Online psychotherapy at Covid-19 times

Covid-19 and online psychotherapy


How can we take care of our mental health while in quarantine? Online psychotherapy could be an important tool.

Until a couple of months ago, no one would have imagined that half of the world was soon going to be in lockdown, that we would be stuck at home with no chances to meet our loved ones, unable to travel and visit friends or family, without an office to rush to in the morning, or schools to leave the kids at … 

Our habits have been turned upside down and after an initial reaction of denial, shock and anger perhaps, now we’re doing our best to adapt to the current situation. 

Coronavirus is an invisible new inhabitant of our world that has altered our perception of time, relationships and sense of security. However, this ‘break’ could really represent a good opportunity to reshuffle our routine and think both our life and habits through.

Is there anything that you wish to leave behind in the pre-Coronavirus times? Were there things you may have taken for granted and not appreciated enough? Was the pace of your life too fast? Were you missing out on the important things? 


The impact of quarantine on our mental health

With quarantine underway, fear of contracting the virus, economic instability, fear of losing or actual loss of our loved ones, forced and prolonged isolation are all significant risk factors that may take a significant toll on our mental health.

Prolonged lockdown is indeed presenting different challenges within different age groups. Apparently young people are mostly struggling with boredom, family conflicts and in complying with social distancing rules, whereas the most vulnerable (the elderly and people with health problems) are struggling with solitude. People in their 40s and 50s seem to find it difficult to handle home-schooling and work altogether (S. Barari et al, 2020). 

Scientific research suggests that the main effects of prolonged quarantine consist in increased anxiety, depression and irritability, plus an increase of post-traumatic stress symptoms in healthcare workers that are exposed to emotionally-charged situations on a daily basis. 

The longer the quarantine lasts, the worse the impact on our mental health may be.

In these difficult times, mental health support becomes even more vital and, given social distancing measures, online psychotherapy is the only viable way to therapy.

How does online psychotherapy work?

Online psychotherapy works exactly like face-to-face therapy.

In parallel with the massive use of technology in our daily lives, mental health support has been recently delivered in non-traditional ways, other than the classic face-to-face offline approach. Phone and video calls, emails and also instant messaging are being used as the means to deliver therapy.

Consultation via video call is the most frequent one and, as I personally believe, the best way to access online counselling. Several GDPR compliant platforms can be used, such as Skype and FaceTime.

The sessions work exactly like face-to-face therapy in terms of duration, frequency, confidentiality and how therapy is held.


Is it more difficult to open up online compared to face-to-face meetings?

Not necessarily. Research suggests that young people feel more comfortable with internet-based counselling, especially via instant messaging compared to other traditional forms of psychological support. Anonymity seems to promote more direct communication while reducing feelings such as shame and embarrassment (Kuka, 2014).  

Will the relationship with the therapist feel different compared to face-to-face therapy?

The idea of talking about inner struggles with a therapist never physically met before may raise concerns in some of us. ‘How can I trust a person I have never met? Will the therapist be able to get a full picture without body language cues?’ are indeed common questions.

The screen may sometimes represent a barrier when reading non-verbal cues, but research suggests that online therapy is as useful as face-to-face therapy and that patients report good rates of satisfaction by using this method. 

After all, if you think about it, nowadays there is an abundance of things happening online. We take on new hobbies, make new friends, exchange ideas with like-minded people, hold group meetings and, sometimes, fall in love, too!

In my personal experience, it is possible to establish a solid therapeutical relationship with a therapist online, despite the traditional face-to-face experience still being the preferred method for some people.

Does online psychotherapy work? 

Personally, I believe in the efficacy of online counselling and my experience so far has been promising. 

Data collected in scientific research suggest that online therapy has the same efficacy of face-to-face therapy. In particular, internet-delivered Cognitive Behavioural Therapy has proved its efficacy for treating anxiety as well as depressive disorders and its effects last over time (Wagner, 2014; Andrews, 2018) .

Is online therapy suitable for everyone? 

Online therapy is suitable for most people, yet it may not be for everyone.

It is not recommended for people with suicidal intent, psychosis or acute psychiatric disorders. In general, online therapy is not recommended for people experiencing acute conditions that may require the patient to seek medical help.

