# Anxiety > How anxiety works, from persistent worry to panic attacks, and what therapy with clinical psychologist Jess Chadakorn in Melbourne's north-east involves. Source: https://jess.ac/areas-of-support/anxiety/ Anxiety is the body's alarm system, there to protect you. For some people it sounds too often or too loudly, and worry, panic or avoidance starts to shape everyday life. Therapy begins with understanding how anxiety works for you. ## What anxiety is and when it becomes a problem When the brain senses a threat, the fight-or-flight response speeds up heart rate and breathing, tenses the muscles, slows digestion (one reason anxiety can feel like a knot in the stomach) and narrows attention onto whatever seems risky. In real danger this is useful, and it usually settles once the moment passes. Anxiety becomes a problem when the alarm keeps sounding after the danger is over, or goes off for things unlikely to cause harm. Worry may take up hours of the day, the body may stay on edge, and some people start arranging their week around avoiding the feeling. Around one in four Australians will experience an anxiety condition in their lifetime. ## Common forms of anxiety Generalised anxiety is persistent worry about everyday matters such as work, money or health. Panic attacks are sudden surges of intense fear that peak within minutes, and they can feel so physical that people fear a heart problem. Worry about the next attack often follows. Social anxiety centres on a fear of being judged, health anxiety on worry about serious illness, and specific phobias on particular things or situations, such as heights or needles. Some medical conditions can mimic anxiety, so new physical symptoms should be checked by a doctor. Anxiety often occurs alongside low mood or chronic pain, and it is common after trauma. For some autistic people and people with ADHD, it is linked with sensory overload or the effort of masking (hiding or toning down natural ways of doing things) in settings not designed for them. Jess has a particular interest in working with neurodivergent people, and therapy can include changes to surroundings and routines as well as ways of coping. ## How avoidance keeps anxiety going Cancelling a daunting plan or asking someone else to make a call brings quick relief, and the brain registers that avoiding seemed to keep you safe. The relief is short-lived, and you miss the chance to learn that you could have coped or that the feared outcome did not happen. Next time the anxiety can feel stronger, and more situations start to feel off limits. Avoidance can also be subtle. Sitting near the exit, rehearsing what to say, repeated checking and seeking reassurance are known as safety behaviours. They make sense in the moment but can take the credit for getting you through, so someone who always carries water in case they feel faint may never learn they would have been fine without it. Recognising these patterns is often an early focus of therapy. ## What therapy for anxiety involves An assessment comes first and, where it helps, can include a diagnosis such as panic disorder or generalised anxiety disorder. From it Jess develops a formulation of the patterns keeping your anxiety going, such as avoidance, and a treatment plan agreed with you and reviewed as therapy progresses. Treatment draws on evidence-based therapies and may involve testing the predictions anxious thinking makes, such as asking a colleague whether anyone noticed your hands shaking during a presentation. It can also include ways to settle the body, graded exposure (spending time in avoided situations, step by step) and making room for anxious feelings so they have less say over your choices. Someone kept awake by worry might focus more on thinking patterns, and someone who has stopped catching the train more on graded exposure. ## Things people often notice - Worry that is hard to switch off - A busy mind at bedtime - A racing heart or a knot in the stomach - Putting off tasks or plans that feel daunting - Seeking reassurance again and again - Feeling tense or on edge ## Approaches Jess may draw on - **[Cognitive Behaviour Therapy (CBT)](https://jess.ac/approaches/cbt.md).** CBT looks at how thoughts, feelings, body sensations and actions influence each other. It is widely researched for anxiety and often includes graded exposure. - **[Acceptance and Commitment Therapy (ACT)](https://jess.ac/approaches/act.md).** ACT focuses on making room for anxious thoughts and feelings while still moving towards what matters, such as going to a friend's birthday despite nerves. - **[DBT skills](https://jess.ac/approaches/dbt-skills.md).** DBT skills such as paced breathing are designed to help the body settle when anxiety rises quickly and feels overwhelming. - **[Psychodynamic therapy](https://jess.ac/approaches/psychodynamic-therapy.md).** Psychodynamic therapy explores how earlier experiences and relationships shape present worry, which some people find useful when the source of their anxiety is hard to name. ## For children and teenagers In children, anxiety often shows up in the body or behaviour, such as tummy aches, clinginess at drop-off or worried questions. Teenagers may withdraw from friends or avoid school. Parents of younger children are closely involved, learning to respond to worry and encourage brave steps. Teenagers usually spend more time alone with Jess and help decide how parents are involved. ## Questions ### How do I know if my anxiety is enough to see a psychologist? There is no set threshold. People often seek help when anxiety affects sleep, work, study or relationships, or when avoidance is growing. ### Will I have to face my fears straight away? No. Facing feared situations is often part of therapy for anxiety, and you and Jess plan each step together, starting with something manageable and moving on once it feels easier. Early sessions focus on assessment and ways to settle the body. ### Do I need medication for anxiety? Psychologists don't prescribe medication. Some people use medication for anxiety alongside therapy and others do not. A GP or psychiatrist can advise whether it may be useful, and therapy can continue at the same time. ## Further reading - [Anxiety](https://www.healthdirect.gov.au/anxiety) (healthdirect Australia) - [Anxiety disorders](https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anxiety-disorders) (Better Health Channel, Victorian Government) - [Understanding anxiety disorders](https://www.beyondblue.org.au/mental-health/anxiety) (Beyond Blue)