Therapy for Anxiety in Edinburgh

What anxiety is

Anxiety is not, in itself, a malfunction. It is a useful part of you that has become too loud — the part that scans the room for threats, that rehearses tomorrow’s difficult conversation, that wakes at three in the morning to ask whether something you did yesterday was misread. This part is doing the work it is designed to do. It just isn’t designed for the life most of us lead most of the time. It’s set up to respond to extreme situations, in which threats are real, fast-moving and physical. When we apply this system to unanswered messages, or a meeting that might go badly, or a choice between sandwiches at the supermarket, it can quickly become debilitating.

Fear has an object. Anxiety does not. You can point to the thing that frightens you — a presentation, a flight, a particular person — and call it fear. Anxiety is looser and more abstract. It’s dread without a target. A tightness and a pause in a room where there is nothing visibly wrong.

Freud described anxiety as a signal of internal danger — a warning the mind sends to itself when something psychological, rather than physical, is being avoided. This framing is useful, because it suggests that the danger that triggers our anxiety is often not its surface level justification. The dread before tomorrow’s meeting may have as much to do with older fears — of being judged, of being seen as inadequate, of being abandoned — as with anything in the meeting itself. For some people, these older fears belong to a self that learned the rule of always being ready, in a context where being ready mattered, and forgot how to switch off when the context changed.

None of this is fringe — though it may sound that way at first. A 2014 meta-analysis of 14 randomised controlled trials involving 1,073 patients found that psychodynamic therapy for anxiety did not differ significantly from alternative treatments (Keefe et al., 2014) — meaning that alongside the symptom-focused approaches NICE recommends as first-line, there is a real evidence base for understanding-led therapy as well.

What anxiety looks and feels like

For some, anxiety announces itself plainly: a racing heart, a sense of imminent threat, a body that reacts to a meeting as if it were meeting a tiger. For others it is quieter, less erratic but a background hum that never lifts. The feeling that something is about to go wrong. The feeling of being permanently braced.

The body often knows first. Your chest tightens before the meeting. Your stomach won’t settle. Your shoulders rise. Your mind, searching for somewhere to put the feeling, begins to supply reasons: here is a list of all the things that go wrong, that might go wrong, that will go wrong; a replay of something said last week, shorn of context, tone reversed; variations of a catastrophe. You begin to worry about your worry. The thoughts are jagged, starting and stopping, zigzagging from one concern to another, as if at any moment someone might burst into the room and drag you away.

Sometimes the anxiety cannot be expressed directly in the therapy room. Some people come to therapy and seem perfectly composed. They describe an outside-the-room life in which they cannot sleep, cannot face certain conversations, cannot leave the house without checking three times that it is locked — and in the room they roll their eyes at themselves and find it absurd. If I showed you what it’s really like — they seem to say to me — you’d think I was unwell, you’d think I was crazy: you’d tell me to get a hold of myself and you’d refuse to work with me again. Part of the work, in this case, is making it safe enough for that hidden version of yourself to come into the room too, so that we can both see it, and try to learn more about it.

What anxiety might be saying

Sometimes the cause of your anxiety lies in plain sight. The diagnosis that was supposed to be behind you. The bereavement, the addiction, the difficult childhood. You may have dealt with the cause — done the work, taken the course, and completed the treatment. And yet here anxiety remains, rearing its head, persistent and out of proportion. The connection between this earlier trauma and the present anxiety can be indirect enough (or unwanted enough) to be invisible to you. That’s okay. I can hold these feelings until you’re ready for them. It may only be when you feel safe enough in our sessions that the connection between then and now becomes clear.

Sometimes there is no obvious cause. You feel anxious without being able to say what you feel anxious about. You feel restless, braced for something, but it doesn’t come. The anxiety is a character in search of a story. Or in search of the right story, because the absence of a conscious tale does not mean there isn’t one. It usually means the story was learned early enough that it wasn’t legible as such, but was indistinguishable from your perception of the world. Children who grew up needing to stay alert around the adults in their lives — to read their moods, anticipate turbulence, manage someone else’s distress — develop a character that prizes vigilance. Decades later, that vigilance remains. They are still ‘on’. Though the threat is long over, the hair-trigger remains.

How I work with this specifically

The work is relational before it is anything else. The psychoanalyst Wilfred Bion described the therapist’s task as something like the task of a parent receiving an infant’s overwhelming distress. The parent must take in what the infant cannot yet hold alone, process it, and return it to the child in a form that is bearable. I find this symbol a useful one. Not because clients are like children, but because in our distress, we are all like children. More so, perhaps, than we would like to imagine. What we need is someone who can work with us at the pace that we can bear. Who will not push upon us prescriptions or interpretations without listening to us first. Who will listen to us without judgement and with compassion. This is what I try to offer. What changes a person’s relationship with their anxiety, in this kind of work, is often as much the experience of being met as it is the things that are said.

To illustrate what I mean, here is a composite picture of this type of work, drawn from my experience working with a variety of clients, but not describing any one individual. The client is a professional in their thirties, composed and articulate, outwardly thriving, with a good job and a committed relationship, who describes an anxiety that eats at the edges of their life. Their sleep, their friendships, the career change they would like to make but cannot bear to. In the room, they wonder at how they behave outside it; the anxiety they describe outside is barely visible. The shift, when it comes, is not from technique, but from relationship, from a sense of safety that the two of us have developed which allows this hidden, anxious version of themselves to come into the room. This is the part of them that they have been hiding, the one they had been sure I would be horrified by, the one they had been managing alone for years — and I am able to meet it without horror but with compassion. Over time they are able to meet this part with compassion too. The work that follows is about understanding what that part of them has been keeping watch for — and whether the watch still needs to be kept.