If you wish to try online therapy, a good Internet connection and a quiet and private environment to take the call are important. Feeling comfortable opening up is key, therefore you may want to find a suitable time and place where your privacy is protected.

 Which therapist should I choose?

The process of picking your therapist is a very personal one. Check the credentials as well as the qualifications of your chosen therapist to understand whether their area of expertise matches your requirements. 

Then, in the same way as face-to-face therapy, proceed to book an initial session with a couple of therapists or have a quick phone chat with them to address your questions and see how you feel. Your inner guidance will tell you – the best therapist for you is the one you feel comfortable opening up to.


Andrews G, Basu A, Cuijpers P, Craske MG, McEvoy P, English CL, Newby JM.

‘Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis’, Journal of Anxiety Disorders, vol 55, April 2018, Pages 70-78

Wagner B, Horn AB, Maercker A. “Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial”, Journal of Affective Disorders, volumes 152–154, January 2014, Pages 113-121

Barari S, Caria S, Davola A, Falco P, Fetzer T, Fiorin T, Hensel T, Ivchenko A, Jachimowicz J, King G, Kraft-Todd G, Ledda A, MacLennan M, Mutoi L, Pagani L, Reutskaja E, Roth C, Raimondi F Slepoi. “Evaluating COVID-19 Public Health Messaging in Italy: Self-Reported Compliance and Growing Mental Health Concerns”

Kuka DL (2014) “Adolescent Help-Seeking: The Promise of Text Counseling”. Retrieved from Sophia, the St. Catherine University repository website:

Trapped among worries and rumination, what about Mindfulness?

Past, present and future are the three elements of our timeline that strongly influence our self, mind and our psychological functioning. Our sense of self is shaped by our past history, and our expectations and goals are a sort of compass that orientates our present. Our mind constantly navigates among past, present and future and most of the time we are not completely aware of this.

How many times have we found ourselves trapped by worry regarding the future? And how many times was that scary vision of the future not even close in time as it may potentially happen although we are not even sure when?

Or on the contrary how many times have we found ourselves ruminating over and over again on past episodes, on things that happened and that we would like to change, on our mistakes and people’s behaviours?

While worrying about the future typically leads to anxiety, rumination often causes low mood.

Beyond the negative consequences that this mindset has on our mood, it also involves a specific risk: missing out on the present moment – our today.

Being constantly focused on tomorrow or yesterday doesn’t allow us to be present in what is happening in the now hence to appreciate and enjoy the beauty of what we actually have or are experiencing.

Oriental philosophers have been the first to embrace this thought and to transform it into a real mantra for living, using meditation as a daily activity. In recent years, some principles of Eastern philosophy have been adopted and tailored to the Western lifestyle, and it comes with the name of Mindfulness.

Being mindful means being aware of the present moment, being in the here-and-now and it can be practiced through meditation or simply by asking yourself gentle questions in order to bring awareness to your senses.

Beyond the efficacy of stimulating a state of calm and awareness, mindfulness can be a powerful tool to fight and contrast our mind’s tendency to wander into the past or future when such activity is not needed or useful.

If you recognise yourself in this tendency to focus too much on the past or future instead of the present moment, working on being mindful through psychotherapy can be quite helpful in tackling such inclination.

How intolerance of uncertainty makes you anxious

Intolerance of uncertainty

One of the main constructs linked with anxiety is intolerance of uncertainty.

Uncertainty is a peculiar companion of our life, not particularly loved by most of us but surely always present. Daily life situations, economical and political unstable scenarios doubtlessly intertwine to trigger issues related to our threshold of tolerance of uncertainty.

But why is uncertainty such a scary monster for some of us? 

If we look at our daily life through a magnifying glass, we will notice that it is permeated by little daily elements of uncertainty. All things considered, no one has a crystal ball to make well-thought-out decisions and to know for sure what the future will bring. Therefore a dose of uncertainty is normal to experience in life.

We are all different in how we react to uncertainty, but for some of us it can be a cause of intense unease and distress.

If you have trouble dealing with uncertainty, you may find yourself trapped by worry and negative thoughts.

