Critical Values Based Practice Network

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Anxiety and Social Factors

Written by Bob Diamond on . Posted in Clinical Psychology Bite-Size

Anxiety and Social Factors

Issue 49 – March 2017

Author: Bob Diamond (robert.diamond@nottshc.nhs.uk)

Key points

  • Anxiety, along with other mental health difficulties, are frequently caused by traumas in earlier life and socio-economic difficulties, such as poverty, poor housing and living in impoverished environments.
  • Anxiety appears to be on the increase in the Western world and this increase may well be influenced by the mismatch between social expectations on how we ought to live and the reality that we confront.
  • Increased anxiety typically leads to an increase in arousal and awareness. Responses to heightened anxiety include, fight, flight and freezing (passivity, submission). 

Implications for practice

  • Clarify the influence of traumas and material deprivations on our mental health and whenever possible ensure that any potential practical assistance has been secured.
  • Try to provide an opportunity to clarify and confirm the mismatch between the reality we experience and the social expectations that place pressures on us to lead our lives certain ways.
  • Whenever possible try to provide support to link with the three foundations of well-being: control, respect and affiliation. Doing and achieving things, of any magnitude, along with making sense of our experiences are the most likely ways to reduce extreme anxiety.

Making Sense of Social Factors and Anxiety

Anxiety is often caused by traumas earlier in life, and social and material inequalities1, such as deprived environments, inadequate housing, poverty, and restricted access to educational and occupational opportunities. Anxiety may also be caused by the tension between the way we feel we ought to live and the actual reality. Anxiety may well serve protective functions by raising awareness to potential dangers. Typical responses to anxiety include fight, flight and freezing (passivity, submission), these may manifest as aggression, avoidance or indifference. Anxiety is becoming increasingly pervasive and inextricably linked to many mental health difficulties. Currently women and people under 35 are twice as likely as older men to experience anxiety. It has been reported that anxiety is much higher in North America and Western Europe and it is also linked to many physical conditions2.  Our well-being may well be enhanced the more we can make sense of our lives. We search for confirmation of our experiences from our circumstances, if you like, a validation of our senses. Anxiety arises the more our experiences are invalidated. For example, children may suffer abuse which, in turn, is either ignored, minimised or doubted. The pain that is experienced is not acknowledged, comfort and reassurance is not given and therefore, confusion and uncertainty creates an insecurity and anxiety. We are more likely to feel invalidated the more detached, isolated and alienated we become from others and society. What is becoming increasingly clear is that anxiety and more generally mental health difficulties are closely linked with traumas suffered from our past through the many forms of neglect and abuse encountered.  Some evidence suggests that early trauma may have a psychobiological impact on the developing brain3.  From our histories, our material resources may be depleted, and our sense of who we are in relation to others, time and place may well be damaged. The insecurity that we feel manifests in doubts, fears, shame and in general it does not equip us to manage the rigours of adult life We live in a society that confers privileges and status to what is considered a successful life. Values such as individuality and materialism are encouraged as aspirational markers of such success. David Smail comments, “Behind many symptoms of anxiety lies an injury to the person’s self-esteem, a despairing, inarticulate awareness that he or she has not lived up to the standards of adequacy which we are all complicit in setting. The most obvious ideal, of course, is that, as well as successful, you should be strong, confident, attractive and powerful; the world is your oyster, and if you fail to find a comfortable place in it, there must be something the matter with you.”4 Faced with the inevitable reality that most of us are unlikely to achieve, what is portrayed as, the optimum way to live, we are then confronted with failure, disappointment and potential rejection. Anxiety can then arise out of a mismatch between reality and what we are presented with as the ideal way to organise our lives. Given this rupture, we experience increased anxiety, which may be presented in various behavioural forms, such as, aggression, avoidance, or indifference.

What to do

Developing an awareness of the tensions and insecurities caused by past traumas and the pressures from environmental, economic and social inequalities on our mental health may provide helpful explanations that assist us to make sense of our distress. Whilst at the same time, ensuring that all potential means of improving a person’s environment and material resources are maximised. When supporting people who have suffered traumas, always reassure and listen as you provide a respectful space for people to consider what has happened to them. The principal stages of trauma support work are: education and stabilisation; trauma processing; and reconnecting to one’s life5. Whenever possible, try to provide an opportunity to clarify and confirm the mismatch between the reality of our lives and the influences and pressures from social expectations that prescribe the way we ought to live. Essentially we are assisting in the processes of comforting, clarifying and encouraging 6. Whilst gaining an understanding of the historical and contextual influences affecting anxiety is essential, a grounded approach such as relaxation, doing and achieving things together can be crucial. In general, the foundations of well-being rest on three factors: a sense of connection, a sense of respect from others; and a degree of influence and control in our lives 7. Bearing these in mind and with specific regard to anxiety, we can try to establish a sense of coherence and meaning from past experiences, whilst encouraging people to, if at all possible, exert some influence in developing social connections that hopefully embrace a degree of mutual respect. It should be added, however, that access to such resources remains unequal in society. 

REFERENCES  

  1. Fryer, T., Melzer D., Jenkins, R. & Brugha, T. (2005). The distribution of the common mental disorder: Social inequalities in Europe. Clinical Practice and Epidemiology in Mental Health. Clinical Practice and Epidemiology in Mental Health, 1,14
  2. Remes, O., et al (2016). A systematic review of reviews on the prevalence of anxiety disorders in adult populations. Brain and Behavior; 6 June 2016; DOI: 10.1002/brb3.497
  3. Read J, Perry, B.D.  Moskowitz, A. Connolly, J. (2001) The Contribution of Early Traumatic Events to Schizophrenia in Some Patients: A Traumagenic Neurodevelopmental Model  Psychiatry  2001, 64(4) Winter 319 -345
  4. Smail, D  (1997)  Illusion and Reality  Trafalgar Square Publishing,  London
  5. Herman, J (2001) Trauma and recovery. London: Pandora
  6. Smail, D.  (2005)  Power, Interest and Psychology, PCCS Books, Ross-on-Wye
  7. Friedli, L. (2012): ‘What we’ve tried, hasn’t worked’: the politics of assets based public health , Critical Public Health, DOI:10.1080/09581596.2012.748882

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