At the beginning of You Can Be Happy we introduced the four components of well-being. One of the four doesn’t tend to feature in books about happiness, but we believe the evidence suggests it’s as important as any of the others. That component is ‘fewer negative emotions’, and in Chapter 5 we set out some of the techniques you can use to achieve this.

But negative emotions are often fuelled by specific psychological problems, such as worry, stress and feeling down or depressed. In this chapter we look at the most common types of psychological problems. Perhaps you’ll recognise a trigger for your own unhappiness in one or other of them, and when you’ve recognised it, you’ll be in a much better position to deal with it.

If your unhappiness does happen to have its roots in one of these common problems, you’ll almost certainly find that tackling that problem is enough to bring about a considerable improvement in your well-being.

All of the problems we discuss in this chapter exist on a spectrum. This means that the impact they have on individuals varies hugely. Some people are affected quite severely, while lots more experience relatively mild difficulties. If you’re at the mild end now, that doesn’t mean you’re going to end up at the severe end later. Often things get better simply with the passage of time, but if you’re finding life tough there’s a lot you can do to speed up the process.

Admitting you may have a problem, and seeking help for it, can be scary. It doesn’t help that although psychological problems are incredibly widespread, most people don’t like to talk about them. This means that it’s easy to feel that you’re the only person in the world experiencing difficulties. But as you’ll see from the statistics in the following pages, you most definitely are not.

Of course you don’t have to tell anyone else what you’re going through if you don’t want to (though it’s often a good idea to make an exception for your doctor). On the other hand, if you do feel able to discuss your feelings with trusted friends and family, you may be surprised to discover that they have much more personal experience of this sort of thing than you think.

Taking the plunge and confronting a problem can be daunting, but you’ll be so pleased and proud when you’ve done so. Not only are these problems extremely common, they are also very treatable. A vast amount of research has been carried out and huge strides made in clinical practice using cognitive behaviour therapy (CBT).

There’s no need to put up with things, no need to ‘grin and bear it’. For common psychological problems, however much they’re troubling you, scientifically proven, highly effective therapies are now available. We discuss how to begin getting help at the end of this chapter.

ANXIETY PROBLEMS

Anxiety can take many forms, here we focus on the six main types:

• Worry
• Phobias
• Panic
• Obsessions and compulsions
• Shyness and social anxiety
• Trauma

Worry

Worry is such a normal part of human experience that the doctor and writer Lewis Thomas once commented: ‘We are, perhaps uniquely among the earth’s creatures, the worrying animal.’

When we worry, we become preoccupied with an aspect of our life, trying to anticipate what might go wrong and what the consequences will be if it does. People often imagine that worrying helps them deal with issues; unfortunately, it usually has the opposite effect.

That’s because worrying and problem-solving are two very different activities. Rather than improving our mood, worrying generally makes us feel worse. Once we start worrying, it can develop into a habit; and if our worrying gets out of hand, life can become very miserable indeed. (The most severe type of worry is called generalised anxiety disorder, or GAD, which affects about 5.7 per cent of people at some point during their lifetime.)

If you’re concerned about your worrying, try the Penn State Worry Questionnaire. First, enter the number that describes how typical or characteristic each of the following statements is of you, putting the number next to each one.

Now add up your scores for each statement. Questions 3, 8, 10, 11 are reversed scored: if for example you put 5, for scoring purposes the item is counted as one. Scores can range from 18 to 80.

People with worry problems usually score above 50. A score of over 60 may well indicate GAD, but bear in mind that the questionnaire doesn’t provide a diagnosis. Think of it instead as a guide to help you decide whether or not to seek additional help.

Phobias

Aretha Franklin has a fear of flying; Madonna is scared of thunder; and Johnny Depp is reportedly afraid of spiders, ghosts and clowns.

Nearly everyone is afraid of something, and for around 11 per cent of us that fear will at some point develop into a phobia – an intense feeling of fright and anxiety that’s out of all proportion to the reality of the threat facing us. Fear of animals, heights, blood, enclosed spaces, water and flying are the most common phobias.

Do the thing we fear and death of fear is certain. RALPH WALDO EMERSON

Panic

For most of us, the word ‘panic’ describes a sudden feeling of intense anxiety. It’s what we experience when we can’t find our passport at the airport, or suspect that we’ve deleted a crucial file on our computer.

Unpleasant though it is, this kind of experience is a very diluted version of the real thing. Genuine panic means being hit by a tsunami of fear, accompanied by a variety of unpleasant physical sensations, such as chest pains, trembling, dizziness and nausea, and terrifying thoughts – for example, that we’re about to lose control or faint, that we’re going mad, or that we’re dying.