The main feature of worry is that it hinges on a chain of negative possibilities, one followed by another, that brings forth a catastrophic and doomed scenario, in our mind much more likely to happen and scarier than it actually is.

Most of the time habitual worriers believe that thinking and anticipating all the possible negative outcomes helps them feel safer and more prepared if the depicted scenarios become real.

Conversely, relying on worry is usually far from being a constructive strategy, as one may easily get lost among negative scenarios and feel confused and scared.

Among worriers’ preferred coping mechanisms, they also avoid uncertain situations and keep things under control as much as possible. The reason this happens is that we often associate uncertainty with a potential danger and a negative outcome, despite the fact that such outcome might not even occur in the first place.

How to deal with uncertainty? 

Accepting that uncertainty is unavoidable and constitutes an inevitable part of our life is helpful and a good starting point. Focus on what you can actually change and improve (and therefore on what you have control of), such as your reactions to uncertainty: decrease your anxiety level through relaxation techniques, do not avoid situations with potentially unknown outcomes by default and challenge your negative thinking. Talking about it with a therapist may definitely help.

Six anxiety traps

Anxiety traps

Psychiatrist Robert Leahy begins one of his books on anxiety and worry asking the readers quite a particular question: if you had to explain to a martian what anxiety is and how an anxious person resonates, how would you do it? 

Usually we are so trapped by our worries and anxieties that we tend to get hooked on a sense of danger and urgency, not thinking about the thoughts that are causing and/or maintaining this psychological state.

Let’s see which are the common “rules” of thought that anxious people usually obey and that can be themselves, as a matter of fact, anxiety traps. These traps are considered by cognitive behavioural therapists the main constructs of anxiety, thus targeted by treatment.

  1.  Personal responsibility: “if something bad could happen, it is your responsibility to prevent it”. Very often anxious people perceive an excessive sense of responsibility, stronger than the actual one.
  2.  “Uncertainty is intolerable and there is no space for doubt”. Anxious people tend to avoid situations characterised by uncertainty, as usually they forecast negative outcomes out of it. Getting control over situations is very often the preferred mean to overcome uncertainty.
  3.  “Negative thoughts are true and real facts”. This is the so-called thought-action fusion; a cognitive bias where thoughts can be confused as actions and facts, and not as just mere interpretations and subjective constructions of reality. People using this bias often believe that having a negative thought may have a strong (and unrealistic) impact on the actual realisation of that thought in the real world.
  4. “If a negative thing happens, it reflects me as a whole person”. Anxious people usually tend to negatively judge themselves generalising a single bad result or behaviour to their person as a whole.
  5. “Failure is unacceptable”. Failing, instead of being perceived as a possible source of learning, is seen in a very rigid way, often with no alternative explanations. Making it scarier than what it could be.
  6.  “You must get rid of negative emotions straight away, because they are dangerous and you are not able to deal with them”. Painful emotions are often considered as useless and source of further negative emotions. As a consequence, one of the aims of anxious people is often not to feel negative emotions, locking down such important information about their inner world.

If you suffer from anxiety and you recognise yourself in obeying these “rules of thought”, you may start questioning how useful they are and start to change your approach.

Cognitive behavioural therapy may help you change the way you resonate and cope with anxiety in a different way.


R. Leahy, “The worry cure: seven steps to stop worry from stopping you”, 2006.

Fear of flying

Fear of flying

Despite being one of the safest means of transport, fear of flying is a common anxiety problem for many of us.

Boeing Corporation found out that 17% of Americans declare to be scared of flying and that this fear is the third most popular reason for avoiding planes (Laker M, 2012). Furthermore, it seems that around 6% of the population suffers from a diagnosed plane phobia, the so-called aviophobia.

This means that if you are afraid of flying, you are most definitely not alone.

Different shades of anxiety

Fear of flying can manifest itself in different ways and its consequences can affect us by impacting several aspects of our life. In less severe cases, it may just generate mild and unpleasant uneasiness when travelling, while for others, it may cause intense anxiety well ahead of time, making our airborne journey a very distressful and negative experience.

