves safe if there is an emergency.

However, in modern-day living, this system gets activated in non-life-threatening situations when we get anxious about daily life, so our fight-flight reaction is kicking in when it’s not really needed. 

The issue is that when this reaction kicks in, the behavioural elements of fight or flight can become problematic for our work, relationships, and lifestyle.

The consequences of “flight”

Flight is when we escape the situation, we leave, we don’t turn up, we don’t face the problem. The amygdala threat alarm rings, the brain goes “get me out of here!”, and we flee.

This is an understandable reaction because the brain is interpreting the situation as threatening and is doing what it can in that moment to return you to “safety”. 

So, we can say that, very short-term, avoidance works for dealing with anxiety.

But this isn’t the whole picture because as adults in modern day, that situation we avoided hasn’t gone away or been resolved; the problem is still there waiting to be dealt with.

We can sum up the problem with avoidance in the image below:

This is a vicious cycle.

Over the longer-term, as we go round and round this vicious cycle, we’re restricting our life, becoming more anxious, confidence is dipping, and our comfort zone becomes smaller and smaller while our anxiety increases and confidence falls. 

What a pickle!

Know that it doesn’t need to be this way.

The first step is awareness. Become aware of what situations you’re avoiding and become aware of what you think about the situation. Common anxious thoughts relate to the problem being too big, you don’t know how to solve it or cope, you’re all alone and nobody else will help you. 

Secondly, begin to talk back to those thoughts to give yourself some reassurance and encouragement. Remind yourself that things often aren’t as bad as the anxiety leads us to believe, that you can do it even if you need to break problems down into smaller manageable chunks or ask for help.

Thirdly, rip the band-aid! Ok, I know this is scary but biting the bullet is short-term “pain” for long-term gain. You can do this.

Top tip – remember to slow down and breathe to help regulate your nervous system as you take these steps.

If this feels too overwhelming to go alone, I’d be happy to help you. We can work out what the problems are, reframe unhelpful thoughts and beliefs, and create manageable steps to get you back out there with confidence.

I offer one-one therapy online and face-face in Edinburgh. 

Drop me an email to get started.

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What is CBT?

What is CBT

CBT – Cognitive Behaviour Therapy – is a highly effective form of therapy that focuses on the link between what we think, what we do, and how we feel as shown in the diagram below:

Our thoughts influence our feelings, our feelings inform our behaviour, and our behaviour can reinforce our thoughts and beliefs. As such, we can find ourselves in “vicious cycles” of unhelpful thoughts, uncomfortable or distressing feelings, and unhelpful behaviours that keep us stuck in the cycle.

Note that I’m saying unhelpful thoughts and behaviours. In therapy, it’s important to step back from judgement as this creates a barrier to effective change. Rather than criticise ourselves as being wrong, silly, or stupid, we can simply notice that what we’re thinking and doing is unhelpful for the outcome we’re seeking. 

CBT aims to help the client develop self-awareness and tools to be more present in daily situations and to be able to identify and adjust unhelpful thoughts and behaviours in order to feel better.

CBT is evidence-based and recommended by NICE guidelines (National Institute of Clinical Excellence) which is the government standards and recommendations for the best practice of health and care treatments and technologies.

What to expect 

CBT sessions tend to last 50 minutes and take place on a weekly basis. 

The sessions are quite structured with an agenda set at the beginning of each session so that both client and therapist know what will be worked on. The therapist will typically lead on this in the beginning sessions as the client becomes familiar with therapy but there is always scope for the client to add items to the agenda, perhaps particular situations that have been on the client’s mind that week.

CBT is usually more time-limited than other forms of therapy – typically 6-20 sessions – to work on a specific problem. For example, if you have a problem with anxiety in social situations, the first few sessions are about understanding what happens for you in social settings in terms of your thoughts, feelings, and behaviours and considering where this problem has originated from. The next few sessions might work on adjusting your thoughts and testing new behaviours. The remaining sessions are used to create a plan to maintain your progress before moving towards an end. 

CBT involves out-of-session work which may involve things like reading over some information, reflecting on your experience, practicing CBT tools and models, or trying out new ways of doing things. The purpose of this is to build forward momentum for the change you’re working on and create new pathways in your brain to turn these new strategies into habits.

We’re only together for 50 minutes each week, do you think that alone is enough to change your life? Like with most things, you’ll get out what you put in! If you’re struggling to do the agreed work, let your therapist know so a solution can be found.  

CBT with me

I am calm, friendly, and organised and I make it my mission to help clients make meaningful, sustainable change. As my client, I want you to understand yourself more fully, to get to the root of the problem, and to feel empowered to make choices and decisions. 

I encourage you to turn up as yourself – no need to worry about getting things right or wrong, or oversharing, or swearing. The time and space we have together is safe for you to say what needs said and I’ll be here to guide you forward.

I’m big on holistic health so I’ll likely check in with your hydration, nutrition, exercise, sleep, and caffeine consumption as these factors all interlink with our mental health and wellbeing.

Language is also a key point of interest for me – language says a lot about the meaning we give to ourselves, other people, and the world. Don’t be surprised if I ask you what you mean by certain things or pick up on words, phrases, or images – I’m not quizzing you, I’m genuinely keen to hear more about your perspective!

