Anxiety & Nervous System Regulation
When Anxiety Calls the Shots
Anxiety can be surprisingly difficult to understand when you’re experiencing it.
Sometimes you know exactly what you’re anxious about. Your mind is several steps into the future, anticipating what could go wrong and trying to prepare for it.
Other times, the reaction seems to arrive first.
Your heart starts pounding during an ordinary conversation. You suddenly feel uneasy around someone you have no obvious reason to distrust. A particular place, sound, expression, sensation, or situation puts you on edge before you’ve had time to make sense of why.
You can even know rationally that you’re safe and still have a body that is behaving as though you aren’t.
That apparent contradiction makes much more sense when you understand something important about anxiety: your conscious thoughts aren’t the only information your brain uses to decide what might be dangerous.
Your nervous system is continually taking in information and comparing what is happening now with what it has learned from previous experiences. Some of that learning is easy to recognize. Some of it operates well outside conscious awareness.
That means anxiety can begin in different places. You may notice the thought first: What if something goes wrong? You may notice the physical response first: a tight chest, hot cheeks, cold hands, nausea, trembling, or a sudden rush of adrenaline. Sometimes what you notice first is simply an urge: Get out of here. Fix this. Check again. Don’t do it.
By the time you become aware that you’re anxious, your brain and body may already be responding to something they’ve identified as important.
And because anxiety is designed to get your attention, it feels pretty convincing.
How Anxiety Paints Us Into a Corner
When something reduces anxiety, your brain pays attention to the relief. That’s one reason avoidance, checking, reassurance seeking, overpreparing, and trying to eliminate uncertainty can become such persistent ways of managing it.
Imagine that you’re anxious about sending an important email. You read it again. You make another change. You check the recipient. You read it one more time.
Each check gives you a little relief.
Your brain notices.
The next time you need to send something important, checking is already associated with feeling safer. What began as an attempt to avoid a mistake can become something you feel like you need to do whether you want to or not.
Avoidance can work the same way. You postpone the difficult conversation and immediately feel better. You cancel the trip and the anxiety drops. You seek reassurance and feel relieved when someone tells you everything is okay.
Relief is powerful information to the brain.
When something appears to make a threat go away, your brain has good reason to remember what you did and make that response easier to reach for again.
The difficulty is that it can learn another lesson at the same time: Good thing we avoided that.
Your nervous system gets fewer opportunities to learn that you could tolerate the uncertainty, handle the conversation, recover from a mistake, or discover that the thing you feared wasn’t going to happen at all.
And because these strategies really can make you feel better in the short term, changing them can initially make you feel more anxious.
That’s part of what makes anxiety so good at painting us into a corner. The things that bring immediate relief can gradually take over more of your life. You spend increasing amounts of time trying to become certain enough, prepared enough, reassured enough, or safe enough to proceed.
What Anxiety Is Doing in Your Brain and Body
By the time you notice anxiety, your brain has likely already begun preparing your mind and body for a potential threat.
That response has a purpose: if something genuinely dangerous is happening, a quick response matters. Your brain doesn’t want to wait for you to consciously evaluate every piece of available information before you respond.
When the threat system activates, priorities begin to change. Your heart rate and breathing change. Muscles get ready to help you escape or fight. Digestion slows. Your attention narrows toward whatever seems most important for keeping you safe.
Your thinking changes too.
When the brain is prioritizing survival, you have less access to some of the abilities that are easier to use when you feel safe, including perspective, flexible thinking, decision making, and finding the words you want to say.
That can create some upsetting and confusing experiences.
You can know exactly what you wanted to say before a difficult conversation and suddenly struggle to find the words once you’re in it. You can understand intellectually that you’re safe while your heart is pounding and every part of your body is telling you otherwise.
The physical sensations themselves also become part of the alarm cycle. Your heart starts racing. You notice that it’s racing and become frightened by what that means. Your brain interprets that something is wrong, the threat response intensifies, and the sensations become even stronger.
When anxiety happens so automatically, it can be tricky to understand what is happening and why.
Understanding your specific experience gives us useful places to intervene.
What You and I Can Do With Your Anxiety
I want therapy to help you feel better. I also want you to understand enough about your own anxiety that you know what to do when it shows up again.
So you should expect to learn some science.
I spend time helping clients understand what is happening in the brain and body during anxiety: how your nervous system detects and responds to threat, what happens to your thinking when that system takes priority, and why the physical sensations of anxiety can sometimes add to the alarm.
My approach draws from Cognitive Behavioral Therapy (CBT), mindfulness, and somatic therapy, and I like clients to understand why the things we’re doing can help. If we use a breathing technique, I want you to know what we’re asking your nervous system to do. If we use a CBT skill, I want you to come away with insight into what’s happening and a better idea of how to respond.
Over time, you can become more familiar with your own anxiety: what it feels like when your nervous system becomes dysregulated, what tends to make it feel worse, and what helps you feel and function better.
The more you understand what your anxiety is doing, the more opportunities you have to make those choices for yourself instead of having anxiety call the shots.
Get started here
Complete the secure inquiry form below and I’ll personally respond within one business day. We’ll schedule a brief consultation call where you can share a general sense of what brings you to therapy, ask questions about my approach, and decide whether working together feels right for you.
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Mindfulness is the practice of intentionally paying attention. In a world that constantly competes for your focus, learn how mindfulness can help you return to the present moment and the life you’re already living.
Licensed Professional Counselor
Cheryl Zandt
Telehealth Counseling in Washington DC and Virginia
Cheryl Zandt is a Licensed Professional Counselor providing online therapy for women in Virginia and Washington DC. For more than 20 years, she has worked with women experiencing anxiety, burnout, panic, relationship challenges, life transitions, and other sources of stress and overwhelm.
