Most of us experience some level of emotional discomfort from time to time and many of us will suffer from a full blown psychological or mental health difficulty at some point in our lives if not recurring episodes yet these incidents still feel alien to us in a way that physical pain does not. Physical pain hurts but we rarely take it personally yet psychological issues not only cause the expected pain but usually come along with other baggage and false meanings attached such as ‘why can’t I cope’ and ‘no one else feels like this’. When people begin to learn this and understand that they are actually feeling stressed, anxious or depressed because that’s part of being a regular human being some of the problems begin falling away.
In an attempt to summarise this whole concept more clearly, we got permission from Dr Rick Norris to publish the first chapter, or Step 1, of his book, Think Yourself Happy here, below.
As usual, please feel free to comment or ask any questions.
We hope this free chapter helps.
Step 1
You are not alone
At the start of an episode of the television series Cheers, the character Norm walks into the bar. Woody the barman calls out ‘Hi, Norm, how’s life?’ To which Norm replies ‘Not for the fainthearted’. Norm is right. Life can be very daunting at times; the twenty-first century world is a very complex and potentially stressful place for everyone.
Into every life a little rain must fall
If you’re reading this book the chances are that you’re not as happy with your life as you’d like to be. You’re not alone; whether you’re rich or poor, black or white, gay or straight – into every life a little rain must fall. It’s this rain that makes us feel stressed, anxious or depressed.
All my clients have their fair share of troubles but when they first come to see me I like to find out about them as people before I ask them about their difficulties. Finding out about each person is important; everyone is individual, with their own personality, their own experiences, their own work circumstances, their own dreams and their own troubles.
Who are you? What words best describe you?
What kind of work do you do?
What are the most important relationships in your life?
What’s your social life like?
What is your deepest dream?
What gets in the way of your happiness?
Hopefully it didn’t take you more than a few minutes to jot down some information about yourself. Throughout this book, you’ll have the opportunity to learn some valuable steps that will help you understand yourself better. Armed with that knowledge, you’ll be better equipped to look more objectively at your life and I’ll give you the skills to help you deal with your troubles and make your dreams and goals a reality.
Almost everyone has a few troubles. Although the numbers vary, statistics suggest that stress, anxiety and depression are very common. One in six people will suffer from significant mental health problems during their lives[i] and one in four will suffer some form of psychological ill-health.[ii] It’s probably safe to say that almost everyone will experience some form of stress, anxiety or depression at some point in their lives. You’re not alone: it’s a modern-day plague.
[i] UK Office for National Statistics (2000) Psychiatric morbidity among adults living in private households in Great Britain. London: HMSO
[ii] Goldberg, D and Huxley, P (1992) Common mental disorders: a biosocial model. New York: Routledge
What do we mean by stress, anxiety and depression?
Believe it or not, there are about three hundred different types of anxiety and mood disorders! The list includes post-traumatic stress, obsessive-compulsive disorder, phobias, panic attacks, depression, bipolar disorder (manic depression) and major depression.[i] These terms can be quite confusing, so let’s try to simplify them.
Stress is the feeling we experience when we are faced with challenges. Minor stressful challenges could include events such as making a business presentation or going on a first date.
[i] Diagnostic and Statistical Manual of Mental Disorders text version (2000). Arlington, VA: American Psychiatric Association
Think of a recent occasion when you felt stressed: what caused it?
What thoughts were going through your head?
What physical reactions did you experience?
The stress of a minor challenge is short-lived. Once the event is over, the stress gradually disappears; the normal reaction to a minor challenge. However, major challenges can produce stress levels that may be more difficult to deal with successfully. Major challenges often come in the form of life events, such as dealing with the death of a close relative, becoming unemployed, a relationship breaking up or experiencing serious illness/injury. Some life events may be broadly positive but at the same time stressful: we may look forward to the birth of a child or moving house but these events can also bring their fair share of stress.
Think of a recent life event you’ve experienced. How did it make you feel?
How long did it last and how did it continue to affect you?
Most of the time, we cope with stress reasonably well but at certain times we can become overloaded, either with multiple life events or a single life event which seems to drag on forever. Later, we’ll look at life events in more detail to understand why this happens.
Anxiety is a feeling of apprehension or fear. It can result from the stress we experience from either a minor or major challenge. In many ways mild anxiety is a normal and healthy response to a challenge because it helps us prepare to meet it. However anxiety disorders produce very strong or longer-lasting feelings which cause more severe reactions.
