16 Sep 2021

BY: Online Therapy

Anxiety / Anxiety counselling / Anxiety therapy / Online Anxiety Therapy

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Online Therapy: Responding to Anxiety

Article by Anna Keyter and Marvis Bih

What is anxiety?

Anxiety is a normal reaction when a person feels threatened, under pressure when faced with challenging circumstances. Someone may feel anxious before, during or after sitting an exam, going for a job interview or facing a hospital procedure (Smith, Robinson & Segal, 2021). The degree of anxiety differs with the level of risk or trauma involved.

Hence, anxiety is an emotional state that can work for us or against us. For instance, the flight response is useful when we are chased by a lion because the spike in adrenalin will help us run faster, be more alert and get us out of a dangerous situation. This response is evolutionary and is important for our survival.

However, the flight response is not useful when we are reminded of previous traumas which could lead to a heightening of feelings of anxiety. Although we all experience anxiety responses, we often differ in how we perceive the triggers and how we respond to them (Mental Health Foundation, 2014).

Response to triggers

Rape Crisis, (England and Whales) categorises feelings of anxiety as fight, flight, flop, freeze or friend response. These responses are triggered when we believe we are in a high-risk situation and react to life-threatening danger. Immediate responses may include increased heart rate and breathing, sweating, tightening our muscles and an adrenaline rush that gives us a burst of energy. Furthermore, cortisol is released to relieve pain at the moment of danger which could block rational thinking. People who live in times of extreme stress and fear sometimes experience feelings such as brain fog or having an inability to concentrate.

The Sexual Assault Crisis Centre lists 5 F’s of Trauma Response:

  • Fight: Feelings of anger and rage. Physical fights, struggle or pushing someone away.
  • Flight: Spacing out, hiding, running or backing away from the danger.
  • Freeze: Panic, numb-out, standing still.
  • Flop: To protect oneself, the mind might automatically shut down. Muscles go numb and a person could fall.
  • Friend: Calling to others for help and/or ‘befriending’ the perpetrator by pleading or negotiating with them.

Everyone has experienced anxiety at some point. Depending on the level of trauma, triggers can persist until effective coping strategies are learned (Mental Health Foundation, 2014).

Clinicians can use the DASS (Depression Anxiety Stress Scale) as a screening tool to measure Anxiety and Acute Stress Disorder. In clinical settings, the DASS-21 incorporates the clients’ self-reported emotional disturbance as part of the broader assessment. In this way, the clinician can assess the severity of symptoms of depression, anxiety and stress (Shea, Tennant & Pallant, 2009).

Signs and symptoms of anxiety

Apart from irrational fear and worry, some primary and common symptoms of anxiety may include, but are not limited to;

  • Irritability
  • Poor concentration
  • Feeling of dread
  • Consistently looking for signs of danger
  • Anticipating the worst outcome

Psychologists note that anxiety could be more than just a feeling (Smith, et al., 2021). It could include a range of physical symptoms such as

  • Headaches
  • Sweating
  • Shortness of breath
  • Pounding heart
  • Insomnia
  • Stomach upset
  • Dizziness

There are different types of anxiety disorders such as panic attacks, generalized anxiety disorder (GAD), social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder (PSTD), hoarding disorder, separation anxiety and phobias (Smith, et al., 2021; Mental Health Foundation, 2014).

Online Therapy: Responding to Anxiety

It is important to note that anxiety is not an illness but can be a devastating condition. Anxiety CARE UK (2018) notes that “a person cannot just simply decide not to be anxious anymore”. This is because anxiety affects normal human functioning and people need to develop strategies to cope with it. There are some good self-help strategies that can be useful to lower anxiety and manage symptoms of anxiety. These include:

  • Deep breathing
  • Regular exercise
  • Yoga or meditation
  • Getting enough sleep
  • Watch caffeine, nicotine and alcohol intake
  • Learn to connect with others especially if loneliness triggers or worsening symptoms
  • Practice relaxation techniques (Smith, et al., 2021; Anxiety CARE UK, 2018)

These self-help strategies are less likely to work in the case of an acute disorder. In acute circumstances, it is important to seek professional help such as Cognitive Behavioral Therapy, Exposure Therapy, and in severe cases, medication can be administered (Mental Health Foundation, 2014). Similarly, free-floating (or chronic) anxiety may resolve more quickly with professional help.

Online Therapy: Responding to Anxiety – If you feel you would like tome professional help in working through your anxiety, feel free to contact us:

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Anxiety CARE UK. (2018). Anxiety. Ciara healthy thoughts. Available at: https://ciarashealthythoughts.wordpress.com. Accessed 30th March 2021.

Mental Health Foundation. (2014). Living with anxiety. Understanding the role and impact of anxiety in our lives. United Kingdom: Mental Health Foundation.

