Anxiety – How to work with it in the consulting room

Written by APHP

July 12, 2023

How to work with anxiety

Did you know that over 8 million people in the UK experience an anxiety disorder, which makes it one of the most common mental health issues in the world?

As a therapist, anxiety is certainly one of the most frequent issues that client’s present and although it may not be the main reason for coming to therapy, anxiety is a factor that is experienced in relation to many issues that clients are facing.

First and foremost I use psycho-education in order to give the client some understanding about what is happening in their body when anxiety is doing it’s thing.  More often than not, anxiety is heightened due to a lack of understanding about what is happening and why.  When a client gains some insight, it can help to alleviate some of the anxiety because the reasons for it are no longer unknown.  That’s not to say that the client will know the cause of their anxiety because this could be a traumatic event that has bee stored away, but by educating them about the workings of their body and how anxiety manifests, this can really help.

I tend to use the basis of the Polyvagal Theory, explaining that the vagus nerve is the longest cranial nerve in our body and is responsible for a lot of the autonomic nervous system (ANS) functions, such as breathing, heart rate and digestion to name just a few.  Our ANS is always surveying the environment to see if there are any threats to us. We have 3 different states of nervous system activation and we move between these depending on how safe we feel but when we have suffered a trauma for example, or an extreme fear, we become dysregulated and therefore cannot navigate through these states effectively.  This is why we suffer physical symptoms when anxiety is present because the vagus nerve is connected to many of our organs and is associated with our main bodily functions.

Strengthening the vagus nerve – anything that focuses on regulating breathing, heart rate and aiding digestion is always a good place to start.  I advise clients to consider diaphragmatic breathing, singing, humming and talking, as well as eating food that is going to improve the connection between the brain and gut – so avoiding anything that could be acidic, foods that cause gas, or any other food known to be irritants.

A technique to help in the moment.  When a client is experiencing anxiety and needs to be able to reduce it immediately, I encourage a few grounding techniques.  Aside from the most popular 5, 4, 3, 2, 1 technique (5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell and 1 thing you can taste), I encourage clients to engage their senses in other ways.  By engaging your senses, it brings you to the present, to the here and now, engaging the conscious part of your brain, which helps to disengage the emotional part.  Suggestions include:

  • Tensing all muscles in the body and then relaxing them
  • Going for a run, doing star jumps or any other form of exercise.
  • Running cold water over wrists
  • Finding something really textured and recognising how it feels 
  • Giving yourself a hug and a stroke – using the Havening touch technique
  • Playing a mental game of alphabet categories – choosing, for example,, animals and then working our way through the alphabet thinking of an animal beginning with each letter.
  • Having a drink of your favourite beverage or eating your favourite food
  • Putting on your favourite perfume and smelling deeply – or using essential oils such as lavender, rose, chamomile, known for their calming properties.
Accepting it
Sometimes, anxiety is heightened because we fear what is happening to us when the physical symptoms present and we try to fight them.  This inner conflict can actually make things worse.  I encourage clients to accept the anxiety is there, acknowledge it’s existence and know that it is there for a reason.  Anxiety is a response to an unknown threat but it is there because it is trying to keep us safe and a certain level of anxiety is needed in order to keep us safe in some situations.
Listening to it
What is the anxiety telling you?  Can you break it down and listen to what it perceives to be a threat?  I help clients to work through anxiety inducing situations that they experience and break the elements of that situation down into smaller chunks in order to process them.  Sometimes we take a virtual and metaphorical helicopter ride and hover above a situation which helps to emotionally remove the client from the situation and allows time to look at it from a different perspective.
Naming it
Making friends with anxiety is another way that clients can gain a sense of control.  By naming it and seeing it as a visitor rather than an integral part of them that they can’t change, it helps to separate the client from the anxiety.  Some clients choose a name they are fond of so that they can nurture it and treat it with kindness, some choose a really obscure or even funny name so that the can treat it like a silly part of them.  I encourage clients to choose whatever works for them.  By seeing anxiety as a separate entity, clients are able to talk to it using it’s name, acknowledge it is there, ask it what it is trying to tell them and then choose whether to tell the anxiety to be quiet, disappear for now or to stay close by in case it is needed.  This level of control can be really powerful and conducive to a clients healing process.
Reframing it
In some situations, it is useful to reframe anxiety as something else, such as excitement.  I recently contributed to an article in Metro regarding the possibility of turning anxiety into excitement.  The feelings of both of these emotions are very similar and we can look at the situation and analyse if there is a chance that we could be excited rather than anxious. For example, starting a new job or new school….looking at the opportunities for making new friends and learning new skills can be really exciting. 
I hope that some of these ways of working with anxiety are useful and that you may feel inspired to use some in your own practice when working with clients.
Best wishes
Hayley McAuley
NRPC Editorial & Research Specialist
Useful links to theories and techniques referred to above:
Published : Jul 12, 2023