Think of a time when you felt really fearful or apprehensive. Was it something specific that caused quite strong feelings of fear or was it a more generalised nagging anxiety?
What physical reactions did you experience?
Anxiety disorders can be acute or chronic. Acute anxiety is often sparked by a particular trigger that causes quite intense symptoms such as panic attacks. Although it seems to go on forever, normally, the effects of acute anxiety don’t last very long. The Olympic gold medal-winning cyclist, Chris Hoy, is a good example of a person who suffered from acute anxiety. Early in his career, Chris was plagued with performance anxiety; before a big race, he would begin to panic, worrying whether he was good enough or whether he would be able to live up to everyone’s expectations. His palms would sweat, his legs would turn to jelly and he would feel a huge sense of dread. However, using techniques similar to those in this book, Chris was able to overcome this acute anxiety.
People who suffer from chronic anxiety experience long-term feelings of dread and apprehension. Their reactions are less intense than those of people who suffer from acute anxiety but the effects last much longer. Chronic anxiety often doesn’t have a specific trigger; it can be a general feeling, often described as ‘free-floating’ anxiety. One client I worked with, Indira, exhibited symptoms of free-floating anxiety. Nothing specific was directly causing her anxiety; she just worried about lots of situations in her work, home and personal life.
Depression is a state of mind rather than a specific feeling. A depressive state of mind usually results in a serious, long-term, lowering of enjoyment of life and/or an inability to visualise a happy future. People who suffer from severe depression take no pleasure from life and frequently lose all hope.
Have you ever felt depressed? Do you know how the depression started?
How long did it last?
How did it affect other areas of your life?
Depression can develop over time or it can be brought on by major life events. Eamon was a forty-year-old client whose wife had died in a car accident. He was left to care for their three children as well as working full time. Unsurprisingly, poor Eamon became depressed and found it very hard to find any enjoyment in life while he attempted to come to terms with this painful and difficult situation.
Two factors combine to produce a depressed state of mind. First, depressed people play negative thoughts over and over again (negative introspection). Second, they stop doing things, especially the things they used to enjoy. Someone diagnosed with severe depression will often spend hours lying in bed or sitting at home constantly thinking negative thoughts.
Increased levels of anxiety can cause both depression and anxiety disorders. However, we can experience anxiety disorders without going on to experience depression. Equally, we can experience depression without having an anxiety disorder. If we’re really unlucky, we can experience both anxiety disorders and depression.
How the brain reacts to stressful challenges
As you completed the previous exercises about how you felt when you were stressed, anxious or depressed, no doubt you’ll have written down some of your physical and psychological reactions.
My colleague Glyn uses a character he calls ‘cave man Dave’ to explain how the brain reacts to a stressful challenge. If cave man Dave were out hunting for food and he came across a dangerous wild animal, his brain would switch on his sympathetic nervous system (SNS), flooding Dave’s body with the hormone adrenaline. The body’s response to adrenaline – traditionally known as the ‘fight or flight’ response – would help Dave either to fight or run away from the wild animal. Once Dave had either got away safely or killed the beast, his brain would switch off his SNS and his adrenaline levels would subside.
Some stress and anxiety is a perfectly normal reaction to the challenges we face every day. As we can see from cave man Dave, it helps us to deal with challenges effectively. However, because many of our modern-day challenges are complicated psychological challenges, which can worry us for long periods of time, (rather than simple and immediate physical challenges such as being chased by wild animals) it’s not so easy to switch the SNS off. Earlier, when you completed the exercise on anxiety, I asked you to think about a time when you were fearful or apprehensive. As you were recalling this memory, your SNS may have started producing adrenaline. The more vivid the memory then the more adrenaline you would have produced.
Think of a time when you felt really relaxed and happy – perhaps a memory of a walk in the country or spending time with friends or family. Take three or four minutes to recall what you could see, hear, smell, touch or taste (it may help to close your eyes)
Describe your mood now. How do you feel?
When we feel relaxed and positive, or we take part in enjoyable activities, the parasympathetic nervous system (PNS) releases neurotransmitters, such as serotonin and norepinephrine, which results in a positive mood. In short, the PNS gives us the ‘feel-good factor’.
