Anxiety, Anxiety Attacks, and Prolonged Anxiety

A peer-reviewed exploration of how unresolved trauma rewires the brain, regulates the nervous system, and silently orchestrates our everyday lives.

There is a particular kind of suffering that doesn’t announce itself with a single, datable event. It doesn’t always arrive in the form of a car accident, a natural disaster, or a violent assault — the traumas most commonly depicted in clinical textbooks. Instead, it accumulates. It seeps in through years of emotional neglect, through childhoods spent walking on eggshells, through relationships that felt unsafe, through the ongoing experience of being small in a world that felt threatening. This is complex trauma, and its effects are as pervasive as they are often invisible — to others, and sometimes even to the person living inside them.

In 1994, psychiatrist and Harvard scholar Judith Lewis Herman first articulated the concept of Complex Post-Traumatic Stress Disorder (C-PTSD) in her landmark book Trauma and Recovery, arguing that the diagnostic framework available at the time failed to capture the full range of psychological devastation wrought by prolonged, repeated traumatisation — particularly when it occurs in childhood, within relationships, and from which there is little or no escape (Herman, 1992). Decades later, the World Health Organisation formally recognised C-PTSD as a distinct diagnosis in its ICD-11 classification (2019), distinguishing it from standard PTSD as a more severe subtype that is more common following repeated interpersonal trauma, with prominent disturbances of emotion regulation, self-identity, and relational capacities.

But the question that haunts clinicians, researchers, and the people living with it remains: how, exactly, does trauma get under the skin? And what does it actually look like — not in a clinical checklist, but in the texture of a real human life?

The Brain on Alert: What Trauma Does to Your Neurobiology

To understand complex trauma, we first need to understand what happens inside the brain when threat — especially repeated threat — rewires the system designed to protect us.

The human stress response is centred on what is sometimes called the threat triad: the amygdala, the hippocampus, and the prefrontal cortex. The hippocampus, amygdala, and the medial prefrontal cortex are all important limbic structures involved in the processes that undermine mental health, and hyperarousal of the sympathetic nervous system with sustained allostatic load along the Hypothalamic-Pituitary-Adrenal (HPA) axis has been theorised as the basis for adult psychopathology following early childhood trauma.

In plain terms: when a threat is perceived, the amygdala — our brain’s alarm system — fires first. The amygdala instantly sends signals to the hypothalamus and brainstem, which results in activation of the autonomic nervous system and secretion of cortisol and catecholamines, the key drivers of stress reactions. This is adaptive. Under normal circumstances, once the danger passes, the prefrontal cortex helps regulate the alarm back down. But when stress is chronic — when there is no “once the danger passes” — the system becomes recalibrated.

Research has demonstrated what happens to these structures under prolonged duress. Chronic stress exposure leads to dendritic atrophy in the prefrontal cortex, dendritic extension in the amygdala, and strengthening of the noradrenergic system. High levels of norepinephrine release during stress rapidly impair the top-down cognitive functions of the prefrontal cortex, while strengthening the emotional and habitual responses of the amygdala. In other words: the rational, regulating part of the brain shrinks back; the reactive, threat-detecting part grows stronger.

Neuroimaging data reinforces this picture. Research consistently shows altered connectivity between the insula, amygdala, and prefrontal regions in individuals with PTSD, with hyperactivation of the amygdala and insula coupled with hypoactivation of prefrontal regions during emotion processing and regulation tasks — an altered connectivity pattern thought to contribute to heightened threat sensitivity and difficulties in emotion regulation.

The world’s largest childhood trauma study, published in 2024 by researchers at the University of Essex, uncovered a disruption in neural networks involved in self-focus and problem-solving, meaning that those under 18 who experienced abuse may struggle with emotions, empathy, and understanding their own bodies.

This is not metaphorical damage. It is measurable, structural, and neurologically real — and it shapes everything that follows.

The Body Keeps the Score: Physical Manifestations of Unresolved Trauma

Bessel van der Kolk’s seminal phrase — that the body keeps the score — has entered popular consciousness for good reason. It describes something clinicians and survivors have long observed: that unresolved trauma does not stay neatly contained in the mind. It lives in the muscles, the gut, the skin, the breath.

