Many people arrive on this website because they are looking for therapy, which makes sense as I have had a private practice in Ireland for a long time, but the therapy landscape has changed and there are different ways to access therapeutic help that I want to talk about today.
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When anxiety, OCD, panic, health anxiety or anger starts affecting your life, the natural thought is:
“I need to talk to someone.”
Sometimes that is exactly right. One-to-one therapy can be the best option, especially if symptoms are severe, complex, risky, or you feel unable to work on the problem by yourself.
But there is another group of people I hear from all the time.
They know something is wrong.
They want help.
They may be waiting for an appointment.
They may not be able to afford weekly private therapy.
They may not know which therapy model they need.
They may feel embarrassed or uncertain about talking to someone.
They may want to start quietly, privately, and immediately.
For those people, a structured online course can be a very good first step. It used to be that I was the only clinician offering courses and online therapy, but now it is common practice. This article is not about therapy with me personally, or my courses. It’s going to talk generally about them whether with me or with someone else; as with all my articles, my aim is to give you quality information to help you make an informed choice.
I want to answer, or at least get you thinking about:
“What is the safest, most useful next step for where I am now?”
That is what I want to help you decide.
Therapy is not one thing
When people say they are looking for therapy, they often mean very different things.
One person wants to understand why they feel anxious all the time.
Another wants to stop panic attacks.
Another is terrified by health symptoms.
Another is stuck in OCD checking or intrusive thoughts.
Another keeps losing their temper and damaging relationships.
These problems do not all need the same approach.
That is why I would not start by asking, “Do you need therapy or a course?”
I would start by asking:
“What pattern is keeping this problem going?”
For anxiety, the pattern may be avoidance, worry, safety behaviours, body alarm and overthinking.
For panic, it may be fear of body sensations and avoidance of places where panic might happen.
For health anxiety, it may be checking, Googling, body scanning and repeated reassurance.
For OCD, it may be intrusive thoughts, compulsions, mental reviewing, reassurance seeking and avoidance.
For anger, it may be a rapid threat response, body escalation, judgemental thinking, blame and reactive behaviour.
Once you know the pattern, the type of help becomes clearer.
When one-to-one therapy is the better first step
I would usually suggest one-to-one therapy, GP support or specialist support first if:
- you feel at risk of harming yourself or someone else
- there is violence, abuse, coercive control or serious risk
- symptoms are severe or you are barely functioning
- you are very depressed, traumatised or unsafe
- you are using alcohol, drugs or other behaviours to cope in a risky way
- you have tried self-help repeatedly and cannot get started
- your symptoms are complex and need proper assessment
- you need medication advice from your GP or psychiatrist
An online course is not crisis care. It is not a replacement for urgent help, medical care or individual therapy when those are needed.
But many people are not in that category.
They are struggling, but they are not unsafe. They want to begin. They need structure. They need a clear explanation and practical exercises, not another random collection of tips.
That is where a course can fit very well.
When a structured course can be a good first step
A course may be a good starting point if:
- your symptoms are mild to moderate
- you can work independently
- you want to start now
- you want privacy
- you are waiting for therapy
- you cannot afford weekly private sessions
- you want to understand the problem before deciding what to do next
- you need a framework, worksheets and repetition
- you recognise the pattern and want practical steps
This fits with a stepped-care way of thinking.
You start with the least intensive useful help, then step up if needed. In Ireland, HSE SilverCloud is an example of guided digital CBT: the HSE describes these as online CBT-based courses or workbooks, usually completed over 6 to 8 weeks with supporter check-ins. Aware’s Life Skills Online Programme is also based on CBT principles and is designed for people in Ireland with mild to moderate depression, stress and/or anxiety.
So the idea of structured online psychological learning is not unusual. The important thing is choosing a course that matches your actual problem.
The mistake: choosing by symptom rather than cycle
Many people choose help based on the symptom they dislike most.
“I want to stop worrying.”
“I want to stop panicking.”
“I want to stop checking.”
