When your mind won’t switch off, not even once you finally sit down.
Constant worry, thoughts on a loop, a body on high alert, poor sleep and the feeling of always being on edge without quite knowing why. Anxiety responds very well to psychological therapy, often within a few months. Sessions in Cambridge and online, in English or Spanish.
No GP referral or prior diagnosis needed. Individual 60-minute session: £90 in person, £80 online.
You don’t need all of them. If two sound familiar, this page is for you.
Many people first come in saying they can’t stop, they’re sleeping badly or they’re snapping at everyone. These are the forms it most often takes in my consulting room.
Anxiety and depression often turn up together. In the first session we look at how much of each is there, because the plan isn’t the same.
Anxiety is an alarm system that works too well. It’s built to protect you from real danger, but with anxiety it also goes off when there isn’t any. Simply understanding how it works takes away some of the fear.
Simplified diagram of the brain seen from the side. The amygdala sits deep inside the temporal lobe; it is shown here in its approximate position.
It’s like an oversensitive smoke alarm: it goes off just the same for a house fire as for burnt toast.
The good news is that the brain learns. Every time the alarm goes off and nothing bad happens, as long as you don’t run from it, the amygdala recalibrates a little. That’s a big part of what therapy does: teaching the alarm system, through practice, that it can stand down.
Seven quick questions about the last two weeks. The GAD-7 is a short questionnaire used by GPs and therapists around the world to spot symptoms of anxiety. It scores itself when you finish, and the tide rises to meet your score.
Before you start: this is a screening questionnaire, not a diagnosis. A high score doesn’t mean you have a disorder, and a low one doesn’t rule it out. Only an assessment with a professional can look at your situation properly. Your answers aren’t published anywhere: they only reach José if you leave your email.
If you’re going through a really hard time: Samaritans 116 123 (free, 24/7) · text SHOUT to 85258 · NHS 111 · emergencies 999. In Spain: 112 / 024.
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A word about the cut-off. 10 is the cut-off from the original study: in primary care, a score of 10 or more picked up 89% of people with generalised anxiety disorder and correctly ruled it out in 82% of those without it (Spitzer et al., 2006). Treat it as a guide, not a hard line. And remember: this is a screening, not a diagnosis. Scores also run high with panic, social anxiety or post-traumatic stress, without telling them apart, and they describe the last two weeks, not who you are. If you score 10 or more, or your symptoms worry you, talk to a mental health professional.
If things feel hard right now: talking helps. You can book a free 15-minute call or speak to your GP.
If you’re thinking about harming yourself: call 999, NHS 111 (choose the mental health option) or Samaritans on 116 123 (free, 24/7). In Spain: 112 / 024.
Your result is calculated in your browser. It’s only sent to José if you leave your email, and it’s never published.
Anxiety shows up in three places at once: in your body, in your head and in what you do. Many people recognise the symptoms in just one of them and don’t realise the other two are part of the same thing.
What makes anxiety stick around isn’t the threat: it’s what you do to calm it down. Avoiding, checking or going over and over it works for five minutes, and strengthens the loop for tomorrow.
Pick a situation, choose what you do when the anxiety rises, then move through the days. You’ll see why avoiding brings relief today but makes tomorrow harder, and why staying is tough at first and then gets easier.
Solid line: the day you’ve chosen · dashed: earlier days · the buoy is you, moving through the situation. No units: it’s a sketch.
Your week’s crests (each day’s peak)
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. doi.org/10.1016/j.brat.2014.04.006
An anxiety attack, or panic attack, is very unpleasant but it isn’t dangerous. It usually peaks within a few minutes and then eases on its own. What drags it out most is fighting it or trying to escape.
These steps won’t make it vanish instantly. They help you get through it without adding fuel to the fire, which is exactly the opposite of what your body is urging you to do in that moment.
If the attacks keep coming back, or you start avoiding places for fear they’ll return, that is treatable, and treatment works very well.
Breathe in as the moon rises and the tide comes in; breathe out, more slowly, as it sinks. It isn’t about forcing the anxiety away, but about stopping over-breathing and keeping it company while it passes. Try it first at a calm moment, so that when you need it, you’ll already know the rhythm.
Press “Start”. Breathe in for a count of 4 and out for a count of 6.
When you’re ready
4 in · 6 out
2:00
During the day, work, people and noise keep your mind busy. At night all of that switches off, you’re tired and less able to put the brakes on your thoughts, and your bed ends up linked with going over things. That’s why so many people fall asleep exhausted and wake at four in the morning with the whole list running.
