Five Signs of Work Stress

Work can be stretching in the best ways, yet sustained pressure can tip into stress that harms your health and relationships. If you have been telling yourself to just push through, you are not alone. Many UK workers notice creeping changes long before they use the word burnout. 

Did you know that in a study of over 4500 people, Mental Health UK found that 91% of people reported extremely high levels of pressure or stress in the last year.   

Source: The Burnout Report 2026. 

In this article, we highlight five clear warning signs of work stress, why they matter and what you can do today.  It includes practical steps you can try at your desk, alongside guidance on when to seek extra help. If you recognise yourself here, consider it a nudge to act with care rather than a verdict on your capacity. 

Who are we? 

Openforwards supports adults and young people in Birmingham and online. Our approach blends practical skills with warmth, so you feel supported as you regain balance. 

The five warning signs to take seriously 

Below are five common early indicators of work-related stress. You do not need every sign for stress to be a problem. One or two can be enough to merit a reset. 

1) Sleep disruption 

You fall asleep late, wake in the small hours or clock up fewer hours than you need. Racing thoughts about tasks and mistakes keep replaying. Over time, you feel foggy and rely on caffeine to get going, which then makes sleep worse. 

Try this: 

• Set a consistent wind-down routine for 30 to 45 minutes, lights dimmed, screens parked outside the bedroom. 

• Keep a pen and pad by the bed; do a five-minute brain dump of tasks and worries before lights out. 

• If you wake and cannot settle after 20 minutes, get up, read something low-key, and return when drowsy. 

One of our clients, a project manager had gotten into a habit of checking email at late at night.  He switched to a notebook list at 9pm and a no-email-after-9 rule. Within two weeks, middle-of-the-night wake-ups reduced. 

2) Irritability and snappiness 

You feel on edge and overreact to small delays or questions. Colleagues notice you are shorter in tone. At home, you snap at your partner or children, then feel guilty. This is often a sign that your nervous system is running hot. 

Try this: 
 

• Use micro-breaks. Every 60 to 90 minutes, step away for two minutes of slow breathing or a short stretch. 

• Name and normalise: say to yourself, I am stressed and my body is protecting me. That label can reduce escalation. 

• Choose one boundary phrase you can use kindly, such as, I can help after lunch, I am at capacity this morning. 

3) Health complaints that keep coming back 

Frequent headaches, stomach issues, muscle tension or chest tightness can all be stress-related.  You may visit your GP and find nothing medically alarming, yet symptoms persist. 

Try this: 

• Track patterns across the week to spot triggers like skipped meals, back-to-back meetings or high-stakes calls. 

• Eat regularly and hydrate.  Blood sugar dips from eating snacks and highly processed foods can lead to anxiety and irritability. 

• Book movement into your diary as you would a meeting. Even a brisk 10-minute walk counts. 

4) Panic or near-panic 

Your heart races, you feel dizzy or shaky, or you fear you might faint during meetings or on the commute. Panic is frightening but not dangerous. It is a sign your threat system is firing too often. 

Try this: 

• Slow, steady exhale breathing: inhale for 3, hold, exhale for 6 and hold.  Repeat for two minutes. 

• Gently face the situations you avoid, in small steps. Stay long enough for the wave to rise and fall. 

• If panic is frequent, structured support such as CBT or ACT can help you reset the cycle. You can learn more about targeted help for panic in our guide to why panic happens and what eases it at OpenForwards. 

5) Presenteeism 

You are technically at work but your tank is empty. You re-read the same email, avoid decisions and spend longer working to make up for poor focus, which deepens the spiral. 

Try this: 
 

• Pacing: break work into small, clearly defined chunks, then take a timed micro-break before the next block. 

• The 3 priorities rule: choose no more than three must-do items for the day and protect them first. 

• Finish-lines matter. Set a firm stop time and leave less urgent tasks for tomorrow. 

When stress becomes a health risk 

Job stress is too much when it starts to impair daily living, relationships or health. Warning signs include sustained sleep loss, frequent panic, feeling hopeless about work, using alcohol or medication to cope, or persistent physical symptoms your GP cannot otherwise explain.  

Stress at work can make you ill; over time, it can contribute to anxiety, depression, high blood pressure, digestive issues and weakened immunity. If any of this sounds familiar, it is valid to take it seriously and seek support. 

What to try today: small steps that compound 

• Pace your workload. Work in 25 to 50 minute focus blocks, then take a 2 to 5 minute pause. Protect at least one longer break. 

• Set boundaries. Decide your earliest and latest work times. Communicate them in your calendar and email footer. 

• Use micro-breaks. Stand, stretch, sip water, look out of a window. Short and frequent beats long and rare. 

• Do a values check. Ask, what kind of colleague or leader do I want to be today? Choose one behaviour that fits that answer, even if it is small. 

• Reduce hidden load. Turn off non-essential notifications, batch email, and simplify task lists. 

If you want more structured strategies for stress, our page on therapy for stress management outlines evidence-based options and ways to start gently. 

How therapies can help 

Evidence-based therapies can shift stress patterns and rebuild resilience: 
 

• ACT (Acceptance and Commitment Therapy) helps you make space for difficult thoughts and feelings, clarify values and take workable steps. It is especially helpful for perfectionism, rumination and avoidance. 

• CBT (Cognitive Behavioural Therapy) maps the link between thoughts, feelings and actions. It offers practical tools to challenge unhelpful thinking, run behavioural experiments and reduce safety behaviours that keep anxiety going. 

• CFT (Compassion Focused Therapy) reduces self-criticism and strengthens the soothing system, which is vital when you tend to drive yourself hard. 

• EMDR (Eye Movement Desensitisation and Reprocessing) can be useful when work stress has been compounded by past difficult experiences or incidents that still feel raw. 

If you are curious about how these approaches feel in practice, you can explore ACT-focused support and how EMDR works in our resources at OpenForwards. 

When to seek professional help 

Consider speaking to a professional if: 
 

• Symptoms persist for more than a few weeks despite adjustments. 

• Panic, dread or low mood are frequent and affecting your work or home life. 

• You are using alcohol, medication or stimulants to cope. 

• You have thoughts of harming yourself. If you are in immediate danger, call 999 or go to your nearest A&E. For non-emergency support, contact your GP or NHS 111. 

OpenForwards provides private therapy in Birmingham and online. If you prefer to see a therapist locally, our team of psychologists and CBT practitioners offers support tailored to work stress, anxiety and burnout. 

Quick FAQ 

• What are 5 warning signs of stress? 

Common signs include sleep disruption, irritability, recurring physical complaints, panic symptoms and presenteeism or reduced productivity. 

• What are the symptoms of severe work stress? 

Prolonged sleep loss, frequent panic, persistent low mood, high irritability, reliance on  alcohol or medication to cope, and physical symptoms without a clear medical cause. 

• Can stress at work make you ill? 

Yes. Ongoing stress can contribute to anxiety, depression, digestive problems,  headaches, high blood pressure and lowered immunity. It is important to address it  early. 

• When is job stress too much? 

When it regularly disrupts sleep, health, mood or relationships, or when you feel stuck  in a cycle of coping behaviours that do not help. 

Gentle next steps 

You do not have to earn rest or help by reaching breaking point. Start with one small change today and build from there. If you would like support, you can learn about therapy options at OpenForwards and arrange an initial consultation in Birmingham or online. 

Helpful links: 

• Learn about therapy in Birmingham and online at our private therapy page: https://openforwards.com/private-therapy-birmingham 

• Read how Acceptance and Commitment Therapy can help with stress and anxiety: https://openforwards.com/psychologists-birmingham/acceptance-and-commitment-therapy-act-birmingham 

• Find out what happens in EMDR and when it may help: https://openforwards.com/how-does-emdr-work 

Work stress shows up in your body, mood and behaviour. Watch for the five signs outlined above, pace your workload, set kind boundaries, use micro-breaks and reconnect with your values. If symptoms linger or escalate, therapies like ACT, CBT, CFT and EMDR can support recovery. Reaching out is a sign of wisdom, not weakness. 

The post 5 warning signs of work stress (and what to do next)  appeared first on Explore our Therapy & ACT Training Birmingham Services.

When I started my business, I visited an exhibition in London that was aimed at helping people in my profession succeed.  Before a marketing workshop, I necked one of the strongest coffees ever brewed.  Unfortunately, 15 minutes later, I started to get a little twitchy.

Picture the scene.  This was an oversubscribed event, and there weren’t nearly enough chairs.  A substantial group of us sat on the floor at the front, crowded in without an easy escape route.