Individuals with C-PTSD often exhibit a heightened or diminished awareness of internal bodily sensations, such as heart rate or respiratory changes, which in turn affects their ability to regulate emotional responses to stress or trauma cues appropriately. This disruption of interoception — the ability to sense and interpret one’s own bodily signals — is central to understanding why so many trauma survivors find it difficult to know what they are feeling, or feel overwhelmed by physical sensations without understanding why.

The autonomic nervous system (ANS), which governs involuntary functions like heart rate, digestion, and breathing, is thrown into chronic dysregulation. Two PTSD subtypes have been proposed: a dissociative (hyporeactive) subtype characterised by extreme inhibition of emotion, and a re-experiencing/hyperaroused subtype characterised by under-modulation of emotion. One person with complex trauma may be perpetually activated — heart racing, muscles braced, breath shallow, unable to relax in quiet moments. Another may feel chronically numb, flat, and disconnected from their own physical experience. Both are responses to the same underlying dysregulation, expressed differently.

Common physical symptoms include persistent sleep difficulties and nightmares, chronic muscle tension, jaw clenching and headaches, gastrointestinal problems, and an exaggerated startle response — the flinch at a door slamming, the spike of panic at an unexpected touch. Perhaps most confounding is the presence of chronic pain without a clear medical explanation, which is increasingly understood not as psychosomatic dismissal but as a genuine physiological consequence of a nervous system that has been held in prolonged fight-flight-freeze activation.

Symptoms related to arousal and reactivity — such as irritability, hypervigilance, and sleep disturbances — are associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, increased activity of the noradrenergic system, and weakened inhibition of limbic systems by the frontal cortex. Together, these neurobiological changes sustain the chronic dysregulation of systems responsible for fear, arousal, and emotional control.

For many survivors, these physical symptoms are the first — or only — place the trauma appears. They visit doctors for fatigue, for chronic pain, for digestive issues, never connecting these to experiences that may have happened decades earlier. The body, as van der Kolk observed, never forgets.

The Emotional Landscape: Feeling Too Much, Feeling Nothing, or Oscillating Between the Two

The emotional signature of complex trauma is not one thing. It is a constellation — and it is often internally contradictory. Survivors may describe feeling intense, overwhelming emotion that seems disproportionate to any visible trigger, while also describing long stretches of emotional numbness or flatness, as though a dimmer switch has been turned down on their inner life.

Complex PTSD was formulated to include, in addition to the core PTSD symptoms, dysregulation in three psychobiological areas: emotion processing, self-organisation (including bodily integrity), and relational security. The emotional dysregulation that characterises C-PTSD is not simply moodiness or sensitivity — it is a nervous system that has lost the capacity for flexible, graduated response, instead lurching between extremes: flooded and overwhelmed, or shut down and dissociated.

Shame is a central emotional feature, often more prominent than fear in complex trauma — particularly when the trauma was interpersonal and relational. Individuals with clinical levels of dissociation display increased levels of both state and trait guilt and shame, coupled with a tendency toward social withdrawal and an obsessive preoccupation with social interactions. This shame is not a rational judgement. It is somatic, preverbal, often arriving before conscious thought, producing a pervasive sense of being fundamentally flawed or different from other people.

Other common emotional experiences include persistent anxiety or a low-grade, free-floating dread that is hard to attribute to any single cause; depression; grief; and a deep difficulty trusting others — not as a choice, but as a nervous system default shaped by past experience of betrayal or abandonment. Rapid mood shifts, difficulty feeling pleasure, and a sense of being disconnected from oneself or from one’s life are also frequently reported.

What makes the emotional experience of complex trauma so disorienting — and so often misunderstood by others — is that these responses are frequently not linked to what is visibly happening in the present. A benign comment, a tone of voice, the smell of a particular place: these can trigger a cascade of emotion that, to an outside observer, seems entirely out of proportion. The key word is trigger — and it speaks to a nervous system that has learned to pattern-match present cues to past danger with alarming efficiency.

The Cognitive Architecture of Trauma: How It Reshapes Thought

Complex trauma does not merely colour how a person feels. It rewrites how they think — about the world, about other people, and most profoundly, about themselves.

Prolonged and complex trauma exposure leads to the establishment of highly probable hypotheses — for example, perceiving situations as unsafe or others as inherently dangerous — that are based on the impact of the trauma and the physiological response it triggers. Such trauma-based predictions often get reactivated in later situations, regardless of whether they match current sensory data, allowing them to override actual perceptions and elicit negative emotions tied to present circumstances instead of being correctly attributed to past events.