Anxiety can be managed using any sort of safety behaviours like choosing a specific seat or side of the plane, or having specific rituals before the flight such as checking the weather forecast, as well as self-medication (homeopathic or non-homeopathic) or a glass of wine aboard to calm the nerves. Again, for others, the idea of flying may be terrifying to the extent that setting foot on a plane is utterly inconceivable.

Triggers of fear of flying

Different factors may trigger this fear, such as being exposed to a traumatic event related to flying (directly or indirectly), or behaviours taught by a “model” of behaviour (the so-called social learning), or suffering from other phobias (i.e. claustrophobia or fear of heights) or other psychological disorders.
Specifically if you suffer from a panic attack disorder and you experience one of them during a flight, it is most probable that you will be very anxious in future flights; instead if you suffer from a generalised anxiety disorder, it is very likely that you will be very distressed when travelling in general.

Cognitive factors

Several psychological factors affect this problem.

Very often, flying phobia stems from the lack of control experienced while on a plane.

Avoiding to fly is a maintaining factor and will worsen fear in the long-term, as fear has to be faced to be overcome. Some cognitive biases can contribute to the fear of flying, like the tendency to catastrophise noises, turbulences and our own bodily reactions and emotional responses (as possible cues of an upcoming disaster), cognitive distortions (by perceiving a low-probability event as a highly possible one) and intolerance of uncertainty.

Fear of flying: treatment

If you feel that your fear of flying is negatively affecting your life, lifestyle, work and relations by limiting your degree of freedom, you should think about asking for help.

A Cognitive behavioural psychotherapist can help you manage anxiety by changing the negative beliefs and biases in which your fear is rooted; psychotherapy indeed can help you to start enjoying the pleasure of flying and travelling again.

Laker M, “Specific Phobia: flight”; Activitas Nervosa Superior 2012, 54, no 3-4.

Relaxation techniques: allies against anxiety

Relaxation techniques and anxiety

Anxiety is an emotion that activates physical responses in our body, such as a change in heartbeat, breath frequency and muscle tension.

The main reason of these changes stems from the fact that anxiety triggers the so-called primitive fight-or-flight response, which consists of the body’s automatic reactions by either fighting or fleeing the threat when a hazard is identified, to guarantee survival.

As a consequence, our heart beats faster to pump more oxygen to the muscles, our main muscles contract for increased strength and speed and we may perceive troubles breathing due to the contraction of the muscles of the chest.

The tricky facet of the matter lies in the fact that this activation can maintain a high level of anxiety, giving rise to a vicious cycle. Anxious people are very sensitive to these physical changes and may interpret these responses in a negative way, as evidence of something bad about to happen or afoot. These individuals might feel like they are losing control or getting crazy or are affected by a serious disease.

Another component contributing to the vicious cycle is an increase in respiratory rate, which can be regarded to as a maintaining factor, as well. When we are anxious, we are easily prone to hyperventilating, meaning a higher number of breath cycles per minute and breathing using the chest and not the diaphragm. As a consequence, we take in too much oxygen and that may lead to typical anxiety symptoms such as dizziness, confusion, air hunger and so on.

As these psychical changes maintain or enhance pre-existent anxiety, aiming to reach a state of calmness is a useful tool to relieve and prevent anxiety.

Cognitive behavioural psychotherapy tackles anxiety on different levels, either the cognitive, physical and behavioural one.

Relaxation techniques are an effective ally that can be used in therapy while working on the causes and interpretations that create and perpetuate anxiety disorders.

The patient is taught different types of techniques by their therapist and is encouraged to practice as much as possible in their daily life to master stress and anxiety and keep them under control in stressful situations.

Among the most common relaxation techniques, you may find slow breathing, progressive muscle relaxation, isometric relaxation and relaxation through guided imagery.

Slow breathing, as the name itself suggests, helps you thwart hyperventilation through constant breathing at a particular frequency.

On the other hand, progressive muscle relaxation and isometric relaxation focus on relaxing the muscles of our body, alternating contraction and relaxation of specific muscles.

Guided imaginary allows you to relax through imagination, visualising yourself in a peaceful state and place instead.