Before long, I started sweating profusely, and my heart felt like it was going to burst out of my chest.  I wasn’t sure if I was going to pass out or be sick.  Either way, it felt too much to stay where I was.  I had to get up and leave.

I headed directly to the nearest bathroom.  I splashed water on my face and controlled my breathing as best I could while I waited for it to pass. 

Nothing terrible happened.  Luckily, my worst fear didn’t come true.  I didn’t embarrass myself, and after 10 or 20 minutes, I started to feel normal again. 

In hindsight, I know it was the coffee.  However, I didn’t understand why it was happening at the time.  I’d never had this reaction to caffeine before, and it took me until much later to work it out.  In the meantime, there I was, trying to keep it together, concerned, uncertain and frustrated that I was missing out on the workshop.

Why did this make me anxious?

Caffeine is a stimulant drug, which means that when ingested, it activates the sympathetic nervous system.  In smaller doses, caffeine can increase focus, energy and productivity.  However, in larger or excessive amounts, it can have uncomfortable effects.

When activated, the sympathetic nervous system accelerates your heart rate.  You begin to pump blood faster around your body.  Your blood pressure increases, and your body temperature and adrenaline release increase.

Human evolution has allowed this reaction to occur.  Sometimes, people call it your survival response.  When encountering a threat, your body goes into flight, fight or freeze.  In other words, you try to run away, defend yourself or hideaway. 

In short, we get anxious because we have an evolved survival response that keeps us alive. 

But this isn’t the whole explanation.  There are many reasons we get anxious.

Language is a gift and a curse.

Anxiety is different from fear.  All animal species get scared.  However, humans only genuinely get anxious. 

Anxiety concerns what might happen in the future, whereas fear is a survival response to a present threat.  Language enables us to imagine the future and remember the past.  As far as we know, other animal species cannot time-travel in their minds.

When a dog chases a squirrel in the park, it runs up the nearest tree.  That’s it’s survival instinct.  When the dog passes by, the squirrel comes down again.  It doesn’t sit in the tree worrying about what might have happened.  It isn’t concerned with getting chased again.  As soon as the threat has ended, so has its fear response.

People are different.  We wait, and we keep watch.  We assess risks and create safety plans.  While that may be invaluable in some situations, the same tendency can prolong our fear, turning it into anxiety.

Life Experiences Shape Us

Our life experiences influence our minds and bodies.  We learn about the world, what others are like, and who we are daily.  During your childhood and adolescence, your environment shapes you.  Once you reach adulthood, your sensitivity to the world reduces, and past experiences significantly influence your automatic reactions. 

This helps us to understand why feelings can be confusing.  Sometimes, we feel scared when there is no apparent threat or guilty when we haven’t done anything wrong.  Feelings aren’t merely reactions to what is happening in your current situation; they are your learning history arriving into the present moment.  Let me give you an example.

When I was about 10, I used to get picked on by a couple of older boys on my street.  They’d chase me, throw things at me and verbally threaten me.  I learned that others can be intimidating, and I can feel unsafe.  I knew that, in some circumstances, I was vulnerable.

I found it humiliating as well.  When I returned home, I’d be furious, thinking, how dare they?  I’d fantasise about revenge but worry about bumping into them whenever I went out.  Either way, my heart rate accelerated, and my mind and body went into flight, fight or freeze.

Fast forward to the business exhibition many years later.  After a strong dose of caffeine, during my panic, I remember feeling scared of humiliation.  What if people mocked me?  Again, I felt vulnerable.

However, when you think about it, my fear and vulnerability don’t entirely make sense.  I knew that no one at the workshop wanted to harm me.  No one was threatening me.  However, I still felt scared and unsafe, just like when I was bullied as a child.

The mind and the body remember.

What’s happening here is natural.  This is how it works because your primary biological evolved response is survival.  It isn’t rationality.  Nor is it logic or self-compassion.  In other words, as far as your central nervous system is concerned, it is better to be safe than sorry.

Life experiences get stacked on top of each other.  My encounters with the bullies on my street were layered on top of other anxious moments before that.  The caffeine fiasco was stacked on top of everything else that had occurred before. 

There is no escaping learning, and you cannot control it.  You are not the master of what gets stored in your memory bank. 

Similarly, you cannot unlearn because every new experience gets added to all that has happened beforehand.  Your mind and your body remember to protect you.  That’s just the way it is.

The struggle can make you more anxious.

One final reason I want to mention why we get anxious is regarding the struggle.  Naturally, we don’t like anxiety.  However, when we don’t like something, we try to keep our distance and redirect our energy into escape, avoidance, and excessive control. 

The natural sequence goes like this.  We don’t like a feeling, and we don’t want a feeling, so we try to get rid of it.  Attempts to avoid fear and anxiety can take over your life, which, rather than freeing you from it, makes you a slave to it.

The post Why do we get anxious? appeared first on Explore our Therapy & ACT Training Birmingham Services.

Anger is a natural emotion. It shows up when something matters: respect, fairness, safety, being heard. The problem isn’t anger itself. The problem is when anger becomes the only gear you have—when it hijacks your body, your mouth, and your relationships before you’ve had a chance to choose.

CBT for anger management (Cognitive Behavioural Therapy) helps you slow that moment down. Not to make you “nice” or a push-over—but to help you respond with more control, more clarity, and more self-respect.

This page explains what CBT for anger looks like in practice, the techniques we use, and how you can tell therapy is working.

When anger becomes a problem (signs people often notice)

You might recognise some of these:

• You replay arguments for hours (or days), getting angrier in your own head.
• You say things you don’t mean, then feel ashamed afterwards.
• You feel tense and “wired” a lot of the time—jaw clenched, shoulders up, stomach tight.
• You go from 0 to 100 quickly, especially when you feel criticised or ignored.
• You withdraw, go cold, or stonewall because exploding feels dangerous.
• Your anger is affecting work, driving, parenting, or your relationship.

If any of this fits: you’re not alone—and you don’t have to keep living on a hair trigger.

How CBT helps with anger management

CBT focuses on the chain reaction that builds anger:

Trigger → Thoughts → Body → Urges → Actions → Consequences

Anger often feels sudden, but there are usually early signals—physical cues and “hot thoughts”—that arrive before the outburst.

In CBT for anger, we learn to spot and work with each part of the pattern:

1) Notice the early warning signs

You learn your personal “tell”—the earliest hints that anger is rising:

• heat in the chest
• faster breathing
• tunnel vision
• a harsh inner voice
• a familiar thought like “They’re disrespecting me” or “This is so unfair.”

2) Calm the body first (because thinking follows physiology)

When the body is in threat mode, reasoning gets clumsy. We practise simple tools that help your nervous system step back from the ledge—breathing, grounding, muscle release, and “pause” techniques you can actually use in real life.

3) Work with “hot thoughts” (without pretending everything is fine)

CBT doesn’t ask you to lie to yourself. It helps you test whether your mind is being:

• black-and-white
• mind-reading
• catastrophising
• building a prosecution case from one piece of evidence

We shift from rigid, escalating thoughts to more balanced, useful ones. Not “I should just let it go”—but something like:

• “I feel hurt here. I can set a boundary without going nuclear.”
• “This matters. Let me choose how I respond.”

4) Choose a response that protects what matters

Anger often has a value underneath it: dignity, fairness, loyalty, safety. CBT helps you express that value with more skill—so you get the impact you want without the fallout you don’t.

What happens in CBT sessions for anger

In the first sessions, we slow things down and get specific. Not “you have anger issues”—but your anger, in your life.

We’ll map out:

• your main triggers (home, work, driving, feeling criticised, feeling ignored)
• your typical anger cycle (what happens in your body, your thoughts, your behaviour)
• what anger costs you (relationships, sleep, health, confidence)
• what you want instead (calm authority, steadiness, repair, boundaries)

Then we build a plan. CBT is practical and collaborative—more like coaching the skill of responding, less like analysing your childhood for weeks (unless that becomes relevant and helpful).

Sessions may include:

• in-session practice (so you don’t just “understand it”, you can do it)
• cognitive tools to loosen unhelpful assumptions
• behavioural experiments: small real-world tests between sessions
• communication skills: assertiveness, time-outs, repair after conflict
• self-compassion work (because shame and self-attack often keep anger burning)

You’ll leave with small, realistic practices—because change happens between sessions, in the moments that matter.

