A whole-person exploration of words, physiology, experience and the possibility of change

“I am anxious.” “I feel anxious.” “I have always been an anxious person—it is just who I am.”

I hear versions of these sentences frequently in clinical practice. Yet the word anxiety can conceal as much as it reveals. It may describe fear, worry, shame, grief, anger that has not felt safe to express, physical sensations the person cannot explain, or a nervous system trying hard to protect them.

Are we always looking at a disorder—or might we sometimes be witnessing an understandable response to perceived adversity?

Words matter: a state is not an identity

When we repeatedly say, “I am anxious”, a state can begin to sound like an identity.

“I am noticing anxiety” creates a little space. It does not minimise the experience. It reminds us that anxiety is something happening within a person, not the whole of who that person is.

A diagnosis may validate suffering, guide treatment and open the door to support. However, labels can also become explanations for everything. I regard a diagnosis as a working description—not a complete account of a person or a reason to stop looking.

Is anxiety the feeling—or the alarm?

It can be useful to move beneath umbrella words. If someone says, “I feel anxious”, we might gently ask:

What are you noticing? Do you feel frightened, unsafe, ashamed, sad, angry, overwhelmed or uncertain? What is happening in your body? What do you fear may happen next?

Anxiety can be understood as an alarm involving thoughts, sensations, emotions and protective actions:

• Thoughts: worry, catastrophic predictions, scanning for danger or difficulty tolerating uncertainty
• Sensations: a racing heart, breathlessness, nausea, shaking, dizziness, sweating or muscle tension
• Emotions: fear, dread, shame, grief, anger or vulnerability
• Actions: avoidance, checking, reassurance-seeking, over-preparing, pleasing others or withdrawing

The alarm is real, even when the danger is not visible to somebody else. Our physiology responds not only to what is happening, but also to what the brain predicts may happen, based on current circumstances, bodily signals and previous experience.

Disorder—or a response that no longer serves us?

Is “disorder” always the most helpful word?

Might what we call anxiety sometimes be better understood as a maladaptive response to perceived adversity: a protective mind-and-body response that has become overly sensitive, persistent or no longer appropriate to present circumstances?

I use the word maladaptive carefully. It does not mean foolish, weak or wrong. Vigilance, emotional suppression, keeping everyone happy or avoiding conflict may once have helped someone remain connected or safe. The difficulty comes when the response continues automatically, consumes energy or restricts life after the context has changed.

The better question may be not, “What is wrong with you?” but:

“What has your system learned to expect—and what is it trying to protect?”

Context: it is the specific ingredients, proportions and how they are mixed that are the recipe

I’m not ok (but not bad enough…)—it’s not a competition in adversity!

People may dismiss challenging life experiences because “somebody else had it worse”. This can be particularly relevant when thinking about childhood. If we remember a broadly happy childhood, we may assume that our earlier experiences have little relevance.

But adversity is not a competition.

What matters is what happened—or was absent—how it was experienced, whether support was available and what the person had to do to adapt.

Relevant “ingredients” might include loss, illness, bullying, violence, neglect, unpredictability, discrimination, traumatic medical experiences or not feeling safe to express emotion.

Research shows that difficult early-life experiences are associated with a greater likelihood of anxiety and altered stress physiology. They are not necessarily the whole story, nor do they prove the cause of anxiety in any individual.

This is not about blame. It can, however, help us understand why certain protective responses developed and, importantly, remind us that they are not fixed traits. No matter how long someone has described themselves as “anxious”, greater understanding can create new possibilities for change.

Connection shapes us—but does not fix our future

Human nervous systems develop in relationship, and the quality of those relationships can profoundly influence whether we experience the world primarily through connection or protection.

This matters not only while we are growing up, but also in how we show up at work, with friends, as parents, with intimate partners and for ourselves. It can influence the quality of our listening and communication.

We learn whether our signals are noticed, whether distress can be shared and whether connection remains available when emotions become difficult.

Experiences of safety, trustworthy relationships and co-regulation—the settling influence one person’s nervous system can have on another—can help the brain and body update what they expect.

Our system moves through multiple states; nothing is fixed. The goal is not permanent calm.

Healthy systems mobilise when needed and find their way back towards steadiness afterwards. Difficulties arise when we become stuck in protection or struggle to find our way back—not broken, just stuck.

The body must remain in the conversation

Whole-person care must never settle for “it is all anxiety” or imply that symptoms are “all in someone’s head”.

