The anxiety expert who wants us to change how we think (and live)

‘In my 30 years of working in physical and mental health I haven’t witnessed anxiety levels as high as they are now,” says Owen O’Kane, a psychotherapist and one of the country’s leading experts on mental health.

O’Kane, the bestselling author of three books on mental health, has not only worked with those struggling with severe anxiety — as an NHS mental health clinical lead and in his own private practice — but has also experienced the misery of it first hand. Growing up in Belfast during the Troubles andbeing bullied as a child for being gay have had a lasting impact. His professional and personal experiences led him to develop a new approach, which he explores in his latest book, Addicted to Anxiety — How to Break the Habit. In it, he explains how we need a new way to look at anxiety that isn’t about treating it with traditional therapy or drugs, and that sometimes the key to managing anxiety is to embrace it.

Over the years O’Kane has seen a rise in the prevalence and severity of anxiety. He has come to believe that there is an addictive component to it, with some sufferers almost dependent on the feelings that accompany being anxious. He has found that many rely on it as a coping mechanism for their life, rather than focusing on ways to combat it.

In 2023 the Mental Health Foundation surveyed 6,000 people aged over 18 and found that nearly three-quarters (73 per cent) had felt anxious at least sometimes in the previous two weeks, with 20 per cent reporting feeling anxious most or all of the time. Anxiety levels were found to be highest among 18 to 34-year-olds and it was the most common referral reason for mental health treatment among children, the children’s commissioner reported last year.

Cognitive behavioural therapy (CBT) is the primary treatment for anxiety offered on the NHS in England. The recovery rate is 45 per cent and improvement rate 60.7 per cent, according to a 2024 annual report on NHS talking therapies for anxiety and depression.

“People treat anxiety in different ways,” O’Kane says. “Sometimes they treat it very mechanically: ‘This is happening to you and you need to switch it off.’ CBT is very much functional: ‘Change your thoughts and you’ll feel different.’ Which is fine if it works — but if only it were that straightforward.”

O’Kane’s belief is that anxiety has similarities to an addiction in that it’s used to cope with or avoid emotional pain or difficulty. It offers the promise of keeping you safe, which makes it hard to let go of. But he says that changing the way you relate and react to your anxiety can be transformational. If traditional therapy or medication aren’t working for you then there are other options. “I’ve noticed the one common ground for most models offering treatment for anxiety is that anxiety is something happening to you. While I agree with this to a point I don’t believe it’s the entire picture,” he says in the introduction to his new book. “I believe you have a bigger role to play in the maintenance of your anxiety than you might realise.”

Here O’Kane explains his approach to anxiety and how to free yourself from its control.

Avoiding risk will not help your anxiety — quite the opposite

“Anxiety comes with a very big promise of ‘if you listen to me I will keep you safe’,” O’Kane says. “And for most people that’s quite alluring. People get hooked on the process of anxiety — the thoughts, the behaviours, the emotions, the decision-making. It’s hard to let go of.” But he claims strategies like avoiding risk, which briefly alleviate anxiety, ultimately maintain it.

Typically, if you’re anxious you become obsessed with the alarming information your mind spews out (“tell me more!”). The more you engage, the more content it will create, O’Kane says. He suggests two key “circuit-breakers”. First, create a new relationship with your thoughts — acknowledge them instead of resisting them and “observe the thoughts as mental events”. He adds: “Don’t look for meaning, value, significance or guidance.” They will quieten. Secondly, practise the art of letting go. You have a choice, he says: “Hold on to that thought and remain anxious, or let it go and feel calmer.” It’s a conscious decision requiring patience and discipline, he says.

Learn to tolerate discomfort — more exposure to it will help

“An anxious person will do everything they can to not feel discomfort, not feel risk,” O’Kane says. Anxious thoughts (“why haven’t they called me back?” or “I need things to be like this!”) reflect low tolerance of uncertainty. “An anxious person thinks ‘I want to know, I need to know’,” he says. “Well, actually, that is impossible. Can I get you to be more tolerant of the fact that life is a constant not knowing? Life is full of rejections, knockbacks, ups and downs, and uncertainties — that’s how it’s meant to be, that’s how you grow.