CBT anger management techniques you’ll learn

Here are the core tools we commonly use:

Grounding and breathing skills

• paced breathing (longer out-breath)
• dropping shoulders and unclenching jaw
• “name 5 things” grounding to interrupt spirals
• tension release (especially hands, jaw, shoulders)

Thought work (cognitive restructuring)

• spotting “hot thoughts” and the story your mind is telling
• identifying thinking traps (mind-reading, all-or-nothing, “should” rules)
• generating fairer, more workable perspectives

Anger “pause” plans

• a short script for time-out: “I’m getting heated. I’m taking 10 minutes and I’ll come back.”
• rules for re-engaging: when, how, and what helps you stay constructive

Problem-solving

• define the problem clearly (not the whole relationship / whole workplace)
• list options
• pick one small next step
• review what you learn

Assertiveness and boundaries

Anger often shows up when boundaries aren’t working. We practise clear requests and limits that reduce resentment:

• “When X happens, I feel Y. I need Z.”
• “I can do A. I can’t do B.”
• “I’m happy to discuss this when we can both stay respectful.”

CBT for anger at home and at work

Anger isn’t one-size-fits-all. It behaves differently in different places.

At home

We might focus on:

• cooling-down routines after work (so you don’t walk in already at 70%)
• repair conversations after conflict (because repair builds safety)
• agreed “rules of engagement” (no shouting, no insults, time-outs allowed)
• parenting triggers and pressure points

At work

We might focus on:

• micro-pauses before replying to emails or messages
• managing criticism and perceived unfairness
• meeting strategies (when you feel talked over or dismissed)
• workload boundaries (because exhaustion makes anger louder)

And we’ll keep one eye on values—the kind of person you want to be in these places. Not perfect. Just more you, with more choice.

How long does CBT for anger management take?

It depends on what’s driving the anger and what you want to change.

Some people notice early shifts in a few sessions—especially in body regulation and “pause” skills. Deeper, more lasting change usually comes from:

• practising between sessions
• testing new behaviours in real situations
• learning repair and boundary skills (not just “calm down” skills)

In other words: you’re not just learning anger control. You’re learning a steadier way to live.

When anger is linked with anxiety, stress, or low mood

Anger often travels with other states:

• anxiety (hypervigilance, threat scanning, irritability)
• burnout (short fuse, numbness, cynicism)
• low mood (frustration, shame, “what’s the point” thinking)

In CBT we treat the whole pattern, not just the outburst. If stress or anxiety is part of the maintaining loop, we’ll address it directly—without turning your anger work into a totally different therapy journey.

Why choose Openforwards in Birmingham?

We work with anger in a way that’s:

• practical (skills you can use in the moment)
• compassionate (because shame doesn’t help you change)
• collaborative (we build the plan together)
• real-life focused (home, work, driving, parenting—wherever it bites)

We offer support in Birmingham (Jewellery Quarter) and online across the UK and worldwide.

Getting started

1. Book an initial consultation
    We’ll map what’s happening, what’s maintaining it, and what you want instead.
2. Leave with a clear plan
    Not vague encouragement—practical steps you can try this week.
3. Build steadiness over time
    You’ll learn to notice earlier, regulate faster, and repair better.

You can’t always control what sparks anger. But you can learn to control what happens next.

FAQs: CBT for anger management

Is CBT effective for anger management?
 CBT is widely used for anger difficulties because it targets the key maintaining loops: threat-based thinking, body arousal, and reactive behaviours—then replaces them with practised skills and new response patterns.

Will CBT stop me feeling angry?
 Not usually—and that’s not the goal. The aim is to help you feel anger earlier, understand it better, and express it in ways that protect your relationships and self-respect.

What if I feel ashamed about my anger?
 That’s common. Shame often keeps anger cycling: you explode, then you attack yourself, then you’re more tense and reactive next time. Compassion is not a luxury add-on here—it’s part of the mechanism of change.

What if my anger feels out of control or unsafe?
 If there’s any risk of harm to yourself or others, prioritise immediate support and safety planning. A good assessment helps you get the right level of support quickly.

The post CBT for Anger Management: Compassionate, Effective Support in Birmingham appeared first on Explore our Therapy & ACT Training Birmingham Services.

If you’re searching what are the best ACT beginner courses online, you’ll get the best return on your time (and your CPD budget) by choosing training that teaches the psychological flexibility model and gets you practising: demos, guided exercises, roleplay, and therapist language you can actually use in-session.

This guide recommends a short list of reputable beginner-friendly options, including: Psychwire (Russ Harris), Contextual Consulting, ACTivating Your Practice, Praxis, ACT Courses, Foundations of ACT (Diana Hill), and Rikke Kjelgaard I’ll also include ACT Courses at Openforwards as a UK-based, skills-first option for people who want practice and feedback—not just information.

Quick note: this is a training guide for practitioners. It’s not therapy advice for the public.

What “beginner ACT” should actually give you

A good beginner ACT course should help you do three things:

1) See the process: spot what’s happening in terms of psychological flexibility (or stuckness).
2) Choose a move: pick an intervention that fits the function, not just the worksheet.
3) Say it like a human: use ACT language that lands with real people, in real sessions.

If a course only leaves you with a handful of exercises and lots of PDFs… that’s interesting, but it’s not necessarily usable.

How I chose these courses (so you can trust the list)

I prioritised courses that are:

• Clearly ACT-focused (not “ACT-ish” as a side dish)
• Designed for clinicians (or at least clinically transferable)
• Explicit about format, structure, and what you’ll practise
• Run by trainers with a strong ACT track record

Where platforms host lots of trainers (e.g., Praxis), I treat the platform as an option—but encourage you to check the presenter and the learning design.

How to choose the right beginner ACT course online

1) Live vs on-demand

• On-demand: flexible, repeatable, good if you’ll actually schedule practice.
• Live/cohort: better for accountability, feedback, and the confidence boost of trying things out loud.

2) Is it experiential?

Look for:

• therapy demos (real or roleplay)
• guided exercises
• structured practice and feedback (or at least peer discussion)

You can’t “think” your way into good ACT. (Trust me, many of us have tried.)

3) Do you want foundations or an intensive?

• Foundations: hexaflex awareness + core methods (usually best first)
• Intensive/immersion: deeper, broader, sometimes faster—great if you want that pace

Quick comparison (high level)

Mini-reviews: best ACT beginner courses online

1) Psychwire — ACT for Beginners (Russ Harris)

Best for: therapists who want a clear, practical introduction with strong teaching and high production value.
Format: structured online intake with weekly releases (with community forum).
What you’ll get: step-by-step ACT foundations, demonstrations, exercises, quizzes, and a forum to learn alongside others.
Why it’s on the list: Russ is exceptionally good at making ACT simple without diluting it’s philosophy.
Consider if: you learn best with direct feedback—pair this with a consult group/supervision to build fluency.
Good next step after this: focused ACT training for specific presentations + supervision.

2) Contextual Consulting — The ACT Pathway (and on-demand ACT training)

Best for: clinicians who want a solid contextual foundation and a clear progression beyond “intro.”
Format: pathway-style programme plus a large on-demand library.
What you’ll get: structured training over multiple sessions/modules, plus optional Q&As and resources.
Why it’s on the list: strong emphasis on functional analysis, processes, and building real clinical flexibility. Trusted training from Dr Joe Oliver and co.
Consider if: you want something smaller/cohort-based—there’s a lot to choose from, so pick an intro-level entry point.
Good next step after this: intermediate workshops + group supervision/consultation.

3) ACTivating Your Practice — introductory training (Part One)

Best for: therapists who want to be trained (with practice) rather than attend a “nice workshop.”
Format: online course designed as an introduction for beginners, with options to go live or self-paced depending on intake.
What you’ll get: teaching + demonstrations + an emphasis on practice (and often feedback).
Why it’s on the list: it’s explicitly designed as a beginner starting place, not an advanced “cool techniques” bundle. Excellent trainers in Dr Richard Bennett & Dr Dawn Johnson.
Consider if: you prefer a highly standardised curriculum—check how the learning is structured in the current intake.
Good next step after this: skills consolidation via peer practice / consult group.

4) Praxis — ACT Basics (Matt Boone)

Best for: clinicians who want a clean ACT fundamentals course with CE hours and a self-paced format.
Format: on-demand course.
What you’ll get: fundamental ACT concepts with experiential exercises and demonstrations.
Why it’s on the list: practical, structured, and easy to fit around work.
Consider if: you want live interaction—this is primarily self-paced.
Good next step after this: a live cohort training or focused population-specific ACT.