Relaxation techniques are an effective range of simple and easy-to-learn tools to help you manage anxiety and reach a state of relaxation.

If you are currently going through a bad patch and find it difficult to cope with stress on your own, or if you think that you might suffer from an anxiety disorder, seeking the help of a counsellor or a psychotherapist is warm-heartedly recommended.

Therapy can help you address the issue on different levels and reach a new balance.

Looking into social anxiety

Social anxiety

Anxiety triggered by social situations is quite a common issue. I guess everyone has felt very anxious at least once in a lifetime with regard to speaking in public, taking exams, a job interview, attending a party with strangers or starting a conversation with an unknown person.

Instances implying potential social judgments can undoubtedly represent a source of anxiety.

A certain amount of anxiety is acknowledged as useful in order to improve our performance (both socially and professionally), by making us more focused on the task, for example. If the level of intensity related to anxiety raises excessively though, the risk of a counterproductive response may arise too, worsening our performance.

Feeling a bit anxious or stressed in social situations is no big deal per se. It usually occurs quite often as a matter of fact. But for some of us, social anxiety can quickly escalate to overwhelming levels, with the person experiencing unbearable unease or even a panic attack to the extent that they would rather avoid exposure to said social situations in the first place. If this condition significantly impacts our daily routine and brings forth intense discomfort, it might relate to a Social Anxiety Disorder.

Social anxiety can be generalised or specific, depending on how many social situations are intensely feared. Usually the most feared situations relate to speaking in public, eating, drinking or writing in public, engaging in a conversation, participating in group activities, speaking with a person of authority, taking exams.

Social anxiety and shyness

Social anxiety, if generalised, can be confused with shyness at times. The main difference here lies in shyness being a personality trait occurring at a very early developmental stage as well as being a normal part within the process of growing up. Although shyness as a trait can significantly change throughout a person’s lifetime, it tends to be stable and continuous. On the contrary, people suffering from social anxiety usually experience a sudden onset, which crucially marks the difference between pre-onset and post-onset functioning.

Why does this happen?

Anxiety is an emotion that we can experience when a potential danger is perceived. When this happens, our archaic reptilian brain activates several bodily reactions connected to the fight or flight response. The fight or flight response prepares our body to react to a potential danger promptly in order to survive. We may experience tachicardia due to the increased heart rate as our body aims to provide contracted and ready-to-react muscles with oxygen. The body can also interrupt digestion to save energy so that we may experience stomach or abdominal pain. We may feel dizzy and mentally confused too, because of the sudden blood concentration in the main muscles and, for the same reason, we may experience a tingling or torpidity in our body extremities.

Social situations as a threat

The reason why we feel anxious in a social situation is the threat we perceive in it.

If this happens, it is important to ask yourself: What is the threat? What could possibly happen that I fear? What’s the worst that can happen?

Trying to get an answer to these questions really depends on the person. The tricky aspect of anxiety is that most of the times we are not even aware of the specific reason that triggered such a response.

In the case of social anxiety, the perceived threat is often the fear of acting in an embarrassing or shameful way, or making a display of our anxiety-related symptoms in front of other people with the risk of incurring negative judgment.

When a social situation is perceived as a threat, several other processes take place and worsen the anxious state.

We might try our very best in an attempt not to show any anxiety, using tricks to hide the symptoms with the result of focusing even more on how we could appear to others rather than on our performance (that can eventually be affected).

If you recognise yourself in the dynamics described above, you may think about seeking help.
cognitive behavioural psychotherapy can help you recognise the process that takes place in these situations and break the vicious cycles. Cognitive behavioural psychotherapy can also help you handle anxiety effectively and make you feel more confident about yourself.

When a distressful thought becomes an obsession: OCD

Thought and Obsession

An Obsession can be defined as a frequent, intrusive and distressful thought.

Our mind and our thoughts are not always under our complete rational control, even if we would like them to be. We can’t always decide rationally which thoughts or images are allowed to come to our mind. Indeed we produce constantly a very large number of thoughts, some of them pertinent to our lives, work, relationships, etc. and some of them not pertinent, sometimes even weird, which can pop up in our mind even when we are focused on something else. It happened to all of us, while working or studying, to start thinking about something else without being totally aware of it (e.g. the grocery list, weekend activities, etc. etc.).