“Tolerance of discomfort is where you find comfort, paradoxically. Tell yourself ‘I can tolerate difficult things, I can tolerate difficult emotions, I can tolerate rejection’. Then the anxious refrain of ‘what if?’ becomes ‘I’ll handle this’; then ‘this shouldn’t be happening’ becomes ‘what can I learn?’ and ‘this is unfair’ becomes ‘this is part of life’. It boosts confidence and quietens anxiety. You can navigate your way around the anxiety and build a new relationship with it.”

How to deactivate the physical symptoms of anxiety

According to O’Kane, when you’re anxious the state of alarm that happens in the mind immediately manifests in the body. He suggests combating this by deactivating the physical sensations of danger. Recognise where you hold tension: is it in your tight shoulders? Your churning stomach? O’Kane suggests grounding yourself by regulating your breath or allowing your mind to wander to visualise a place of calm. “We all know what it’s like to just stop, drop our shoulders, catch our breath and steady ourselves.”

He adds: “Anxious clients often need to slow down. The minute you take the vigilance and sense of threat from the body and just let it flop, it will immediately send a message to the brain saying ‘no danger’ and the brain will respond accordingly.” O’Kane says that using deep breathing to engage the prefrontal cortex — the part of the brain responsible for higher-level cognitive function — allows you to access more rational thinking.

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Reframe your relationship with anxiety — look on it as a friend that’s trying to help

Most people have an awful relationship with their anxiety, according to O’Kane. “They are attached to it, they need it and hold on to it, but they hate the feelings and discomfort that it brings.” He adds: “They see it as an absolutely necessary evil that they can do nothing about — because they believe that if they don’t listen to it, something might go wrong.”

However, O’Kane tells his clients that it can be “one of the most primal, helpful mechanisms that you have”. He says: “I try to frame anxiety as ‘the part of you that’s scared’.”

O’Kane encourages people to regard their anxiety as an ally. “Your anxious self believes it’s helping you out. It wants to protect you. It just wants to keep you safe.” If you take this view, he says, “you start relating to it as an ally. If you relate to it as an enemy, that’s exactly what it becomes.” See it as benign but recognise too that “your anxious self is working way harder than it needs to”.

Imagine, for instance, that you’re about to take a risk, such as giving a work speech or asking someone out. It triggers anxiety and a rush of self-doubting thoughts. Pause and mentally take a step back. Remind your anxiety of a few facts, talk to it in your head: “I’ve done this before. Many of these doubts aren’t true. Thank you for your support but I can manage.”

When you relate to your anxiety compassionately, you learn to negotiate with it. “When I’m working with clients, they notice that when they do this, the anxiety quietens,” O’Kane says. “Their brain listens to what they’re saying.”

Recognise that the physical feeling of anxiety can be addictive

The biochemicals produced when you’re anxious are similar to those produced when excited, O’Kane says. “When we’re excited, most people are OK with that because it comes with feelings that are generally quite comfortable. Chemicallyit feels good.” When you’re anxious, much like when you’re excited, you enter a state of hyperarousal. That higher energy state creates a sense of safety. One anxious client, who is making progress in therapy, told O’Kane that she was concerned because she woke up without knots in her stomach. “It felt so unusual,” she told him. “I worried what was wrong.” He says, “We become so used to those physiological feelings that they too can become addictive.” So to relinquish your anxiety is unnerving. “It’s like going out of the house without an umbrella when it’s raining.”

To help break these addictive feelings he’s devised a technique with the acronym “SIMPLY”. Firstly think Space — mentally stepping away from your feelings and thoughts. You might go for a walk, or listen to calming music. Then Identify — ask yourself “what’s going on?” Do you feel overwhelmed? Or even scared? Next think Meet — rather than trying to escape your anxiety, be curious as to why it’s here. Pacify — quieten the body by using regulated, controlled breathing to slow and calm the stress response. Letting go — tell yourself “I am willing to let go of my old habits.” And finally, You — remember, you can manage this and you are responsible for making the changes.

