Counselling for Anxiety: Different Approaches That Can Help
When you're experiencing anxiety, it can be difficult to know what will actually help. You might understand why you're worried, recognise that you're overthinking a situation or know that avoiding something is making it harder in the long run, yet still find yourself caught in the same patterns.
This is one of the reasons I think it's important to understand that working with anxiety doesn't have to look just one way. There are different therapeutic approaches that can help us make sense of what's happening and find new ways to respond.
Some focus on our thinking patterns and behaviours, others explore our relationship with uncomfortable thoughts and feelings, and some help us identify practical steps towards change. In this article, I'll walk you through a few of these approaches and what they can offer.
Different Approaches Used in Counselling for Anxiety
Counselling for anxiety can involve a range of therapeutic approaches, depending on what you're experiencing, what you'd like to change and what feels relevant to your circumstances. Four approaches I draw on in my practice are Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), solution-focused approaches and mindfulness.
1. Cognitive Behavioural Therapy (CBT): Understanding the Anxiety Cycle
Cognitive Behavioural Therapy (CBT) explores the relationship between our thoughts, feelings, physical sensations and behaviours. These elements influence one another, sometimes creating patterns that keep anxiety going.
Imagine you're about to speak up in a work meeting. You have the thought, "“I'll get my words mixed up and everyone will think I don't know what I'm talking about."
You might notice your heart racing, feel increasingly anxious and decide to stay silent. Avoiding the situation brings some immediate relief, but it also means you miss an opportunity to discover that you could have managed the experience, even if it felt uncomfortable.
Over time, similar situations may become increasingly daunting.
CBT helps you recognise these patterns and examine how your responses affect your anxiety. This might involve looking at the evidence behind an anxious prediction, considering alternative explanations or gradually trying something you've been avoiding.
The aim isn't to replace every negative thought with a positive one. It's to develop a more balanced understanding of situations and discover new ways of responding to them.
2. Acceptance and Commitment Therapy (ACT): Changing Your Relationship with Anxious Thoughts
When anxiety shows up, it's natural to want it to go away. You might put off an important decision until you feel more confident, repeatedly seek reassurance or spend hours trying to work out every possible outcome.
Acceptance and Commitment Therapy (ACT) takes a different approach to this struggle. Rather than making the elimination of anxiety the primary goal, ACT explores how you can respond to difficult thoughts and feelings while continuing to do things that matter to you.
Two important elements are acceptance and values-guided action.
Acceptance involves making room for uncomfortable thoughts, feelings and physical sensations, rather than spending all your energy trying to control or avoid them.
Values-guided action involves identifying what matters to you and taking steps in that direction, even when anxiety is present.
For example, you might be anxious about applying for a new job. You could wait until you feel completely confident, or you could recognise that the anxiety is there while still taking a step towards something important to you.
ACT helps you develop more flexibility in how you respond, so anxious thoughts and feelings don't have to make every decision for you.
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3. Solution-Focused Approaches: Finding What's Already Helping
When anxiety has been affecting your life for some time, it can become difficult to see beyond the problem. You might be very aware of what you find challenging, while overlooking the things you're already doing to manage it.
Solution-focused approaches take a particular interest in what's working, when the problem is less intense and what you would like to be different.
A counsellor might ask questions such as:
What is different on the days when your anxiety feels more manageable?
Have there been times when you handled a similar situation differently?
What would be a useful next step towards the change you'd like to see?
These questions help identify existing strengths, resources and exceptions to the problem.
They can also help turn a broad goal, such as wanting to feel less anxious, into something more specific and achievable.
Solution-focused work doesn't require you to ignore the difficulties you're experiencing or assume that anxiety can be resolved with a simple action plan. Instead, it offers a way to explore possibilities and build on what's already helping.
4. Mindfulness: Noticing What's Happening in the Present
Anxiety often draws our attention towards the future. We anticipate what might go wrong, replay conversations or mentally prepare for situations that haven't happened yet.
Mindfulness involves bringing attention to the present moment and noticing what's happening without immediately getting caught up in it.
You might notice a worrying thought, recognise tension in your shoulders or become aware that your mind has started running through worst-case scenarios again.
Rather than automatically following every thought or trying to push it away, you practise noticing it and bringing your attention back to the present.
Mindfulness isn't about emptying your mind or forcing yourself to feel calm. An anxious thought can still appear, and you can still feel uncomfortable. The practice is about becoming more aware of your experience and developing different ways of responding to it.
Mindfulness can be practised through dedicated exercises and incorporated into other therapeutic approaches, including Acceptance and Commitment Therapy and some forms of Cognitive Behavioural Therapy.
Which Approach Is Right for You?
Each of these approaches offers a different way of understanding and working with anxiety. Cognitive Behavioural Therapy can help us recognise patterns in our thinking and behaviour, Acceptance and Commitment Therapy explores how we respond to difficult thoughts and feelings, mindfulness develops our awareness of the present moment, and solution-focused approaches help us identify strengths and practical ways forward.
In practice, these approaches can complement one another. The most useful starting point depends on what you're experiencing, what you'd like to change and what feels relevant to your circumstances.
In my counselling practice, I draw on CBT, ACT, mindfulness and solution-focused approaches to support clients experiencing anxiety. This means our sessions don't have to follow one rigid formula. We might explore the thinking patterns contributing to your anxiety, practise responding differently to uncomfortable feelings, or identify practical steps towards something you'd like to change.
You don't need to arrive knowing which approach you need. Part of our work together is understanding what's happening for you and exploring strategies that fit your needs and circumstances.
If anxiety is affecting your everyday life, counselling can offer an opportunity to make sense of what's happening and find different ways of responding to it.
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