Anxiety

Anxiety is worry, tension or fear that shows up in your body, your thoughts and your behaviour. For some anxiety disorders, NICE recommends cognitive behavioural therapy (CBT) as a first-line psychological treatment. Person-centred anxiety counselling online doesn't claim to treat those disorders. It offers a place to explore what your anxiety is connected to, and some people value it alongside or after other help.

What does anxiety feel like?

Anxiety is different for everyone, and it isn't always obvious from the outside.

It can be physical: a tight chest, a racing heart, a stomach that won't settle, waking at 4am already alert. It can be mental: going over a conversation again and again, imagining the worst, finding it hard to concentrate. It can show up in what you do: checking, over-preparing, avoiding the phone call, saying yes to keep things calm.

Some people know exactly what they're anxious about. Others feel a constant, low hum of unease with no clear cause. If worry is the main thing, the worry test (the Penn State Worry Questionnaire) can help you see how much of your day it takes up.

What is the best therapy for anxiety?

I want to be straightforward here, because anxiety is an area where the evidence points clearly in some directions.

In England, the National Institute for Health and Care Excellence (NICE) publishes guidance on what the NHS should offer:

• Generalised anxiety disorder (GAD). NICE recommends a stepped approach. It begins with education and active monitoring, moves to low-intensity help such as CBT-based guided self-help, and then, for people with marked difficulties or who haven't been helped enough, offers individual high-intensity psychological therapy (CBT or applied relaxation) or medication (NICE CG113).
• Panic disorder. NICE recommends CBT as the psychological treatment (NICE CG113).
• Social anxiety disorder. NICE recommends individual CBT developed specifically for social anxiety (NICE CG159).

So if you've been diagnosed with one of these conditions, or think you might have one, CBT is the approach with the strongest backing in UK guidance. In England, adults can usually refer themselves to NHS Talking Therapies without a GP appointment. Elsewhere, a local doctor is a good first step.

How does person-centred therapy understand anxiety?

Carl Rogers had his own way of understanding anxiety. He described it as "a state of uneasiness or tension whose cause is unknown" (Rogers, 1959). In his theory, anxiety rises when experience doesn't fit our picture of ourselves, our self-concept, and that mismatch is close to breaking into awareness.

Imagine someone who has always seen herself as calm and capable. Now she's struggling in a new job abroad, and part of her is furious about the move. That anger doesn't fit "calm and capable", so it's pushed away, and what she feels instead is a vague, constant tension.

Rogers called this mismatch incongruence. The opposite, congruence, is when what you experience and how you see yourself line up more closely. The glossary entry on anxiety gives a shorter overview.

Why anxiety can grow abroad or in a close-knit family

Anxiety often grows in particular situations. None of these makes it your fault. They can make it understandable.

• Moving to a new country. Everyday tasks suddenly carry risk: the phone call in German, the school form, the appointment you're not sure you booked correctly. The ongoing strain of adjusting to a new culture is sometimes called acculturative stress. Add the loss of friends who knew you, and expat loneliness can feed the worry.
• High expectations from family or work. If you grew up in a family where the question was always "what will people say?", anxiety about getting things wrong can feel normal. For many South Asian women, it's tangled up with duty, guilt and the wish not to disappoint. The page on family duty and self looks at this more closely.
• Being the person everyone relies on. When you're the steady one, there's no obvious place to put your own fear.
• Keeping part of your life hidden. Holding a secret from family, at work or in a community takes constant watchfulness.

If this sounds familiar, you may want a counsellor who doesn't need culture explained from scratch. I write more about that on South Asian counselling online.

Can person-centred counselling help with anxiety?

Person-centred counselling isn't a technique for reducing symptoms, and it doesn't replace CBT where CBT is recommended. Here's where it may fit:

• When anxiety is tied to your life circumstances. Family pressure, a move, a relationship, cultural expectations. Some people want time to explore these rather than to work on the anxiety directly.
• After or alongside CBT. Some people learn tools that help and then want space to look at the bigger picture.
• When you're not sure what's wrong. You might feel uneasy and not know why. Talking freely, with someone who listens closely, can help you notice what the unease is about.
• When you want a relationship more than a programme. Rogers proposed that change becomes possible when a person feels deeply understood and accepted by someone who is being genuine with them (Rogers, 1957).

And here's where it may not fit as well: if you mainly want structured techniques, homework or a time-limited programme for panic or phobias, a CBT therapist is likely to be a better match. A good counsellor should tell you that.

You can read more about the approach, and how I work with it, on person-centred counselling.

Anxiety self-checks and free resources

The GAD-7 is a seven-question screening questionnaire used widely in primary care. It's scored in your browser and nothing is stored or sent. A result is a starting point for a conversation with a doctor or counsellor, not a diagnosis.

If you'd rather start with self-help, I keep a list of free anxiety resources: workbooks and guides from public health services and university teams, most of them based on CBT. Some are available in German, Dutch and French. It helps to try one module at a time rather than everything at once.

When to look for other or urgent help

Please speak to a GP or doctor if anxiety is affecting your daily life, if you're having panic attacks, or if you're avoiding places or people because of fear. If you have chest pain or breathlessness, get it checked by a doctor, even if you think it's anxiety.

If you're in immediate danger, or worried you might act on thoughts of harming yourself, please get help now:

• UK: call 999 or go to A&E. For urgent help that isn't an emergency, call NHS 111 and choose the mental health option. Samaritans are free on 116 123, 24 hours a day.
• EU: call 112.
• Sri Lanka: the National Institute of Mental Health runs the National Mental Health Helpline on 1926.

Related reading

• People-pleasing, for anxiety about letting others down.
• Online therapy for expats, on the strain of living abroad.

I'm a trainee person-centred counsellor and BACP student member, working under supervision. If, having read this, person-centred counselling feels like the right fit, you can book a session.