Anxiety Archives - Stephanie Mathewson Therapy

December 13, 2023May 1, 2026

Why is Anxiety Worse at Night?

Anxiety often shows up in full force at night. You may notice you go through your entire day, moving from one task to the next with not much anxiety. Then once you get home, and try to unwind all of a sudden anxiety takes centre stage.

This happens because our days are filled with a lot of distraction. Our attention is focused on work, relationships, parenting, chores, etc. Our mind is busy and we are less likely to notice worries or anxiety.

At night time however, our mind is less focused and anxiety may grab our attention. For you this may look like:

worrying about things that might happen in the future
self-criticism
physical sensations: tightness in the chest, pit in the stomach
memories of things that happened in the past

This nighttime anxiety may prevent you from falling asleep. You may notice that the harder you try to fall asleep the more anxiety shows up and the less likely sleep happens.

Anxiety and Insomnia

When we struggle falling asleep it is quite common to start having worries and anxiety about sleeping. This worrying about sleep leads to less sleep, and less sleep leads to more worrying. Making us caught in a viscous cycle.

I remember being caught in this cycle at one point in my life. I struggled to fall asleep one night and barely slept at all. My mind kept me up worrying about stuff that could go horribly wrong in the future. The next day I felt exhausted. Throughout the day I started having worries about it happening again the next night. These worries kept me up again, and more stress and exhaustion followed.

In a way, sleep is about letting go and giving up control. The more you try to control it, the less likely it will come. One of the best conditions for sleep is leaning into the present moment. Check out these tips for doing so below.

Tips for Managing Sleep Anxiety

Make a wind down routine: a relaxing wind down routine before bed can set good conditions for sleep. A good routine should include turning the lights off an hour before you want to get into bed. Being in darkness stimulates melatonin production, our bodies natural sleep hormone. While you are in the dark you could do something relaxing such as watching TV or reading a book with a night light. It can be helpful to do these activities outside of your bedroom, and put away your phone an hour before bed.

Practice dropping the struggle with thoughts: the more we get caught up in worries the less likely we are to fall asleep. You can practice dropping the struggle with worries by practicing noticing your worries for what they are… thoughts. You could try saying to yourself I notice I’m having the thought that I won’t fall asleep. It can be helpful to have something to anchor you in the present, for example your stomach rising and falling with each breath, or the feeling of your sheets on your skin. Each time your mind pulls you away from this anchor (and it surely will), gently bring your attention back to your anchor. To learn more about this practice click here.

Make room for discomfort: of course we do not want to experience anxiety and worries at night. It’s uncomfortable and distressing! The more we fight with our thoughts and feelings however, the less likely sleep will come. See if you can practice welcoming your difficult thoughts and making room for discomfort that shows up. You can do this by gently and compassionately naming what you are feeling, for example oh, here is fear, or here is sadness. You can do this with thoughts that keep showing up as well, for example ah, here is the I can’t sleep story. Being compassionate to yourself can be a helpful way to make room for discomfort, to read more on this topic click here.

Keep living your life: sometimes anxiety at night, and insomnia that follows can prevent us from living. We may start avoiding doing what we want to do because we fear it will get in the way of our sleep, for example going out with friends or other after work activities. Try to continue living your life the way you want! Paradoxically, the less focus you place on insomnia the more likely sleep will naturally come.

Resources

Sleep School App: this is an evidence-based app created by sleep doctors. It takes you through a program to help overcome sleep anxiety and insomnia. Definitely worth checking out if you struggle with sleep!

Headspace App: this is a meditation app that has sections focused on sleep. Here you will learn skills for dropping the struggle with worries and focusing on the present.

November 27, 2023May 1, 2026

Why Do We Worry?

Worry is a natural part of being human, it shows up for all of us. Our minds have evolved to look for danger everywhere. Worry is our mind scanning for potential threats that might happen in the future. This is a normal and essential part of the human experience.

If we think back to thousands of years ago, worry was even more crucial for our survival. If we did not have an initial thought that maybe that tiger is going to harm us, or perhaps that plant is poisonous, or look out for that lion that always lurks behind the same tree we would all be dead and humanity would not exist.

Worry exists for a very good reason, and you need worry to show up from time to time. Trying to get rid of it would be a fool’s errand. It is not something we can stop. Worrying on the other hand, is something we do have some control over.

