Anxiety usually gets worse for one of four reasons. It is being managed but not understood. It is being hidden. It is being fought. Or something in your life changed, and the anxiety noticed before you did. All four keep the signal switched on, and none of them are fixed by turning the volume down.
Which is the part most people are never told: you cannot reduce anxiety that you do not understand. That idea is the foundation of how our psychologists approach anxiety therapy, and it is what this essay is about.
In short
Anxiety tends to get worse when it is managed instead of understood, hidden out of shame, fought instead of listened to, or reacting to a change you have not named yet. Coping skills lower the intensity, and the intensity climbs back because the source is untouched. The step that actually brings it down is naming, specifically and usually with another person, what the anxiety is about. That is slower than a breathing exercise. It is also the only thing that lasts.
Reason one: it is being managed, not understood
Many people can notice the thoughts they have when they are anxious, or where they feel anxiety in their body. Far fewer can say what their anxiety is about. That is not a failure of intelligence. To be anxious about something is to be afraid of it, and fear makes us avoid the very thing we would need to look at. When your knowledge of your anxiety is limited to what you need to avoid and how it feels in your chest, you are missing the information that would let anything change.
Imagine that every time the check engine light came on in your car, you took it to a mechanic and asked them to turn the light off without looking at the engine. You might find a mechanic willing to do it. You would never fix the car.
Coping skills are the light switch. Deep breathing, exercise, grounding, a walk, a bath. I recommend all of them, and I use them. But if you find yourself reaching for the same skills over and over with no lasting change, that is the light coming back on. The anxiety has something to say that has not been heard yet.
Reason two: it is being hidden
It is hard to understand the things about ourselves that we are ashamed of. Most people hide their anxiety because it feels like a defect, and we hide what we feel guilty about.
Hiding compounds the suffering. People carrying high levels of manageable anxiety become exhausted by the effort of concealing it, and the concealment adds a second layer of shame on top of the original fear. When someone asks me why their anxiety is getting worse, this is often the honest answer. Nothing new has happened. The hiding has been running for a long time, and it costs something to keep it running.
Reason three: it is being fought
I know many therapists who keep Chinese finger traps in their offices. You slide a finger into each end, you pull, and the trap tightens. The harder you work at getting free, the more stuck you are. The way out is to stop pulling and push your fingers toward each other, which is the last thing instinct suggests.
Anxiety behaves the same way. The effort to force it away or hate it away is the pull, and it tightens the very thing you were trying to loosen. You cannot hate away anxiety. My colleague Dr. Aguilera Rice works this paradox from another angle in ACT for anxiety, where the way out is to stop fighting rather than to fight better.
Reason four: something changed, and the anxiety noticed first
This is the reason behind most of the emails I get with the word “lately” in them. Why has my anxiety gotten worse lately? Why is it worse for no reason?
In my experience it is almost never for no reason. It is for a reason you have not let yourself think about yet. Some of the usual candidates:
- A loss or a transition. A move, a new job, a child leaving, a parent aging, a relationship that has gone quiet. Anxiety often arrives before grief does, because it is easier to be afraid of the future than to feel what has already changed.
- Your body is running on less. Sleep, in particular. Anxiety and poor sleep feed each other, and a few weeks of short nights can make an ordinary week feel dangerous. Caffeine and alcohol both raise baseline anxiety, alcohol especially the morning after.
- A responsibility you did not choose. Caring for someone, holding a team together, being the one everyone leans on. Anxiety is often the first sign that you have taken on more than you have said out loud.
- Avoidance has been shrinking your life. Every time you avoid the thing you are anxious about, the relief teaches your nervous system that the thing was dangerous. Over months, the avoided territory grows and the safe territory shrinks. The anxiety is not getting worse on its own. It is being fed.
- An old fear got touched. Something in the present rhymed with something in the past, and the anxiety is about the past as much as the present. This is the reason people most often miss, and it is the one psychodynamic therapy is built to find.
If you cannot say what changed, that is not a dead end. It is the clearest signal of all that the change is worth a conversation, because unnamed changes are the ones anxiety reacts to most.
Not sure what changed?
That is often the best reason to talk with someone. Our psychologists offer a free 15-minute consultation in Carlsbad, Encinitas, Vista, and Pasadena, and online across California.
Book a free consultationHow common is anxiety?
Part of what makes anxiety so isolating is the belief that you are the only one carrying it. You are not. The National Institute of Mental Health reports:
- 19.1% of U.S. adults had an anxiety disorder in the past year
- 23.4% of U.S. adult women had an anxiety disorder in the past year
- 14.3% of U.S. adult men had an anxiety disorder in the past year
- 31.1% of U.S. adults will experience an anxiety disorder at some point in their lifetime
Statistics from the National Institute of Mental Health. Roughly one in three people will meet criteria for an anxiety disorder in their lifetime, and many more will live with anxiety that never gets a name. If shame is telling you that your anxiety makes you unusual, the data disagrees.
Understanding gives you freedom
There is a difference between feeling anxious and recognizing that you are feeling anxious. One requires that you reflect on your experience, and reflecting creates a small gap between you and the feeling. That gap seems inconsequential. Expanding it is often the beginning of everything. My colleague Dr. Aguilera Rice writes about one version of this skill in cognitive defusion.