5) ACT Courses — ACT online learning (including “ACT in Practice” style courses)

Best for: therapists who want to go deeper into applying ACT across cases, with strong lineage and clinical demonstrations.
Format: online courses with a strong emphasis on applying ACT in practice.
What you’ll get: conceptualisation support + demonstrations/real-play/roleplay exercises (depending on course).
Why it’s on the list: helps bridge the “I get ACT” → “I can do ACT” gap. Training with Dr Steve Hayes.
Consider if: you want bite-sized basics—some people prefer a gentler on-ramp.
Good next step after this: deliberate practice + supervision focusing on therapist behaviour in-session.

6) Rikke Kjelgaard – 2 Year Programme

Best for: people who want to commit to a longer programme.
Format: in-person and online programme based in Denmark.
What you’ll get: a broad overview of the ACT model plus practical tools and resources.
Why it’s on the list: Facilitated by world-reknowned ACBS Peer-reviewed ACT Trainers.
Consider if: you want deep clinical skills practice—check how much experiential/feedback is included.
Good next step after this: a more advanced cohort training or consult group.

7) Foundations of ACT — Diana Hill

Best for: therapists who want a modern, warm foundations course with strong self-practice (and a mind-body flavour).
Format: 6-module on-demand course.
What you’ll get: psychological flexibility skills across the six processes, with practices to deepen learning.
Why it’s on the list: very accessible, and self-practice can meaningfully improve your clinical “feel” for ACT.
Consider if: you want heavily clinical/roleplay-based learning—pair with skills practice or supervision.
Good next step after this: clinical application training + deliberate practice.

8) Openforwards — ACT Basics (UK-based, skills-first)

Best for: therapists who want ACT to become a practical craft: language, timing, functional focus, and supported practice.
Format: live online training when dates run (plus community options for ongoing practice).
What you’ll get: foundations taught in a clinician-friendly way, with an emphasis on “what do I do next in session?”
Why it’s on the list: many clinicians don’t need more information—they need practice, feedback, and repetition that sticks. Training with ACBS Peer-reviewed ACT Trainer, Jim Lucas.
Consider if: you want instant access today—Openforwards trainings run periodically, so check the latest schedule.
Good next step after this: the ACT Training Community / consult-style practice to build fluency.

Suggested learning paths (choose your route)

Route A: “I want foundations that translate into sessions fast”

• Pick one solid foundations course (Psychwire / Praxis / Contextual intro)
• Add a practice group (even monthly) to build fluency
• Use supervision to tighten case formulation and therapist language

Route B: “I’m busy; I need flexible on-demand”

• Choose one on-demand foundations option (Praxis / Foundations of ACT / Act Online Training)
• Schedule 30 minutes a week for deliberate practice
• Add a community or supervision so you don’t stay in “watching videos” mode

Route C: “I want immersion and depth”

• Foundations first
• Then a deeper application/immersion (e.g., ACT Courses)
• Ongoing consult group + supervision to make it your own

FAQs

What are the best ACT beginner courses online for therapists?

A good beginner ACT course teaches psychological flexibility clearly and gets you practising. Look for demos, guided exercises, and a structure that helps you build fluency—not just knowledge. Options in this guide include Psychwire (Russ Harris), Contextual Consulting, ACTivating Your Practice, Praxis, ACT Courses, and others.

How do I know if an ACT course is truly “beginner”?

Beginner courses should cover the hexaflex, core methods (defusion, acceptance/willingness, values, committed action, present moment, self-as-context), and show you how to use them in-session. If it assumes you already know how to formulate functionally and flex interventions, it may be intermediate.

How long does it take to get competent at ACT?

You can start using ACT principles quickly, but clinical fluency typically comes from repeated practice across cases—especially with feedback (consult group or supervision). To identify where you are on the ACT Practitioner Developmental Path, read this article.

Do I need ACT supervision after a beginner course?

Not “need,” but if you want ACT to become reliable in your work (rather than a concept you admire from a distance), supervision or consult groups are one of the quickest ways to build competence.

The post What are the best ACT beginner courses online? (2026 guide for therapists) appeared first on Explore our Therapy & ACT Training Birmingham Services.

Starting therapy is a bold and caring step.

It takes courage to face what’s painful and to choose a path that looks after your wellbeing.  But sometimes, the hardest part isn’t booking the first session — it’s telling your family.

You might worry they’ll misunderstand, make awkward jokes, or ask questions you’d rather not answer. You might fear they’ll see therapy as a weakness or wonder what they did wrong. These worries are common — and they make sense.

Talking about therapy can be painful.  You may feel guilty for stirring up the past, but doing so is really an act of love, connection, and change, and those are tender topics in any family.

Let’s explore how you can open this conversation with clarity and kindness — and how your loved ones can support you once the talking begins.

Start with your purpose and your boundaries

Before you begin, pause and take stock. What’s your reason for sharing this? Do you want emotional support, understanding, or simply to inform them? Getting clear on your purpose helps you steer the conversation when emotions get wobbly.

Then think about your boundaries. What feels private? What are you ready — and not yet ready — to share?

You might begin simply:

“I wanted to let you know I’ve started therapy. I’ve been feeling overwhelmed lately, and I want to take care of my mental health. I’m not ready to talk about details, but your support would mean a lot.”

It’s short, honest, and grounded. Boundaries like these don’t close doors; they build safe bridges for the conversation to cross.

Choose a calm moment

Every good conversation needs space to breathe. Try to pick a time when people aren’t distracted or in the middle of something stressful. You could say, “There’s something I’d like to share — is now a good time?”

If face-to-face feels too intense, start with a message and arrange a moment that suits you both. You’re allowed to go at a pace that feels safe.

Be honest and straightforward

You don’t owe anyone a long explanation. In fact, the simplest words are often the strongest.

You could say:

“I’ve booked an appointment with a therapist next week.”

Then, if it feels right, share your reason in practical terms:

“I want to learn some ways to handle stress and feel better day to day.”

And you can make a small request:

“It would help me if you could check in after sessions.”
or “I’d prefer to keep this private within the family for now.”

If it helps to normalise the idea, you can add:

“Just as I’d see a physio for a knee injury, I’m seeing someone trained to help with mental health.”

When your family doesn’t quite get it

Not every family speaks openly about emotions. Some think therapy is for people who are “really struggling.” Others believe you should “just get on with it.”

If that happens, start with empathy:

“I can see this might sound new or unusual to you.”

Then, keep it grounded and factual:

“Therapy is a place to learn practical tools and reflect. It helps people handle life better — at work, at home, in relationships.”

If stigma or criticism shows up, stay calm and steady:

“I hear your view, but I’m going ahead because it’s important for my health.”
“What would help most is encouragement, not advice on whether I should go.”

Sometimes, a small piece of information can be helpful too. Many effective approaches, such as Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT), are evidence-based and widely used.

If your family is curious about local options, you can direct them to trusted information about therapy in Birmingham, including the various formats and approaches available through qualified psychologists and counsellors.

Handling questions without oversharing

Families are naturally curious. They might ask:

• “Why do you need therapy?”
• “What do you talk about?”
• “How long will it take?”
• “How much does it cost?”

You can prepare a few responses in advance.

Keep it brief:

“I’m working on managing stress and anxiety, and it’s already helping.”

Protect your privacy:

“I appreciate you asking, but I’d rather not go into details.”

Be transparent where you choose:

“It varies for everyone. I’ll review progress as I go.”

And if they want practical info about options and costs, you can gently suggest looking up therapy in Birmingham to see what’s available locally.

Handling pushback with calm courage

If someone says, “Therapy means you’re weak,” you can respond:

“Getting help shows I care about my health, just like seeing a GP.”

If they say, “Talking will make things worse,” try:

“Bottling things up hasn’t helped. My therapist helps me pace it safely.”

If they say, “Just think positive,” you can say:

“I appreciate the thought. Therapy helps me learn practical tools for when life gets hard.”

And if the talk gets heated, you can step back:

“I value our relationship. Let’s take a breather and pick this up later.”

Remember — you don’t have to convince anyone. You’re modelling self-care in real time, and that’s quietly powerful.

How to support someone starting therapy

If you’re the one listening, here’s how to be helpful:

• Lead with belief and respect. Say, “I’m proud of you for doing this.”
• Follow their boundaries. Ask what they want to share.
• Offer practical support. A lift, a quiet evening, or help with chores can mean a lot.
• Make space for feelings. “That sounds tough — I’m here.”
• Avoid interrogation. Try “How are you feeling today?” instead of “What did you talk about?”
• Celebrate effort, not outcomes. Showing up takes courage — notice that.

