Key Takeways
The chest is tight. The shoulders are up around the ears. There is a slight buzz that does not quite resolve. Maybe sleep does not come, or comes thinly. Maybe the gut is unsettled, or the appetite is off. The mind is running, but it is running because the body is already running.
This is anxiety living in the body.
People often arrive in therapy with anxiety and expect the work to be about the thoughts. About catching the catastrophising, naming the cognitive distortion, talking themselves out of it. Sometimes that helps. Often it does not, because the body got there first. And until something in the body is met, the thoughts will keep coming.
I am a psychotherapist in Vancouver, working online across Canada. What follows is about what anxiety actually is when it lives in the body, and what therapy can hold for it.
When the body is doing its job
Anxiety in the body is not a malfunction. It is a nervous system that has decided something requires attention.
When the brain detects threat, whether real, remembered, anticipated, or vague, it activates the body. The heart rate rises, breathing quickens, blood moves to the muscles, digestion slows. This is the same system that helped our ancestors survive. It is also the system that helps us notice when something in our life is not right. The capacity to feel anxious is part of what makes us human.
The trouble is not the anxiety itself. The trouble is that the system was built for short, acute threats: a predator, a fall, a sudden danger. It was not built for years of chronic stress, daily exposure to bad news, ongoing financial precarity, climate uncertainty, and the slow weight of loss that many of us carry. When the system stays activated and never gets to come down, the anxiety stops feeling like a useful signal. It starts feeling like noise that will not stop.
Holistic psychiatrist Ellen Vora, in her book The Anatomy of Anxiety, makes a useful distinction between anxiety driven by the body's physiology, like poor sleep, blood sugar, hormones, or inflammation, and anxiety that is the body trying to tell you something meaningful about your life. Both are real. Both deserve care. They just need different responses.
Why thinking your way out does not always work
Most of what we are taught about managing anxiety lives in the head. Reframe the thought. Challenge the cognitive distortion. Notice the catastrophic thinking and replace it with something more balanced. These tools have value. They are not the whole picture.
Here is the difficulty. The body is a faster-acting system than the mind. By the time the conscious mind notices the anxiety and tries to talk it down, the body has already been activated for several seconds, sometimes longer. The thoughts that are running are often the mind trying to make sense of what the body is already doing. You are not anxious because you are thinking anxious thoughts. You are thinking anxious thoughts because the body is anxious.
This is why purely cognitive approaches often only get part of the way. The thoughts soften, but the chest stays tight. The reframe lands, but sleep is still thin. The body is doing what it was built to do, and it does not stop just because we ask it to.
Psychologist Alexandra Shaker, in her 2025 book The Narrowing, traces this same path. Anxiety often registers in the body before it has any cognitive content. Meeting it begins with the body, and the thinking comes back into the conversation later, with more room to actually be useful.
When the anxiety is the body talking
Some anxiety is a signal that the body is out of balance. The suffering is real. What this kind of anxiety needs is not insight. It is sleep, food, rest from screens, blood sugar that does not crash, an unhurried meal, a walk outside, or a doctor's eye on hormones, inflammation, or thyroid.
These are not character failings. They are signals that the body needs something specific. Sometimes the most therapeutic intervention for an anxious body is sleep. Sometimes it is something to eat. Sometimes it is rest from the news. Sometimes it is a slow, ordinary movement of the body that does not have to mean anything more than itself.
Other anxiety is the body telling you something in your life genuinely needs attention. A relationship that is no longer right. A job that is taking more than it gives. A loss that has not been grieved. A boundary that is being crossed.
Therapy that takes anxiety seriously distinguishes between these two, slowly, over time. We do not rush to interpret. We let the body show us what it has been carrying, and we follow what it tells us.
When the world is in the anxiety too
There is something else I want to name directly.
The anxiety in your body did not arrive yesterday. Some of what is in there is personal history. Early experiences that taught the nervous system to scan, to brace, to expect that something is wrong before there is evidence. That history matters. It often shapes what looks like an over-reaction to a small present-day situation.
