Worfolk Anxiety Management
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A new and better way to buy anxiety books

24 February 2017 - Chris Worfolk

You can already buy our book on Amazon and Apple iBooks. It is a convenient way to buy: you can use your existing account and payment methods and have it delivered directly to your device. As easy goes, these methods have to be high up the list.

However, there are some notable drawbacks to doing it this way.

First, you can only select one format. You can have a copy that works on your Kindle, or your iBooks, or your PC. Every time you want the book in a different format to work on a difference device, you have to purchase it again.

Second, when we publish updates to the book, you may not receive them. Neither Kindle nor iBooks sends out notifications when an updated version is released, even though it is free to upgrade to the newest edition.

Third, there is no discount for buying multiple products. What if you want our current book and our upcoming book? What if you want the eBook edition and the paperback edition? In all of these scenarios, you have to pay full price for both.

How we are fixing this

We are launching our web store. Starting today, you can purchase our books directly from us.

The first product we will be making available is the eBook edition. You can buy this for immediate download. When you do, you get access to all formats: Kindle, iBooks, e-readers and PDFs (PCs). Whatever device you are using, we have a version for you.

As part of our roadmap, we will be making the paperback version available as well, and our new book will follow shortly, also. Once it does, we will be working on discounts for buying multiple products at once.

The most generous returns policy you will find

Everything in our web store comes with a 30-day money back guarantee. If you are not satisfied, you can return the product for a refund. This includes digital products.

We are pushing the boundaries of what you would expect from a store. Our books do not have to be returned in their original condition. We want you to give them a try. Therefore, if they come back with a bent spine and folded corners, that's fine, you will still get your money back.


Our web store is the best place to buy our products from. It offers you our eBooks in every format for once price and an industry-leading returns policy for both digital and paperback editions. Click here to explore the store.


Woman looking down

What to do when CBT doesn't work

20 February 2017 - Chris Worfolk

Cognitive behavioural therapy (CBT) is go to therapy when you have anxiety. It is the often the first idea your doctor will suggest. There is a reason for this: it remains the most effective treatment we have1.

However, even with CBT, we only see a success rate of around 80%2. For a significant percentage of people, CBT does not produce the desired result. If you find yourself in this situation, what do you do next?

Here are six suggestions.


Counselling refers to a range of different therapies. However, they all share a base of being talking-based. Studies show it can be highly effective3.

The disadvantage of counselling is that it is hard to know how long it will take4. It could take eight weeks, or it could take a year. Currently, we have limited evidence as to how much time is required. This is difficult if you are funding it yourself.

CBT, again

When you did your first round of CBT, did you do all of the homework? Like, did you really do it? I ask that not to be mean, but because the first time I did CBT I did not complete all of the homework. I was new to it and did not understand that was an essential part of the therapy.

I wrote about this in a previous blog post (see Why CBT doesn't work - and what to do about it). If you are not familiar with CBT when you start the programme, you may not have gained the best results from it.

Additionally, you may not have clicked with your therapist. This does not mean that you will not have a better relationship with another.


The idea of accepting our anxiety may sound like giving up to some. However, there is a difference between giving up, and accepting that you will always be anxious, but could still lead the life you want to live. In fact, there is a therapy for it. It is called Acceptance & Commitment Therapy (ACT).

ACT is new, but there are some useful books out there for it. Try The Mindfulness and Acceptance Workbook for Anxiety by John Forsyth and Georg Eifert5.

You can find that talking to others is helpful. If so, consider joining a local support group such as the one run by my charity, Anxiety Leeds.


Mindfulness is all about living in the moment. As Paul Dolan points out in Happiness By Design6, our happiness is determined by what we pay attention to. Mindfulness teaches us to steer our minds away from our anxious thoughts and towards experiencing the present moment.

The evidence for the efficacy of Mindful Based Therapy continues to mount. A meta-analysis by Boston University look at 39 studies and concluded mindfulness was effective in reducing the symptoms of anxiety and depression7.


You probably don't want to try drugs, right? Or maybe you have tried them and found that they did not work for you either.

Antidepressants do come with some unpleasant side-effects. However, they can produce remarkable benefits, also. That would be worth having, no? It is a trade-off of pros and cons.