The SNS and PNS can’t both be switched on together: we can’t feel stressed and relaxed at the same time! If we feel constantly challenged, stressed and anxious, the SNS will be switched on and the PNS switched off. With the switch for the SNS jammed on, the body is continuously flooded with adrenaline. This means that the PNS is locked off, reducing the amount of neurotransmitters being produced.
If we experience lots of stress, and the SNS is constantly switched on, we can eventually suffer from anxiety disorders or depression, with both psychological and physiological effects. Psychological effects include a range of problems such as irrational worries and fears, inability to concentrate, making errors even on simple tasks, experiencing strong negative emotions such as anger or sadness in response to minor incidents, numbness to any feeling at all and feeling suicidal. The physiological symptoms are just as varied: sleeplessness, loss of appetite, skin disorders, depletion of the immune system (leading to increased risk of infections) and high blood pressure. Even heart disease and cancer are implicated as symptoms of psychological illness.
It’s not surprising that if we feel stressed, anxious or depressed, we may decide to visit the doctor. Every year, millions of people visit their GP for psychological problems – further evidence that you’re not alone. Doctors often prescribe antidepressants to try to help but it’s important to understand that antidepressants are only designed to deal with the chemical imbalance in the brain, not the negative thinking patterns at the root of the problem. While antidepressants may make people feel better in the short term, they’re not a long-term solution and aren’t licensed for extended use. The most effective long-term solution for psychological problems is to learn the steps in this book, to help you to think more positively. More information on antidepressants is available on the website http://www.mindhealthdevelopment.com but this should not replace discussion with your GP or a qualified mental health practitioner.
Why are some people more likely to suffer from stress, anxiety and depression?
Understanding how the brain reacts to stressful challenges is very important but it’s a mistake to think of anxiety disorders or depression just as chemical imbalances.[i] Although imbalance clearly is a factor, psychological and genetic conditions are also involved. Some mood disorders are inherited but even someone who has inherited a predisposition to a mood disorder will only be susceptible to psychological problems if they suffer a significant negative experience.[ii] People who suffer a significant negative experience in early life seem to be more prone to psychological problems later on in life.
[i] Marano. HE (1999). Depression: beyond serotonin. Psychology Today, March 1999
[ii] US National Institute of Health Publication Number 00–4501 (1999 reprinted 2000)
Think about your childhood and teenage years. What were the positive things you experienced when you were growing up?
What challenges or difficulties did you face in your early years?
Threat sensitivity
My experience as a psychologist suggests that many of (though by no means all) the people I’ve counselled had difficulties in their early life. As a result, they became ‘threat sensitive’ quite early in their childhood or adolescence. Ordinarily, we don’t experience serious life events in childhood or, if we do, hopefully we’ll remain relatively protected from them by our parents. However sometimes children suffer deeply from negative experiences and are often unable to verbalise them, which can lead to threat sensitivity. From an early age, threat sensitive people are more likely to notice potentially negative aspects of life. Although we all experience life events (into every life a little rain must fall!), threat sensitive people are affected more deeply and find it harder to cope with them. They are also more susceptible to stress, anxiety and depression.
I’ve noticed that people who suffer from threat sensitivity seem to have been exposed to at least one of three early life experiences. The first is the effect of threat sensitive parents, whether through nature or nurture. Threat sensitive parents can pass this predisposition on to their children (nature), or influence their children by repeatedly telling them to be careful or warning them of the dangers of doing or not doing certain things (nurture). The second type is exposure to a life event that caused general anxiety for a time: a nasty divorce, the death or serious illness of a parent or moving house or school several times.
The third type of early life experience is when something very traumatic happens in childhood or adolescence, for example mental, physical or sexual abuse. Traumas such as these are quite different from life events. Life events, although often sad and stressful, are fairly normal, whereas trauma results from unusual, if not abnormal, experiences. It’s not difficult to see why threat sensitivity results from traumatic experiences.
If one of these three experiences featured in your answers to the questions on your childhood and teenage years you may, through no fault of your own, be more susceptible to psychological ill-health. In Step 3, we’ll look in more detail at what makes people more susceptible to psychological ill-health.
A twenty-first century plague?
While threat sensitive people are more prone to psychological distress, this doesn’t explain why the problem is so widespread. To understand, we need to look at the environmental factors that have contributed to making psychological ill-health a twenty-first century plague.
