Paradoxical Anxiety: When Relaxation Makes Anxiety Worse

Sometimes you guide a client into what should be a soothing and calming state, only to watch them tense up, speed up their breathing, and finally open their eyes. They may say something like “I feel worse when I try to relax”. Or, as one of my clients did, “it feels weird, and I don’t like it”. Following a recent experience with such a client, I thought it would be worth looking at paradoxical anxiety, known in research as relaxation-induced anxiety (RIA).

This is a phenomenon where attempts at relaxation, (such as breathing exercises, meditation, or hypnosis) increase anxiety symptoms, discomfort, agitation, or fear (Heide and Borkovec, 1983).

It’s not a reflection on your work, and it’s not resistance. It’s also not as unusual as you might think, since if it’s mild, clients often don’t like to mention it. So, this blog will be a practical guide to what’s going on with Paradoxical Anxiety during relaxation; why it matters; and how to handle it in a way that reassures both you and your client.

What is Paradoxical Anxiety or Relaxation-Induced Anxiety?

As the name suggests, it’s a paradox where attempts at relaxation bring about the opposite of the desired effect. It can happen during or immediately after an attempt to relax. Clients affected by RIA tend to describe:

• a feeling of being trapped or panicky, especially when their eyes are closed.
• A strong urge to stop the exercise, perhaps by opening their eyes or getting up.
• A fear of losing control.
• Uncomfortable physical symptoms like tingling, heaviness, floating, or dizziness.
• Irritation, restlessness or a strong sense of danger, even whilst knowing they are safe.

And, because people link hypnosis and relaxation (which they expect to feel pleasant), clients often assume they are “doing it wrong”.

What Causes Relaxation-Induced Anxiety or Paradoxical Anxiety?

There isn’t a single explanation as to why relaxation causes anxiety, and different theories might fit different clients. But research has offered a few explanations of RIA:

Contrast Avoidance: This is a helpful model for hypnotherapists that suggests some people are particularly sensitive to variations in emotions. They maintain a level of anxiety all the time because if they felt calm, when a negative spike came, it would feel even worse. (Newman and Llera, 2011).
Think of it this way. Having a constant base level of relaxation is like holding your car at the biting point at a junction. You are closer to setting off when a gap in the traffic comes along than if you used the brake. In the same way, being anxious reduces the contrast between where you are normally and what you feel when anxiety rises.
Kim and Newman (2019) also say that RIA is linked to a fear of large or sudden emotional shifts rather than to relaxation itself.

Misreading Body Signals: Along with relaxation come changed body signals about breathing, heart rate, muscle tension and so on. Clients who are very sensitive to internal sensations can misread these as threatening. Bear in mind that anxiety makes us hypervigilant. We tend to engage in specific patterns of thinking (cognitive distortions) (link), like catastrophising, which exaggerate our perceptions of danger. Relaxation is unfamiliar and, interpreted through this lens, creates a need to escape.

Control: For some clients, a feeling of safety is based on constant vigilance and control. Anxiety often makes us less flexible and unable to respond to changing circumstances, so we fall back on the familiar. This is one reason that stress and anxiety tend to make habits harder to change. We may try to control things in ways that are often extreme or unrealistic, or develop an overwhelming habit of perfectionism. If the client’s unconscious mind desires control as a coping mechanism, closing their eyes and allowing their mind to wander may be too challenging.

Type C Personality. You may be familiar with stress personalities (link), which is a somewhat controversial model but is a useful shorthand here. It broadly classifies us as Type A if we let our stress, anger and frustration out on others, Type B if we generally cope well with it, and Type C if we repress it. Like a pressure cooker, your mind can only repress so much, and eventually, it will be too much. In a pressure cooker, there’s a safety valve that literally “lets off steam”.  Our minds don’t have this, and it can lead to complete overwhelm and loss of everyday functioning. If a client is almost at their limit for holding in emotion, you might get an abreaction when they relax, as they can’t contain it any longer. But you might also get a client who is afraid to relax in case that happens.