But some of what is in there is also collective. The climate is changing. The political moment is heavy and ongoing. Collective grief is high, for what is being lost, for who is being targeted, for the futures we were taught to expect. The nervous systems we are trying to calm are not separate from the world they are living in.
When a client tells me they cannot sleep at night, I do not rush to interpret it as a personal pathology. I want to know what they are reading before bed, what is happening in their family, what is happening to their community, what is happening in their body. Often, the anxiety is doing the work the world has given it to do.
This does not mean anxiety is hopeless. It means a body-first approach has to take both the personal and the collective seriously. Sister posts on climate grief therapy and existential therapy for climate anxiety hold pieces of this thread.
What a body-first session can hold
When a client arrives with anxiety, what therapy can do is specific.
It can begin with slowing down. Bringing attention to the chest, the shoulders, the gut, the hands. Not as a technique applied to the body, but as a collaborative noticing of where the anxiety is living right now and where it is not. Sometimes naming "the tight place is here, and it is this size" is the beginning of the body settling.
It can involve learning the early signals. Many people only notice anxiety once it is large. Part of body-first work is learning what the early signs are: the small tightening before the spiral, the breath catching before the thoughts race. Catching it early is gentler than catching it late.
It can include working directly with the nervous system through approaches like Sensorimotor Psychotherapy, parts work, and Focusing-oriented therapy. None of these is a quick fix. They are slow, attentive ways of letting the body know it is allowed to come down.
It also includes the body's larger life, not just the room. Sleep. Food. Movement. Research from Dr. Jennifer Heisz's NeuroFit Lab at McMaster University shows that even moderate movement reduces anxiety in the body, both immediately and over time. Not as an obligation. As a way of telling the body it is not stuck.
And it includes patience. Anxiety did not arrive in the body in a session, and it does not leave in a session. What therapy offers is a steady place where the body can begin to learn it does not have to be on alert all the time.
If you have been carrying anxiety in your body for a long time, I want to say this. You are not broken. Your nervous system is doing what it was built to do, in conditions it was not built for. That is a sane response to a hard situation, not a failing to be corrected.
The work, when you are ready, is slow and gentle. It does not require you to think your way out of what you are feeling. It begins where the anxiety already lives, and it builds from there.
When you are ready, my practice has room for that.
Frequently Asked Questions
Is body-first therapy the same as CBT for anxiety?
CBT, or cognitive behavioural therapy, works primarily through the thoughts. It can be helpful, especially for specific phobias or persistent thought patterns. Body-first therapy starts in a different place. It works directly with the nervous system through somatic awareness, parts work, and approaches like Sensorimotor Psychotherapy. The thoughts are not ignored. They are met after the body has had a chance to settle. Many people find that combining the two serves them better than either alone.
How long does it take for anxiety to settle in this kind of work?
There is no single answer. Anxiety that has lived in the body for years usually does not resolve in a few weeks. What I see, in steady ongoing work, is that the body begins to learn it has somewhere to come down. That recognition is often the first shift. From there, the work continues at the body's pace, not on a timeline.
What if I just need help sleeping?
Sleep is a major piece of how anxiety lives in the body. If you are not sleeping, almost everything else is harder. Therapy can support the conditions for better sleep, but it is also worth working with a doctor if sleep has been disrupted for a long time. Sleep is foundational, and addressing it is therapeutic in itself.
Do I have to identify as anxious to bring this to therapy?
No. Many people I work with would not describe themselves as anxious. They would say they are tired, or that their bodies feel braced, or that they cannot relax. Anxiety in the body does not always announce itself by that name. If something in your body has been on for too long, that is worth bringing to a session.
What if my anxiety is about climate or politics?
Climate and political distress are forms of anxiety, and they are not irrational. They are proportionate responses to real situations that are happening in real time. The body-first approach in this post applies to those forms too.