This is one of the most important — and least appreciated — aspects of complex trauma: it is a predictive system. The brain, having learned that certain patterns were dangerous, pre-empts new experience by applying old templates. What looks from the outside like an irrational response is, from inside the traumatised nervous system, a completely logical extension of what was learned.

Common cognitive patterns include intrusive thoughts and unwanted memories that break through without warning; flashbacks, in which the emotional and sensory reality of a past event is re-experienced as though it were happening now; difficulty concentrating; and what many survivors describe as “brain fog” — a sense of mental slowness or inability to think clearly that reflects the prefrontal cortex’s compromised functioning.

Dissociation deserves particular attention here. Trauma-related dissociation is a biological response to a stressful event in which the victim finds themselves in a completely helpless situation, to which the body responds by stopping processing perceptual, cognitive, and emotional information. In complex trauma, this can manifest as memory gaps, a sense of watching oneself from the outside (depersonalisation), feelings that the world is unreal or dreamlike (derealisation), or the more complete “spacing out” that renders a person temporarily absent from a conversation or situation. Far from being a dramatic phenomenon, many survivors experience low-grade, everyday dissociation — the phenomenon of “losing” large portions of a day, or not being able to remember much of childhood.

Complex trauma occurring within attachment relationships would interrupt emotional development and the development of social cognition and social information processing. This manifests in the cognitive realm as difficulty reading social situations accurately, misinterpreting others’ intentions (typically in the direction of perceived threat), and an impaired capacity for what researchers call mentalisation — the ability to understand one’s own and others’ mental states. Relationships become cognitively exhausting and confusing, because the mental models built from early experience are fundamentally distorted.

Negative core beliefs — “I am not safe,” “I am worthless,” “I am different from everyone else,” “I am fundamentally broken” — are not conscious intellectual conclusions. They are deeply embedded assumptions, formed in the crucible of early experience, that filter all subsequent perception. A compliment slides off; a criticism confirms what was already “known.”

The Behavioural Imprint: How Trauma Lives in What We Do

Perhaps the most visible — and most judged — dimension of complex trauma is its behavioural expression. The patterns that emerge from unresolved trauma are, in a very real sense, adaptations: strategies that once served survival and have since become habits the nervous system cannot easily relinquish.

Hypervigilance is one of the most consistent. The person who scans a room upon entering, who monitors tone of voice and facial expressions with exhausting precision, who cannot sit with their back to the door — this is not anxiety in the ordinary sense. It is a nervous system executing a threat-detection protocol that was once, in a different context, an entirely rational response to an unpredictable or dangerous environment.

Avoidance — of people, places, conversations, and feelings that echo past pain — is another core feature. Avoidance mechanisms are associated with reduced functional connectivity between the prefrontal cortex and limbic structures, reflecting processes of emotional and cognitive suppression related to trauma. The problem is that avoidance, while offering short-term relief from activation, prevents the nervous system from ever learning that the avoided thing is no longer dangerous. The threat remains vivid and alive precisely because it is never re-encountered in safety.

People-pleasing and difficulty setting limits are particularly prevalent in those whose early trauma occurred within attachment relationships — where expressing needs was dangerous, and whose sense of safety became contingent on managing others’ emotional states. The adult who cannot say no, who exhausts themselves maintaining social harmony, who feels profound guilt or dread at the prospect of disappointing anyone, is often unconsciously re-enacting the relational dynamics of a much earlier, much more constrained world.

At the other end of the behavioural spectrum: sudden anger, emotional outbursts, or what appears to others as aggression or volatility. The affective domain problems characteristic of C-PTSD are evidenced by heightened emotional reactivity, violent outbursts, reckless or self-destructive behaviour, or a tendency towards experiencing prolonged dissociative states when under stress. These are not character flaws. They are the product of a regulatory system that was never properly developed, because the environment that should have co-regulated it — usually a safe, consistent caregiver — was not consistently available.

Increased use of alcohol, substances, or other numbing or regulating behaviours is extremely common, and again, makes perfect adaptive sense: when the nervous system cannot regulate itself, external means of regulation become necessary.

Perhaps the most enduring behavioural signature is the re-enactment of relational patterns. Complex PTSD is associated with traumatic events that start earlier in life and are perpetrated by acquaintances or family members. When the source of trauma is relational — a parent, a partner, a sibling — the nervous system learns that intimate relationships carry particular qualities: unpredictability, danger, simultaneous need and threat. Those templates, if unaddressed, get applied to future intimate relationships with remarkable fidelity, producing cycles of conflict, dependency, or distrust that can baffle and exhaust both the survivor and those around them.

