Generalised Anxiety

All human beings feel anxious at some point in their life, with the degree of anxiety

depending on the context we are in. Anxiety can be triggered by stresses and/or threats or

by unforeseen situations. To some extent, anxiety can be helpful as it allows us to be more

aware of the things around us and lets us be more organised and prepared, thus avoiding

careless mistakes. Freud (1936) stated that anxiety works to alert us to danger. Feelings of

anxiety are usually temporary and cease once the event or activities have passed or we

learn how to cope with the feelings. In that sense, anxiety can be an important part of our

life, especially when anxiety triggers us to respond to a situation that could threaten our

survival. So, although anxiety is associated with unpleasant feelings, it can be helpful.

However, anxiety can be also harmful if the feelings are severe and do not fade with time.

Long-lasting feelings of anxiety can become overwhelming and cause mental distress.

Indeed, distress from anxiety can be so severe it can be considered as a mental disorder.

Symptoms

Anxiety can be indicated by a variety of symptoms. For example, the Mental Health

Foundation, (2014) lists “irritability, difficulties concentrating and depression” and physical

symptoms such as “heart palpitations, sweating, tensions and pain, heavy and rapid

breathing, dizziness, fainting, indigestion, stomach aches, sickness and diarrhoea” (p. 11),

while the DSM-IV (American Psychiatric Association, 2013) refers to restlessness, feeling

fatigued, difficulty concentrating, irritability and sleep disruption. Overall, from my working

experience, my clients who have anxiety share that they are not able to relax, be themselves

and enjoy themselves, and always want to know what will happen next or in the future. It is

important to note also that people react to anxiety differently and not everybody expresses

the same symptoms.

Possible contributing factors

There are many possible factors that can contribute to a person feeling anxious, but in

general, anxiety develops from some form of unpleasant experiences that have negatively

stimulated the person. Trauma is a major factor that can contribute to anxiety; for example,

when a person experiences abuse, violence, loss, death, separation, illness, bullying,

threats, natural disaster, accidents and/or war. Houwer (2020) states that “traumatic events

would become associated with the negative emotional responses that typically arise in those

events” (p. 5). The COVID-19 pandemic is an example that has caused much distress and

anxiety for many people (Broughton, 2020). People are worried about getting the virus, so

they are washing their hands many times a day even when they do not need to. Some

people prefer not to go to public places as they are so worried someone will cough around

them. Some people have lost their job due to the lockdown, and so they are anxious about

their financial situation, domestic violence (Foon, 2020) and future (Malpass, 2020).

Perceived failure can be another factor that contributes to anxiety disorders; for example,

anxiety can be triggered when a person experiences involuntary redundancy, is under-

performing at school or at work, or their relationship breaks down. Anxiety is linked with

feelings of loss and failure as people perceive threat and vulnerability (Robinson, 2010).

Some researchers have shown that family can also play a role in anxiety (Goekoop, et al,

2006, Rougemont-Buecking, et al, 2008). Our upbringing experiences are affected by family

dynamics and environmental influences within families, as well as the quality of the home

environment and parenting style (McLaughlin et al., 2008). I believe this “quality” referred to

be McLaughlin et al. (2008) can also encompass negative factors such childhood trauma

due to poverty, separation, grief, and loss as well as parental behaviours that might threaten

the family, thus creating fear and anxiety about the future. Although some people feel excited when faced with a new experience or environmental changes, others feel anxious due to the uncertainties of the changes. Oberle et al. (1990) said that environment and people’s behaviours are related to anxiety levels. Examples of experiences that are potentially stressful include meeting a deadline, bearing a heavy workload, living in an unpredictable environment, being put down, starting new employment or a new school, moving into a new house, and immigrating to a new country.

Effects on a client’s functioning from intra-personal, relational and

developmental perspectives

Depression is a common co-morbidity of anxiety, as when people have anxiety, their anxiety

may lead to depression. Some researchers have argued that the symptoms of anxiety and

depression can be overlapping (Fajkowska et al., 2018; Norton et al.; Tiller, 2013). Tiller

(2013) says that “Patients with depression often have features of anxiety, and those with

anxiety commonly also have depression. Both mental conditions may occur together,

meeting criteria for both” (p. 28). Anxiety is the most frequently seen mental disorder in

primary care, followed by depression (Mental Health Foundation, 2014). Depression can

express itself in a variety of ways; for example, people suffering from depression may lack

motivation to keep up with their daily routine, stay in bed all the time, become forgetful, or cryfor no apparent reason. Moreover, depression can lead to some behaviours that we as

counsellors need to pay attention to, including aggressive and/or abusive behaviours and

self-harming, as well as an increased suicide risk. Beck and Alford (2009) explain that

people who have depression have “negative feelings toward self” (p. 19). Consequently,

some depressed people behave in ways to show they are “worthless”, reflecting their loss of

satisfaction with their life and their feelings that they are not good enough.

Anxiety can also lead to low confidence and self-concept. Sowislo and Orth (2013) said that

anxiety and depression are partially related to low confidence, as anxiety connects with

cognitive and emotional vulnerabilities. People who have low confidence may act

aggressively towards others in different ways. Abusers are often suffering from anxiety and

depression, their insecure feelings demonstrating in a different, and inappropriate, way

(Fooladi et al., 2014; Walfish et al. 1990).

Trusting issues are also a symptom of anxiety (Brinkman; Hartsell-Gundy, 2012).

Because anxiety can develop from a person’s feelings of insecurity and beliefs that the people and environment around them are under threat and not safe, an anxious person may find it difficult to trust others. Due to these effects described above, a person suffering from anxiety will often unintentionally destroy relationships. This can result in a vicious cycle as the anxious person experiences more stress and feelings of vulnerability as they are losing their important relationships.

Dr Mel Wong

PhD(Ed), MCouns, MEd, PGDipCounsTh, GCertCCS, BEd