Why Is Anxiety So Hard to Shift? Understanding What Keeps Anxiety Going — and How Therapy Can Help

What your brain is doing, what anxiety may be getting in the way of, and how change can happen

If you've ever experienced anxiety when you know that you're not actually in danger, you may have wondered why the feeling can be so convincing.

You might understand perfectly well that giving a presentation isn't dangerous, that a difficult conversation is unlikely to be catastrophic, or that a physical sensation is probably related to anxiety, and yet your body can still respond as though something important needs your immediate attention.

This can be confusing because we often assume that if we understand something logically, our emotional response should follow. In reality, anxiety isn't simply the result of consciously deciding that something is frightening. Your brain is continually taking in information, making associations and assessing what might be relevant, and some of these processes happen before you've had time to consciously think through what is happening.

Understanding this can give us another way of looking at anxiety. Rather than seeing the anxious response as evidence that something is necessarily wrong, we can begin to understand it as a system that has developed to protect us, but which can sometimes become overactive or respond to situations that aren't actually dangerous.

The aim of therapy isn't necessarily to make that system disappear or to reach a point where you never feel anxious. It is more about understanding what is happening, learning from new experiences and developing greater freedom in how you respond when anxiety appears.

The brain's alarm system

One of the brain structures involved in the anxiety response is the amygdala, which plays an important role in detecting things that may be relevant to threat and preparing the body to respond. It can be useful to think of it as part of an alarm system: its job is to notice potential danger and get you ready to do something about it.

An alarm system doesn't need to establish with complete certainty that there is a problem before it responds. If you were walking through a forest and saw something that looked like a snake, for example, it would be useful for your body to react quickly rather than waiting until you had carefully established exactly what you were looking at. You might react first and realise a moment later that it was actually a piece of rope.

This helps explain why anxiety can sometimes happen before you've consciously worked out why. Information coming into the brain can contribute to an emotional and physical response before you've fully processed what you're seeing, hearing or experiencing.

The cortex is involved in processes such as thinking, interpretation and making meaning from experience, while the amygdala can respond more rapidly to information that might signal threat.

Of course, the brain is considerably more complicated than a simple "amygdala versus cortex" model, but the distinction can be useful for understanding the experience of anxiety. It helps explain why you can sometimes feel anxious before you've consciously worked out why, and why telling yourself that you're safe doesn't always make the physical response disappear immediately.

When your thoughts can trigger anxiety

Anxiety doesn't only begin with something happening around you. It can also begin with what your mind is imagining, remembering or interpreting.

You might be preparing for an important meeting and start imagining yourself making a mistake. You might be waiting for someone to reply to a message and begin imagining that they're angry with you. You might notice an unusual physical sensation and start wondering whether it means something is wrong. Or you might think about something that happened in the past and find that the thought brings back some of the feelings associated with it.

In these situations there may be no immediate external threat, but the thought or image can still contribute to a genuine anxiety response. We can become anxious about something that might happen, something that happened previously, something we are imagining, or simply something that remains uncertain.

This can become particularly important when anxiety leads to rumination. You might start repeatedly analysing what is happening, going over possible outcomes, trying to work out what something means or searching for a way to make yourself feel certain.

Rather than simply being a response to anxiety, this kind of thinking can become part of the threat system itself. The cortex is continually interpreting and generating information, and when that information is focused on possible danger, the brain can continue sending signals that something needs attention. In this sense, anxious thinking can keep feeding the alarm system even when there is no immediate danger in the outside world.

You might notice yourself thinking, What if something goes wrong? What does this mean? What if I've missed something? How can I know that everything is going to be okay? Each question can generate another possibility to consider, keeping your attention focused on the perceived threat.

This can create a feedback loop: anxiety generates anxious thinking, and anxious thinking can generate more anxiety.

That can make anxiety feel very real even when there isn't an immediate danger.

How anxiety becomes a cycle

Once anxiety has been activated, we naturally look for ways to make the feeling go away.

We might avoid the situation that is making us anxious, seek reassurance, check that everything is okay, distract ourselves or spend a great deal of time thinking about the problem in the hope that we can finally work out what to do.

These responses make sense. If something feels threatening, it is natural to want to get away from it or find a way of making yourself feel safer.

The difficulty is that some of these strategies can provide relief without giving the brain an opportunity to learn something new. If you avoid a situation and feel better afterwards, for example, your brain may learn that avoiding it was what kept you safe. If you repeatedly seek reassurance whenever you feel uncertain, reassurance can become part of the way you manage uncertainty rather than giving you the opportunity to discover that you can tolerate not knowing.

Exposure works partly by creating a different experience: allowing anxiety to be present while remaining in contact with the situation rather than automatically escaping from it.

This is one of the principles underlying exposure-based treatments such as ERP. The aim isn't simply to make you feel less anxious in the moment, but to change what you learn from your experiences.

Anxiety isn't a prediction of what will happen

Anxiety is often anticipatory. We can become highly anxious about something before it happens, sometimes imagining all the ways that it might go wrong, only to find that the actual experience is considerably easier than we expected.