If relationship patterns are part of what’s being explored, couples or family work can also help. For local options, couples therapy in Birmingham offers structured ways to build new habits of listening and understanding.

Keep the conversation alive

Talking once is a start, but it might be helpful to keep the conversation going. You can check in with small gestures — a text, a walk, a cup of tea. You don’t need to talk about therapy itself every time. Just staying connected matters.

You might share simple updates like, “I’m learning to pause before reacting,” or “I’ve been sleeping a bit better.” It reassures loved ones that therapy is practical, grounded, and part of a wider journey toward health.

When to step back

Sometimes, even after honest effort, your family may not understand. If the conversation continues to turn painful or dismissive, it’s okay to step back.

You can lean on a friend, a support group, or talk it through with your therapist. Setting limits isn’t rejection — it’s self-respect.

Final thoughts

Talking to your family about starting therapy is a courageous act. It’s also an act of love — for yourself, and for the relationships that matter most.

Start with your purpose. Be clear about your boundaries. Speak kindly and hold your ground when needed.

If your family doesn’t fully understand yet, that’s okay. Be patient.  Give them time.  Focus on your values.  You are investing in a happier and healthier future.

And when you’re ready to explore your next steps, you can find trusted, evidence-based support through therapists in Birmingham who’ll help you begin the process of building your emotional resources.

The post How to Talk to Your Family About Starting Therapy appeared first on Explore our Therapy & ACT Training Birmingham Services.

Feeling stuck with OCD? You’re not alone.

If you’re living with obsessive-compulsive disorder (OCD), you’ve probably tried hard to stop your thoughts or control your anxiety, and found that it only makes things worse. You might be wondering what the best evidence-based treatments for OCD actually are, and whether they could help you.

That’s a fair question. There’s a lot of advice online, and some of it is confusing or contradictory. You might hear about medication, CBT, or exposure therapy, and not know which one is right for you.

This article is here to give you a clear, evidence-based overview – without the jargon – so you can make an informed decision about your next step.

At Openforwards, we help people with OCD and anxiety using therapies that are scientifically backed, practical, and compassionate. We’ll walk you through the key treatments recommended by the NICE Guidelines, explain how they work, and show how we integrate modern approaches like ACT (Acceptance and Commitment Therapy) to make treatment more effective and meaningful.

The Best Evidence-Based Treatments for OCD

Quick Summary: Best Evidence-Based Treatments for OCD

1. Cognitive Behavioural Therapy (CBT), including a specific method called Exposure and Response Prevention (ERP)
2. Medication, usually a type of antidepressant called an SSRI

According to the National Institute for Health and Care Excellence (NICE), the best evidence-based treatments for OCD are:

That’s the official guidance used across the NHS and Talking Therapies services.

But recovery isn’t just about following a formula, it’s about how these treatments are delivered, the skill of your therapist, and how well you can engage with the process.

At Openforwards, our therapists are trained to combine evidence-based methods with compassion and creativity, helping you face OCD at a pace that feels safe yet effective.

Our lead therapist, Jim Lucas, is a specialist in OCD Therapy having helped 100s of people stuck in loops of intrusive thoughts, reassurance-seeking and mental compulsions.

Exposure and Response Prevention (ERP): Facing fears, not feeding them

ERP is considered the gold standard psychological treatment for OCD. Here’s what it involves, in plain English:

• Exposure means gradually and directly facing the thoughts, images, memories, sensations, emotions or situations that trigger your anxiety.
• Response Prevention means resisting the urge to carry out compulsions or rituals (like washing, checking, or seeking reassurance).

At first, this can sound terrifying. Why would you choose to feel anxious? But here’s the paradox: the more you avoid or neutralise anxiety, the stronger it becomes. ERP helps your brain learn a new lesson, that you can feel anxiety without acting on it, and that it naturally fades over time.

The goal isn’t to get rid of anxiety altogether, but to break the cycle of fear and compulsion so that OCD stops controlling your life.

Frequently Asked Questions About OCD Treatment

A real story (shared with permission)

A few years ago, I worked with someone – let’s call her Sarah – who spent hours each day checking doors, taps, and appliances. She knew it didn’t make sense, but she couldn’t stop. Together, we created small, structured challenges: leaving the house without checking more than once, sitting with the anxiety, and noticing that nothing bad happened.

In the early weeks, she felt awful: shaky, tearful, certain something bad was going to happen. But gradually, as she practised, her anxiety stopped running the show. She started spending less time on rituals and more time doing what she loved.

That’s what ERP is really about – learning to be free from compulsions one step at a time.

Why ACT Adds Something Extra

At Openforwards, we often use an enhanced form of exposure based on Acceptance and Commitment Therapy (ACT). This approach doesn’t just aim to reduce anxiety, it helps you live a meaningful life while anxiety is present.

Where traditional ERP focuses on getting used to fear, ACT-enhanced exposure focuses on learning to make room for it.

We do this by helping you build three key skills:

1. Willingness: opening up to uncomfortable thoughts and sensations rather than fighting them.
2. Defusion: seeing intrusive thoughts as just thoughts — not rules you need to follow.
3. Values: using what matters most to you (e.g. family, love, creativity, honesty) as your reason for doing exposure practice.

So instead of “I have to touch this doorknob to prove I can do it,” you might say, “I’m touching this doorknob because I want to be present for my family without OCD running my life.”

That shift turns exposure into an act of purpose and self-respect.

Why Anxiety Reduction Isn’t the Goal

Research shows that how much your anxiety drops during a session doesn’t predict long-term recovery. People who get better aren’t necessarily the ones who feel calmer fastest, they’re the ones who keep practising, even when it’s hard.

So in therapy, we focus less on “getting rid of anxiety” and more on “building the capacity to live fully with it.” Paradoxically, that’s often when the anxiety finally loosens its grip.

The Therapist Factor: Skill and Courage Matter

You might assume that if ERP is the best treatment, all therapists use it. Unfortunately, that’s not the case. Studies show that many therapists avoid exposure because they worry it could distress their clients or make things worse.

That fear, sometimes called anxiety sensitivity, can lead to watered-down treatment. The result? People stay stuck.

At Openforwards, our therapists are specially trained in ERP and ACT. We know how to guide exposure carefully, with compassion and courage. We help clients go at the right pace, stay accountable, and reconnect with what matters most.

It takes bravery on both sides. The best outcomes happen when therapist and client work together, both willing to face discomfort in the service of a better life.

What About Medication?

Prescribed drugs can help reduce the intensity of anxiety and intrusive thoughts, especially when the effects are severe. In such instances, NICE recommends SSRIs as a first-line option alongside therapy. For some people, combining prescribed drugs with CBT/ERP gives the best results.

If you’re considering medication, your GP or psychiatrist can help you weigh up the benefits and side effects. Therapy can often begin alongside or after medication.  However, medication may inhibit your progress due to emotional numbing and reducing your dosage or coming off it completely can support your recovery.

Making a Decision About Treatment

Here’s what the research and experience tell us:

• The best evidence-based treatments for OCD are ERP/CBT, ACT-enhanced exposure, and in some cases, SSRIs (sometimes in combination).
• Anxiety reduction isn’t the key: learning, willingness, and courage are.
• Therapist skill matters: training, supervision, and compassion make exposure both safe and effective.
• Change happens through practice, not just insight.

When you’re looking for therapy, choose someone who:
✅ Offers ERP as part of CBT
✅ Has experience treating OCD and anxiety disorders
✅ Integrates values and meaning into the work
✅ Supports regular practice between sessions

How to Decide Which OCD Treatment Is Right for You

• Mild OCD: Start with CBT/ERP in NHS Talking Therapies or private practice.
• Moderate to Severe OCD: Combine ERP/CBT with medication (SSRIs).
• If you’ve tried therapy before: Ask about ACT-enhanced or inhibitory learning-based exposure.
• If anxiety feels unbearable: Begin with willingness and mindfulness skills, then gradually introduce exposure.
• Always choose: A therapist trained in ERP and ACT who offers structured, supervised practice.

What to Do Next

If you’re struggling with OCD, you don’t have to face it alone. At Openforwards, we specialise in helping people face fear wisely, using evidence-based therapies that restore hope and choice.

Not sure if you’re ready for therapy? Take the OCD quiz to understand more about how much OCD is running your life.