If the insomnia has lasted several weeks, it deserves treatment in its own right: cognitive behavioural therapy for insomnia (CBT-I) is the first-choice psychological treatment, and it combines well with treatment for anxiety.
Not every worry needs the same response. A practical worry is about a real, current problem you can do something about. A hypothetical one usually starts with “what if…?” and is about something that hasn’t happened and that you can’t act on right now. Sort these eight and see which branch of the tree each one lands on.
Card 1 of 8
Is it a real, current problem you can do something about?
Can you do something about it right now?
This is the hands-on version of “worry time”. When a worry turns up outside its slot, especially in bed, don’t argue with it or try to solve it there: jot it down, decide when you’ll look at it, and leave it in tomorrow’s drawer.
The technique is called worry postponement, and it comes from the stimulus-control approach described by Borkovec and colleagues (1983): give worry a fixed time and place, so it stops popping up wherever it likes and your bed goes back to being for sleep.
The drawer is empty. Anything you park will appear here, in time order.
What you write stays on this screen: it isn’t saved or sent. If you reload the page, the drawer empties, so print or copy it if you want to keep it.
Borkovec, T. D., Wilkinson, L., Folensbee, R., & Lerman, C. (1983). Stimulus control applications to the treatment of worry. Behaviour Research and Therapy, 21(3), 247–251. doi.org/10.1016/0005-7967(83)90206-1
A quiet, private room on a leafy road in south Cambridge. Under a mile from Addenbrooke’s and the Biomedical Campus, about two miles from the city centre. Online sessions are available too.
Anxiety is one of the problems that responds best to psychological therapy. I use cognitive behavioural therapy combined with third-wave therapies, the combination with the strongest research support.
The first things to shift are usually your sleep and how intense the peaks are, often within the first few weeks. The background worry takes a little longer. Most anxiety work is completed in a reasonable number of sessions, and by the third or fourth I’ll give you a concrete estimate for your case.
That’s for your GP or psychiatrist to decide, not me: as a psychologist I don’t prescribe. Many people with anxiety are treated with therapy alone; for others, medication and therapy work well together. If you’re already taking something, we work in the same way, and if I think it would help to talk to your doctor, I’ll tell you.
Because a relaxation technique used to escape the symptom ends up becoming part of the loop. It lowers your arousal for ten minutes and confirms that the situation was dangerous. The work isn’t about breathing better; it’s about changing what you do when anxiety shows up.
Stress usually has an identifiable cause and eases when that cause goes away. Anxiety keeps itself going and moves from one topic to the next. If it comes from an ongoing situation at work, burnout and work stress may be the better fit. We’ll work it out in the first session.
Yes, and the research finds no significant difference in effectiveness compared with in-person therapy. For anxiety it also has a practical advantage: you do the exercises in your real-life setting, which is where the problem shows up. More detail on online therapy.
No. This is private practice: you get in touch, we talk for fifteen minutes and, if you decide to go ahead, we start. Many people come while they’re on an NHS waiting list, or after a course of therapy that helped but didn’t go far enough.
Yes, lots: palpitations, a tight chest, feeling short of breath, a knotted stomach, dizziness, tingling or muscle tension. It’s adrenaline getting your body ready to run. If the symptoms are new or very intense, see your GP first to rule out other causes. You’ll find the full list under symptoms of anxiety.
An anxiety attack on its own doesn’t damage your heart, although the symptoms are very similar and fear of a heart attack is one of the most common fears during an attack. Precisely because they’re so alike, if you have chest pain, especially for the first time or if you have risk factors, the right thing to do is go to A&E or call 999: only a doctor can rule it out.
Because the trigger isn’t always something outside you. It might be a bodily sensation, a thought that passes almost without you noticing, or weeks of built-up stress. The alarm goes off all the same, and because you can’t see the cause, it’s even more frightening. Not finding the reason doesn’t mean there isn’t one, and therapy helps you learn to spot it.
Anxiety is a normal, useful emotion, so the goal isn’t never to feel it again, but for it to stop running your life. With treatment, most people improve clearly: they sleep better, stop avoiding what they used to avoid and learn to recognise the signs of a relapse so they can stop it in time.
This is not an emergency service. If you are in crisis or worried about your safety right now, call 999 or go to A&E. You can also call Samaritans on 116 123 (free, 24/7), text SHOUT to 85258, or call NHS 111 and choose the mental health option. In Spain: 112 / 024.
Fifteen minutes by phone or video, free and with no obligation. Tell me how the last few months have been and I’ll tell you what I think would help.
Book your free callOr email me at jose.gonzalez.m@cop.es or message me on WhatsApp at +44 7490 975208.