How does anxiety therapy work?

Anxiety disorders are most prevalent mental health-related disorders. However, knowing this might not solve the problem. So if you want to seek treatment, what might you expect? 

In a recent interview, Professor David Barlow highlighted 5 dimensions of good anxiety treatment. In this article presents a summary of these dimensions.

When treating anxiety there are five dimensions that a therapist looks at. :

  • Creating awareness
  • Tackling the interpretation
  • Identifying avoidant behaviours
  • Learning how the body responds
  • Understanding your emotional experience

Creating awareness about your anxiety

Creating awareness of your personal experience is a key component in not only treating anxiety difficulties but also various other emotional difficulties. There are two key factors to be aware of, repression and avoidance.

Repression occurs when we subdue or inhibit ourselves from experiencing an emotion. For instance, when you are watching a movie that really moves you but you subdue the urge to shed a tear. In the correct circumstances, it can help with social conformity. However, when you keep on subduing feelings that you should actually pay attention to, it can become unhealthy. Therefore, part of the treatment process is to become aware of the emotional experience a person experiences and to stay with the feeling and not repress it.

Tackling the interpretation

It is always amazing to observe people at an amusement park. I find it fascinating to see how the two people can have completely different experiences for the same event. (Do yourself a favour and just watch this slingshot video to relate to the point I am trying to make.)


It is amazing to see that two people are going through the exact same objective event can have completely different subjective experiences. In other words, it is the same event but they have the opposite experience. One enjoys the ride and the other hates every moment.

The different experiences of the friends for the same event is a great illustration of how our interpretation of situations or events influences our emotional experience directly. Therefore, one of the key components in treating anxiety is to create awareness of how a person interprets certain events. Once the awareness has been created the next aim is to equip the client to develop different cognitive interpretations about the anxiety-provoking events.

For instance, if a person has a fear of speaking in public, the reality is that the crowd is a neutral situation. However, the client’s appraisal (interpretation) of the situation is what is causing anxiety. Therefore, during the therapeutic process, the client is taught how to challenge their appraisal and interpretation of an event. By challenging the interpretations the client becomes more flexible in the way they interpret their anxiety-provoking events.

This is where cognitive behavioural therapy has made inroads in this field. Part of the cognitive behavioural therapy process is to become more aware of your interpretations and more subtly your automatic thoughts about an event. Then, the cognitive therapy focusses on evaluating the thought and becoming more flexible in your interpretation.

Identify avoidant behaviours

Avoidance is very similar to repression, the major difference being that you try to stay away from an emotional experience or distract yourself from an emotional experience.

For instance, when you have a test the next day, that is causing you to feel overwhelmed, you rather binge watch a TV series or fake an illness. These avoidance behaviours can be very subtle, but in the long run, the anxiety is not addressed. This can have a snowball effect on a client’s wellbeing.

Taking into consideration the snowball effect of avoidant behaviours, the aim of therapy will be to make the client aware of the avoidant behaviour and equip the client with the necessary tools to approach the anxiety-provoking situation. Additionally, the client is also equipped alternative coping strategies in place of the avoidant behaviour.

Learning how the body responds

Very often our body can tell us about our emotional state much quicker than we realise what is going on. Small changes in our bodily experiences can become warning signals. The role and the aim, therefore, becomes to create an awareness within the client to identify how their body responds to emotions. In other words, when a client becomes anxious, how does the body respond? Does their heart rate go up? Do they start to perspire?

By creating the awareness of the bodily response to anxiety, the client can become more proactive in identifying the sources of their anxiety. Additionally, by knowing the bodily response the client can also learn how to calm down and control their bodily responses.

This will make the client feel more in control of their emotional experience as well as empower them. Lastly, it can also help the client to appraise or interpret their anxiety proving experiences differently.

Understanding your emotional experience

The last component in the treatment of anxiety is to take the skills learnt during the therapeutic process and start practising it in the real world. However, the client is not thrown into the deep end immediately. The emphasis in this dimension is to highlight the emotional experience for the client during the exposure to certain anxiety-provoking events.

Certain events have certain triggers that cause anxiety levels to rise. Consequently, part of the cognitive behavioural therapy process, for instance, is for the client to engage with anxiety-provoking events in small exposures, and then assisting them in reflecting on the experience afterwards in a safe environment. This empowers the client to become aware of their thought processes during these overwhelming events. It also provides that therapist with information about the skills and tools to equip the client with.