The Anxious Body: Working Beyond Thoughts Alone
"I know it's ridiculous. I know nothing bad is going to happen. But my heart still pounds."
Most practitioners will have heard a version of that sentence. The client has the insight. They can name the unhelpful thought and even argue against it. And still the body carries on as if the danger were real.
In short, anxiety lives in the body as well as in thoughts. Cognitive work is powerful, but many clients also need approaches that work through the body: slowing the breath, settling the body with clinical hypnosis, and learning through careful practice that frightening sensations are safe.
An integrative practitioner, using more than one approach chosen to fit the person, decides which of these to use and in what order.
When Insight Isn't Enough
It helps to think of two directions of change.
From the mind down: changing how the client understands and responds to their thoughts, which then calms the body.
From the body up: changing what the body is doing, which then makes different thoughts possible.
Both work, and they work best together. But when a client is highly anxious, the mind-down route can be hard to reach. It's difficult to weigh the evidence for a thought while your heart is racing.
For these clients, the body is often the more accessible place to begin.
Three Ways of Working With the Body
1. Slowing the breath
A 2018 systematic review of slow breathing (around six breaths a minute) found it was linked with greater calm, comfort and alertness and with reduced anxiety, alongside measurable changes in heart rhythm. It's simple, it's portable, and clients can practise it anywhere.
The practical point is the exhale. A breath out that's longer than the breath in is one of the quickest signals of safety a client can give their own body.
2. Settling the body with clinical hypnosis
Clinical hypnosis uses focused attention to help the body settle and to let the client rehearse feeling calm in situations that usually trigger anxiety. A cue learned in session, such as a word, a breath or a touch of thumb and finger, can then carry that calm into daily life.
For many clients, this is the first time they've experienced their body settling on purpose rather than by accident.
3. Learning that sensations are safe
Some clients aren't only anxious; they're frightened of anxiety itself. A racing heart means a heart attack; dizziness means fainting.
CBT for panic has long included a body-based method for this: deliberately bringing on harmless sensations, for example by spinning in a chair, breathing through a narrow straw or running on the spot, in a planned and gradual way. The client learns from experience, not argument, that the sensation rises, peaks and passes.
Even one of the most thought-focused therapies, in other words, has always worked through the body.
Choosing Where to Start
If the client... | You might start with... |
is so anxious in session they can't think clearly | the breath and hypnosis to settle the body before any discussion |
is frightened of specific sensations, such as a racing heart | a clear explanation of what's happening, then gradual practice bringing on harmless sensations |
settles in the body, but the worrying continues | cognitive work on the worries themselves |
reacts strongly to reminders of a frightening experience | building steadiness first, then trauma-focused work such as EMDR when the client is ready |
None of these is a fixed rule. The point is that the choice is deliberate.
A Word of Caution
Always check that physical causes have been considered. Caffeine, thyroid problems, some medications and heart conditions can all produce symptoms that look like anxiety. If a client's symptoms are new, changing or haven't been checked, refer them to their GP first.
The Body Is Part of the Work
Practitioners who work only with thoughts can help many clients. Practitioners who can also work with the body can help more of them and often help them sooner.
This is the kind of practice our Advanced Practitioner Diploma in Integrative Psychotherapy (APDIP) is built around. You can begin with a single specialist certificate, such as EMDR or Integrative Psychotherapy, and each one counts towards the full diploma. Register your interest to hear about the next intakes first.
FAQ
Why do clients still feel anxious after cognitive therapy?
Insight changes thoughts, but the body can continue to react as if danger were present. Combining cognitive work with body-based approaches often helps.
What are body-based approaches to anxiety?
Examples include slow breathing, clinical hypnosis to settle the body, and gradual exposure to harmless bodily sensations, which is part of CBT for panic.
Should physical causes of anxiety be ruled out?
Yes. Caffeine, thyroid problems, some medications and heart conditions can mimic anxiety. New or changing symptoms should be checked by a GP.
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