The quiet ones

Specialist CBT therapy for anxiety, OCD, depression and more in West London

I sometimes meet people who look as though they are coping. They arrive on time, finish work, manage family responsibilities and may even be the person who keeps a room calm. Yet they describe an interior life that has become harder to recognise: a low level of dread, a flatness they cannot explain, a wish to withdraw, or a tiredness that does not feel restored by a weekend. Outward functioning does not tell us how serious a difficulty is, and it does not establish a diagnosis. Low mood, exhaustion, irritability, sleep disruption and reduced concentration can have emotional, social and physical contributors. A change that is new, severe, persistent or accompanied by concerning physical symptoms deserves appropriate medical advice. If someone is at immediate risk of harming themselves or cannot stay safe, they should call 999, attend A&E or contact urgent crisis support. In a first assessment, I would be interested in the pattern rather than relying on appearances. When did the change begin? What has become effortful? Is the person sleeping differently, avoiding people, working longer to avoid being alone with their thoughts, or letting activities that once mattered become smaller? Are there recent losses, health concerns, medication changes, relationship pressures or other circumstances that need attention? These questions help establish whether CBT may be appropriate and whether medical or other specialist support should also be involved. Silence is not a symptom in itself. Some people are private by temperament, some are protecting others, and some are unsure whether what they are experiencing warrants help. The point is not to turn quietness into a clinical category. It is to make room for an honest account of the cost of carrying on as usual. If CBT is appropriate, the work is collaborative. We may map links between mood, thoughts, routines, avoidance and self criticism. We may consider how activity, connection and rest have changed, without assuming that a standard plan will suit everyone. Any behavioural experiment is agreed within therapy and adapted to the person’s circumstances. It is not a demand to force positivity, disclose private information or undertake change alone. For some, the first useful step is a conversation in which they do not need to prove that they are unwell enough. A fuller assessment can clarify what is happening, what support is already in place and which next step is safest and most useful. The plan can change as more is understood. You can read more about <a href="/therapy/low mood/">CBT for low mood</a> and the <a href="/guides/depression comprehensive guide/">depression clinical guide</a>. The Lyceum Clinic offers assessment led CBT online and in West London. A first conversation can help decide whether this support is appropriate or whether another route should be considered.