Trauma-adjacent reactions: Not all clients experiencing paradoxical anxiety have trauma in their backgrounds, but some do. Where this applies, stillness and relaxation can allow intrusive imagery, dissociation-like sensations or a general sense of threat. This is true not just of hypnotherapy but also appears in research on adverse experiences during meditation and mindfulness practices. (Farias et al., 2020)

Overall, however, whatever reason your client interprets relaxation as unsafe, it’s best to work with their experience instead of general principles.

Why Paradoxical Anxiety Matters

Many people – therapists and the public alike – think of relaxation and hypnosis as the same thing. Therapists often present it that way, as it reassures clients that trance is a natural state and not some weird, trippy kind of experience.  Even if you don’t use hypnosis, you probably teach anxious clients relaxation exercises.

So, finding that they feel worse when they try to relax, destroy clients’confidence. They may believe that they can’t be hypnotised, or even helped at all.

That’s not the case, of course, but you will have to adjust your approach at least to begin with.

How to Work With Relaxation-Induced Anxiety in Therapy

• Normalise it: reassure your client by saying something like, “Some people do find relaxation brings up a wave of anxiety at first, but we can adjust it to suit you better.”
• Terminology: change your wording, such as using safe settling instead of relaxation to avoid any past associations.
• Use eyes open trance: some people do well with their eyes open. Try a soft gaze on a spot on a wall or becoming more aware of their surroundings: what they can see/hear or how they are sitting. Use common sense here. Those whose anxiety goes up when they focus inwards should focus on their environment instead, and vice versa.
• Try active or alert approaches: If being still is the issue, movement can help. (link). Try out slow, steady pacing, gentle tapping, or hand movements linked to breaths. You could also bring in some techniques more often used with younger clients, such as asking them to distract their conscious mind with doodling, using a fidget toy, or crafting while you are talking.
  Once some of the activation has been “used up”, you will be better placed to access some calm.
• Pace it: avoid putting a lot of emphasis on deep relaxation. Relax just one part of the body, or go for slightly more relaxed than usual.
• Give choices: phrases like “your eyes can be open or closed, whichever feels best”, “you can adjust your position at any time” or “you are in charge of how this works” can be very reassuring, especially to those whose anxiety is linked to loss of control.
• Future pace calm and control: use words that link calm to capability not vulnerability such as “calm and in control” or “steady and capable”.

Supporting Clients with Paradoxical Anxiety at Home

If your client is willing to practice at home:

• Make it short (1-3 minutes at the most)
• Make it predictable (same place and time every day)
• Make it a choice (they can stop at any time)
• Pair it with things they find already comforting (warm drink, weighted blanket, familiar scent)

If you feel they’re not ready for this yet, give them a normalisation take like noticing what makes their body settle naturally, without trying to force relaxation.

Paradoxical Anxiety in Therapy

Paradoxical Anxiety, or Relaxation-Induced Anxiety, isn’t a sign that your approach has failed or that the client can’t be helped.  It’s simply that their nervous system is so used to being on the alert that they are finding it difficult to switch off. This may be through fear of emotional contrasts of letting go, or of heightened sensitivity to physical sensations.

It’s one of those situations where you need to remain aware of your client, offer reassurance, and approach things in a way that suits them and makes them feel safe. Flexibility, as with most things, is the key.

And, once the client has learned to settle without feeling the need to interrupt the process, you can help them to relax again, without the sting.

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Disclaimer
The information and ideas shared on this blog are based on the author’s professional experience, research, and training. They are intended for educational purposes and to support reflection and professional development. Therapists should always apply their own professional judgment and consider the needs of individual clients when using any techniques or suggestions discussed here.
While every effort is made to ensure the information is accurate and helpful, no responsibility can be accepted for any loss, damage, or difficulties arising from the use or misuse of material contained in these articles.