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Navigating Anxiety: Therapy Approaches & Solutions

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What to expect in therapy for anxiety

Anxiety is often a sign that there's something deeper that we're trying to push away: uncomfortable feelings, sensations or memories. Our discomfort usually comes from our struggle with these feelings, rather than the feelings themselves. When we uncover what's beneath the anxiousness, and understand why we feel this way, it can sharpen our intuition, and help us get closer to what we really need. 


Tackling anxiety in this way gives my clients (in and around Japan) the confidence to take actions towards their idea of a meaningful life.  

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Is it true that anxiety is becoming more common?

Many may feel that anxiety is becoming more common. We hear stories from family and friends, schools are talking about it more, and health reports suggest the same.

The good news is, we're getting better at talking about mental health. As we become more open and understanding, more people are sharing their experiences and seeking the help they need. This might be why we're seeing more cases of anxiety being reported.

Awareness of anxiety has grown, but often we don't go beyond just knowing about it. We might think we should just tough it out or that it will pass. But when anxiety starts affecting our relationships, work, or health, it's time to take a closer look and really understand it.

(Do you find yourself worrying often, or ruminating about the past? You might find this article helpful)

Why did we evolve to have anxiety?

From an evolutionary perspective, anxiety is believed to have developed as a survival mechanism to help our ancestors identify and respond to threats in their environment. Here's a more detailed look:

  1. Fight or Flight Response: At its core, anxiety is linked to the "fight or flight" response, an innate physiological reaction that occurs in response to a perceived harmful event or threat. When faced with danger, our ancestors needed to decide quickly whether to face the threat (fight) or flee to safety (flight). This response would involve a rapid release of stress hormones, increased heart rate, heightened senses, and a burst of energy—all of which would be beneficial for survival.

  2. Vigilance and Awareness: Chronic low-level anxiety or wariness might have kept our ancestors on alert, allowing them to detect predators or other threats more quickly. This heightened vigilance could make the difference between life and death.

  3. Social Cohesion: Humans are inherently social creatures. Feeling anxiety in response to potential social conflicts or the possibility of being excluded from the group might have encouraged behaviors that maintained social harmony and cohesion. Being part of a group provided protection, shared resources, and increased chances of reproductive success. Thus, individuals sensitive to social dynamics might have had an evolutionary advantage.

  4. Risk Aversion: Anxiety could have promoted risk-averse behaviors, steering individuals away from potentially dangerous situations they didn't need to engage with. For example, being cautious around unfamiliar terrain or unknown animals would be safer than approaching recklessly

When is the best time to go to therapy for anxiety? What are the signs of anxiety?

5. Learning from Past Experiences: Anxiety can also be seen as a mechanism to remember past dangerous or negative experiences, making it less likely for an individual to repeat the same mistakes. The emotional weight of anxiety reinforces the memory of such events, leading to better decision-making in similar future scenarios.

6. Child Rearing: The natural anxiety many parents feel concerning the safety and well-being of their offspring ensures attentiveness to children's needs, increasing the likelihood of the child's survival to adulthood.

While these evolutionary benefits of anxiety make sense in the context of prehistoric environments, in today's world, many of the threats our ancestors faced are no longer relevant. However, our evolved responses remain. Modern-day stressors, such as work pressures, social dynamics, or financial worries, can trigger these same anxiety responses, even though they don't necessarily require a "fight or flight" decision. This mismatch between our evolutionary past and our current environment is one reason why anxiety disorders are prevalent in modern societies.

Anxiety can be best described with the 3 As:

  • Arousal: increased heart rate, rapid breathing, muscle tension, sweating, and a general sense of restlessness

  • Apprehension: excessive worry, fear, or anticipation about potential future events or situations

  • Avoidance: actively trying to steer clear of situations, places, or things that trigger anxiety (could also include procrastination or difficulty making decisions, avoidance of social situations)

In addition, it could involve sleep disturbances, intense and sudden feelings of panic or terror, compulsive behaviours (like repeatedly checking things), or substance use to self-soothe.

Social anxiety is something many are experiencing for the first time post-pandemic, and understandably so. If you notice yourself feeling anxious in/ before social situations, you may find this article on 3 strategies to deal with social anxiety helpful. You could also read about performance anxiety or stress here.

If you are experiencing these symptoms over time and you feel like they are interfering with your life, it may be a good idea to seek support.

What are the various ways you can address anxiety without medication?