Whatever you decide, remember: recovery isn’t about becoming fearless — it’s about learning to live well with fear.

References and Further Reading

• NICE (2005). Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31). NICE Guidelines
• NHS Talking Therapies. Help for anxiety, depression and OCD. NHS UK
• Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35.
• Twohig, M. P., et al. (2018). Acceptance and Commitment Therapy as a Treatment for Obsessive-Compulsive Disorder: A Randomized Trial. Behavior Therapy, 49(6), 940–953.
• Craske, M. G., et al. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23.
• Schneider, R. L., et al. (2020). Therapists’ attitudes toward exposure therapy: Addressing clinician misconceptions and barriers. Depression and Anxiety, 37(9), 810–823.

The post Evidence-Based Treatments for OCD: CBT, ERP and Other Therapy Options appeared first on Explore our Therapy & ACT Training Birmingham Services.

What the Research Really Tells Us

Therapy often helps — but not everyone, and sometimes not in the ways we hope.

• Lambert’s influential review suggests that approximately two-thirds of clients show improvement or recovery in psychotherapy trials, leaving a substantial minority who do not respond or who worsen. clinica.ispa.pt+2PubMed+2
• Some newer reviews estimate that around 30% of patients in clinical trials fail to respond significantly. PubMed
• Regarding deterioration: in a meta-analysis of psychotherapy for depression, the pooled “deterioration risk” was lower in therapy groups vs controls, but deterioration still occurs. ScienceDirect
• In large “real world” effectiveness reviews, psychological therapies show robust effect sizes (e.g. d ≈ 0.8–1.0 for depression, other outcomes) in pre–post designs. PMC

So yes — therapy has a strong evidence base. But it is not uniformly effective for every person or every issue.

A few caveats:

• “Improvement” is often measured via symptom scores; other domains (meaning, relationships, values) are less consistently tracked.
• Many trials are limited in follow-up, sample diversity, or methodological consistency. PMC
• What “works well” for one person may not for another — variability is the rule, not the exception.

Why Therapy Sometimes Misses the Mark

There is no single reason therapy fails. Instead, failure often points to gaps in the relationship, process, or adaptation. Here are some common pitfalls:

1. Mismatch in therapist–client fit. The relational chemistry, personality, style, or worldview may not align.
2. Protocol over presence. Therapists may stick too rigidly to method rather than responding to the client in the moment.
3. Lack of clarity or drift. Without periodic review of goals, sessions can lose direction.
4. Emotional pacing errors. Going too deep too soon, or avoiding depth too long.
5. Unrepaired ruptures. Misattunements or tensions that aren’t surfaced or resolved weaken trust.
6. Client avoidance or withholding. Clients sometimes hold back for understandable reasons (see next section).

Each one is neither moral failure nor an indictment of therapy — but a signal that the process needs recalibration.

The Hidden Half: What Clients Don’t Always Say

One of the lesser-discussed realities is that clients seldom share the full story in therapy.

• Research on disclosure and concealment in psychotherapy indicates that nondisclosure is common — often because of shame, fear, perceived boundaries, or the desire to “protect” the therapist. Taylor & Francis Online
• For example, a recent study of physical health issues (which may impact mental health) found that although clients reported moderately severe physical concerns, they discussed them in therapy in only ~12% of sessions; clients initiated most disclosures. PubMed
• Psychological inflexibility (rigid experiential avoidance) has been shown to predict client non-disclosure in outpatient therapy settings. ScienceDirect

When relevant material is withheld, therapists can only work with what’s visible — which restricts possibility. Therapy becomes partial, like diagnosing from half the symptoms.

What you and your therapist can do:

• Periodically (explicitly) ask: “Is there something I’m not hearing?”
• Normalise that some thoughts or memories feel “too difficult to say.”
• Foster an environment that tolerates messy, conflicted, or ambivalent truths.
• Use check-in verbs (“How are we doing?”) and agenda-setting to invite hidden content.

When Therapists Play It Too Safe

Therapists are human, too — and they carry fears. One under-discussed cause of why therapy doesn’t work is therapist over-caution.

• Some therapists delay or avoid challenging interventions (e.g. exposure work for anxiety, confrontation of avoidance, emotional deepening) in the hope of preventing distress.
• This fear of “doing harm” can lead to safe-but-stagnant therapy — a kind of relational numbing.
• But for change to happen, some risk is necessary. Clients often bring in pain, avoidance, vulnerability — therapy must be willing to explore it, not shy away.

This is also a developmental task: therapists must grow psychological flexibility — the ability to risk discomfort in the service of values.

Good supervision, reflective practice, and continuing professional development (CPD) are essential. Therapists who name their fears, track their outcomes, and lean into difficult work tend to support more transformative change.

The Uncomfortable Truth: Therapy Is Not Medicine

Here’s a distinction worth emphasising:

Therapy is not medicine. It’s a working relationship in which both people take responsibility for change.

Medicine often implies passive receipt: you take a pill, the body—or brain—does the rest. Therapy is more like a co-created conversation, experiment, and action plan. It requires engagement, disclosure, adaptation, and risk from both parties.

• Client’s responsibility: honesty, effort, experimentation outside sessions, and communicating when things feel off.
• Therapist’s responsibility: to listen deeply, guide safely, challenge kindly, and stay responsive rather than rigid.

When therapy succeeds, it is not because one side “did their job”—it’s because both engaged in a creative, evolving partnership.

Common Fears about Therapy

Here are questions many people wrestle with.

What You Can Do to Increase the Odds of Therapy working

You have agency. The following practices can help nudge therapy into a more alive, effective space.

1. Choose a therapist intentionally. Interview, look for relational fit, check their ability to name doubt, not just credentials.
2. Set shared goals and benchmarks. Ask: What will count as “better”?
3. Bring your rough edges. Therapy works best with real, messy life — not just curated stories.
4. Be your own quality control. If something feels off, name it. Don’t wait.
5. Expect discomfort. The edge of growth is awkward.
6. Review and adapt. If you’re stalled, pause and reflect with the therapist.
7. Consider formal feedback tools. Methods like FIT (Feedback Informed Treatment) or routine outcome monitoring help therapists notice when things go off track. Wikipedia+2PubMed+2

What to Do If Therapy Feels Stuck

If after several months you feel little change, you don’t have to resign yourself. Use this as an opportunity:

• Ask directly: “Are we taking risks? What is being avoided?”
• Reassess whether you feel safe and seen — and challenged.
• Open a conversation about what’s missing or hidden.
• If necessary, try a new therapist or approach — it’s not failure, but recalibration.
• Sometimes pausing (stepping back, letting things breathe) helps new energy enter later.

When Things Go Wrong: A Note on Deterioration

Deterioration is rare but real. In trials, some patients worsen or report increased symptoms.
Lambert and colleagues estimate around 5–10% in adult trials might leave worse off. researchinpsychotherapy.org+2clinica.ispa.pt+2

In a meta-analysis of depression therapies, the risk of deterioration was lower in therapy vs control, but the fact remains that harm is possible. ScienceDirect

Thus, risk matters. That’s why supervision, outcome tracking, feedback, and safety practices are critical in every therapy practice.

What to Carry Forward: A “Therapy Reality Snapshot”

• Therapy doesn’t guarantee success — 20–30% of clients may see little change; 5–10% may deteriorate in some form
• Non-disclosure is common — clients often withhold significant parts of their lives, limiting what’s possible
• Therapists sometimes err on the side of safety — delaying needed risk out of fear, which can stall progress
• Therapy is a co-creation, not a prescription — both client and therapist hold responsibility
• Active strategies can improve odds — feedback systems, goal reviews, speaking up, choosing fit

Final Reflections: Why therapy doesn’t always work and what to do about it

Therapy doesn’t always work — but that doesn’t mean it’s broken. It means it is fragile. Complex. Alive.

Failures often stem from fear (on one or both sides), hidden content, or lost rhythm. But those are cracks that can be repaired. They are not irreparable.

You don’t have to settle for “therapy didn’t help.” You can insist on accountability, bravery, and partnership — in both directions.

If you want to talk about how therapy might work better for you, or explore different approaches or therapists, I’d be glad to help. We can figure out the way forward together.

Want to know more about Therapy?

Our FREE Booklet will tell you almost everything you wanted to know about therapy.

Learn More

References

Barkham, M., Lutz, W., Lambert, M. J., & Saxon, D. (2021). The efficacy and effectiveness of psychological therapies. In M. Barkham, W. Lutz, & L. Castonguay (Eds.), Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (7th ed., pp. 23–61). Wiley.

