We Are Worried Sick: As A Nation
Wednesday, April 29th, 2009
Celia Dodd of the Independent (21 04 09) investigates the concept that as a population we are becoming ever increasingly worried. The writer asks the audience, ‘Are you stalked by irrational fears? You’re not alone. Clinical anxiety is four times more common than depression – and it’s on the rise. What’s causing the panic?
Dodd argues that for her anxiety had never been a problem until about six years ago and she identified that her worrying was getting out of control. As indicated by the author most of us can dismiss random thoughts about crashing the car or their children having accidents, For Celia this had become impossible. Instead they spiralled off into ever-more catastrophic “what ifs?” and triggered an overwhelmingly physical panic.
It got to such a point that if she heard an ambulance, then she would assume one of her children were in it.
Things came to a head, one morning; she got up at 5am to catch a train and collapsed. There was no obvious trigger, but her GP diagnosed a panic attack, and because I didn’t want medication, referred me for counselling on the NHS. That helped a bit, but a year later she went back to the GP because her anxiety levels still didn’t feel normal.
Cognitive behavioural therapy at the local NHS community mental health resource centre was the next step for Dodd. There a trainee therapist diagnosed generalised anxiety disorder plus, halfway through therapy, post traumatic stress disorder, dating from a time many years ago when she her boyfriend were mugged at knifepoint.
As she suggests, she is not alone and from that point of view the Mental Health Foundation (MHF) have launched of a report on the issues surrounding anxiety, particularly in Britain as figures have risen sharply, 12% to be exact since the 1990’s.
It has been suggested that four million people suffer from clinical anxiety, four times the number with depression. Anxiety often goes hand-in-hand with depression and other mental health problems, and according to figures from the Office of National Statistics, seven million people suffer anxiety overall. One in three will suffer panic attacks, which are often the precursor to more entrenched anxiety disorders, at some stage in their lives. Yet less than a quarter of anxiety sufferers receive any treatment, while less than five per cent receive psychological therapy.
Fundamentally, we as a population need to ask why are we becoming more anxious as a rule of thumb? The Charity, Anxiety UK’s Nicky Lidbetter reports a marked increase in calls since the start of the economic crisis. And the MHF report points to a “culture of fear” inflamed by the focus, by press and politicians, on terrorism, knife crime, MRSA and bird flu, and points out that the economic crisis does not only cause anxiety, but is also driven by it.
There are many ranges of disorders from agoraphobia to panic disorder and OCD, adds to the confusion.
With reference to Lidbetter, misdiagnosis is common, with many anxiety sufferers being prescribed anti-depressants, which can prove counter-productive. “Anxiety disorders are the poor relation of depression, and their severity is often underestimated,” she says. “I think the general perception is that depression is more severe and perhaps more worthy of attention.”
This may be because anxiety is largely hidden. Sufferers are often dismissed as the “worried well” because many carry on working and coping with everyday life, often self-medicating with alcohol or drugs.
Dodd goes on to contemplate the fact that non-worriers can’t understand why anxiety is such a big deal. She has often found difficulties in explaining her situation to non-suffering friends.
Moreover, Cosmo Hallstrom, Consultant psychiatrist says, “Anxiety can be a devastating condition. I’ve seen people whose lives have been crippled by it – they are housebound, they can’t work, they underperform. It’s one reason why people take to drink. But at the other end of the spectrum it may be a variant of normal. One of the problems is at which point we consider it crosses the boundary.”
The context of general unease that most of us now inhabit can get to the most laid-back person: finances and jobs are less secure, we have high levels of debt, we measure our lives against those of celebrities, and we’ve got too much time to ponder how unfulfilled we feel.
“The commonsense assumption is that we’re afraid of things that are dangerous,” says Phillip Hodson of the British Association for Counselling and Psychotherapy. In fact, once there’s a clear objective threat, anxiety is not so necessary because people have more sense of control. War tends to reduce anxiety, and suicide rates go down. The anxiety levels we’ve got now are because we haven’t evolved to deal with the complex modern world. We’re conditioned to expect we can have anything we want if we are successful, that we can do more than we can, that we don’t need much sleep.”
Graham Davey, professor of psychology at Sussex University, says: “These days news is often displayed in ways which are emotive and fearful when there’s really no underlying threat, so it becomes very easy for people to exaggerate their fears. The problem is that while it’s very easy to make someone anxious it’s almost impossible to stop them being anxious by saying it’s not a threat any more. Because people naturally adopt a ‘better safe than sorry’ attitude, and to stop feeling anxious they want objective evidence – usually from their own experience.
One also needs to look at the fact that some people are more prone to anxiety, thanks to genes or upbringing. High achievers, perfectionists and people-pleasers are also susceptible. But often it’s a combination of vulnerability and bad luck that can affect anyone, according to Professor Paul Salkovskis, the psychologist who transformed lives on Channel 4’s programme, House of Obsessive Compulsives.
Salkovskis, who is also clinical director of the Centre for Anxiety Disorders and Trauma, run by the Institute of Psychiatry, believes passionately that cognitive behavioural therapy is what many anxiety sufferers need, because unlike other therapies, its effectiveness has been carefully evaluated.
His view is endorsed by the Government, which is now at least some way towards achieving its election manifesto pledge of 10,000 new CBT therapists to be employed by the NHS to deal with mild to moderate mental ill-health.
Professor Salkovskis explains: “CBT is a type of applied common sense which works on a shared understanding between patient and therapist. It all boils down to the rather glib phrase we use to people who are anxious: ‘Pull yourself together’. That’s exactly what sufferer’s need, but they don’t know how. We have evidence that CBT helps. We seek to have very brief treatments and to avoid the big pitfall of traditional psychotherapies, which is dependency.”
CBT appeals because it’s evidence-based, offers a quick, cheap fix (12 sessions average), and is dead practical – no self-indulgent Freudian delving into your childhood. But not everyone is so convinced. Nicky Lidbetter says, “CBT is a good therapy and it certainly works for some people. But it doesn’t suit everybody. We must take a much more holistic approach and have a variety of other treatments on offer. Sometimes simple changes to lifestyle can really help.”