The Hidden Prevalence: Who Is Affected, and Why It Goes Unrecognised

A critical but often overlooked dimension of complex trauma is the breadth of experience it encompasses. While the public imagination tends toward extreme, dramatic events, trauma is substantially broader. Trauma exposure is common — lifetime estimates in the United States range from 50% to 89%, and in an international study of 69,000 adults, 70% reported lifetime exposure to a traumatic event and 30.5% reported being exposed to four or more traumatic events.

Crucially, C-PTSD is a stress-related mental disorder generally occurring in response to complex traumas — commonly prolonged or repetitive exposure to traumatic events from which one sees little or no chance to escape. This includes, but is not limited to, childhood neglect, emotional abuse, domestic violence, bullying, medical trauma, community violence, and the cumulative stress of marginalisation and systemic inequality. The question is not only what happened, but how long, how often, and within what relationship.

One of the most striking clinical observations is the capacity of highly traumatised individuals to present as high-functioning — capable, competent, even successful externally, while carrying an enormous internal burden. The dissociative and compensatory strategies that trauma produces can be extraordinarily effective at maintaining surface functionality, making it difficult for others — and sometimes the person themselves — to recognise that anything is wrong. The absence of obvious distress does not equal the absence of suffering.

Patients with CPTSD report earlier onset of trauma, more trauma perpetrated by acquaintances or family members, and more comorbidities than those with PTSD. This comorbidity — with depression, anxiety disorders, substance use, chronic pain, and personality difficulties — means that complex trauma is often treated piecemeal, its symptoms addressed in isolation from their common root.

The Path Forward: What Healing Requires

Understanding complex trauma is not merely an academic exercise. It is, for millions of people, the difference between a lifetime of confusion about why they are the way they are, and a coherent framework that opens the door to recovery.

The same neuroplasticity that allows the brain to be shaped by trauma also provides the basis for healing and recovery — the brain can re-wire, the nervous system can regain regulation, and evidence-based trauma therapies and intentional lifestyle practices offer concrete pathways to support this healing process.

Treatment approaches specifically designed for complex trauma — including trauma-focused CBT, EMDR (Eye Movement Desensitisation and Reprocessing), and phase-based approaches such as STAIR — aim to work not just with conscious narrative but with the body, the nervous system, and the deep relational wounds that lie at C-PTSD’s core. Techniques such as Mindfulness-Based Stress Reduction, which has been found effective in addressing C-PTSD symptomology, incorporate elements designed to enhance interoceptive tolerance and accuracy, facilitating a more nuanced understanding and integration of bodily sensations with corresponding emotional states.

The recognition that persists through all the research is this: complex trauma is not a weakness of character, not a failure of resilience, and not a permanent state. It is a deeply human response to experiences that exceeded the capacity of the nervous system to integrate — often with very limited support and at a very young age. Its symptoms, however disruptive, are adaptations that once served a purpose. The task of healing is not to extinguish those adaptations by force, but to slowly build the safety, the relational experience, and the neurological capacity from which they are no longer needed.

If something in this article resonates — if you recognise patterns that keep repeating, reactions that feel disproportionate to present circumstances, or a persistent difficulty feeling safe, calm, or connected — it may be worth exploring with a qualified therapist who works with trauma. The body remembers. But it can also, with time and the right conditions, learn something new.