Research has found that therapy, specifically Cognitive Behavioral Therapy (CBT), is just as effective in treating anxiety (especially panic disorders) as using CBT along with medication. Interestingly, people who only use CBT are less likely to experience a return of symptoms after treatment ends compared to those who also take medication.


Medications like Benzodiazepines can be tricky in treatment. They might make people think they need the drug to handle their anxiety, which could actually make it harder for them to deal with their anxiety or panic symptoms on their own. This can slow down their recovery process.


There are also many effective non-drug treatments for anxiety. Here are some ways to manage anxiety without medication:

Therapeutic Interventions for Anxiety

Cognitive Behavioral Therapy (CBT): CBT is one of the most researched and effective therapeutic interventions for anxiety. It involves identifying and challenging negative thought patterns and beliefs and replacing them with healthier, more realistic ones.

Mindfulness and Meditation: Mindfulness practices, which involve staying present and fully engaging with the here and now, have been shown to reduce anxiety symptoms.

Exposure Therapy: For certain types of anxiety, like phobias or PTSD, gradually and repeatedly facing the source of fear in a controlled and safe environment can be helpful.

Physical and Relaxation Techniques

Exercise: Regular mild to moderate physical activity can help reduce anxiety symptoms. Exercise increases the production of endorphins, which act as natural painkillers and mood elevators. However, since heavy exercise can also increase anxiety among people who have a strong tendency for it, it's best to consult a mental health specialist about your exercise routine.

Deep Breathing and Relaxation Techniques: Deep breathing, progressive muscle relaxation, and guided imagery can help reduce anxiety by promoting relaxation and counteracting the body's fight-or-flight response.

Biofeedback and Neurofeedback: These techniques train individuals to control physiological functions to help reduce anxiety. Sensors measure bodily functions like heart rate, and this data is displayed in real time to the user.

Image by Le Minh Phuong

Lifestyle & Dietary Adjustments

Limiting Caffeine and Sugar: Reducing intake of stimulants.

Sleep: Ensuring adequate and high-quality rest.

Limiting Alcohol and Drugs: Reducing or eliminating substance use to prevent increased anxiety and interference with any medications.

Social and Emotional Support

Social Support: Talking to someone and having a support system can significantly reduce feelings of anxiety. This may seem obvious, but it is actually one of the strongest protective factors for mental health in general. You may also be interested in the water tank metaphor (diathesis stress model) that helps to explain this. 

How does talk therapy help with anxiety?

Talking to a therapist can help with anxiety in several ways. With therapists who use Cognitive Behavioural Therapy (CBT), and/or Acceptance and Commitment Therapy (ACT), counseling usually covers the areas in the following diagram:

How Talk Therapy Helps with Anxiety (1).png

In addition, therapy can include skill building on problem solving, relaxation or mindfulness techniques, and ways in which you can feel more safe in the present moment. The ultimate goal is for you to learn how to 'be your own therapist', with a rich understanding of how anxiety manifests for you, where it stems from, and what you can do to live your best life despite it.

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I hope this article has been helpful to you, and do note that these are only a few first steps based on research. For more details and customised support, I would recommend talking to a therapist. 


  • Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive therapy and research, 36(5), 427–440.

  • 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.

  • Mennin, D. S., & Fresco, D. M. (2014). Emotion regulation therapy. In Handbook of emotion regulation (pp. 469-490). Guilford Press.

  • Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Thompson-Hollands, J., Carl, J. R., ... & Barlow, D. H. (2012). Unified protocol for transdiagnostic treatment of emotional disorders: A randomized controlled trial. Behavior therapy, 43(3), 666-678.

  • Kircanski, K., Lieberman, M. D., & Craske, M. G. (2012). Feelings into words: Contributions of language to exposure therapy. Psychological Science, 23(10), 1086-1091.

  • Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316.

  • Lebowitz, E. R., & Ollendick, T. H. (2012). Reframing intolerance of uncertainty in children: A content-based analysis. Journal of Anxiety Disorders, 26(3), 429-435.

If you're new here, I'm Diya John, a counselor and psychotherapist with a Masters in Psychology and a Diploma in Counselling from Australia. I founded Therapy Garden to make evidence-based counseling more accessible to expatriates, immigrants and the international community. I am based in Tokyo, Japan but I work with clients in different parts of the world via online therapy. You can book a free consultation or read more about my areas of specialisation and services.

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