Understanding Anxiety
Anxiety is one of the most common mental health problems in the world. In Ireland, 42% of adults have a mental health disorder1, with 7% living with Generalised Anxiety Disorder (GAD). In the UK, 6% of the population—over 8 million people—experience anxiety2. If you’re feeling overwhelmed, restless, or constantly on edge, you’re far from alone.
I’m Dr Elaine Ryan, a psychologist with more than two decades of experience treating anxiety disorders. As someone who has also personally experienced panic disorder, I understand how isolating anxiety can feel—and I’m here to help you unravel it through evidence-based approaches.
Many people come to see a psychologist thinking they will just ‘talk’, but a key part of what I do is like detective work, breaking down what drives your anxiety, I don’t have a magic wand behind my style of working but I do have decades of experience using models that provide a structured framework that turns all your anxious thoughts and feelings into something you can understand with actionable steps to help you overcome it. All anxiety can be understood using scientific models and throughout this guide I shall show you how anxiety isn’t something that is just happening to you; it follows a pattern that you can interrupt and change.
Dr Elaine Ryan
Watch: How I help you understand and overcome anxiety
Table of contents
What is anxiety?
Anxiety is your body’s natural “fight-or-flight” response to a perceived threat. If you nearly trip down the stairs and feel that sudden rush of fear (heart pounding, breath catching), that’s anxiety functioning correctly—it keeps you safe.
However, anxiety becomes a problem when it’s triggered in everyday situations (like a work meeting) with no real threat, lingering and intensifying until it interferes with your daily life. In these cases, anxiety isn’t a helpful warning system; it’s an overactive alarm that leaves you feeling stressed, drained, and sometimes unable to function.
Quick Check: Is Anxiety Really “Random”?
Even though anxiety often feels random, modern psychology and neuroscience show it follows a predictable cycle of (1) a situation or trigger, (2) anxious thoughts (“What if I mess up?”), (3) emotional and physical reactions (racing heart, dread), and (4) behaviours (avoidance, escape). Recognising this cycle is a key step in learning to manage your anxiety and throughout this article I shall show you how if all fits together; understanding anxiety is like piecing together a puzzle.
Mini Exercise: Recall a recent time you felt anxious. What sparked it? What “doom” thought jumped into your mind? How did your body react? Did you do something—like cancel plans or leave early? Notice how each link led to the next. We shall use your data later to show that anxiety often unfolds in four parts: a triggering situation, the thoughts that spark fear, the emotions that follow, and the bodily sensations that drive you to act or avoid. We can break each step down through something called ‘chain analysis,’ showing that anxiety isn’t random, but rather a sequence we can interrupt. But first I need to explain normal anxiety, as not all anxiety needs to be treated.
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Normal versus Clinical Anxiety
Normal (situational) anxiety is a temporary response to stressors like an interview or an exam, it occurs in response to a specific situation and then goes away. It becomes abnormal, or clinical anxiety, when it is excessive, persistent, and interferes with daily life. If you are struggling with anxiety, you should read my guide which gives a step by step explanation on how to overcome anxiety.
The Impact of Anxiety
Anxiety can affect every area of your life, this makes sense when you understand situational and clinical anxiety that I spoke about above. With normal anxiety it knows when to go way, i.e. when the threat has passed, but with clinical anxiety, that threat switch is permanently on, so you can feel the effects of anxiety from when you wake up in the morning until you go to bed at night, even during the night if a cortisol spike wakes you up. It can affect;
- Work or School: Difficulty concentrating, fear of presentations, avoidance of tasks.
- Relationships: Irritability, withdrawal from social events, or fear of being judged.
- Physical Well-Being: Sleep disturbances, muscle tension, headaches.
- Emotional Health: Feelings of inadequacy, low self-esteem, persistent worry.
If you are reading my article as you feel you need help, I appreciate that it can feel overwhelming but in my clinical experience of working with clients for over two decades I know that anxiety follows specific patterns that we can understand and change using science- based models like Cognitive Behavioural Therapy (CBT), but before I get onto that I shall outline some of the common symptoms of anxiety to see if you can recognise yourself in it.