The Difference Between Worry and Worrying

There is an important difference to make between worry and worrying.

Worry is that initial thought that shows up when we sense uncertainty. It is automatic, we have no control over it. It’s our brain sounding the alarm – doing its number one job which is to keep us safe. Sometimes our worry is helpful and there is a very real threat that requires our attention. Often though our worry is a false alarm, like a smoke detector that goes off because we burned the toast.

Worrying is different than worry. Worrying is how we respond to the initial thoughts of worry. When we are worrying we are giving those thoughts all are full attention, and treating them as a very real threat – when perhaps no real threat is present. Worrying sucks us down a spiral, we keep going over and over the ‘what ifs’.

We are actively doing it, which means we do have control over it. If worrying is something you do often, it can feel like there is no choice as it has become such an ingrained habit. Almost as if you’ve fallen down that spiral staircase. Stopping it is definitely not easy, but it is possible.

The 4 Types of Worrying

It can be helpful to identify what types of worrying you tend to engage in. Some of these types do overlap.

Mental Review: this is when we go over things that happened recently to gain more clarity, trying to convince ourselves that everything was okay. For example, maybe you were at a party, you left feeling great, like you had a fun time with your friends. Then the next day some doubt starts entering your mind – “maybe I was annoying, maybe I offended someone, maybe my friend Bob was upset with me”. You start going over the events trying to convince yourself that this did not happen, or gain more information about it.
Mental Preparing: this is like mental reviewing but instead we are trying to gain clarity in the future. This is when you start going over what ifs – what if I miss my train? what if I become financially destitute? What if my wife leaves me? What if a loved one passes away? What if I am alone forever? This type of worrying is very future focused. You may get caught up in worrying about something that might happen many many years into the future.
Reassurance Seeking: we reassurance seek when we ask the same question to people over and over. When we are reassurance seeking we are looking for a specific answer, namely that everything is going to be okay. This is different than asking a question to seek out information. When we are seeking out information we are able to tolerate ambiguity and accept whatever answer we get. When we reassurance seek we are trying to gain certainty in things that are impossible – maybe it’s a certainty that you will never get sick, or that everyone likes you. We may also do this internally, for example tell ourselves over and over that everything will be okay.
Rumination: this is when we go over and over a perceived problem in our life. Problem solving is very helpful. Rumination can often feel like problem solving however it is very different. It is like out of control problem solving. We can get sucked into analysis paralysis, or get stuck trying to figure out a problem that cannot be solved. This can show up when we are faced with a dilemma – do I leave my job for a new one? Do I move to a new town? While there are important considerations to make in choices like these, we can start ruminating about what is the ‘correct choice’. If it is a dilemma, there will likely be pros and cons on both sides making no one correct decision. Another common rumination we might engage in is trying to figure ourselves out, maybe trying to figure out ‘what’s wrong with me?’ We might continually go over all our past mistakes trying to find some answer or solution.

Reasons Why Worrying Happens

There are two main reasons why we engage in worrying. Worrying does something for us, which is why we keep doing it:

Controlling for Uncertainty: Life is filled with uncertainty. We do not know what the future holds. Worrying can feel like we’re in control of this, it helps us feel like we are gaining a sense of certainty. It comes from a good place, it’s us wanting to exert control over our lives and protect what is important to us. The issue is worrying can pull us away from what matters to us. We can become paralyzed by it, and not engage in the things we want to.
Reduces Distress: This might sound odd, as worrying and feelings of anxiety that accompany it are distressing. However, worrying can provide some relief from other and perhaps more uncomfortable feelings – maybe it is a fear that shows up, or guilt coupled with the belief that if you don’t worry and something bad happens it will be your fault, or maybe it is some other difficult feeling. Worrying can provide some temporary relief from this, it can make you feel like you are solving a problem or preparing yourself for something bad happening. The issue is that this relief is very temporary, and there is a lot of distress that comes with worrying.

To sum things up there is a key difference between worry and worrying. Worry is a natural part of being human and helps protect us from danger, we need worry. Worrying on the other hand is more active, and something that we engage in. We do it because it helps us gain certainty and temporarily reduce distress.