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Frontiers in Psychiatry. (2024). Tracing the paths: a systematic review of mediators of complex trauma and complex post-traumatic stress disorder. https://doi.org/10.3389/fpsyt.2024.1331256
• Frontiers in Psychiatry. (2024). A network analysis of ICD-11 Complex PTSD, emotional processing, and dissociative experiences. https://doi.org/10.3389/fpsyt.2024.1372620
• Guzman Torres, E. et al. (2023). Predictors of complex PTSD. Borderline Personality Disorder and Emotion Dysregulation. https://doi.org/10.1186/s40479-022-00208-7
• Herman, J. L. (1992). Trauma and Recovery. New York: Basic Books.
• Kaplan Therapy. (2025). The trauma-brain connection. https://kaplantherapy.org/trauma-brain-connection/
• Kozlowska, K., et al. (2022). Childhood Trauma, the HPA Axis and Psychiatric Illnesses. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2022.748372
• Lanius, R., et al. (2024). Reconceptualizing complex PTSD: A predictive processing framework. Neuroscience & Biobehavioural Reviews. https://doi.org/10.1016/S0149-7634(24)00305-1
• MDPI Journal of Clinical Medicine. (2025). Impact of PTSD duration on hippocampus, amygdala and prefrontal cortex. https://doi.org/10.3390/jcm14207242
• MDPI International Journal of Molecular Sciences. (2025). Hyperarousal, dissociation, emotion dysregulation and re-experiencing. https://doi.org/10.3390/ijms26115216
• Quirk, G. J. & Beer, J. S. (2014). The effects of stress exposure on prefrontal cortex. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC4244027/
• Siciliano, R. E. & Compas, B. E. (2022). Autonomic nervous system correlates of posttraumatic stress symptoms in youth. Clinical Psychology Review. https://doi.org/10.1016/j.cpr.2022.102125
• Stein, M. B. & Bhatt, D. (2024). Neurobiology and treatment of posttraumatic stress disorder. American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.20240536
• University of Essex. (2024). World’s largest childhood trauma study uncovers brain rewiring. ScienceDaily. https://www.sciencedaily.com/releases/2024/02/240205165831.htm
• van Dijke, A., et al. (2015). Association of childhood complex trauma and dissociation with C-PTSD symptoms in adulthood. Journal of Trauma & Dissociation. https://doi.org/10.1080/15299732.2015.1016253
• van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.
• World Health Organization. (2019). International Classification of Diseases (11th ed.).

Low self-worth is one of those things almost everyone has heard of, but it’s often misunderstood. It’s not simply “not liking yourself” — it’s a deeper, often quiet belief that you’re somehow not enough: not good enough, not lovable enough, not worthy of good things. This belief can shape how a person thinks, feels, behaves, and connects with others, sometimes without them even realising it’s happening.

This article walks through what low self-worth can look like, how it tends to develop, why it’s not always the explanation for a behaviour it might seem to explain, and what genuinely helps.

What Does Low Self-Worth Actually Look Like?

Low self-worth doesn’t show up in just one way — it tends to ripple across several areas of a person’s life.

In the way someone thinks

• A harsh inner voice that’s quick to blame and slow to forgive
• Black-and-white thinking about their own worth (“I’m a failure” rather than “that didn’t go well”)
• Brushing off compliments or achievements (“I just got lucky”)
• Constantly comparing themselves to others, usually unfavourably

In how someone feels

• A background hum of shame or guilt that isn’t tied to anything specific
• Anxiety in situations where they feel judged or evaluated
• Taking criticism much harder than the moment probably warrants
• Struggling to feel like they deserve good things — joy, rest, success

In how someone behaves

• People-pleasing, and real trouble saying no
• Avoiding challenges for fear of failing in front of others
• Perfectionism, partly as a way to dodge criticism before it happens
• Overcompensating — bragging, chasing status, or over-achieving to cover up insecurity underneath
• Self-sabotage, like procrastinating or quitting before they can “fail properly”
• Over-apologising, even when nothing’s actually their fault

In relationships

• Putting up with disrespectful or unequal treatment
• Needing frequent reassurance from others
• Trouble setting or holding boundaries
• Pulling away from people to avoid the risk of being rejected

Physically

• Guarded body language, poor posture, avoiding eye contact
• Neglecting self-care, sometimes because they don’t feel “worth the effort”

Worth remembering: none of these signs are exclusive to low self-worth. They overlap with anxiety, depression, trauma responses, and other things going on for a person. It’s the overall pattern — and the story underneath it — that matters, not any single item on this list.

Where Does It Come From?

Low self-worth is very often learned rather than something a person is simply born with — which is actually good news, because what’s learned can also be unlearned.

Watching the adults around us Kids learn a lot about how to treat themselves by watching how the important adults in their life treat themselves. A parent who’s constantly self-critical or dismissive of their own needs is teaching a child a template, even without saying a word directly to them.

Love and attention that come with strings attached If approval or affection is only given for achievement, appearance, or good behaviour, a child can learn that their worth depends on ticking boxes — rather than being something they simply have, no strings attached.

Being told directly Repeated criticism, shaming, or put-downs from parents, teachers, or peers get absorbed, especially in childhood before a person has the tools to separate “someone said this about me” from “this is true about me.”

