Background: Surgical procedures are a stressor that triggers anxiety. Previous surgical experiences and uncertainty about the outcome of the procedure increase anxiety. Increased anxiety in patients results in changes in their hemodynamic status, characterized by increased blood pressure, heart rate, and respiratory rate. One way to manage anxiety is through counseling using a thinking, feeling, and acting approach. Therefore, this study aimed to determine the effect of counseling using a thinking, feeling, and acting approach on preoperative anxiety and blood pressure levels in patients. Case Description: Mr. Y, 63, presented to the eye clinic at KMU Eye Hospital in Lamongan with complaints of blurry and cloudy left eye for the past three months. The patient reported a history of controlled hypertension and diabetes mellitus and had previously undergone cataract surgery in his right eye. The patient stated that the previous surgery was very long and painful, making the planned second surgery very anxious. The main problem was anxiety, which contributed to the patient's increased blood pressure. The patient's anxiety level was measured at 43, categorized as mild anxiety, and his blood pressure was 169/96 mmHg. Counseling, using a thinking, feeling, and acting approach, was conducted for 30 minutes before cataract surgery. Results: The study revealed a decrease in anxiety levels, indicated by a decrease in verbalization of anxiety, anxious behavior, and blood pressure. The anxiety level also decreased from 43 (mild anxiety) to 31 (no anxiety). Conclusion: Counseling using a thinking, feeling, and acting approach can reduce anxiety levels and blood pressure in pre-cataract surgery patients.