What Most People Call Anxiety Is Often Shame

How shame can hide beneath anxiety, and why it matters for healing.

Many people come to therapy saying, “I have anxiety.” They can feel it: the overthinking, the racing heart, the dread, the avoidance, the constant questioning of themselves.

Anxiety often becomes the name we give to the whole experience. But underneath some of those feelings there may be something quieter and harder to see: deeply held fears of being inadequate, unacceptable, exposed, rejected or fundamentally unworthy. In other words, shame.

This guide explores how shame and anxiety can become mixed up, why it matters, and how therapy with me is designed to recognise and work with the shame that may sit beneath your anxiety.

Anxiety and shame: what is the difference?

Anxiety

“Something bad is going to happen.”

Anxiety looks ahead. It anticipates threat, danger or uncertainty, and prepares the body to protect itself.

Shame

“Something is wrong with me.”

Shame looks inward. It is a painful judgement of the self: the sense of being inadequate, unacceptable or flawed.

The two often become closely intertwined. For example, someone may feel anxious about speaking in a meeting because they fear making a mistake. But the intensity of that anxiety may come from the shame they expect to feel if others see them struggle.

Sometimes anxiety is partly the anticipation of shame, and avoidance is an attempt to prevent experiencing it.

Five ways shame can hide inside anxiety

1. Anxiety about making mistakes

What it can look like: Checking work repeatedly, fearing getting things wrong, replaying errors long after they have happened.

What may lie beneath: A fear of what a mistake means about you as a person. An ordinary error can trigger an overwhelming sense of inadequacy, humiliation or worthlessness.

2. Anxiety about social situations

What it can look like: Spending hours replaying conversations, worrying how you came across or whether you said something embarrassing.

What may lie beneath: Shame about being seen and judged, or being discovered to be less acceptable than the person you are trying to present.

3. Anxiety about disappointing people

What it can look like: Intense distress when saying no, expressing a need or setting a boundary.

What may lie beneath: A belief that having needs, inconveniencing others or falling short of expectations makes you selfish, difficult or undeserving of love.

4. Anxiety about success or being visible

What it can look like: Wanting an opportunity, then feeling overwhelming anxiety when it arrives, and sometimes avoiding it altogether.

What may lie beneath: A fear of being exposed, criticised or found out as inadequate. Avoidance protects against the humiliation you anticipate.

5. Anxiety in close relationships

What it can look like: Panic when someone seems distant, disappointed or does not reply to a message.

What may lie beneath: An old sense of unworthiness: “I’m too much.” “I’m difficult to love.” “Something about me makes people leave.”

These are possible patterns, not proof that every experience of anxiety hides shame. Anxiety and shame can exist separately, and they can also feed each other. Therapy helps us understand what is true for you.

Why shame so often goes unrecognised

Shame can become so familiar that we do not recognise it as shame at all. Instead, we may describe ourselves as anxious, introverted, an overthinker, a people pleaser, a perfectionist or “just insecure”.

What we may not see is how much of our emotional life has become organised around avoiding the experience of being exposed as inadequate.

For people who grew up with criticism, humiliation, conditional acceptance or emotional neglect, shame can become woven into their relationship with themselves. It can feel like personality, rather than something that was learnt. And anything learnt can, with the right support, begin to change.

How shame can drive anxiety

When we have learnt that mistakes, disagreement, vulnerability or needing care put our worth or belonging at risk, everyday situations can begin to feel dangerous. We may become constantly watchful of our own behaviour, of other people’s reactions, and of anything that might expose what we believe is wrong with us. That vigilance is exhausting, and it can keep the cycle going.

1. Old belief: “There is something wrong with me.”
2. A trigger: A situation that could expose me.
3. Anticipated shame: “They’ll see I’m not good enough.”
4. Anxiety and vigilance: Overthinking, checking, over-preparing and avoiding.
5. The belief stays: It is never tested or challenged.

Why calming the body is not always enough

Breathing exercises, grounding and relaxation are valuable. They reduce the physical intensity of anxiety and create enough safety to respond differently. I often teach them, and they are an important foundation.

But on their own, they may not change the underlying belief. You can learn to calm your body before a meeting and still carry a deep fear that being seen as imperfect makes you unworthy. When shame is part of the picture, it needs to be recognised and worked with too.

How therapy with me works with shame

My approach recognises that anxiety is often only part of the story. Alongside helping you manage anxious feelings, therapy with me is designed to gently notice and address the shame that may lie underneath. This can include:

• Recognising shame. Helping you notice when anxiety is carrying fears about your worth, and putting words to experiences that may have felt nameless.
• Building safety first. Using regulation and grounding skills so you have enough steadiness to explore what lies beneath.
• Understanding where it came from. Making sense of how shame may have been learnt, without needing to uncover hidden memories or find a single cause. Many people already understand where their shame came from and still struggle with it, and that is okay.
• Developing compassion. Drawing on compassion-focused therapy to soften the inner critic and build a kinder relationship with yourself.
• Experiencing something different. Shame is learnt in relationships, and it often heals in relationships. In therapy, you can practise being seen, imperfect and vulnerable, and be met with acceptance rather than judgement.
• Working with painful memories. Where it helps, approaches such as EMDR can process experiences that still carry a strong sense of shame.
• Changing beliefs gradually. Over time, testing and loosening long-held beliefs about worthiness, and building relationships and ways of living that support a different view of yourself.

This work takes time, and it is often best done with ongoing support. We go at your pace.

Healing from shame is not just about understanding it. It is about having the chance to experience something different from what shame taught you to expect.

Reflective questions

You can use these prompts for private reflection or bring them into a therapy session.

1. When I feel anxious, what am I most afraid others will see or think about me?
2. Which of the five examples feels most familiar?
3. What might change if I believed I was acceptable, even when imperfect?

Support between sessions

If anxiety or low mood is making day-to-day life much harder to manage, please speak to your GP or bring it into our sessions. For urgent support, call NHS 111 and choose the mental health option, or call Samaritans on 116 123 at any time.

If you or someone else is in immediate danger, call 999 or go to A&E.

You may also find my guide Ways Shame Shows Up helpful alongside this one.

Book a consultation →

Related reading: When Perfectionism Stops You Starting · When Food Became Comfort

References

• Gilbert, P. (2010). Compassion Focused Therapy: Distinctive Features. Routledge.
• Tangney, J. P., & Dearing, R. L. (2002). Shame and Guilt. Guilford Press.

This resource is for general psychoeducation and does not replace individual assessment or care.