Stress and work
As recently as the 1950s, people had a much simpler relationship with the world of work. It was fairly typical for a person to stay with the same employer for their whole working life; there were fewer choices of job and primarily, people worked to have enough money to live. In the twenty-first century, it’s very different. It was recently calculated that the average American, with two years of college education, will change jobs eleven times before retirement.[i] Although the reasons for changing job are many – promotion, dissatisfaction, redundancy or sacking – generally, the twenty-first century workplace is much less stable than its 1950s counterpart.
[i] Schwartz, J (2004). Workplace Stress: Americans’ Bugaboo. New York Times, September 5, p.D2
What’s your current job?
How long have you been in your current job? How long were you in your previous job?
What do you like about your job?
What do you dislike about your job?
How much sickness absence have you had in the last 12 months?
In the twenty-first century, work seems to be one of the main sources of stress, anxiety and depression. Despite the evidence that modern workplaces are safer than ever and we are, in relative terms, much better paid than our parents or grandparents, we continue to see worrying trends in sickness absence from work. A Japanese study suggested that a hugely disproportionate percentage of heart attacks are suffered on Monday mornings, when people are getting ready to start their working week.[i] The stress some people experience at the thought of beginning another working week can lead to significant surges in blood pressure, which can cause heart attacks.
If you noted that you’ve had time off work because you were stressed, it’s another example of why you’re not alone. According to a recent report, mental ill health is the second-largest cause of sickness absence in UK organisations.[ii] Interestingly, one survey pointed the finger at work itself as a significant source of stress, suggesting that 14% of the working population experienced work-related stress at a level that made them ill.[iii]
Even if we really enjoy our work, it can still be difficult to get the right balance between our work and personal lives. In the 1950s, it was easier; in the twenty-first century it has become much more difficult to know where the boundaries lie. One of the main causes of the blurring of our work/life boundaries is technology. We are far more accessible than we used to be: mobile phones mean it’s easy for work colleagues to call us about a problem regardless of where we are; portable computers and other devices with fast connections to the Internet mean we can take work with us whenever and wherever we want. I’ve counselled dozens of people who’ve told me that the only way they can keep up with the pressure of work is to take it home. However, while it’s easy to put the blame for our difficulty in achieving a work/life balance on our employer’s expectations, lots of us want to work from home.[iv]
I once worked with an IT Director, Guy, who lived and worked just outside London. He proposed to his boss that he should spend one week a month working from his holiday home in Spain. His mobile phone worked in Spain, he had a fast Internet connection there, he could join in conference calls at any time and if he were required to return to the UK quickly, there were several daily flights from a number of nearby airports. Unfortunately, Guy’s boss turned down the proposal, because he couldn’t see past the fact that if Guy were in his holiday home, then he must be on holiday, not at work. This example highlights just how complex the balance between work and life can be but if we don’t get it right, it’s easy to suffer from stress, anxiety or depression.
[i] Murakami, S, Otsuka, K, Kubo, Y, Shinagawa, M, Yamanaka, T, Ohkawa, S and Kitaura, Y (2004). Repeated ambulatory monitoring reveals a Monday morning surge in blood pressure in a community-dwelling population. American Journal of Hypertension, 17 (12) 1179
[ii] Chartered Institute of Personnel and Development (2007). New directions in managing employee absence. London: Chartered Institute of Personnel and Development
[iii] Health and Safety Executive (2007/2008). Labour Force Survey. London: HMSO
[iv] Deeks, E (2000). Petrol shortage fuels tele-working mini-boom. People Management Magazine 28September 2000
Changes in family life and the community
Sometime it’s difficult to know whether work stress negatively affects our personal life, whether the stress in our personal lives negatively affects our work – or both. What does seem to be clear is that the complexity of life in the twenty-first century has significantly affected our lives.
Where do you live?
With whom do you live?
How long have you lived there?
How well do you know your neighbours?
How friendly are you with the people in your neighbourhood?
Family life and communities have changed radically since the 1970s. We live in a much more geographically mobile society. Social commentators suggest that 1970s neighbourhoods with even the loosest community ties would be regarded as strong communities by twenty-first century standards. In the 1950s, family members – grandparents, aunts, uncles and cousins – often lived locally, frequently in the same street, sometimes in the same house; today, families are dispersed across countries or even continents. Neighbours often worked at the same company or factory; today, people commute from dormitory towns to hundreds of different workplaces in large cities. Streets of back-to-back terraced housing meant that neighbours were physically close, which encouraged community spirit; today, many communities were destroyed as these houses were pulled down.