“I want to stop being angry.”
“I want to stop thinking these thoughts.”
That is understandable, but treatment works better when you look at the cycle.
For example, if you have health anxiety, the symptom may be a racing heart or a headache, but the maintaining cycle may be Googling, checking, reassurance and doubt.
If you have panic, the symptom may be dizziness or breathlessness, but the maintaining cycle may be fear of sensations and avoidance.
If you have OCD, the symptom may be intrusive thoughts, but the maintaining cycle may be compulsions and mental rituals.
If you have anger, the symptom may be shouting, but the maintaining cycle may be threat interpretation, body escalation and reactive behaviour.
A good course should teach you the cycle and then show you where to intervene.
How to choose the right first step
Use this as a simple guide.
Choose a broad anxiety course if:
You feel anxious often, overthink, avoid things, feel on edge, worry about the future, struggle to switch off, or feel that anxiety has become automatic.
This is where Retrain Your Brain fits.
The aim is to understand how your brain and body learned anxiety, then practise teaching your nervous system a different response.
Choose a panic course if:
You fear panic attacks, body sensations, feeling trapped, fainting, losing control, driving, queues, shops, appointments or being far from home.
The work needs to focus on panic sensations, fear of fear, avoidance and safety behaviours.
Choose a health anxiety course if:
You repeatedly check symptoms, Google, ask for reassurance, scan your body, doubt medical reassurance, or worry that something serious has been missed.
The work needs to focus on the health anxiety cycle without encouraging you to ignore genuine symptoms.
Choose an OCD course if:
You have intrusive thoughts, checking, reassurance seeking, mental reviewing, rituals, avoidance or a need to feel certain.
For OCD, CBT with Exposure and Response Prevention is the key approach. The HSE describes ERP as a type of CBT used for OCD, involving gradually confronting obsessive thoughts without engaging in compulsive behaviours.
Choose an anger course if:
You react more strongly than you want to, regret what you say or do, struggle to calm down, get stuck in repeated arguments, or feel anger is affecting relationships, work, parenting or self-respect.
The work needs to teach body regulation, emotional awareness, thinking skills, communication and repair.
Can a course replace therapy?
Sometimes a course is enough to get someone moving.
Sometimes it is the start.
Sometimes it helps someone use therapy better later because they already understand the model.
That is how I would think about it.
A course can give you:
- immediate access
- privacy
- structure
- repetition
- worksheets
- psychoeducation
- practical tools
- a way to start before therapy is available
Therapy can give you:
- personalised assessment
- accountability
- troubleshooting
- support with severe symptoms
- help with complex patterns
- risk assessment
- adjustment when you get stuck
The most useful question is not:
“Which one is better?”
The better question is:
“What level of help do I need right now?”
What I would not do
I would not keep reading endlessly before starting.
Information can become another delay.
At some point, you need to choose a first step and begin practising.
That does not mean rushing. It means deciding:
“This is the pattern I recognise. This is the course or therapy that matches it. I will start there.”
You can adjust later.
You do not need the perfect decision before you take the first useful step.
A practical exercise
Write down:
The problem I want help with:
Anxiety, panic, health anxiety, OCD, anger, or something else.
What I do when it appears:
Avoid, check, Google, reassure, shout, withdraw, replay, scan, test, escape.
What relief I get:
Immediate calming, feeling certain, feeling in control, getting the emotion out.
What happens later:
The anxiety returns, the doubt returns, the argument repeats, the checking increases.
The course or therapy that matches this pattern:
Choose based on the cycle, not only the symptom.
That is a good starting point.
The bottom line
Therapy can be extremely helpful.
A structured online course can also be a very useful first step.
The decision depends on severity, risk, complexity, cost, availability and whether you can practise independently.
If you are safe, motivated, and recognise one of the patterns I describe, a course may help you begin now rather than waiting until everything is perfectly arranged.
Start with the pattern.
Choose the help that fits the pattern.
Then practise.
That is usually where change begins.