Sometimes the thoughts that pop up may be “weird”; this means that sometimes we can make thoughts that are definitely not congruent and maybe opposite to what we normally think or how we usually behave.

It can happen for example to have an aggressive thought, or a pervert or a deeply heretic one, maybe a homosexual thought if we are straight (or vice versa), or to think something really bad about a person that we love or that something really bad could happen… The potential list is very long, but the main feature is that these thoughts imply a scenario that is deeply feared by the person.

Usually since these thoughts are so far away from our beliefs and lifestyle, we don’t give too much importance to them and they tend to spontaneously disappear. But for some of us these thoughts cause intense anxiety and distress, they tend to pop up with a much higher frequency and they don’t disappear as fast as it happens for other people.

The anxiety caused by these thoughts is so intense that it interferes with the person’s daily functioning and he/she, in the attempt to find relief, may try to suppress them, to create rituals that can help to calm them down, to ask for reassurances or to avoid situations or people related to the thought. Also the list of rituals is potentially very long.

What is happening? And why?

If you recognise yourself or a person close to you in the dynamics explained above, it may be possible that you have developed an obsessive compulsive disorder (OCD).

OCD is a serious and subtle disorder that tends not be recognised in the first place, as the person is often very ashamed of having these bad thoughts. In the long-term, OCD may make the person feel like a slave, controlled and dominated by obsessions and compulsions. If you think that this is your case, then consulting a specialist is highly recommended.

People with OCD, compared to others, tend to be very emotionally shaken by the bad thoughts described above, because these thoughts are totally incompatible with their core personal beliefs and the chance of these thoughts becoming “reality” is therefore to be avoided in every possible instance.
If however we can’t control which thoughts pop up in our mind, we can work on our attitude towards them and our consequent behaviours.

Cognitive behavioural psychotherapy is the form of therapy highly recommended to treat this disorder by the National Institute for Health and Care Excellence.

The not-so-imaginary invalid: health anxiety

Health anxiety

Health anxiety is very often underestimated. Let’s see what happens in the mind of an hypochondriac.

A little tingling in our cheek, an anomalous heart beat, maybe slightly faster then usual, a pain in our back that doesn’t seem to leave, a particular ache in a muscle… and in a blink of an eye we are immediately alerted, fully focused on our bodily signals scanning any potential change.

So many worries come to our mind: what is this? Am I having a heart attack? Is this cancer? Or maybe an aneurysm? All raised by a tremendous amount of anxiety.

If it happened to you, how would you behave?

It would be quite normal to gather information from books or the Internet about signs and symptoms of the disease you think you may have and very probably you will urgently book an appointment with your GP asking him/her to run several medical tests.

But what happens to some of us is that books and the Internet will provide much information and many negative scenarios that will scare us even more, and very likely we may focus only on the information that confirm our worries. Moreover, even if test results will show that nothing is wrong with our body, we will feel reassured only for a short period of time, until the next strange body signal appears, which will prompt us to request other specialist exams. And so on…

What is happening?

What was once a normal and understandable way to react to possible abnormal symptoms has become a pervasive and exaggerated way of dealing with our body, which creates intense distress in the person experiencing it and hence several negative consequences and limitations to their everyday life.

This is the so-called hypochondria or health anxiety, a distressful condition where a person’s beliefs and worries are often considered by others as imaginary or fake, making the person feel even more misunderstood and lonely.

On the contrary, health anxiety is a real problem, the person’s symptoms are real and the worries are extremely distressful.

Health anxiety treatment

The good news is that health anxiety can be treated and cognitive behavioural psychotherapy is the most recommended form of therapy in these instances. CBT can indeed help you in acknowledging and changing the cognitive misinterpretations that maintain the problem and in finding new coping mechanisms to better deal with anxiety.

Understanding the symptoms of anxiety


We all agree that being anxious and suffering from anxiety is something that we would rather avoid in the first place.