You might feel extremely nervous before giving a presentation and then discover that, once you start speaking, your anxiety settles. You might spend days worrying about a difficult conversation and then find that the conversation itself is manageable. You might anticipate that you won't be able to cope with a situation, only to discover afterwards that you managed it better than you expected.

This matters because we can easily start treating the intensity of anxiety as information about the situation:

"I feel this anxious, so there must be a good reason."

"I feel like I can't cope, so perhaps I shouldn't do it."

"My body is reacting this strongly, so maybe something really is wrong."

The feeling is real, but that doesn't necessarily mean that the interpretation attached to it is accurate.

Learning to make that distinction can be an important part of changing your relationship with anxiety.

Your brain can learn from experience

One of the more hopeful things about understanding anxiety in this way is that the brain isn't fixed. It can learn from experience, and repeated experiences can strengthen or change the ways we respond.

If you have spent years avoiding something, your brain may have had relatively little opportunity to discover what happens when you stay with it. If you have developed a habit of checking, reassuring yourself or escaping whenever anxiety appears, those responses may have become well-established ways of dealing with uncertainty.

That doesn't mean you've permanently taught your brain to be anxious. It means that learning has taken place, and new learning is possible.

This is where behavioural change becomes particularly important. You can understand intellectually that a situation isn't dangerous, but there is something different about actually experiencing the situation while allowing the anxiety to be there and discovering what happens.

You might approach something you've been avoiding and find that the anxiety changes over time. You might allow an uncomfortable physical sensation to be present without immediately checking it. You might experience uncertainty without trying to resolve it. You might discover that something you had predicted would be unbearable was difficult, but manageable.

These experiences provide your brain with information that it didn't have before.

This is also why exposure isn't simply about forcing yourself through situations until anxiety disappears. It is an opportunity to have a different experience of something that your brain has learned to treat as threatening.

The aim isn't to eliminate anxiety

It can be tempting to make reducing anxiety the main goal of therapy, particularly because anxiety is uncomfortable and can have a significant impact on your life.

But if the aim becomes "I need to stop feeling anxious", anxiety itself can become something that you are constantly monitoring and trying to control.

You may begin avoiding anything that might make you anxious, checking whether you feel calm enough to do something, postponing a decision until you feel completely certain, or spending a great deal of time trying to work out why you feel the way you do.

Sometimes the more useful question is not "How can I get rid of this anxiety?" but "What is this anxiety stopping me from doing?"

That might mean going somewhere, having a relationship, speaking openly, making a decision, taking a risk, pursuing something you care about or simply being able to get on with your day without constantly monitoring how you feel.

The goal isn't necessarily to become someone who never experiences anxiety. Anxiety is part of being human, and there are situations where fear and caution are appropriate.

The aim is to develop greater freedom in deciding what you do when anxiety appears, rather than allowing the presence of anxiety to make the decision for you. This emphasis on continuing to act in line with what matters to you, rather than making symptom reduction the sole objective, is also central to ACT.

Understanding anxiety in the context of your life

Understanding the brain can be useful, but it doesn't necessarily explain why you experience anxiety in the particular way that you do.

Two people can both experience significant anxiety while having very different reasons for becoming anxious, different patterns of avoidance and very different ideas about what they are trying to protect themselves from.

Our experiences and relationships can influence what we learn to pay attention to, what we interpret as threatening and how we respond when we feel vulnerable or uncertain.

A person who has experienced rejection might become particularly sensitive to signs that someone is withdrawing from them. Someone who has experienced a great deal of unpredictability might develop a strong need for control. Someone who has repeatedly felt criticised might become highly alert to the possibility of making mistakes.

Understanding these patterns doesn't necessarily mean spending all of our time looking into the past. Sometimes the most useful thing is to focus directly on what is happening now and experiment with responding differently. At other times, understanding where a particular pattern came from can make sense of something that has previously felt confusing or difficult to change.

I see these approaches as complementary. We can explore the experiences and relationships that have shaped you while also paying attention to what maintains anxiety in the present. We can understand why a particular response developed while also creating opportunities for something different to happen now.

Learning to respond differently

Ultimately, understanding anxiety is only useful if it gives you greater freedom in how you respond to it.

You cannot always control what your brain notices, which thoughts appear or when your body produces an anxious response. Trying to control every internal experience can sometimes become another struggle with anxiety in itself.

What can change is your relationship with those experiences.

You can begin to notice that a thought is a thought rather than automatically treating it as something that needs to be solved. You can recognise that a physical sensation is uncomfortable without immediately assuming that it means something is wrong. You can allow uncertainty to exist without always trying to eliminate it. And you can begin to discover through experience that you are capable of doing things that matter to you even when anxiety is present.

This is why I don't see practical approaches to anxiety and psychological understanding as alternatives. Sometimes change comes from understanding something differently; sometimes it comes from doing something differently and allowing your brain to learn from the experience. Often, both are part of the same therapeutic process.

The aim isn't to make you someone who never feels anxious. It is to help you understand what is happening, develop a different relationship with the anxiety you experience and become less restricted by it.

Considering therapy for anxiety?

If anxiety is beginning to affect your relationships, decisions or the things you want to do in your life, an initial conversation gives us an opportunity to talk about what you're experiencing, what you would like to change and whether my approach might be helpful.

You don't need to have everything worked out before we speak.