Inside that gap you can make a choice. You can keep trying to solve the problem right now, or give yourself permission to come back to it later. You can stay tense, or actively soothe yourself with something your body finds calming. Music, exercise, a bath, a walk, a few minutes of mindfulness. The specific steps differ for everyone. What they share is the sequence: name the feeling, recognize that you can do something different, and choose.
Why this is hard to do alone
If what I just described sounds insufferable, that is because it usually is, on your own. Working with anxiety often requires two minds. A close friend, a spouse, a family member, a spiritual director, or a psychotherapist. Another person helps you stay in the moment long enough to gain the understanding that generates change.
Staying in the moment lets you name the specific fear. “I am anxious about being rejected if I ask them out.” “I am anxious about being abandoned if I let myself get close.” Getting that specific may be painful, scary, or frustrating. For some people it feels meaningless, which is its own clue.
The reason anxiety remains is that the emotions underneath it have not been recognized, processed, or understood, and emotions that have been overwhelming you alone are very hard to understand alone. There is no substitute for an empathic human connection to a part of yourself that feels unworthy of love. Needing someone else does not make you weak. It makes you human. We are hurt within relationships, so it makes sense that we heal and grow within them.
Getting help
If you have been stuck, consider the supportive relationships in your life that might help you understand your anxiety better.
If you think you would benefit from individual or group therapy, feel free to contact me personally about how to find a therapist who would be a good fit. You can reach me at (760) 334-6262 or by email at drkessler@coastaltherapygroup.com. If working with me or someone at our practice is not the right fit, there are many excellent therapists in San Diego County and throughout California, and I am glad to point you toward someone who does this work well.
A quick self-check: If you want to put words to where your anxiety is right now, our free Anxiety Quiz is a short, private screener. Reflective, not diagnostic, and your answers never leave your browser.
Anxiety therapy in North County San Diego
Every clinician at Coastal Therapy Group holds a doctorate in psychology, and we work relationally, which means we are interested in what your anxiety is about and not only in lowering a number on a checklist. Read about our approach to anxiety therapy, or start with a free 15-minute call.
Book a free consultationBefore you reach out
Common questions about reducing anxiety
What is the first step to reducing anxiety?
Understanding it. Most people start by trying to make the feeling stop, which is reasonable but limited. Anxiety is a signal, and signals only quiet down once the thing they are pointing at has been recognized. The first step is naming what you are actually afraid of, in specific terms, rather than treating the anxiety itself as the whole problem. Coping skills help you tolerate the feeling long enough to do that work. They are the beginning, not the destination.
Why does my anxiety come back even when I use coping skills?
Because coping skills manage the intensity of anxiety without changing what is generating it. Deep breathing, exercise, and grounding are genuinely useful, and they will keep being needed if the underlying fear has never been understood or processed. This is the check engine light problem. Turning the light off is not the same as fixing the engine. If you find yourself using the same skills over and over with no lasting change, that is usually a sign the anxiety has something to say that has not been heard yet.
Can anxiety go away completely?
Anxiety itself is not a defect to be eliminated. It is a normal human response to threat, and a life with no anxiety at all would be a life with no stakes in it. What can change is the amount, the intensity, and how much of your life it takes up. Many people move from anxiety that runs their decisions to anxiety that shows up, gets recognized, and passes. That is a realistic outcome and a meaningful one.
How do I know when anxiety is bad enough for therapy?
A useful question is not how severe the anxiety is but how much it is costing you. If it is shaping what you say yes to, keeping you from sleeping, straining your relationships, or taking real energy to hide, that is enough reason to talk with someone. You do not need a diagnosis or a crisis to justify therapy. Waiting until anxiety is unbearable usually just means working with more exhaustion later.
Does talking about anxiety make it worse?
In the short term, naming a fear out loud can feel more intense than avoiding it, and that is often the reason people avoid it. What tends to happen over time is the opposite. Anxiety that is hidden compounds, because hiding it adds shame on top of the original fear. Anxiety that is spoken to another person who responds with steadiness rather than judgment usually loses some of its grip. That is much of what therapy is for.
What kind of therapy helps with anxiety?
Cognitive behavioral therapy and exposure-based approaches have the largest research base for reducing anxiety symptoms, and they work well for many people. Psychodynamic and relational therapy, which is how we primarily work at Coastal Therapy Group, focuses on understanding what the anxiety is protecting you from and how it took shape in your relationships. Both are legitimate. In practice, the fit between you and the therapist tends to predict the outcome more than the brand of therapy does.
Why has my anxiety gotten worse lately?
Usually because something changed and the anxiety noticed it before you did. A loss, a transition, less sleep, more caffeine or alcohol, a relationship that has gone quiet, or a responsibility you did not choose. The other common reason is that you have been managing the anxiety for a long time without understanding it, and managing has a cost that finally came due. If you cannot name what changed, that is worth a conversation, because unnamed changes are the ones anxiety reacts to most.
Why does anxiety get worse for no reason?
In my experience it almost never has no reason. It has a reason you have not let yourself think about yet. Anxiety that seems to come from nowhere is usually anxiety about something that felt too big, too shameful, or too inconvenient to look at directly, so it shows up as a feeling with no story attached. Finding the story is the work, and it is much easier to do with another person than alone.
Thinking about starting therapy?
If this essay resonated, a conversation might help more. Reach out for a free 15-minute consultation. Our care coordinator will match you with the right therapist, with no pressure and no obligation.
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