Composite drawn from clinical experience; no individual client is described.

My work is limited by several constraints. I only work with adults. Where anxiety is bound up with active suicidal risk, untreated medical conditions, severe OCD, or trauma better served by NICE-recommended trauma-focused work, the most useful answer is sometimes a different referral. If that is the case I will say so directly, and try to help you find the right kind of support.

Anxiety therapy in Edinburgh and online

I work in person from a quiet consulting room on Drumsheugh Gardens, in Edinburgh’s New Town — a few minutes’ walk from Princes Street and well-connected by bus from most parts of the city. Sessions are 50 minutes, weekly, ongoing for as long as the work needs and no longer. Online sessions are by secure video call and available across the UK.

The fee is £70 per session.

A free 20-minute consultation is a good place to start — a conversation about what is bringing you, what you might want from therapy, and whether we would work well together. There is no obligation to continue. I reply to enquiries within one working day.

Frequently asked questions

• What’s the difference between anxiety and a panic attack?

  Anxiety is the long-term state — tightness in the chest, worry, background dread. A panic attack is its acute form: a sudden surge in which the body responds as if to immediate threat. Your heart races, your breath shortens, terror takes over. Most panic attacks pass within a few minutes, though they can feel a lot longer at the time. Therapy for panic attacks looks beneath the attacks themselves to the distress that they erupt from, not only at how to manage them in the moment.

• Can therapy help with anxiety that doesn’t have an obvious cause?

  Yes. Psychotherapy is particularly well suited for working with this type of anxiety. The absence of an evident cause does not mean there isn’t one. It usually means the cause came early enough, or was repeated often enough, that it stopped feeling like an aberration and became part of the surface of everyday life. People are extremely adaptable, and upsetting events repeated often enough can become invisible to you. Psychodynamic therapy helps to make these visible, to explore not just what you are feeling, but why you are feeling it.

• Should I be in therapy, on medication, or both?

  I’m not a doctor, so I can’t diagnose anxiety or give medical advice on whether medication is right for you — that conversation belongs with your GP. What I can say from working with clients who both do and don’t take medication is that for some people, anti-anxiety medication alongside therapy works very well. For others it doesn’t suit them — they may have side effects, difficulty finding the right medication, or discomfort with the idea of medication in the first place that counteracts any positive benefits. Either way the decision is yours, taken with your GP, and it won’t affect our ability to work together. That said, if you are on medication, or it changes during our work, it helps me to know as it can have a bearing on what we are doing together.

• What is the difference between CBT and psychodynamic therapy for anxiety?

  CBT identifies and works to change the thought patterns and behaviours that maintain anxiety. It is the treatment NICE recommends as first-line and there is substantial evidence supporting its efficacy. Psychodynamic therapy looks beyond present-tense patterns and behaviours to ask why those patterns developed — and what they have been protecting. Both approaches have evidence behind them. NICE’s own social anxiety guidance includes short-term psychodynamic psychotherapy among the treatments to consider for adults who decline CBT and medication, while noting its more limited clinical effectiveness compared with those first-line options (NICE, 2013). I work psychodynamically because, for many people, lasting change comes from understanding why the anxiety is there — not only from managing what it does. It’s a question of personal fit, and some people find it useful to have tried both.

• My anxiety feels like a part of me. Will therapy take something away?

  Long-standing anxiety can become so familiar that it is hard to imagine your life without it. You may have built your work, your relationships, your sense of yourself around managing it. Therapy will not try to dismantle this overnight. Your defences are there for a reason, and the first step is not removing them, but understanding what they have been protecting you from, and whether the protection is still needed. Change does not require you to become a different person. It means having more choice about how you respond to what you feel.

• Will talking about my anxiety make it worse?

  This is a reasonable fear, and a common one. The risk of having your defences probed and your vulnerabilities exposed, then left there without support, is part of why therapists train and answer to professional bodies. In practice: we agree the terms of our work before any of it begins. You will know when you can see me. I give notice of any time away. And — most importantly — you set the pace, and the terms of where we focus. I will not require you to talk about anything you do not want to, and will not push if you indicate something is off-limits. You can name that something difficult has happened without describing it. You can mark a chapter of your life as off-limits, for now or for good, and I will work with that.

• How long does therapy for anxiety take?

  There is no fixed answer. Some people find that ten to twenty sessions are enough to make a meaningful difference. Others stay longer, particularly when the anxiety has been with them for years, touches many areas of their life, or is bound up with situations that are themselves ongoing. We review the work as we go, and the choice of when to stop is always yours (though I find that knowing a few sessions in advance of an ending is helpful, to ensure that we conclude our work properly). For most people, therapy is not a lifetime commitment — the aim is to reach the point where you no longer feel you need it.

About this page

Written by Tom Wells, MBACP, COSCA. Last reviewed July 2026.

Trained at the University of Edinburgh (PGDip Counselling and Psychotherapy). Registered with the British Association for Counselling and Psychotherapy (profile on the BACP register) and with Counselling and Psychotherapy in Scotland (COSCA).

Scope of practice: adults aged 18 and over; individual therapy only. I do not offer couples therapy, EMDR, formal diagnosis, or medication; where any of these would serve you better, I am glad to point you towards them.