When your mind will not switch off

It is rarely dramatic. It is lying awake at two in the morning arranging tomorrow in your head. It is reading a short message from someone at work four times, looking for a tone that may not be there. It is a stomach that is tight before anything has gone wrong.

People around you may not see it at all, because from the outside you are managing. That is part of what makes it tiring.

Overthinking feels productive. It feels like preparation, like being responsible, like staying ahead of a problem. That is exactly why it is hard to stop. Every loop gives a brief sense of having done something, and then hands the worry back.

Avoiding the thing you are anxious about works the same way. The relief is immediate and the anxiety gets slightly larger each time.

We start with the shape of it: when it began, what sets it off, what you already do to cope. Then we work on the pattern rather than arguing with individual thoughts, because arguing with a thought is just more thinking.

That can mean practical work on sleep and on how the day is structured, learning to notice a loop early enough to step out of it, and slowly approaching what has been avoided at a pace you agree to. Where something older is driving it, we look at that too.

I will not promise that the anxiety disappears, and I would be cautious of anyone who does. What usually changes is how much room it takes up, how quickly you recover from a bad stretch, and how much of your life you organise around avoiding it.

If you are having thoughts of harming yourself, please do not wait for an appointment. Contact emergency services or go to your nearest hospital. This practice is not an emergency service.