The trick with antidepressants is to find the right combination. We do not know exactly how SSRIs work. Therefore, it can take some time to find the right drug and the right dosage for each person.


Anxiety can often be exacerbated by lifestyle factors such as poor diet and lack of exercise. Exercise improves our mood8 and increases our ability to handle stress9. Nutrition is now recognised as one of the core determinants of both physical and mental health10.

Solving these issues is tough: it takes a commitment to a lifetime of looking after yourself. However, the rewards are worth it.

In my new book, I will be looking at how to use exercise, diet, sleep, relaxation and relationships to manage anxiety.


If CBT has been unsuccessful for you, it can feel like there is nothing you can do. This is not the case: there are many other avenues open to you, as I have discussed in this article.

Everyone's psychological make-up is different. Therefore, it can take time to find the right treatment for each person. Do not give up hope if the first few directions you explore are unsuccessful.


  1. Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive therapy and research. 2012;36(5):427-440. doi:10.1007/s10608-012-9476-1. ↩︎

  2. Van Ballegooijen W, Cuijpers P, van Straten A, et al. Adherence to Internet-Based and Face-to-Face Cognitive Behavioural Therapy for Depression: A Meta-Analysis. García AV, ed. PLoS ONE. 2014;9(7):e100674. doi:10.1371/journal.pone.0100674. ↩︎

  3. P. BOWER, N. ROWLAND and R. HARDY. The clinical effectiveness of counselling in primary care: a systematic review and meta-analysis. Psychological Medicine. Volume 33, Issue 2 February 2003, pp. 203-215. DOI: https://doi.org/10.1017/S0033291702006979 ↩︎

  4. Shapiro DA, Barkham M, Rees A, Hardy GE, Reynolds S, Startup M. Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy. J Consult Clin Psychol. 1994 Jun;62(3):522-34. ↩︎

  5. John P. Forsyth PhD, Georg H. Eifert PhD. The Mindfulness and Acceptance Workbook for Anxiety. ISBN: 9781626253346 ↩︎

  6. Paul Dolan. Happiness by Design: Change What You Do, Not How You Think. ISBN: 0141977531 ↩︎

  7. Hofmann SG, Sawyer AT, Witt AA, Oh D. The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review. Journal of consulting and clinical psychology. 2010;78(2):169-183. doi:10.1037/a0018555. ↩︎

  8. Lane AM1, Lovejoy DJ. The effects of exercise on mood changes: the moderating effect of depressed mood. J Sports Med Phys Fitness. 2001 Dec;41(4):539-45. ↩︎

  9. Wikipedia, Neurobiological effects of physical exercise". 28 October 2016. https://en.wikipedia.org/wiki/Neurobiological_effects_of_physical_exercise ↩︎

  10. Sarris, Jerome et al. Nutritional medicine as mainstream in psychiatry. The Lancet Psychiatry, Volume 2, Issue 3, 271-274 ↩︎


Woman standing by a lake in winter

What different types of anxiety are there?

13 February 2017 - Chris Worfolk

Not all anxiety is the same: in fact, none of it is. Everyone experiences anxiety differently. However, there is an incredible universality about anxiety. The feelings it generates are the same, as are the treatments.

Depending on your personal anxiety, you may find yourself identifying with one type of anxiety more than others. Below, I have outlined the major categories.

Generalised Anxiety Disorder (GAD) is a term to used to describe anxiety that covers a range of topics. There are no specific phobias or fears (or simply too many to count) but often a feeling that bad things are going to happen and a worry about the future.

Social Anxiety Disorder (SAD), also referred to as social phobia, is a recurring and significant fear of social situations. Often people are worried that something embarrassing or humiliating will happen, and it is common to worry before an event and after it, even if nothing bad happened. There is a chapter dedicated to SAD further in this book.

Panic disorder is when you regularly experience panic attacks. Some people with anxiety experience these all the time (a dozen a day in some cases!) while others may find they get no panic attacks despite experiencing high levels of anxiety.

Phobias are a feeling that is overwhelming and debilitating, triggered by a particular situation, place or item. Common phobias include claustrophobia, agoraphobia, arachnophobia and acrophobia: more on what these are later.