Early relationships with caregivers Inconsistent, neglectful, or dismissive caregiving is strongly linked to a shaky sense of self-worth in adulthood — the underlying logic often being something like, “if the people meant to care for me didn’t, maybe I’m not worth caring for.”

Peers and wider social environments Bullying, exclusion, and highly competitive or comparison-heavy environments — including social media — can teach the same lesson outside the family entirely.

Broader social messaging Cultural narratives around race, gender, body type, class, or ability can also send repeated messages of lesser worth, reinforced across many different settings over time.

Why It’s Not Always the Explanation

It’s tempting, once you’re aware of low self-worth as a concept, to see it everywhere. But plenty of behaviours that look like they’re about self-worth are actually about something else entirely — or several other things at once.

Take a few common examples:

• Substance use can be tangled up with self-worth (numbing shame or a harsh inner critic), but addiction is genuinely shaped by many factors — genetics, brain chemistry, trauma, mental health conditions, and environment all play a real part.
• Having few or no friends might reflect low self-worth (believing you’re not worth others’ time), but it could just as easily be social anxiety, depression, being naturally introverted, or simply preferring one’s own company. The key difference is usually the story underneath — does the person want connection and feel blocked by fear, or is being alone genuinely fine by them?
• Coming across as arrogant or superior is often assumed to be a mask for hidden insecurity — and sometimes it is. But it’s worth being cautious here, because this assumption can become impossible to disprove (“if they’re arrogant, they’re secretly insecure; if they’re humble, that confirms it too”). Sometimes confidence is just confidence.
• Frequent casual sex or a high number of partners doesn’t automatically point to low self-worth either. For many people, this is simply how they’ve chosen to structure their sex life, without any distress or underlying insecurity attached. What matters more is the function the behaviour seems to serve for that particular person — for example, someone who says they need to tell others about their experiences afterward specifically “to feel validated” is giving you a much clearer signal than the behaviour itself would.

The takeaway: self-worth is worth holding as a hypothesis to test with a person, rather than assumed from the outside based on how something looks.

What Actually Helps

If low self-worth is at the heart of things, here’s what tends to make a genuine difference — not overnight, but over time.

1. Notice and challenge the inner critic Pay attention to the specific language your mind uses about you. Often it’s harsher and more sweeping than how you’d ever speak to someone else. Try the “friend test”: would you say this to someone you cared about? If not, that’s a sign of distortion, not truth. It also helps to separate the behaviour from the self — “that didn’t go well” instead of “I’m hopeless.”

2. Loosen the strings attached to your worth Notice what your sense of worth currently depends on — achievement, appearance, being liked, being productive. Then start building small experiences of worth that aren’t tied to those things: resting without earning it, being liked without performing. This is slow, quiet work, but it’s often the real target.

3. Build evidence, not just insight Small, doable actions build a track record of competence over time — self-worth grows partly through lived proof, not just understanding. Avoiding challenges or social situations might feel safer, but it also blocks the very experiences that could prove the harsh self-view wrong.

4. Practise boundaries Struggling to say no, or putting up with poor treatment, is common with low self-worth. Practising small boundaries — even minor ones — can genuinely shift things, not just relieve symptoms temporarily. Pay attention to the fear beforehand versus what actually happens afterward; they’re often quite different.

5. Try self-compassion rather than self-esteem Self-compassion doesn’t require feeling good about yourself — it just means relating to yourself kindly, especially when things are hard. That’s often a far more achievable starting point than trying to force positive self-regard from a standing start. Remembering that struggling is part of being human (not a personal failing) is a big part of this.

6. Pay attention to relationships If low self-worth was shaped by relationships, it often needs relationships to help un-shape it too — this is part of why therapy, and a genuinely supportive relationship, tends to work better than self-help alone. Where possible, it also helps to reduce contact with people or environments that actively reinforce the negative self-view.

7. Shift from approval to values Instead of asking “what will make people think well of me,” try asking “what actually matters to me.” This shift — living by your own values rather than by anticipated approval — reduces the constant self-monitoring that keeps worth tied to outside opinion.

A Final Note

Self-worth work is rarely quick, and it’s rarely a straight line. It’s more like slowly rebuilding a belief system than fixing one single thought. Old patterns will likely resurface here and there — that’s not a sign the work isn’t working, it’s just part of how deeply learned beliefs unwind over time.

If this sounds familiar to you personally, it’s worth having a conversation with a psychologist or therapist — someone who can help you work out what’s underneath the patterns, and support you through actually shifting them.