Common Symptoms of Anxiety
Physical Symptoms:
- Increased heart rate
- Shortness of breath or other breathing problems
- Chest pain
- Dizziness
- Tension in your muscles
- Feeling sick
Cognitive Symptoms:
- Worry
- Thoughts racing
- Find it hard to concentrate
- Scared that you are going lose control
Behavioural Symptoms:
- Avoiding situations or places that you think might make you anxious
- Feeling restless
- Irritable, and
- Sleep disturbances Learn more about the connection between anxiety and sleep.
If you want to learn more about how anxiety affects your body and mind, see my comprehensive Anxiety Symptoms page for more detailed explanations.
If after reading about the symptoms you suspect you might have anxiety, that is more than the situational anxiety I mentioned at the start of this article, then you need to understand the different types of anxiety disorder, as there are several.
Types of Anxiety Disorders
Generalised Anxiety Disorder GAD
Generalised Anxiety Disorder (GAD) is a common mental health condition characterised by persistent and excessive worry about a wide range of everyday things. You can learn more about the symptoms, causes, and treatments for GAD on my dedicated Generalised Anxiety Disorder page.
- Worries out of proportion to the situation
- It’s very difficult to control your worry even though you know it is not helping
- Worry affects many aspects of your life, such as how you cope in work, your relationships and your health.
- You probably have physical symptoms, feeling restless but also tired, hence the expressions ‘tired but wired.’
Panic Disorder
Panic disorder is more than having a panic attack, with panic disorder you have repeated attacks over an extended period of time and that interfere with your life.
During a panic attack, you might experience:
- Racing heart
- Chest pain
- Shortness of breath
- Feeling like you can’t catch your breath
- Choking or smothering sensation
- Dizziness
- Lightheaded
- Shaky
- Sweating or chills
- Feeling sick, tummy upset
- Scared that you are going to lose control and ‘go crazy.’
Example. You’re driving to work, something you have done many times before, when suddenly, your heart starts pounding, you feel dizzy, and your chest tightens. This is terrifying, especially when you are in control of a car, or on the M25 going into London! You might feel like you’re having a heart attack or that you’re about to lose control. This is what a panic attack can feel like. Learn about the differences between anxiety and panic attacks.
People with panic disorder often worry about having more panic attacks and may start to avoid situations where they fear an attack might happen. In the example I used above, it is understandable if the person tries to avoid driving.
Learn more about Panic Disorder, its causes, and effective treatments on my Panic Disorder page
Phobias
A phobia is much more than not liking something. For example, I am much better now with spiders, I am not overly keen on them, but don’t fly into a tailspin if I see one. In my professional life, I have worked with a client who moved house as they could not find a spider. That is a, albeit, an insane, phobia. A phobia is an intense, irrational fear of a specific object or situation. People with phobias often go to great lengths to avoid their triggers, as with my client, which can significantly disrupt their lives.
Common types of phobias:
Specific Phobia
where you are afraid of a specific object or situations, for example, blood, animals, flying.
Agoraphobia
Fear of situations where escape might be difficult or help unavailable, such as using public transportation, being in open spaces, being in enclosed spaces, standing in line, or being in a crowd. This often occurs with panic disorder.
Social Anxiety Disorder
Social anxiety, also known as social phobia, is more than just being shy. It’s an intense fear of social situations where you might be judged or negatively evaluated. This can lead to avoiding social gatherings, public speaking, or even everyday interactions like making phone calls or eating in public. Learning how to overcome social anxiety can greatly improve your quality of life.
Example: Imagine you’re at a party. You feel like all eyes are on you, judging your every move. Your heart races, your palms sweat, and you just want to disappear. This is a glimpse into what it’s like to live with social anxiety. It can make it incredibly difficult to connect with others and enjoy social events.
Learn more about Social Anxiety Disorder
Separation Anxiety Disorder
While often associated with children, separation anxiety can also affect adults. It involves excessive fear or anxiety about being separated from people you’re attached to. This can lead to constant worry, clinginess, and difficulty being alone or away from loved ones.
Example: An adult with separation anxiety might experience intense anxiety when their partner goes on a business trip. They might have persistent worries about something terrible happening, struggle with sleep, and find it challenging to function until their loved one returns.
Selective Mutism
Often first noticed in childhood, selective mutism involves a consistent inability to speak in specific social situations, despite being able to speak in other settings. This can significantly impact a child’s school performance, social development, and overall well-being.
Example: A child with selective mutism might speak freely at home with their family but remain completely silent at school, even when asked direct questions by teachers or classmates.