Cuijpers, P., Karyotaki, E., Reijnders, M., & Purgato, M. (2018). The effects of psychotherapies for adult depression are overestimated: A meta-meta-analysis. World Psychiatry, 17(3), 316–329. https://doi.org/10.1002/wps.20584

Hansen, N. B., Lambert, M. J., & Forman, E. M. (2002). The psychotherapy dose–response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9(3), 329–343. https://doi.org/10.1093/clipsy.9.3.329

Hill, C. E., Knox, S., Pinto-Coelho, K. G., & Lindsay, J. J. (2018). Clients’ concealment and disclosure in psychotherapy: An integrative review. Psychotherapy Research, 28(5), 691–705. https://doi.org/10.1080/10503307.2017.1380867

Lambert, M. J. (2013). Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (6th ed.). Wiley.

Rozental, A., Kottorp, A., Boettcher, J., Andersson, G., & Carlbring, P. (2019). Negative effects of psychological treatments: An exploratory factor analysis of the Negative Effects Questionnaire for monitoring and reporting adverse and unwanted events. PLOS ONE, 14(1), e0210217. https://doi.org/10.1371/journal.pone.0210217

Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547–559. https://doi.org/10.1037/a0028226

The post Why Therapy Doesn’t Always Work (and What You Can Do About It) appeared first on Explore our Therapy & ACT Training Birmingham Services.

If you feel stuck or discouraged, you’re not alone. Many people ask, “Why isn’t therapy helping my anxiety?” The truth is, therapy can work, but sometimes it takes the right conditions, approach, and patience.

This guide will help you explore:

• Why therapy might not seem to be working
• How to spot signs of hidden progress
• What to do if you feel stuck with your therapist
• The different therapies that can help with anxiety
• When to consider a new approach without giving up hope

Why Therapy Might Not Help Anxiety Right Away

Several factors can make therapy feel slow or ineffective. None of them mean you’re beyond help.

1. The fit isn’t quite right

The relationship with your therapist is crucial. If you don’t feel safe, understood, or hopeful, it’s hard to practise new skills. Sometimes, it’s simply a matter of finding the right match.

2. The approach may not be the best match

There are many effective therapies for anxiety — CBT, ACT, EMDR, CFT and counselling. If one doesn’t suit you, another might.

3. Expectations are unclear

If you’re expecting therapy to erase anxiety, you may miss smaller but important signs of change, such as better sleep, less avoidance, or more energy.

4. Skills need practice between sessions

Sessions plant the seed; daily life waters it. Without practising skills between sessions, progress can stall.

5. Life stress is high

When work, relationships, or health challenges are overwhelming, therapy can feel slower. In these moments, supportive routines and self-care are key.

Signs Therapy May Be Helping (Even If It Doesn’t Feel Like It)

Progress with anxiety is often subtle. You may be improving if:

• You notice anxious thoughts sooner and get less swept away
• Panic still happens, but symptoms pass faster
• You’re facing things you used to avoid
• Sleep, appetite, or energy are steadier
• You’re less critical of yourself when anxiety shows up

These are meaningful steps, even if anxiety hasn’t disappeared.

Practical Ways to Get More from Therapy

If therapy feels stuck, try these small but effective changes:

• Set clear, flexible goals – e.g. “I want to drive on the motorway again”
• Bring real-life examples into session to practise with
• Practise little and often (five minutes a day beats one big effort at the weekend)
• Track tiny changes in mood or behaviour to notice progress
• Collaborate openly – ask your therapist for adjustments if needed

When to Speak Up or Change Approach

You may want to review things with your therapist if:

• You feel stuck after 4–6 sessions
• You don’t feel understood or clear on the plan
• You’re doing home practice but don’t see how it fits your life

A good therapist will welcome your honesty. Sometimes small adjustments help; other times, it may mean changing approach or therapist.

👉 If you’re in Birmingham or the West Midlands, explore therapy with us at Openforwards. We’ll help you find the right fit.

Therapies That Can Help When Anxiety Feels Stuck

Different people respond to different approaches. Common therapies for anxiety include:

• Cognitive Behavioural Therapy (CBT): Change thought–feeling–action patterns and gradually face fears.
• Acceptance and Commitment Therapy (ACT): Build flexibility to handle anxious thoughts and move towards your values.
• EMDR: Helpful if anxiety is linked to trauma or distressing memories.
• Compassion Focused Therapy (CFT): Reduce self-criticism and build a kinder inner voice.
• Systemic Family Therapy: Improve communication at home to create calm.

What If Therapy Makes Anxiety Feel Worse?

This can happen. When you face fears or talk about painful topics, anxiety often rises before it falls.

Ways to handle it:

• Slow the pace or break tasks into smaller steps
• Use grounding techniques like paced breathing or noticing five things around you
• Balance challenge with care through rest, movement, and supportive routines

If anxiety feels overwhelming, tell your therapist so you can adjust together.

How Long Should You Try Therapy Before Deciding?

Four to eight sessions is often enough to spot early signs of fit. By then, you’d ideally notice:

• Clear goals and a shared plan
• New skills you can use
• A sense of being understood and hopeful
• Small positive changes outside sessions

If not, it may be time to change therapist or approach — without losing what you’ve already learned.

Finding Hope When Therapy Feels Stuck

Feeling discouraged doesn’t mean therapy is failing. Progress is rarely a straight line. With the right fit, therapy can make a big difference to anxiety — even if it takes a little time.

👉 If you’re ready to explore therapy in Birmingham that truly fits you, get in touch with us at Openforwards. We’ll help you find an approach that supports you best.

The post What to Do If Therapy Isn’t Helping Your Anxiety: Hopeful Next Steps appeared first on Explore our Therapy & ACT Training Birmingham Services.

Introduction

If you’re thinking about training in Acceptance and Commitment Therapy (ACT) in the UK, one of the first questions on your mind is probably: How much is this going to cost me? Training is an investment — of time, money, and effort — and knowing what to expect can help you plan well and avoid surprises.

In this post I’ll take you through:

• What “ACT training” really means (levels, forms)
• A breakdown of typical price ranges
• How to spot misleading claims about “accreditation”
• Example UK training providers and what they charge
• How to get more value (discounts, funding, lower-cost paths)
• Tips for choosing the right fit

What is ACT training (in this context)?

Before diving into prices, it helps to clarify what kinds of training people typically refer to when they talk about “getting ACT training.” Here are some variations:

• Introductory workshops — 1–2 day events to introduce core ACT theory and exercises
• Intermediate/advanced workshops — deeper dive into specific processes and more practice opportunities (e.g. defusion, values, ACT for particular populations)
• Extended programmes — multiple sessions over weeks or months, combining practice, reflection, supervision
• Online / self-paced courses — video lectures, recorded webinars, modules you can work through on your own
• Supervision / consultation — coaching or mentoring to help you apply ACT in your own context
• Conference / intensives / retreats — immersive events, often with role-plays, experiential labs, group practice

Each of these has different cost structures and what you “get” (hours, feedback, live practice, etc.).

One additional note that’s particularly important in the UK: there is currently no truly independent, external accreditation or certification of ACT training. Any provider claiming “certified ACT training” should be viewed with caution, since that can introduce a conflict of interest: the trainer is effectively certifying themselves or their own framework. It’s wise to dig into who is endorsing the course, what standards they use, and what independence exists. In other words: accreditation claims should raise questions, not close doors.

Cost breakdown: What you might expect to pay

Below is a rough guide to price ranges you’ll see in the UK, to help orient expectations. Your actual cost may vary depending on the trainer, location, group size, and included extras (materials, supervision, follow-up).

Again: these are ballpark figures, not guarantees. Always check what is actually included (meals, materials, feedback, recordings, etc.).