Perhaps one of the most significant factors in the rise in mental health problems is the increase in the breakdown of relationships. Separation and divorce are more common now than they’ve ever been. In the UK in 1961, there were just over 27,000 divorces; in 2008, there were 136,000. Not only is the divorce rate much higher but the number of marriages has steadily declined, from a peak of more than 480,000 in 1972 to 270,000 in 2008. In the same period, the population increased from 56 million to 62 million, so it’s pretty clear that relationships are a lot less stable in the twenty-first century.[i]
Your answers to the exercise on ‘where do you live’ may reflect these statistics. The chances are your answers will be very different to those your grandparents or even your parents would have given at your age.
[i] UK Office for National Statistics (2010) London: HMSO
Think about the house, the family and the neighbourhood you grew up in as a child. How was it different to where you live now?
Higher expectations
Psychological health problems appear to be a global problem. More than 25% of the population of both developed and developing countries is likely to suffer from some type of mental health problem.[i] However, it seems that in the West, depression in particular is linked to higher – and often unrealistic – expectations. We want it all and we want it now!
In the twenty-first century, in developed countries, most of our basic needs are met with relative ease. Even if we aren’t able to work, welfare and social security mean that very few people die of starvation or exposure to the elements. Consequently our expectations are much higher. We want a great relationship with an attractive and interesting partner, well-behaved and lovely children, a spacious house, a new car, several foreign holidays a year, a well-paid job and good friends to socialise with. Beyond the tangible rewards, we want to be appreciated, respected and cared for, to be consulted and involved in the decisions affecting our lives, to have the opportunity to use and develop our talents and to feel that we add value and make a difference. Unfortunately we don’t have a god-given right to any of them. And when these – sometimes unrealistic – expectations are not met, we are likely to suffer from anxiety and depression. Having more realistic expectations of life sets us up for success; we’re more likely to achieve them and therefore our levels of satisfaction with life are likely to be much higher.
[i] WHO Annual Report (2001). Mental health: new understanding, new hope. Geneva: The World Health Organization
Are all your expectations realistic? Which of your expectations may be unrealistic?
Summary of Step 1
If you’re suffering from stress, anxiety or depression, you are not alone – psychological ill-health is very common. We live in a complex, twenty-first century world in which, despite the fact that there are about three hundred types of mental disorder, our brains still react to challenges in the same way as cave man Dave’s. Although we all share the same structures in the sympathetic and parasympathetic nervous systems, some people are more threat sensitive than others and therefore more likely to develop psychological health problems. Certain genetic and psychological factors explain why some of us are more threat sensitive than others but environmental factors also explain why our twenty-first century world is potentially a more threat sensitive place in which to live.
[1] UK Office for National Statistics (2000) Psychiatric morbidity among adults living in private households in Great Britain. London: HMSO
[1] Goldberg, D and Huxley, P (1992) Common mental disorders: a biosocial model. New York: Routledge
[1] Diagnostic and Statistical Manual of Mental Disorders text version (2000). Arlington, VA: American Psychiatric Association
[1] Marano. HE (1999). Depression: beyond serotonin. Psychology Today, March 1999
[1] US National Institute of Health Publication Number 00–4501 (1999 reprinted 2000)
[1] Schwartz, J (2004). Workplace Stress: Americans’ Bugaboo. New York Times, September 5, p.D2
[1] Murakami, S, Otsuka, K, Kubo, Y, Shinagawa, M, Yamanaka, T, Ohkawa, S and Kitaura, Y (2004). Repeated ambulatory monitoring reveals a Monday morning surge in blood pressure in a community-dwelling population. American Journal of Hypertension, 17 (12) 1179
[1] Chartered Institute of Personnel and Development (2007). New directions in managing employee absence. London: Chartered Institute of Personnel and Development
[1] Health and Safety Executive (2007/2008). Labour Force Survey. London: HMSO
[1] Deeks, E (2000). Petrol shortage fuels tele-working mini-boom. People Management Magazine 28September 2000
[1] UK Office for National Statistics (2010) London: HMSO
[1] WHO Annual Report (2001). Mental health: new understanding, new hope. Geneva: The World Health Organization
It was very kind of Rick to answer our call for assistance and give us the valuable information from his book. If you would like to read more you can buy the full book online here. At the time of publishing, Mind Health Development LTD makes no profit from the sales of this book.
Mind Health Development 