Post-traumatic stress disorder (PTSD) is a form of anxiety linked to a specific traumatic event.


There are different types of anxiety. Some, like PTSD, have their unique causes and treatments. However, for most types of anxiety, the solutions are the same. For all anxiety, there is a strong universality of experience: regardless of the type you experience, your feelings will probably be similar to everyone else's.


Avocado and tomatoes

Can low potassium cause anxiety?

6 February 2017 - Chris Worfolk

The internet is awash with tales of causes and cures for anxiety. One of which is the idea that low potassium can cause anxiety.

According to Natural News, there is almost nothing low potassium cannot cause:

"If you suffer from anxiety, depression, insomnia, constipation, high blood pressure, heart disease, kidney stones, hyperthyroidism, arthritis, obesity, headaches, pain in the eyes, muscle spasms, "restless leg syndrome," fatigue, or muscle tension, to name a few, you may be deficient in potassium."

Live Strong also claims that low potassium can be a cause:

"In relation to potassium, low levels can cause mental fatigue, stress and anxiety."

But is there any evidence for this?

The answer is maybe. We know that diet has a big effect on mental health1. When we eat well, our mental health improves, and when we eat poorly, our mental health declines.

However, the specific question of whether low potassium can cause anxiety is less clear.

There is one study to support the case: published in 1990 in the journal Anaesthesia2. It looked at 200 pre-operative patients and noted that they had small decreases in their levels of potassium.

However, it did not establish cause and effect. Therefore, we cannot say whether low potassium caused their anxiety, or whether their anxiety caused their drop in potassium levels. Increasing their potassium was not used as a treatment.


A well-rounded and healthy diet is the best way to improve your mental health. Potassium may or may not have an effect on some people with anxiety. However, there is no evidence that adding potassium to your diet improves anxiety.


1 O'Neil A, Quirk SE, Housden S, et al. Relationship Between Diet and Mental Health in Children and Adolescents: A Systematic Review. American Journal of Public Health. 2014;104(10):e31-e42. doi:10.2105/AJPH.2014.302110.

2 McCleane, G. J. and Watters, C. H. (1990), Pre-operative anxiety and serum potassium. Anaesthesia, 45: 583–585. doi:10.1111/j.1365-2044.1990.tb14837.x



Is anxiety dangerous to your health?

30 January 2017 - Chris Worfolk

Spending all of your time worrying is a draining exercise. However, spending time worrying about whether your worry is itself destructive is a whole new level of stress. Luckily, the answer is not as bad as you may think.

Some people worry that anxiety is dangerous to their health. They are concerned that the process of worrying will somehow damage their brain, to have a physical and measurable effect on their physical health.

Anxiety is not physically dangerous

It might feel like you are doing yourself serious physical harm when you are having a panic attack or experiencing severe anxiety. However, the evidence says that you are not.

Panic causes similar symptoms to exercising. One of the reasons that exercise is recommended is that it helps habituate you to those types of feelings. The body can cope with this stuff. People rarely die from too much exercise, and regularly die from too little.

What changes occur when we worry?

It is true that anxiety does have some effect on the body. We see this in the physical symptoms that it causes: sweating, increased heart rate, tight chest, etc. However, these are all short-term effects.

There are also some longer-term effects: repeating anxious thoughts leads to us forming those patterns in our brain. However, there is nothing inherently dangerous about a thought! Best of all, the fact that we _learnt_ these thought patterns means we can _unlearn_ them as well.

What about anxiety and life expectancy?

There is a correlation between people with anxiety and shorter life expectancy. However, the important word here is "correlation". There is no evidence that anxiety causes premature death. In fact, it makes sense that it is the other way round.

If you have been dealt a poor hand in life, such as a medical condition or genetic illness that will shorten your life, or one of the many socioeconomic factors that affects life expectancy, you are more likely to have anxiety. It is short life expectancy that causes anxiety, not the other way round.

Worry, but don't worry about worry

Anxiety is unpleasant and something none of us wants to go through. However, you can struggle with it safe in the knowledge that the act of worrying is not doing further damage to your body.


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