How to Stop the Spiral of Worrying

If you find your worrying is pulling you away from the life you want here are some things you can do:

First notice that you are engaging in worrying – one way to do this is identify what type of worrying you are doing – i.e. mental review, reassurance seeking, rumination, or mental preparing?
Try embracing uncertainty – remind yourself of what you can control and what you cannot control.
Practice making room for any discomfort that arises – for e.g. breathing into sadness, guilt, fear, or something else. Self-compassion can be a useful tool for this, check out more info on this topic here.
Engage in what you want to do in this moment – do you want to engage in worry, or is there another move you are wanting to make in this moment that would pull you closer towards the life that you want? Getting in touch with what is important to you can provide a useful guide, check out exercises for this here.

Additional Resources

Here are some books that can help you break free from worrying:

Worrying is Optional By Ben Eckstein

Things Might Go Terribly Horribly Wrong By Kelly G. Wilson and Troy DuFrene

If you find worrying is controlling your life and you are looking for help reach out to a mental health professional.

October 14, 2022May 1, 2026

How Are Panic Attacks Treated in Therapy?

Disclaimer: If you notice yourself experiencing what you think are panic attacks, it is always best to visit your Doctor (GP) as a first stop to make sure these symptoms are not caused by an underlying health condition. Once your doctor gives you a clean bill of health, they might refer you to a therapist for panic attacks.

What is a panic attack?

Panic attacks are a heightened form of anxiety. They can be an unbearably overwhelming experience. Heart racing, a tightness in your chest, hands tingling, feeling like you just can’t catch a breath.

It’s no wonder that many people end up in the emergency room for fear that they are having a heart attack. When a panic attack shows up, it can feel like something is going terribly wrong with our bodies.

What is happening when we have a panic attack?

We humans have evolved to avoid things that are unpleasant, dangerous, and painful. If we think back to ourselves as cave people on the savannah, avoiding dangerous things meant that we would not become another creatures lunch!

We not only avoid painful things outside our body, we are also wired to avoid unpleasant experiences inside our body as well. In Acceptance and Commitment Therapy (ACT) we call this process experiential avoidance.

Experiential avoidance is something we all do, myself included! I don’t want to feel shame or have my mind tell me I’m a failure so I don’t go for that promotion at work. I don’t want to feel the fear and embarrassment that would come if the cute girl at the coffee shop rejects me, so I won’t go ask her out on a date.

When we are struggling with a panic attack, our minds see our racing heart, tightness in our chest, and shortness of breath as an alarm signal that something is wrong. Our mind might start telling us I am dying, I am having a heart attack!

Of course, our mind is just trying to help us and keep us safe, however a cycle of panic has now begun. Our racing heart is now pounding even faster, our chest feels even tighter, and we start grasping for the next breath.

In psychology we say that panic attacks are anxiety about anxiety. When anxiety shows up, it is natural to have the physical sensations described above. Our minds however can start seeing these physical sensations as a very real and dangerous threat. Just like we would a lion on the savannah! We naturally try to get rid of anxiety, and doing so creates panic.

How are panic attacks treated?

So how are panic attacks treated in therapy? A therapist will help you identify what triggers your panic attack. This would include physical sensations (for e.g. your heart rate increasing), what your mind is saying (your thoughts), what feelings show up in your body, and in what situations a panic attack is more likely to occur.

You might have already guessed, if trying to get rid of anxiety is what causes a panic attack, would it make sense to practice the opposite of trying to get rid of it? Yep! That’s exactly what we do!

In therapy we call this skill willingness. Willingness means practicing making room for what feelings and bodily sensations are showing up moment to moment. A big part of therapy for panic attacks is about building this skill.

Once this skill is practiced, it would then be put to use in what we call interoceptive exposure (currently the best evidenced based method for treating panic attacks). Interoceptive exposure means you and your therapist would gradually expose yourselves to the feared physical sensations. That could be dizziness, a racing heart, shortness of breath, nausea, or a tightness in your throat.

This could be done by both of you running up and down on the spot, rapid deep breathing, spinning yourself in a chair, or breathing through a straw to name a few.

If this sounds scary to you, you’re right, it is scary! Taking a step like this marks a profound act of courage. It is scary, and possible! A former first lady of the U.S. said it best:

“You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You must do the thing which you think you cannot do.”
– Eleanor Roosevelt

Photo by Andrey Metelev on Unsplash

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