My biggest aim is for you to feel better within yourself and about yourself, I’m here for you.

If you work with me through an insurance provider, we’ll have allocated session numbers to help you work on resolving a particular problem. I’ll draw out a research-based treatment plan and we’ll work methodically towards reaching your hopes within our timeframe.  

If you work privately with me, sessions can be a little more flexible if needed, and you may wish to continue seeing me over a longer period of time. This can be for various reasons – perhaps a life event occurs that you’d like some support navigating; perhaps you’d benefit from regular accountability, or perhaps you like knowing you have someone impartial to speak to. 

Ways to work with me

  • I provide online therapy sessions via Zoom on Mondays, Wednesdays, and Thursdays.
  • I provide face-face therapy sessions in Edinburgh on Tuesdays.

How to get started

Drop me an email with your name, your preference for remote or face-face sessions, and your availability and we can arrange an initial call to get started!

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Get inside the mind of a therapist.

How do you review something so layered, so insightful, so expertly created? 

These are the questions I’m asking myself as I sit down to write this review of “Maybe you should talk to someone” by American psychotherapist Lori Gottlieb.

In this instant New York Times bestseller, Gottlieb tells her story of being a therapist, whilst also attending therapy as a client herself, the very same position I was in when my good friend gifted me this book. 

Gottlieb begins by posing the question, “how do we change?” and through the pages of her book she responds, “in relation to others”. The therapeutic process is brought to life by Gottlieb sharing her clients’ stories, her own perspective of sessions and clients, and how she finds relating to her own therapist, Wendell. The latter of which she captures brilliantly in her line, “I both loved and hated Wendell for saying that”. 

The strength and depth of the therapeutic relationship is the basis for effective work. But just like any other relationship, it can be complicated. It’s the process of turning up, sitting in discomfort, and doing the work from both client and therapist that creates safety for exploring and creating change. 

This book is an expertly crafted interweaving of stories that exemplify the therapeutic arc taking us from what’s bringing clients to therapy now, laying it all out, editing the narrative, moving towards meaningful change, and coming to an end.

Gottlieb introduces us to four of her clients:

  • A twenty-something who is into bad guys and booze
  • A thirty-year-old newlywed with a terminal illness
  • A forty’s TV producer who calls everyone else an idiot
  • A 69-year-old contemplating suicide if things don’t get better

Through these tales we sit in ambivalence with the twenty’s client, face death with the thirty’s, learn about defence mechanisms with the forty’s, and seek forgiveness with the almost-septuagenarian. The craftsmanship of the writing absorbs you in each client making it easy to follow each client’s journey. 

Just like therapy, as the stories unfold and we delve into the depths of learning with Gottlieb and her clients, there’s a somewhat sudden, yet also subtle, shift as the pace picks up as they all move through their change process, pictured below:

Stages of Change, James Prochaska, 1980s

Gottlieb describes this change process as happening “gradually and then all at once”. 

This book is one to be highlighted and scribbled on as Gottlieb brings an abundance of knowledge to every page. 

You’ll find out about:

  • Erikson’s psychosocial changes
  • Four ultimate concerns
  • Misery-seduction dynamic
  • Privacy vs. secrecy
  • Projection and projective identification
  • Reacting vs. responding
  • Ultracrepidarianism
  • Unconditional positive regard
  • And much, much more!

It’s not just the psychological context but also Gottlieb’s graceful articulation of tender moments of therapy that you’ll want to underline. A standout line for me was: “I watch her hear what she already knows” which for me called to mind so many of my wonderful clients, particular moments where we’ve sat in the reality of it all, where I’ve seen emotions appear before my eyes, where I’ve felt a physiological shift in my body and observed the shift in them as we arrive at and embody realisations. 

Therapists are somewhat mysterious as our work is bound with confidentiality, meaning that people often struggle to grasp the nature of our day-to-day as we can’t elaborate or exemplify what we do. By bringing the four clients plus herself as a fifth client, Gottlieb provides a real insight into how clients present and how therapists work in session, and how therapists are in Gottlieb’s words, “a card-carrying member of the human race” which is not a flaw, it’s our biggest credential.

Gottlieb captures the sense of mystery when she addresses the question that we therapists often get asked “what kind of people do you see in your practice”, to which she responds, “just like any of us, which is to say, just like whoever is asking”. 

You don’t need to be in crisis, you don’t need to have a diagnosis, therapy is for any of us.  

Throughout writing this review, I caught myself being tempted to refer to the author as “Lori”. This speaks to the familiarity she creates through her writing. It feels deeply personal and vulnerable whilst also feeling very considered and expertly crafted. I also struggled to write this review because I didn’t want to say too much that would spoil the story unfolding for you!

I highly recommend this book – whether you’re interested in going to therapy, have already been, are a therapist yourself, you want to learn more about humans, or you just want a damn good read.

Expertly written, this book is an absolute gem that I’m sure I’ll be rereading for years to come. 

* Bonus recommendation: If you read the book and enjoy it, I’d also recommend watching Couples Therapy on BBC iPlayer which is a similar behind-the-scenes look at therapy, facilitated by Dr. Orna Guralnik.