The HSE provides information on selective mutism and how to get a diagnosis.
Less Common Anxiety Disorders
In addition to the common types discussed above, there are other anxiety disorders that you might encounter:
- Substance/Medication-Induced Anxiety Disorder: Anxiety caused by the use of substances (e.g., alcohol, drugs) or withdrawal from them.
- Anxiety Disorder Due to Another Medical Condition: Anxiety directly caused by a medical condition, such as hyperthyroidism, heart problems, or neurological conditions.
- Other Specified Anxiety Disorder and Unspecified Anxiety Disorder: These are categories used when someone experiences significant anxiety that causes distress or impairment but doesn’t fully meet the criteria for any of the specific anxiety disorders.
Each anxiety disorder has distinct triggers and patterns, but all can be addressed by understanding their underlying thought–feeling–behaviour cycles.
Cause of Anxiety: Understand the Factors
Anxiety typically arises from a mix of factors:
Thought Patterns
Negative thinking, catastrophizing, mind-reading.Learned worry behaviours from caregivers or past experiences. onstantly dwelling on worst-case scenarios, overestimating threats, or engaging in self-criticism can trigger and fuel anxiety. Learn more about anxiety triggers.
Cognitive Distortions: These are inaccurate or unhelpful thinking patterns that make us more vulnerable to anxiety.
Brain Chemistry & Genetics
Imbalances in neurotransmitters (serotonin, GABA, norepinephrine).
Amygdala: This small, almond-shaped structure acts as the brain’s alarm system, processing emotions, particularly fear and anxiety. When it perceives a threat (real or imagined), it triggers the stress response, preparing the body to fight or flee. Learn about the role of the amygdala in anxiety.
Prefrontal Cortex: This area is responsible for decision-making, planning, and impulse control. It helps regulate the amygdala’s response and assess whether a perceived threat is real or not.
Neurotransmitters: These are chemical messengers that transmit signals between brain cells. Imbalances in neurotransmitters like serotonin, GABA, norepinephrine, and dopamine can contribute to anxiety.
Family history of anxiety can increase your vulnerability.
Life Experiences
Traumas, chronic stress, sudden life changes.
Modern stressors (e.g., workload, finances, social media pressures).
Environmental & Lifestyle Factors
Poor sleep, high caffeine or alcohol intake, inadequate stress management.
How to Know if You Need Professional Help
A stepped-care approach is often used:
- Mild Anxiety: Try self-help (books, online resources) and lifestyle changes first.
- Persistent or Worsening Anxiety: Consider therapy (e.g., CBT) and/or medication.
- Severe Anxiety: May require specialized or intensive treatment, combining multiple modalities and professional oversight.
If you follow a stepped-care approach, you may not need treatment by a psychologist, as you can start with self-help. I would have used a stepped care approach when working in the UK, and see that the HSE adopts the same. The idea of this type of working is to do with resources, efficiency and cost, for example, it does not make sense to use all the resources of a mental health team to help someone with mild anxiety, self- help may suffice. The National Institute for Health and Care Excellence (NICE for short) gives guidance on a Stepped Care Approach, which suggests
- Assessment, education and discussion of treatment options
- This could be a meeting with your local GP, who diagnoses anxiety or refers you to a psychologist for psychological assessment. Your GP or mental health consultation will explain anxiety to you and recommend treatment options, which may start with self-help.
- Self-Help
- This can be self-help that you undertake alone on in groups
- CBT with a Psychologist
- If self-help does not work for you, you might be referred to someone like myself, a psychologist for CBT.
- Highly Specialised Treatment
- When I worked in the UK I was part of a highly specialised multi-disciplinary team where people would be seen by psychologist, have psychiatrists to monitor medication and could also involve in-patient care.
If anxiety interferes with your work, relationships, or overall well-being despite self-help efforts, seek professional guidance.
Diagnosis
If you suspect you might have an anxiety disorder, it is essential to meet with a licensed mental health professional; a psychologist or psychiatrist can undertake an assessment and tell you not only if you have anxiety, but what type you have.
