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.

July 31, 2023May 1, 2026

How is OCD Treated in Therapy?

Obsessive-Compulsive Disorder (OCD) is a mental health condition that affects 1-2% of the population. The World Health Organization estimates that it is one of the top 10 causes of illness related disability worldwide.

You might wonder if OCD can be cured? The issue with this question is that mental health is not black and white. Instead it can be better understood as a pattern of thoughts, feelings, and behaviours. OCD has a very specific pattern of thoughts, feelings, and behaviours.

Psychotherapy (in particular Exposure and Response Prevention) can help free you from the OCD cycle, and gain more autonomy in your life.

The OCD Cycle

To understand how OCD is treated in psychotherapy, it is first important to understand the OCD cycle.

If you are caught up in this cycle you’ll find it consists of four parts:

Obsessions – First an intrusive and distressing thought or image (called an obsession) will show up in your mind. This thought can feel very alarming, and will often centre on something you care about. You might have a thought that you will harm someone you love, or maybe you will bring in a germ that will get someone you care about sick.
Feelings of Distress – This thought or image will trigger significant distress. You may feel anxiety, fear, guilt, shame, or a feeling like you are losing control.
Compulsions – Because so much distress shows up, you do something (either an action or a mental act inside your head) to get rid of it. If the obsession is about harming someone maybe you start avoiding being alone with people you care about, or maybe you say a prayer in your head to try to protect them.
Relief – This compulsion provides you with some relief from the distress. This relief however does not last, and the cycle starts again when another obsession shows up.

Everything we do, we do for a reason – we just may not know the reason at first! With OCD, the final part of the cycle is what keeps it going. The compulsion provides you with relief from the distress.

In some sense doing the compulsion works for you. However you may notice that there is no end to the cycle, and even though you feel some relief it is not long before another obsessive thought shows up again.

How is OCD Treated in Therapy?

Research has shown that Exposure and Response Prevention (ERP), a form of Cognitive-Behavioural Therapy (CBT), is effective for treating OCD. In ERP the aim is to interrupt the OCD cycle.

In therapy you are gradually exposed to situations where obsessions will show up, and then you practice interacting with the obsessions in a new way where you watch thoughts come and stay and go instead of getting caught up in them. These skills can help take the power out of your thoughts so they no longer bully you or push you around.

An important part of breaking the OCD cycle is the response prevention part – as we allow the obsessive thoughts to come and stay and go we reduce and eventually stop the compulsions. This work can be challenging as your distress levels might increase. What you will find though is that this distress does not last forever, it will often peak and then subside.

Thought-Action Fusion – Don’t Believe Everything You Think

One experience that is very common in OCD is something called thought-action fusion. This is just a fancy way of saying that you see thoughts as the same as actions. For example, you might be sitting in a crowded theatre and have the thought enter your head “wow, I could stand up and swear in front of this entire crowd!” Everyone has thoughts like these, but if you have OCD it might feel as if you actually stood up and swore at everyone.

Your mind might start saying “why am I having that thought, that must mean I am going to do it, I should get out of here as fast as possible”. This is why part of therapy involves practicing treating our thoughts as thoughts instead of actions.

Through practice it is possible to relate to your obsessions in a new way, one where they no longer push you around, or control you. This will allow you to move through the world the way YOU want to, not the way OCD wants you to!

Interested in Therapy with Stephanie?

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November 10, 2020May 1, 2026

Emotions as Allies

We all know that being human means we experience a wide range of emotions; happiness, sadness, anger, fear, guilt, surprise, joy, loneliness, and love to name a few.

Yet quite often when a difficult emotion comes up, we try to avoid it, get rid of it, or beat ourselves up for having it in the first place.

Emotions contain messages

We forget that our emotions have evolved for a purpose and often contain important information. Here are some common messages an emotion might be telling us…

Anger often tells us that we have been hurt or treated unfairly. It can serve as a warning sign that there is something wrong that needs to be addressed.

Sadness often tells us we have experienced some type of loss. This could be an external loss such as the loss of a person, experience, or job. It can also be an internal loss such as a loss of meaning or perhaps we are not living up to some ideal we have about ourselves.

Fear has evolved to warn us of some type of danger, its purpose is to protect us. This was especially important back when we were living in caves and there was danger everywhere.

Guilt shows up when we believe we have done something wrong. It can tell us that we need to make amends with someone.