Her approach is thoughtful, collaborative, and grounded in curiosity about why we think, feel, and respond the way we do. She brings clinical experience and research-informed approaches to the work while recognizing that each client is the expert on her own experience.
Cheryl helps clients better understand what has been shaping their experiences, develop practical ways to respond differently, and have more choice in what happens next.
Your questions, answered
What type of therapy do you use for anxiety?
My work with anxiety is grounded in Cognitive Behavioral Therapy (CBT), mindfulness, and somatic approaches. Depending on what you’re experiencing, we might look at patterns in your thoughts and responses, practice ways of working with anxiety when it shows up, or pay attention to what is happening in your body.
There isn’t one approach that works for everyone. We’ll focus on understanding how anxiety works for you and finding ways to respond that give you more choice in your daily life.
How do I know if what I’m experiencing is anxiety or normal stress?
Stress and anxiety are both normal parts of being human. They can even be useful, helping us recognize problems, prepare for challenges, or respond when something needs our attention.
The distinction isn’t always about whether anxiety is present, but how persistent or disruptive it has become. You might notice that worry is taking up a lot of your time, affecting your sleep or concentration, making decisions harder, showing up physically, or influencing what you do and avoid.
You don’t need to figure out whether your anxiety is “bad enough” before talking with a therapist. We can look together at what you’re experiencing, how it’s affecting your life, and whether there are changes that would be helpful.
Should I consider medication for anxiety?
It depends on the severity of your symptoms, how much they’re affecting your daily life, and your personal preferences. For some people, therapy alone is enough to create meaningful relief. For others, medication can be a helpful tool, especially when anxiety is making it difficult to function, sleep, concentrate, or fully engage in therapy.
I don’t prescribe medication, but I’m happy to help you think through your options and, when appropriate, coordinate care with your physician or psychiatrist. My goal is to help you find an approach that works for you, not to push a particular solution.
What is generalized anxiety disorder (GAD)?
Generalized anxiety disorder involves persistent, excessive worry about different areas of life that can be difficult to control. The focus may shift from one concern to another: work, relationships, health, finances, family, decisions, things that might go wrong, or sometimes simply the feeling that there is always something to worry about.
GAD can also show up physically through symptoms such as muscle tension, restlessness, fatigue, difficulty sleeping, or trouble concentrating.
If this sounds familiar, we can look at the patterns in your anxiety, what keeps them going, and how much they’re interfering with your life. You don’t need to arrive already knowing whether what you’re experiencing has a particular name.
Can therapy help with the physical symptoms of anxiety?
Yes. Anxiety isn’t only something we experience in our thoughts. It can affect breathing, heart rate, digestion, sleep, concentration, muscle tension, and energy.
Therapy can help you understand what is happening when your body responds this way and learn ways to respond differently to the sensations and situations that trigger anxiety. As anxiety becomes less overwhelming, many people also find that its physical symptoms become less disruptive.
Should I consider medication for anxiety?
Medication can be helpful for some people with anxiety, either on its own or alongside therapy. Whether it makes sense for you depends on your symptoms, medical history, preferences, and other individual factors, and that decision is best made with a healthcare professional who can prescribe and monitor medication.
I don’t prescribe medication, but I’m happy to talk with you about your questions or concerns and, with your permission, coordinate with your physician or psychiatrist when that would be helpful. There isn’t one right choice for everyone.
Why does anxiety make it so hard to do things I know I need to do?
Anxiety often convinces us that avoiding something will make us feel better. In the short term, it usually does. The problem is that the anxiety remains, while the task, conversation, decision, or responsibility is still waiting. And when avoiding something brings relief, it can make avoidance even more appealing the next time anxiety shows up.
Therapy can help you understand that cycle and find new ways of responding. The goal isn’t to force yourself through everything that makes you anxious. It’s to help anxiety have less say in what you do and don’t do.
Why does anxiety feel so convincing even when I know my fear probably isn’t true?
Knowing something intellectually doesn’t always change how we feel or respond to it. You may understand that a feared outcome is unlikely and still feel a strong need to avoid something, check again, seek reassurance, prepare for every possibility, or find some other way to feel certain that everything will be okay.
Part of what makes anxiety so persistent is that absolute certainty is rarely available. Anxiety can keep finding another “what if?” even after one concern has been answered.
Therapy can help you understand what keeps that cycle going and practice responding differently to fear and uncertainty. Over time, the goal is not to become certain that nothing bad will ever happen, but to have more freedom to decide what you want to do even when anxiety is asking for guarantees.
Do you treat OCD and intrusive thoughts?
Yes. I work with people experiencing obsessive-compulsive disorder (OCD), including religious scrupulosity. Although OCD is distinct from anxiety disorders, obsessions and compulsions can involve intense anxiety, fear, doubt, or a need for certainty.
OCD can take many forms. Obsessions may involve unwanted thoughts, images, fears, or doubts, while compulsions can include visible behaviors as well as less obvious responses such as checking, seeking reassurance, reviewing something repeatedly in your mind, or trying to achieve a feeling of certainty.
I use Exposure and Response Prevention (ERP), an evidence-based treatment for OCD. Before beginning exposure work, we’ll spend time understanding what you’re experiencing: the obsessions and compulsions involved, when they began, how much time they take, how they affect your relationships, work, and daily life, and what you would like to change.
From there, we work collaboratively. I may recommend different kinds of exposure exercises, including imaginal or real-life exposures, depending on what you’re experiencing. You’ll have room to ask questions, raise concerns, and give me feedback as we decide together how to approach the work.