The brain, mind and body are inseparable: thoughts and emotions have physiology, and bodily changes influence how we think and feel. Palpitations, shaking, breathlessness, weakness, dizziness and brain fog are therefore real experiences—but they are not proof of either a psychological or a physical cause. They deserve thoughtful assessment.

There may be many contributors at play. Depending on someone’s symptoms and circumstances, an assessment may need to consider:

• an overactive thyroid gland or too much thyroid-replacement medication
• anaemia or nutritional deficiencies
• abnormal heart rhythms or asthma
• low blood sugar or hormonal changes
• pain or poor sleep
• prescribed medicines, stimulants or recreational substances
• alcohol use or withdrawal

There can be many different “ingredients” in the anxiety recipe.

Physical illness and anxiety can coexist and amplify one another. Investigating the body is not an alternative to exploring emotional or relational experience. Good medicine makes room for both.

What neuroscience and heart-rate variability can add

Neuroscience helps us understand anxiety as a whole-system experience, not a failure of willpower.

Brain networks involved in detecting significance, interpreting bodily signals and regulating emotion work alongside the autonomic nervous system and stress hormones. The brain is constantly asking:

“What does this mean—and what should I do next?”

Heart-rate variability, or HRV—the natural variation in time between heartbeats—offers one window into autonomic flexibility.

People with anxiety disorders may, on average, have lower resting HRV. However, HRV cannot diagnose anxiety and is affected by many different factors.

Paced breathing and HRV biofeedback may help someone experience greater influence over their physiology. The aim is flexibility, not a perfect score on a wearable device.

A toolkit that supports updating—not suppression

Treatment should not simply silence the alarm. It should help us understand what is setting it off, address genuine threats or illness, and give the person more ways to respond.

Depending on individual need, this may include:

• a careful medical assessment and medication review
• support with sleep, regular nourishment and hydration
• movement matched to the person’s health and capacity, particularly where activity causes delayed worsening of symptoms
• cognitive behavioural therapy or another suitable psychological therapy
• medication where its likely benefits, risks and the person’s preferences support its use
• grounding, paced breathing, HRV biofeedback or mindfulness
• safe relationships and opportunities to experience emotions without becoming overwhelmed

There is no single solution that will be right for everyone. A useful plan needs to reflect the individual person, their health, their history, their current circumstances and what matters to them.

Could somatic therapy or hypnosis help?

Somatic or body-oriented therapies use awareness of sensation, movement, posture and breath as part of therapy. They may offer a gentle route back into connection with a body that has felt frightening, numb or unpredictable.

This work should be paced, consent-led and kept within the person’s capacity. It should not be used to force an emotional release or attempt to recover hidden memories. The evidence is promising but still developing, so these approaches are best viewed as adjuncts delivered by appropriately trained practitioners.

Clinical hypnosis uses focused attention, imagery and therapeutic suggestion. The person remains aware and is an active participant in the process.

Hypnosis may help someone rehearse a different response, change their relationship with bodily sensations or reduce anticipatory anxiety. Like somatic therapy, it is a potentially useful adjunct—not a universal answer or a substitute for investigating new physical symptoms.

A more compassionate clinical question

Instead of asking only, “How do we stop the anxiety?”, I often find it more useful to ask:

“What is this person’s mind-and-body system responding to—and what might help it feel safer, steadier and more able to adapt?”

The response is not “wrong”. It is information.

We can respect how it developed without assuming that it must remain. That is where diagnosis, medical care, psychological understanding, connection and hope can meet.

When to seek help

Please seek medical advice if anxiety is persistent, worsening, restricting your life or accompanied by new physical symptoms.

Urgent help is needed for severe chest pain, fainting, marked breathlessness, a very rapid or irregular heartbeat, acute confusion, or thoughts of self-harm or suicide.

In the UK, call 999 in an emergency. For urgent mental health support, contact NHS 111 and select the mental health option where available.

This article provides general information and does not replace an individual medical assessment.

Sources and further reading

• NICE CG113: Generalised anxiety disorder and panic disorder in adults
• NICE Clinical Knowledge Summary: Generalised anxiety disorder
• Sahle et al. (2021): Adverse childhood experiences and common mental disorders
• Brindle et al. (2022): Childhood adversity and stress reactivity
• Cheng et al. (2022): Anxiety and heart-rate variability
• Goessl et al. (2017): HRV biofeedback and stress and anxiety
• Valentine et al. (2019): Hypnosis and anxiety
• van de Kamp et al. (2023): Body- and movement-oriented interventions