Smith, M., Robinson, L. & Segal, J. (2021). Anxiety disorder and anxiety attacks. Available at: https://www.helpguide.org. Access 29 March 2021.



06 Sep 2021

BY: Online Therapy

Anger Management / Online Anger Management / Online Clinical Psychologist / Online Counselling

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Anger Management Online Counselling

Article by Anna Keyter and Marvis Bih

Online counselling to help with managing your anger

What is anger?

Anger can be defined as strong feelings of displeasure, annoyance, or hostility. The anger that humans experience is more complex than animals because people’s anger may also be self-directed. People can get angry because of experiences and events that happen to them in their lives. An important aspect that can influence a strong emotion like anger, is a person’s interpretation of circumstances or events that engenders feelings, attitudes, thoughts and behaviours (Bartholomew & Simpson, 2005).

The Iceberg Model of Emotions

Primary vs Secondary Emotions

Secondary Emotions

The visible part on the iceberg (Emotions that you want to show)

Primary Emotions

The invisible part of the iceberg (Emotions you want to hide)

Find out what triggers your anger

People’s anger can be triggered by many different events, for example, traumatic experiences, feelings of not being appreciated, losing patience, injustice or worrying about personal problems. Earnest Hemingway coined the ‘Iceberg Model’. This theory relates to one’s experiences of primary and secondary emotions.

Primary Emotions:

People may not be aware of their own underlying emotions that lead to feelings of anger. For instance, fear, vulnerability and sadness (the mountain of feelings that lie below the surface; the invisible part of the iceberg). These are conscious and/or subconscious feelings that a person may want to hide in front of others in order to be less vulnerable. Other examples of unconscious or primary emotions that may lead to anger include fear of being abandoned or being laughed at (Segal & Smith, 2018).

Secondary emotions:

These emotions are what is showed to someone, such as anger and resentment. Secondary emotions are the building up of primary emotions which are then expressed through an outburst, such as anger (the visible part on the iceberg).

For example, a married woman flirts with another man in the presence of her husband. His primary emotions would be fear of humiliation, rejection, loss of control, hurt (psychological pain). The husband does not want to show his vulnerability (primary emotions) but presents with overt anger (secondary emotions). These secondary emotions are what he wants her to see. He may not want to make himself more vulnerable by explaining how hurtful the situation was or that he was fearful of losing her. Instead, he shouts, calls her names and shows behaviour such as hostility.

Therefore, we deduce that anger is often driven by experiences of pain or fear (physical and mental) and expressed as a secondary emotion.

What situations could lead to anger?

  • Physical environment such as personal surroundings may annoy or frustrate someone (Segal & Smith 2018; Bartholomew & Simpson, 2005).
  • Traffic congestion.
  • Lacking income.
  • Misbehaviour of children.
  • Discrimination against race or religion.

Anger that may be due to poor health

  • Frustration may be due to failing physical health.
  • Experiencing chronic pain, fatigue, lack of sleep, anxiety and/or depression.

Attitudes that could contribute to feelings of anger

  • Having strong inflexible attitudes (set ways of thinking and feeling) that develop from core beliefs (Segal & Smith, 2018; Bartholomew & Simpson, 2005).
  • Being at odds (in conflict) with the real world/reality i.e. anti-establishment.
  • Entitlement attitudes.
  • Idealistic attitude believing everyone should always be honest, fair, just and predictable in a real-world that is frequently not that way.

Anger management.

Some tips on how to manage anger are to learn how to identify the behavioural, mental and physical warning signs when you become angry. Various types of therapies help to manage one’s anger, for example, Cognitive Behavioural Therapy CBT, Acceptance and Commitment Therapy ACT and Mindfulness Techniques.

In addition, it is useful to check how justified your anger might be and then talk about your emotions (become mindful of your feelings) rather than acting them out (Segal & Smith, 2018; Bartholomew & Simpson, 2005).

Useful strategies include time-out, distraction (such as exercise), and self-soothing techniques (such as taking a bath with essential oils). It is also useful to think before you speak.

Communication styles (such as avoiding blaming people) are vital when addressing one’s anger. Remember, only talk through the issues when you are calm. Think about the issue and clearly identify possible solutions. Try not to hold a grudge. Sometimes humour works well to release the tension. It is important to recall what worked in the past when confronted with similar situations and also be able to reward yourself when you have overcome the challenge.

Online counselling to help with managing anger

If you feel you need to get help with strategies in dealing with angry emotions, please contact us below.


Bartholomew, N. G. & Simpson, D. D. (2005). Understanding and reducing angel feelings. Texas: Texas Institute of Behavioral Research.

Segal, J. & Smith, M. (2018). Anger Management. Available at: https://www.helpguide.org. Access 29 March 2021.

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