Practical, targeted therapy for anxiety loops, panic, OCD patterns and health anxiety behaviours

CBT (Cognitive Behavioural Therapy) is a practical, evidence-based approach that focuses on the patterns that keep difficulties going in the present, thoughts, behaviours, and the “safety strategies” that give short-term relief but create long-term anxiety.

I offer CBT therapy in Central London (W1W) and online. In my practice, CBT is often used as a targeted tool within an ISTDP-informed formulation: we identify your maintaining cycle, then use CBT methods where they most effectively shift the pattern.

When CBT is most helpful

CBT is especially effective when your difficulty is maintained by a clear cycle involving avoidance, checking, reassurance seeking, or fear of sensations.

CBT may be a strong fit if you:

• avoid situations that trigger anxiety (and feel your life narrowing)
• experience panic symptoms and fear what they mean
• get stuck in repetitive checking or compulsive behaviours
• repeatedly seek reassurance (from people, doctors, Google, or internal “mental checking”)
• feel trapped in “what if…?” loops that drive unhelpful behaviours

This is not about “positive thinking”. It is about changing what keeps anxiety going in real life.

The CBT view: the maintaining cycle

Across anxiety presentations, a typical CBT maintaining loop looks like this:

• Trigger (situation, sensation, thought, uncertainty)
• Threat interpretation (“This is dangerous” / “I won’t cope”)
• Anxiety in the body
• Safety behaviour (avoid, check, control, seek reassurance, escape)
• Short-term relief
• Long-term cost (more fear, less confidence, more restriction)
• The cycle strengthens

CBT works by breaking the link between anxiety and the behaviours that keep it alive.

What CBT looks like in practice

CBT is structured and collaborative. Work may include:

• identifying the specific loop, you’re stuck in
• testing predictions through practical experiments
• reducing avoidance and safety behaviours gradually (at a pace you can tolerate)
• learning a different relationship with thoughts (“a thought is not a fact”)
• building confidence through repeated lived experience

Where appropriate, we also work directly with bodily sensations, because fear of sensations often maintains panic and health anxiety patterns.

How CBT fits within an ISTDP-informed approach

Some people need CBT tools to shift behaviours; others also need to understand what drives the pressure underneath.

In my practice:

• ISTDP provides the organising formulation (what’s being protected against, what emotions/pressures are involved, what defences maintain the cycle)
• CBT provides targeted methods to change avoidance, checking, reassurance, and fear-of-sensation loops

This combination is often especially effective for high-functioning adults who want therapy that is both meaningful and practical.

Best for (common presentations)

CBT work in my practice is commonly used for:

• Panic attacks & agoraphobia: fear of sensations, escape and avoidance loops
• Health anxiety: monitoring, googling, reassurance and uncertainty intolerance
• OCD patterns: checking/neutralising behaviours and intrusive-thought cycles
• Social anxiety: avoidance, safety behaviours, and prediction testing
• Phobias: graded exposure and confidence building

(You can read more on the relevant issue pages below.)

When CBT may not be the whole answer

CBT can be very effective, but if your anxiety is primarily maintained by:

• chronic emotional inhibition
• relationship patterns (people-pleasing, shutdown, conflict avoidance)
• long-standing internal pressure, self-attack, or emotional numbness

…then CBT alone may not address the deeper maintaining pattern. In those cases, CBT is still useful, but we may place greater emphasis on the ISTDP/psychodynamic work to create broader change.

What to expect

Early sessions

• clarify your main difficulty and goals
• map your maintaining loop (behaviours + triggers + fear predictions)
• agree a practical plan (what we will reduce, practise, and test)

Ongoing work

• structured practice between sessions (where appropriate)
• gradual reduction of safety behaviours
• strengthening confidence through evidence in your own experience

Sessions are typically weekly initially, then reviewed.

Related pages

• Panic Attacks & Agoraphobia
• Health Anxiety
• Obsessive Compulsive Disorder (OCD)
• Social Anxiety
• Anxiety
• Persistent Physical Symptoms (PPS)

Frequently asked questions

Do I need homework?
Sometimes. CBT often involves practising new responses between sessions, but we tailor this to what is realistic and helpful.

Will I have to face my fears immediately?
No. Exposure and behavioural change are paced carefully. The goal is confidence, not overwhelm.

Is CBT effective online?
Yes. CBT translates very well to online therapy and can be highly effective.

Do you offer CBT in person in Central London?
Yes, I work in Central London (W1W) and online.

Next step

If anxiety has started to shape your choices, what you avoid, what you check, how you cope, CBT can help you change the cycle.

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