If you’ve ever found yourself thinking “Part of me wants to change… but part of me’s not sure”, you’re not alone. That back-and-forth, weighing things up—“Should I? Shouldn’t I?”—is a normal part of how people process big (and small) decisions. In counselling, this is called ambivalence, and rather than seeing it as a barrier, Motivational Interviewing (MI) treats it as a starting point for meaningful conversations.

What Is Motivational Interviewing?

Motivational Interviewing is a counselling approach that helps people explore their own reasons for change, without pressure or judgment. It’s a respectful, supportive way of helping you work through the push-pull that often comes with making decisions. You’re in the driver’s seat—we’re just here to help you navigate.

You might hear MI described in different ways:

In simple terms:
“MI is a collaborative conversation style that helps strengthen your own motivation and commitment to change.”

In practice:
“MI is about helping you make sense of mixed feelings and explore what’s right for you—based on your values, your goals, and your life.”

MI isn’t about telling you what to do. It’s about listening deeply, asking thoughtful questions, and helping you make sense of where you’re at—and where you might want to go.

Why It’s Not Just a Quick Fix

While MI can be used in short sessions, the research shows it works best when there’s time to really explore your thinking. In studies where people had just one 15-minute session, the outcomes were decent. But when they had more time—say, several sessions of an hour—the results were much stronger. That’s probably because real change often takes time, reflection, and a bit of back-and-forth.

MI originally started in the health world—helping people reduce alcohol use, manage weight, or improve their health. More recently, it’s been used to address things like vaccine hesitancy. But MI isn’t just for health issues. It can also help with things like relationship struggles, career decisions, or anything where you might feel stuck or unsure.

Ambivalence Is Normal

Let’s say you’re thinking about quitting smoking, leaving a relationship, or starting something new. You might feel torn—part of you is ready, and another part isn’t. That’s ambivalence.

MI offers tools to help with this, including something called the Decisional Balance, which simply helps you look at both sides: What are the good things about staying the same? What are the reasons you might want to change?

But here’s the thing—MI isn’t about pushing you toward a particular outcome. If you’re trying to make a decision where there’s no obvious “right” answer—like whether to stay in a relationship—the counsellor stays neutral. They don’t steer you in one direction. Instead, they help you explore what matters to you.

Talking Your Way Toward Change

One of the interesting things about MI is how it pays attention to the language you use when you talk about change.

Some of the things people say when they’re starting to think about change include:

• “I probably should cut down…”
• “I’d like to feel better about this…”
• “I don’t know if I can keep doing this…”

These kinds of statements are called change talk—and they’re actually signs that something inside you is shifting. MI aims to gently encourage and grow this kind of talk, because research shows that the more someone talks about change, the more likely they are to act on it.

There’s also sustain talk, which sounds like:

• “I don’t smoke that much…”
• “I know I should, but it helps me relax.”
• “Now’s not really the right time.”

Both are normal. In MI, there’s no need to rush. Instead, the focus is on listening to both sides of you—and helping you get clearer about what you want to do next.

Getting Skilled Support

Like any professional approach, MI works best when the counsellor is trained and skilled in using it. Some practitioners have their sessions reviewed (with consent) by independent experts to make sure the spirit and skills of MI are being used well.

If you ever hear a practitioner say they “do MI”, you can ask what that looks like. The most effective use of MI goes beyond just asking open-ended questions or offering summaries—it’s about how your counsellor supports you in finding your own reasons for change.

What a Session Might Involve

Motivational Interviewing tends to follow a flexible process with four key parts:

1. Engaging – Building trust and understanding
2. Focusing – Exploring what matters most to you
3. Evoking – Drawing out your own reasons for change
4. Planning – When you’re ready, looking at possible next steps

You don’t have to go through these in a straight line. Some days you might focus on one step, then circle back to another later. It’s all guided by you—your pace, your readiness, your goals.

In Summary

If you’re feeling uncertain about making a change—or you’ve been thinking about it for a while but haven’t quite landed on what to do—Motivational Interviewing could be a really helpful way to explore things.

It’s not about being told what to do, and it’s not about “fixing” you. It’s a respectful, evidence-based approach that helps people work through their own ambivalence, connect with what matters to them, and move toward change when they’re ready.

Change doesn’t have to be instant. And it doesn’t have to be perfect. But it can start with a conversation.