What parents need to tell their anxious child

When my son was anxious, I’d tell him: “You need to run off the energy, this feeling is just adrenaline.” Exercise is a great technique for managing anxiety generally but shouldn’t be used to get rid of specific feelings, O’Kane says. “It just becomes another behaviour which is about avoidance.” He adds: “Totally understandably you’re trying to move your son out of his discomfort as soon as possible. But that in turn keeps the cycle going.”

“Parents want to give kids advice, support, tell them what to do,” he adds. Unfortunately, trying to rescue them is ineffective. O’Kane says that teaching them how they can manage this is more powerful. “Say to them that they can sit through this. They don’t need to numb the anxiety, they don’t need to push it down. This is OK. They will find a way through and it will settle down.” He adds that when this message is conveyed, they gain confidence. “You’re changing neural pathways, teaching them how to self-soothe. They build internal resilience and coping strategies.” He notes, though, that a child’s anxiety rarely exists in isolation. “It’s multifaceted — it can be family dynamics, what’s going on at school, genetic make-up, pressures,” he says, adding that it’s a parent’s job “to tease out what’s maintaining it”. Be willing to chat and listen.

How you talk to yourself matters

How you speak to yourself is important. Even saying bitterly “this is just my luck” increases anxiety as you’re telling yourself that you’re the source of this negativity, O’Kane says. Verbally self-attacking aggravates the fear. You need to be kind to yourself, to reassure yourself, which many of us find hard. When clients tell him they don’t know how to self-soothe, O’Kane asks how they’d respond if they saw a child crying or a friend upset. “That innate ability for kindness, compassion, gentleness is within you,” he says, encouraging you to respond to your anxious self in the same way.

O’Kane suggests a five-step process called HEART — help, embrace, accept, respond, trust — then to let go. He says: “Emotions come up because something needs your help.” He advises embracing the emotion — accept it and be curious about what it’s communicating. Don’t block that emotion or cling to it. Then, having given it “time, space, and compassion”, let it go. He truly believes this approach works, saying: “I see it come alive in my practice every day.”

Sorry, you can’t cure anxiety

You can’t “cure” anxiety, O’Kane says. “This is about learning to live with your anxious self in a way that feels comfortable.” He encourages people to recognise when it’s overworking. Growing up in Belfast during the Troubles, O’Kane’s anxiety was appropriate. “There was a big loss in my family. Someone was killed.” And O’Kane was different. “I was a little gay kid and was bullied.” He adds: “My anxious self developed. It kept me safe. I double checked that there wasn’t a bomb underneath a car every time I got in one.” But when he moved to London as an adult “and would still jump when a car backfired”, he realised: “You carry that anxious self with you.” O’Kane realised that in childhood his anxiety had a necessary function but then the situation changed and it wasn’t needed in the same way. “Most people never go back and update,” he says. If your circumstances have changed and the threat is in the past, acknowledge that.

How to identify your triggers

O’Kane explains that anxiety can be triggered by something as simple as new information to feeling overwhelmed by life but often people are unable to identify its cause. Unlike stress, where there’s often an external prompt, a deadline or exam, “anxiety can be much more subtle”, he says.

“Typically your mind will be on overdrive most of the time,” he adds. “It’s always on the lookout for a problem, overanalysing, trying to predict.” Overanxious people struggle with uncertainty and their anxiety also manifests physically, perhaps with a churning stomach or tight throat.

Being anxious sometimes is a fact of life. But, O’Kane says, “if anxiety is impinging on the way you function, impacting on your relationships, your work, your decisions, how you sleep, all of those everyday things, if it’s preventing you living fully, then it’s worth paying attention to. That’s not how it’s supposed to be.” The first step is to acknowledge your anxiety and then to decide to do something about it.
Addicted to Anxiety by Owen O’Kane (Penguin £18.99 pp352). To order a copy go to timesbookshop.co.uk. Free UK standard P&P on orders over £25. Special discount available for Times+ members