Anxiety is an annoying condition and if its intensity raises, its symptoms may scare the person and bring forth the sensation of not being in control of our body reactions. Experiencing very intense anxiety symptoms in our body may be so terrifying that for many people it may become itself an experience to be very scared of.

In these instances we are talking about what is so called “fear of fear” itself. Fear of fear can bring more intense consequences than anxiety itself, leading the person to avoid any possible situation where they may feel the unwanted anxiety symptoms.

Fear of fear is a very powerful and delicate mechanism that in most cases maintains and/or worsens the initial situation.

The first step to overcome fear of fear is getting to know the enemy.

Let’s try to understand together what is happening to our body when we are so anxious and why.

Understanding the symptoms of anxiety

The first thing that is important to know is that anxiety is an emotion that in our evolutionary history derives from the most primitive emotion of fear, but it has appeared in the history of the human being only after the development of our superior cortical functions. Anxiety is indeed linked to the complex ability of our brain to make long-term plans and assumptions about what could possibly happen in the future; on the contrary fear is a more primitive and archaic instinctive that implies an immediate reaction to a threat in the “here-and-now”.

Secondly, anxiety, like fear, is related to the perception of a threat, and it activates the same brain pathways that are activated by its fellow emotion of fear. In both situations, the automatic reaction that is induced in our body is the fight-or-flight response: our body prepares itself to fight the threat or to run away to ensure survival.

Each symptom that is experienced when we are anxious can indeed be explained and understood in the fight-or-flight perspective.

Let’s see the most commons symptoms that we experience when we are anxious and their physiological explanations:

  • Muscle tension: usually we feel our muscles contracted and rigid; if the anxious condition becomes prolonged in time, we may even feel some sort of pain. This happens because our body is preparing itself to fight the threat or to run away; as a consequence our muscles are in tension and ready to react immediately if it is necessary.
  • Tachycardia or heart palpitations: our heart rate tends to increase so that our heart may pump more blood to our muscles and send more oxygen. This helps our muscles to be better prepared to react to the danger.
  • Tingling or torpidity in our body’s extremities: we may feel tingling in our hands or feet. This happens because the majority of our blood flow becomes concentrated in our main muscles (for the reasons explained above) and not in the extremities. As a consequence this may be experienced as tingles, torpidity or cold hands and feet.
  • Difficulty breathing: we may experience the sensation of having trouble breathing. This happens because the contraction of our muscles may counteract the expansion of our lungs.
  • Air hunger: we may have the feeling of needing air. Very often during anxiety we experience hyperventilation; this means that we increase the number of breaths per minute but the quality our breathing worsens, as we tend to breath using only the higher parts of our lungs (thoracic breathing) and not our diaphragm. Hyperventilation introduces too much oxygen in our body, and the consequence is a worsening of the intensity of anxiety symptoms.
  • Goose bumps: muscle contraction involves as well the skin, causing goose bumps.
  • Stomach ache: very often we may experience stomach ache, as if someone punched us in our stomach, nausea or gastrointestinal problems. This happens because when the fight-or-flight response is activated, all the energy of our body is suddenly concentrated in facing the danger and digestion is interrupted, as it consumes a lot of energy that needs to be used to deal with the threat.
  • Blurred vision: we may have the feeling that our vision is blurred during intense anxiety episodes. What happens is that pupils dilate in order to let more light come in the eye and have a better sight of the danger. Our eyes focus better on details and peripheral vision worsens, giving us the feeling of blurred vision.
  • Dizziness and giddiness: we may experience those symptoms as a consequence of hyperventilation. As written above, hyperventilation brings more oxygen in our body. The consequence is the vaso constrictions of some brain blood vessels, so even if more oxygen is introduced in our body, our brain receives less of it and the consequence may be dizziness.

These are the most common symptoms that we may experience when we are anxious. As you can read, each of them has a specific physiological explanation related to the physiological reactions caused by the perception of a threat.

Taking care of your emotional states is a very important way of taking care of yourself.

Anxiety treatment

If you suffer from a serious anxiety condition, gathering information about what is going on is the first step but it doesn’t substitute specialist help. Psychotherapy and counselling can help you in better handling anxiety symptoms, dealing with hyperventilation and facing the perceived threats that foster your anxiety.