The clinician will use a tool called the Diagnostic and Statistical Manual of Mental Disorders (DSM). According to the DSM, the criteria for anxiety include the following;
- excessive anxiety and worry most days about many things for at least six months
- difficulty controlling your worry
- the appearance of three of the following six symptoms: restlessness, fatigue, irritability, muscle tension, sleep disturbance, and difficulty concentrating
- symptoms significantly interfering with your life
- symptoms not being caused by the direct psychological effects of medications or medical conditions
- symptoms aren’t due to another mental disorder (e.g. anxiety about oncoming panic attacks with panic disorder, anxiety due to a social condition, etc.)
You might also complete a self-report questionnaire like the Beck Anxiety Inventory (BAI).
Following the assessment, they can tell you what type of anxiety disorder you have.
Anxiety Treatment Options with Dr Elaine Ryan Dublin
Whether you decide to make an appointment to see me for psychological therapy in my clinic in Dublin or meet with another therapist, this final section of the article will give you a good overview of what you need to do and who you should see if you decide to seek professional help with your anxiety.
Anxiety counselling – talk therapy rooted in science
Your GP may have referred you for anxiety counselling with someone like myself, a psychologist, and in this section I want to explain how therapy will help you.
It’s “Talk Therapy,” But It’s Also Science
When people hear “talk therapy,” they often picture a patient lying on a couch, free-associating for years while the therapist interprets unconscious conflicts (think classic psychoanalysis). But that’s not the approach we’re discussing here.
In modern, empirically supported therapies, like Cognitive Behavioural Therapy (CBT), we do talk—absolutely—but every conversation is guided by scientific principles that have been rigorously tested in studies worldwide. We look at the connections between your thoughts, feelings, and behaviours, then use research-backed techniques (e.g., thought-challenging, behavioural experiments) to help you change unhelpful patterns and reduce anxiety. Learn more about how CBT can help with anxiety.
- Structured & Goal-Oriented: Instead of wandering through endless childhood memories, we pinpoint specific issues in your present life and work methodically to address them.
- Data-Driven: We might keep track of your mood, do short exercises during or between sessions, and evaluate what’s working—just like in a scientific experiment.
- Time-Efficient: CBT (and similar approaches) are often designed to be short- to medium-term, focusing on practical skills you can master relatively quickly.
Yes, there’s talk—but it’s a purposeful, guided conversation that blends empathy with a science-based framework, ensuring you’re not just venting your feelings but learning tools proven to help you move past anxiety.
The Science of CBT for Anxiety: How It Works
At My Therapist, my approach to anxiety treatment is grounded in science. I use evidence-based therapies like Cognitive Behavioural Therapy (CBT), which have been rigorously tested and proven effective in numerous studies and recommended by organisations like NICE (UK) and the HSE (Ireland).
What is CBT?
Instead of treating anxiety like a mystery, models such as Cognitive Behavioural Therapy CBT map your thoughts, emotions, body sensations, and behaviours—so you see exactly where things go off-track. For example, at the start of this article I asked you to record some data and now we can use that data to demonstrate some of the practical aspects of CBT. We shall do a ‘chain analysis’ in a moment to show you how some of the principles of CBT work.
CBT for Anxiety – How it Works
Picture anxiety as four interlinked parts:
- Trigger/Situation
- Example: An email about having to present at work.
- Thoughts
- “I’ll embarrass myself in front of everyone.”
- Feelings/Emotions
- Fear, dread, worry.
- Physical Sensations
- Racing heart, sweaty palms, tense shoulders.
- Behaviour
- Avoid the meeting, over-prepare obsessively, or skip it altogether.
These pieces reinforce each other: the alarming thought increases your physical symptoms, which heightens fear, which leads to avoidance—and that can confirm your fear was justified. Recognizing this cycle is the first step to breaking it.
Chain Analysis: Understand why you got anxious using CBT
Forward Chain (Trigger ? Thought ? Feeling ? Behavior)
- Identify the initial situation (seeing the email), the worry (“I’ll fail”), the emotional spike (fear), and how you act (avoid).
Backward Chain (Behavior ? Feelings ? Thought ? Trigger)
- Start with your final action (cancelled the meeting) and step backward to see the emotions, the underlying thought, and the original trigger.
Why It Helps:
- You see exactly where you could pause, challenge a thought, or use a coping strategy to prevent the full-blown spiral.
Grounding, thought-challenging, and exposure exercises aren’t just ideas; they’re backed by controlled studies showing they reduce anxiety and help people cope better in daily life.
Because CBT follow a tested blueprint, when you apply them step by step, you’re using the same approach that’s helped countless others recover from anxiety.
