The what, how and why of anxiety

Anxiety is a response that prepares us to cope with threats in our environment. For instance, if you are walking in the woods and you encounter a bear, anxiety will prepare you to respond to that potential threat. This is known as the flight or fight response. This response entails a number of physiological changes that take place in our bodies in order to take instant action to deal with a threat. In that way, anxiety helps us to respond to a threat in order to protect us from a dangerous situation, thereby constituting an adaptive response that is vital for our survival.

However, this flight or fight response may be activated even in situations where the threat is not imminent or not even real. For instance, anxiety may be triggered because you are going to a job interview. In that case, it could be that the idea of being interviewed may feel threatening for you but that does not threaten your survival. Nonetheless, we react in similar ways to real, potential or even imagined threats. That is why human beings do experience anxiety from time to time and that is, as discussed, an adaptive response to threat. However, if anxiety becomes overwhelming because of its frequency, intensity or duration, that is likely to have a harmful effect on you. The experience of excessive anxiety has been categorised into different “disorders” and include, among others: panic attacks, social phobia, generalised anxiety disorder, obsessive compulsive disorder and post-traumatic stress disorder. These experiences of anxiety can be extremely frightening, exhausting and debilitating for the individual.

So how do anxiety issues develop? Most research suggests that these difficulties arise as a result of genetic, psychological and environmental factors. This means that the development of anxiety problems is believed to arise as a combination of having inherited a propensity to develop anxiety, your ability to cope with it and the experiences of difficult situations or events.

Anxiety issues can be treated effectively with psychotherapy. There are many different therapeutic approaches to target anxiety. These include for instance mindfulness, which focuses on accepting your feelings and learning how to be in the moment, rather than ruminating about the past or worrying about the future; cognitive behavioural therapy which focuses on the relief of distressful symptoms; and psychodynamic therapy which aims at identifying the roots of anxiety by targeting unconscious processes that contributed to its development. Although there is no consensus about which therapeutic approach is the best to treat anxiety, I believe that as the cause of anxiety is multi-layered, its treatment should contain a combination of therapeutic approaches to address that complexity.

Media and Self-esteem

Social comparison theory proposes that human beings are constantly assessing themselves and others in order to determine their social and personal worth. In thIs process no one can escape from the unlimited messages that we receive from the media about how an ideal woman or man should be. But how realistic is to compare ourselves with a woman or a man who has probably been on a severe diet, exercising 6 times a week and whose photograph has surely been manipulated to look astonishing? So how does that affect our self-esteem? Probably not in a good way. If we compare ourselves with unrealistic role models we will never be able to accept, appreciate or love ourselves. Additionally, the media reports a need among people to become known by others or in other words to be a “celebrity”. So the media emphasises looks and fame… Then if we are good looking and famous, would that guarantee us a good sense of self-esteem? Probably not.


I remember reading an article about my fellow countryman Bjorn Ulvaeus from the music group ABBA who revealed that he has to have therapy in order to overcome his low-self-esteem. Now you could ask yourself, how is it possible that someone who has experienced such a level of success and admiration by others, may have issues around his self-esteem? The answer is very simple, self-esteem comes from inside and not from outside. Thus, the media give us the wrong tools to feel happy about ourselves. It presents us an ideal that even if we would achieve it, it would probably not help us to build a healthy self-esteem as no amount of external validation will do that. Moreover, self-esteem is not only about how we look or how much others may admire us, it is about the essence of who we are. A good sense of self-esteem does not entail that we are the best, the most good looking, the greatest. It means that we accept and love ourselves exactly as we are.

While helping people to overcome their low self-esteem, I am always amazed to observe how little people know about their strengths and the discrepancies that I notice between how people feel about themselves and how they really are.


How can I have a mental health difficulty if I had the perfect childhood?


It is commonly known that adversity in childhood is associated with, but not solely the cause of, the development of mental health difficulties. I’ve had many patients who wondered how it was possible to develop a mental health condition if they had experienced a good childhood.