📅 Selected ACT / ACT-adjacent Training Options (2025 / 2026)

• PsychFlex – ACT Two-day Introductory Skills Intensive
  📍 London, 25–26 Sept 2025
  💷 £330
  Includes 16 hours CPD, manual, certificate of attendance.
  👉 psychflex.co.uk
• ACTivate Your Practice (AYP)
  📍 Online / hybrid, rolling dates
  💷 Some modules/workshops from as little as £35
  Community-based model with practical workshops, courses, and ongoing membership.
  👉 activatingyourpractice.newzenler.com
• Rikke Kjelgaard — 2-year ACT Specialist Training
  📍 Hybrid (Copenhagen + Zoom), March 2025 – Dec 2026
  💷 48,000 DKK (~£5,600–£6,500 depending on exchange)
  Includes 90 hours of ACT training. Optional extra: supervision programme (32,000 DKK).
  👉 rikkekjelgaard.com
• Praxis Continuing Education & Training (PraxisCET)
  📍 Online, live and self-paced (global audience)
  💷 Prices vary — e.g. ACT for Anxiety Disorders is $449 USD (~£350)
  Wide catalogue of ACT and process-based therapy trainings.
  👉 praxiscet.com
• Contextual Consulting – ACT Training
  📍 UK & online (live and on-demand)
  💷 Prices vary depending on workshop length and format
  Offers introductory, intermediate, and advanced workshops, plus on-demand modules.
  👉 contextualconsulting.co.uk
• Openforwards ACT Learning Centre
  📍 Online (with community & live events)
  💷 Different prices depending on format (monthly or annual)
  Offers modular ACT skills training, supervision, practitioner community, and resources for ongoing learning.
  👉 openforwards.com

Why the wide variation (and what drives cost)

Understanding why ACT training prices vary helps you judge offerings better. Some of the factors:

1. Duration and intensity
   Longer, experiential trainings with more practice, supervision, and feedback cost more.
2. Trainer expertise & reputation
   Trainers with strong record, peer-review credentials, or ACBS involvement (or who are well known) may charge more.
3. Group size & format
   Smaller groups allow more individual attention — but that tends to push up the cost per person.
4. Inclusion of supervision, follow-up support, peer consultation
   Some workshops are “stand alone”; others are embedded in longer programmes or include ongoing support.
5. In-person vs. online / hybrid
   Travel, venue costs, accommodation (for retreats) can add large overheads. Online can reduce cost, but high-quality interactivity and feedback may still require substantial resources.
6. Materials, licensing, recordings, use rights
   Some training includes rights to reuse scripts, digital assets, recordings, etc.
7. Location & accessibility
   London / major cities tend to be higher cost. More remote regions or online offerings may be cheaper.

How to get more “bang for your buck” / funding & discounts

• Employer or organisation funding / CPD budget
  If you work in the NHS, in a charity, or a university, they may cover some or all costs of professional development.
• Early-bird pricing
  Many workshops give discounts for registering early.
• Student / low-income / unemployment discounts
  Some trainers offer concessions or sliding scale rates.
• Group bookings
  If you and colleagues attend together, you may be able to negotiate a reduced per-person fee.
• Instalment payments / payment plans
  Some providers allow you to spread payments over time.
• Free / low-cost previews or taster events
  Providers like Contextual Consulting offer free introductory sessions. Contextual Consulting
  These are good for assessing the trainer’s style and whether you want to commit further.
• Peer learning / reading groups
  Complement paid training with a study group, reading ACT texts, reflective practice.  In the Openforwards ACT Learning Centre community, we have a book club and monthly themes we work through.
• Use open resources and communities
  ACBS (Association for Contextual Behavioural Science) and other ACT communities often provide webinars, content, and free or low-cost workshops.

What to look for when evaluating a training offer

Because there is no independent “certification board” for ACT courses in the UK, your due diligence matters. Here are things you should check:

• Transparency about content and hours
  Make sure you know how many days / hours, how much live vs. recorded / self-paced, how much practice time.
• Trainer credentials & oversight
  Who is teaching, what is their background, is there external peer review or oversight?
• Supervision / feedback / mentorship offered
  Opportunities for guided practice, role-plays, feedback make huge difference in skill development.
• Group size / ratio
  The smaller the group (or the better the ratio of participants to trainers), the more opportunity for individual attention.
• Materials and access rights
  What handouts, slides, recordings, reuse rights are included?
• Follow-up support / community
  After the workshop is over, will there be ongoing group consultation, Q&A sessions, continuity?
• Clear refund / cancellation policy
  Sometimes life intervenes — know your rights if the course changes or you cannot attend.
• No grand claims of “official certification” unless backed by independent body
  Because there is no fully independent accreditation in the UK, claims of “certified” or “endorsed” training should prompt you to ask: By whom, under what standards, and how independent?

Example scenario: estimating cost for your “ACT pathway”

To help give a more concrete picture, here’s a hypothetical path and its cost breakdown (assuming mid-range providers):

1. Introductory 2-day workshop: £400
2. Intermediate 3-day workshop (1 year later): ~£800
3. Ongoing supervision / consultation (10 hours over year): ~£1000 (at £100/hr)
4. Access to online modules, community, recorded webinars: ~£200
5. Conference or intensive (weekend): ~£300

Total (over ~2 years): ~£2,500

That’s one realistic route. Of course, it’s possible to go higher or lower, depending on choices.

In Summary

• ACT training in the UK does not (yet) have independent third-party accreditation — be cautious of providers claiming to offer “certified ACT training” without independent oversight.
• Costs vary widely depending on format, depth, trainer, and included support.
• Typical ranges might be a few hundred pounds for short workshops, and several thousand for extended programmes.
• Several UK providers exist (PsychFlex, Contextual Consulting, university modules, our own Openforwards ACT Learning Centre), each with different pricing models.
• To make your investment count, prioritise supervision, small group learning, and ongoing support rather than just cheaper upfront cost.

The post How much does ACT training cost in the UK? appeared first on Explore our Therapy & ACT Training Birmingham Services.

If you’re looking for therapy in Birmingham, you’re not short of options. The city is home to dozens of highly qualified and experienced therapists, each offering a range of approaches, including CBT, ACT, EMDR, and psychodynamic therapy. But with so much choice, how do you decide who to work with?

To help, we’ve compiled a list of 10 respected therapy practices and therapists in Birmingham. These are organisations and individuals known for their professional standards, clinical expertise, and commitment to client wellbeing.

And yes—we’ve included ourselves. Not because we’re biased (okay, maybe a little), but because we believe in transparency and standing by the quality of what we offer.

1. Openforwards Therapy & Coaching

Location: Jewellery Quarter, Birmingham
Specialisms: Anxiety, OCD, trauma, depression, relationship issues
Approach: ACT, CBT, EMDR, CFT, systemic family therapy

Why It Stands Out:
Openforwards is a team-based practice that integrates evidence-based therapy with a warm, personal approach. Whether you’re seeking support for emotional distress or relationship difficulties, our therapists help you move from feeling overwhelmed to becoming emotionally strong and resourceful. We also offer professional training for other therapists, giving us deep insight into the process of change.

2. Think Psychology

Specialisms: CBT, Mindfulness-based CBT
Why It’s Included: Offers evidence-based psychological interventions.

3. St. Martin’s Counselling and Psychotherapy

Specialisms: Affordable therapy options with qualified and trainee counsellors
Why It’s Included: Longstanding and trusted charity-based service with ethical values.

4. Sarah Benkwitz

Specialisms: Compassion Focused Therapy, ACT & EMDR
Why It’s Included: Known for ADHD /Autism support & Therapy for Therapists.

5. Farishta Jalal

Specialisms: CBT & EMDR
Why It’s Included: Personalized Psychological Care for Neurodivergent and Neurotypical Adults.

6. Kay’s Counselling

Specialisms: Individual and couples counselling, trauma, grief
Why It’s Included: Offers therapy with warmth and accessibility in the Jewellery Quarter.

7. Living Well UK

Specialisms: Free and low-cost mental health support
Why It’s Included: A trusted non-profit providing access to a wide range of services.

8. Elizabeth Doggart Associates Ltd

Specialisms: CBT, EMDR and Integrative Counselling
Why It’s Included: Strong clinical background with excellent reviews and outcomes.

9. Birmingham Healthy Minds – NHS Talking Therapies

Specialisms: CBT and IPT for Depression
Why It’s Included: Free and brief therapy at the point of delivery for anxiety and depression.

10. Natasha Williams

Specialisms: Pregnancy loss or birth trauma after fertility treatment
Why It’s Included: Uses CBT & EMDR to talk about their issues of infertility, pregnancy loss and trauma. 

Choosing What’s Right for You

The best therapy is not about who ranks first—it’s about who feels like the right fit. Whether you’re looking for short-term support or longer-term psychotherapy, Birmingham has an incredible pool of practitioners. We hope this list gives you a useful starting point.

If you’d like to explore whether working with Openforwards could help you, we offer a free initial consultation to help you make an informed decision.

👉 Explore our services or contact us today.

The post Top 10 Therapy Practices in Birmingham appeared first on Explore our Therapy & ACT Training Birmingham Services.