CBT and Scientific Models Give You a Roadmap for Change
Step-by-Step Progress: Scientific models don’t rely on guesswork. They lay out a method: identify the anxious thought, challenge it, observe the change in your feelings, and practice new behaviours. Each time you use these techniques, you reinforce healthier patterns in your mind and body. This isn’t pseudoscience; it’s a well-documented process called “neuroplasticity.”
In Practice: Another Quick Example of How to Apply CBT
Situation: You get invited to speak at a work event.
- Old Pattern:
- Thought: “I’ll definitely make a fool of myself.”
- Feeling: Fear/dread.
- Body: Racing heart, tense stomach (overactive amygdala).
- Behavior: You find a reason to cancel or avoid.
- Using the Model:
- Identify & Challenge: “Is it certain I’ll fail? I’ve spoken up in meetings before without catastrophe.”
- Physiological Shift: Practice slow breathing for 1 minute, calming the fight-or-flight surge.
- New Behavior: You decide to at least attend and share one brief comment.
- Scientific Backing: Studies show repeating this pattern weakens fear pathways and strengthens confidence pathways in the brain (neuroplasticity).
As you keep applying these tested methods, you’re essentially telling your brain: “This isn’t a real threat—calm down.” Over time, your anxiety response decreases. Science-driven approaches don’t just mask symptoms; they aim to rewire the thought-feeling-behaviour loop.
Bottom Line
Using scientific models means relying on strategies proven to help people better understand and manage anxiety. You’re not just following a “hunch” or a “guru’s” advice; you’re applying decades of psychological and neuroscientific research in a structured, step-by-step way—and watching how your mind and body begin to change for the better.
Medication
In some cases, medication can be helpful in managing anxiety symptoms, especially when combined with therapy.
Antidepressants: Certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors(SNRIs), are commonly used to treat anxiety disorders. They work by affecting the balance of neurochemicals in the brain.
Anti-anxiety Medications: Benzodiazepines can provide short-term relief from anxiety symptoms, but they are generally not recommended for long-term use due to the risk of dependence and side effects.
Working with a Psychiatrist: It’s important to consult with a psychiatrist for medication management. They can assess your needs, prescribe appropriate medication, and monitor its effects.
Self Help
My Self-Help Course: My online course, “Retrain Your Brain,” provides a comprehensive program for overcoming anxiety. You’ll learn practical strategies to reduce worry, manage physical symptoms, and improve your overall well-being.
Self-Help Strategies for Managing Anxiety
Relaxation techniques: Deep breathing exercises, progressive muscle relaxation, and meditation can help calm your body and mind.
Mindfulness exercises: Paying attention to the present moment without judgment can reduce worry and rumination.
Exercise and physical activity: Regular exercise has been shown to reduce anxiety symptoms and improve mood.
Healthy sleep habits: Getting enough sleep is crucial for managing anxiety. Establish a regular sleep schedule and practice good sleep hygiene.
Stress management techniques: Learning to manage stress effectively can help prevent anxiety from escalating.
Online Resources: There are various online anxiety resources that you can access.
How to deal with anxiety right now
If you are feeling anxious right in this very moment, the remainder of this article includes videos I made to help you with guided relaxation. They are only short-term strategies and do not replace meeting with a mental health professional for assessment and treatment.
If you are feeling anxious right now, the following brief videos will help you manage your current anxiety.
Controlled breathing
The following video will help you to control your breathing.
7-11 breathing
“Dr. Elaine Ryan is a Dublin-based psychologist with a proven track record in treating anxiety disorders. With over 20 years of experience, she offers compassionate and effective therapy to help individuals overcome their challenges. To schedule an appointment or learn more about Dr. Ryan’s services, please feel free to contact the clinic.”
References
Ekman P. Basic Emotions. Handbook of Cognition and Emotion. 2005:45-60. doi:10.1002/0470013494.ch3
Hockenbury, D. and Hockenbury, S.E. (2007). Discovering Psychology.New York: Worth Publishers.
Vora, E. (2022) The anatomy of anxiety. Orion Spring
Footnotes
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9281488/#:~:text=Results,lifetime%20history%20of%20attempted%20suicide. ↩︎
- https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/adult-psychiatric-morbidity-survey-survey-of-mental-health-and-wellbeing-england-2014 ↩︎