To begin with, most of us have only experienced one childhood so whatever we have experienced, it was for us “normal”. Consequently, it is difficult to objectively appraise how our childhood has actually been. Furthermore, even though we may believe that we had a good childhood it is possible that we have perceived things in a way that affected us significantly. For instance, we may have experienced that our parents favoured and/or even liked our brother or sister more than us, even if those parents didn’t feel that way or never intended to do that. Thus it is about how we perceived what happened around us that could have affected us. This is regardless of whether that perception was accurate or not.

Childhood is a fundamental stage in shaping who we are and therefore everything that we have experienced at that time affects us in one way or another. Additionally, some of us are more sensitive than others which obviously contributes to how we experienced things. Consequently, the answer to the question of this blog, could be that we may not be fully aware about how things may have affected us as children and how those elements may have contributed to the development of our difficulties.

Men and mental health

Statistics from 2009 revealed that 12% of men and 19.7% of women suffered from a common mental health illness such as anxiety, depression, obsessive compulsive disorder and panic disorder (Deverill & King, 2009). Additionally, statistics from the NHS Mental Health Services (IAPT) suggest that only 36% of the referrals that they receive are for men. Finally, it has been found that three in four suicides or 76% are by men, which is also the biggest cause of death for men under 35.


So what do all these statistics tell us? On the one hand it could be that men experience less mental health issues as compared to women. However, on the other hand most suicides are committed by men. How does it all fit together?

Well I have a hypothesis about this. To begin with, the aforementioned statistics about the proportion of men and women who suffer from mental health issues refer only to reported cases. Thus, it could be that men and women experience mental health issues equally but women are more likely than men to seek help for their difficulties. If that was the case, why is that? I would blame the stereotypical expectations that are generally placed on men. For instance, it is widely known that men are expected “to be strong”. Illustrating this notion I will share something from my personal experience. When I was 6 years old a friend of mine fell while playing a football match. He hurt his knee badly as he fell and started to cry. I remember that the other children showed no sympathy for him and instead told him “to be a man” and “not to cry”. Although this is just an anecdote, I would assume that, like me, many people may have heard or experienced something along those lines. Then if a 6 year old boy can be expected not to show any weaknesses at such a young age, could that mean that men might be conditioned to believe that since they are small? Could it be that when a man asks for help that could be seen as a sign of weakness which then contradicts the very essence of what a man is expected to be? If that was the case, that could explain why men are less likely to seek help, and as a result of that they can’t handle their difficulties.

There is a movement at the moment called “It’s good to talk” that arose as a result of the increasing number of men committing suicide. This organisation encourages men to talk about their issues and seek professional help if necessary. I applaud such initiatives and I encourage any man who is suffering from a mental health difficulty to talk about it and to seek help. I hope that such discussions could help men to challenge their own preconceptions about themselves so that they realize that they don’t have to be like a superhero. I would argue that we are all vulnerable at times and that mental health difficulties affect us regardless of gender and whether we are prepared to accept it or not.


Deverill and M. King (2009), ‘Common mental disorders’, in Adult Psychiatric Morbidity Survey

Suicides in the United Kingdom (2011). Office for National Statistics: Statistical Bulletin

Depression and Genetics

I read an article in the news which discussed if depression could
be inherited. I am a bit worried about this kind of artdna-1811955_1280icle because it could mislead people.  For instance, some people may think that if their father or mother suffered from depression that means that they are going to automatically develop that condition.  This is of course not accurate. In contrast, most research coincides with the idea that the development of depression is the result of an interaction between genetics and environment. Thus, whereas people may inherit a certain vulnerability to acquire depression, it still requires a number of adverse experiences for the condition to develop. What worries me is that if people think that depression is merely a question of genetics, they may feel that there is nothing they can do to help themselves. In reality the opposite is true as depression can be treated and managed.