Love tells us that we appreciate someone, and we want to be close to them. It motivates us to connect with others.

How can our emotions help us?

When we try to hide, or fight, or runaway from our emotions, we often miss the message they might be trying to tell us. To help think about this, the next time you’re experiencing a difficult emotion, ask yourself:

Is this emotion telling me I need to address, solve, or come to terms with something?

What does this emotion tell me about what I care about? Are there any values underlying this emotion?

Is this emotion telling me I need to do something differently?

Can this emotion help me empathize with other people who may be experiencing something similar?

Sometimes when we experience a difficult emotion there might not be a clear purpose, or message. In these situations, an emotion like this can be a reminder to be more self-compassionate. To read more about this idea click here.

When we reframe any difficult emotion as having a purpose, or a message (even if it is just to be more compassionate to ourselves), our emotions can become an ally, instead of an enemy we need to run away from.

July 27, 2020May 1, 2026

What if anxiety was not the problem?

Anxiety, it’s painful, it’s annoying, it’s inconvenient, sometimes it can feel downright unbearable. But what if anxiety itself was not the issue?

Anxiety is there to protect us

Anxiety is an emotion that we all get to experience. It shows up to protect us from some type of danger. This could be a physical threat to our life, social rejection, or perhaps the possibility of failure.

Our brains are wired to protect us. The caveman that spent most of their day scanning the environment for any type of threat was more likely to survive and pass their genes onto future generations. The result? We all have minds that are wired to be anxious.

So, what can we do with anxiety? Fight hundreds of thousands of years of evolution? Seems like an unimaginable feat. What if there was something easier we could do?

The costs of trying to get rid of it

What if anxiety was not actually the problem but the problem was all the things we rely on to get rid of anxiety?

The wine we might overindulge in at the end of the night, the person we didn’t ask out on that date, the challenge we turned down at work, the party we did not go to.

What if the problem was also how we treat ourselves when anxiety shows up? All those harsh things we say to ourselves to make anxiety go away.

The struggle

Whenever an uncomfortable emotion shows up our mind almost always starts struggling with it.

For example, let’s say anxiety shows up, a very natural human emotion. Our mind does not like anxiety, it’s unpleasant, so what does it try to do? It tries to get rid of it. Our mind might start saying oh no! There’s anxiety, I don’t want anxiety, why is it coming up right now, what’s wrong with me? Now we have anxiety about anxiety. Our mind might start beating us up, what’s wrong with me, no one else seems to be struggling, I’m pathetic. Now we have sadness about our anxiety about our anxiety. This struggle can seem never ending and create a cascade of even more difficult emotions!

How to drop the struggle

What if there was a way to drop the struggle with anxiety? Anxiety shows up, and it’s not that we like it or want it, but we choose to not struggle with it. This takes a lot of practice, and does not come natural to any human!

There are generally 3 steps to dropping the struggle with any unpleasant emotion.

Acknowledge: the first step is simply acknowledging the emotion. Often times we can get so caught up in a feeling, that we might not even notice what is happening. Acknowledging can be as simple as saying to yourself “I notice a feeling of anxiety” “I notice this feeling in my stomach”.
Allow: the next step is practicing allowing it to be there, even though it is unpleasant. This can include saying to yourself “aha, anxiety, there you are, I recognize you are here to protect me from danger, thank you for trying to do your #1 job!”
Accommodate: the final step is the hardest one. Accommodating means making room for the feeling. Allowing it to come and stay and go in its own time. In practice this can involve taking some deep breaths around the feeling, and as you are breathing around the feeling imagine that you are creating a space for it. If the anxiety grows, try to give it even more space.

How will this be helpful?

Anxiety is an inevitable part of life. It shows up for everyone. Often the issue is not anxiety itself but all the things we do to avoid anxiety in the first place.

When we practice dropping the struggle with anxiety, it’s freer to come and stay and go in its own time. With practice it doesn’t have to hold us back from doing the things we want to do, it can actually come along for the ride.

Practice, practice, practice

This idea sounds simple but requires a lot of practice. If you’d like to practice dropping the struggle with anxiety (or any unpleasant feeling you may be struggling with) check out this guided exercise where I walk you through the steps by imagining an emotion as an object.

If you’d like to learn more, check out this short youtube clip on the struggle switch which explains this idea of dropping the struggle (I reference it in the beginning of the audio exercise).