Around one in five of us have had an unexpected panic attack, generally when we’re very stressed. People who suffer from regular panic attacks may be diagnosed with panic disorder. Around 2.7 per cent of the population are estimated to have experienced panic disorder during the past year, with 4.7 per cent of people developing it at some point in their life.

Obsessions and compulsions

Have you ever left the house and then hurried back, maybe several times, to check you’ve turned off the cooker? Do you sometimes feel the need to wash your hands repeatedly after going to the toilet or touching something dirty?

How about strange thoughts that pop into your mind as if from nowhere? Do you ever find yourself thinking, for example, that you’re about to hit someone? Or shout or swear in the most inappropriate situations – at a church service perhaps, or in a library?

Virtually everyone experiences impulses like this occasionally, but for around 3 per cent of people at some point in their life these normal thoughts and urges spiral out of control: this is obsessive-compulsive disorder (OCD).

Shyness and social anxiety

Forty per cent of people describe themselves as shy, and almost everyone has felt shy at some point – especially as children or young adults. Lots of people are perfectly comfortable with their shyness, but it can be pretty severe, and that’s no fun at all. When shyness is really pronounced, it’s called social anxiety.

Social anxiety takes many forms. Some people find all social situations distressing; for others, the fear only kicks in when they have to perform a particular activity in front of others. Most often that activity is public speaking, but social anxiety can concern everything from dating to eating to using a public toilet.

Just like shyness, social anxiety is rooted in the fear that other people will think badly of us. Around 13 per cent of people will experience social anxiety at some stage of their life.

TRAUMA

Psychologists use the term trauma to refer to really serious life events, such as rape, violent physical assault, serious illness, natural disasters, a bad car accident, the sudden death of a loved one, a terrorist incident, combat, torture or physical and sexual abuse.

About half of us will experience a severe trauma at some point, and no one takes it in their stride. Being knocked for six is normal and natural. It’s the way we deal with a horrible event, working it through in our mind until we get closure and can move on.

In most cases, things begin to improve after a few weeks, but not for everyone; indeed, some people find they’re feeling worse than ever. When this happens, it’s known as post-traumatic stress disorder (PTSD). Around 5–10 per cent of us are likely to suffer from PTSD at some stage during our lifetime.

DEPRESSION

We all feel down occasionally. Sadness, like happiness, is simply part of life. Generally it lifts pretty quickly, but sometimes the everyday blues take root and deepen into depression.

When people are depressed, life seems devoid of interest or pleasure. They feel exhausted and their concentration span shrinks. Making decisions becomes a nightmare, while completing the most basic task – washing the dishes, phoning a friend, even getting out of bed – seems almost impossible.

Depressed people often lose their appetite, though some resort to comfort feeding. They also frequently have problems sleeping, though again it can work the other way – depression leaves some people listless and sleepy.

Depression changes behaviour, but it also fills the mind with negative thoughts: ‘I’m rubbish’, ‘The world is a bad place’, ‘I’ve nothing to look forward to’. People with depression are sometimes wracked by guilt – for past failings and, most especially, for the way they feel now.

Nowadays people are often much more willing to admit to depression, perhaps partly because many celebrities – for example, J.K. Rowling, Alistair Campbell and Stephen Fry – have admitted to battling the illness. Depression is so common that it’s been called the ‘common cold of the mind’. Around 10–20 per cent of us will experience at least one episode of depression at some point in our lives.

ANGER

Holding anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned. BUDDHA

Anger is a perfectly normal and absolutely fundamental emotion. As every parent knows, even the tiniest baby experiences anger – it’s part of being human. Whenever we’re angry with other people, it always boils down to the same thing: we believe they’ve done us wrong, or have prevented us from getting what we want, either deliberately or through carelessness.

Although everyone gets annoyed from time to time, it’s important that we’re able to keep our anger under control. If not, we run the risk of some unpleasant consequences. For example, anger can play havoc with our physical health, making us more susceptible to heart disease and to strokes. It also dramatically increases the chance of us having an accident in the car or at work.

And of course anger and happiness are pretty much incompatible, not least because anger can have such a toxic effect on our relationships. If we’re angry much of the time, we’re unlikely to be very content. On the other hand, if we can learn to control our anger, happiness is suddenly within reach.

STRESS

We all go through periods when life seems a struggle. Perhaps we’re trying to balance the demands of our job against the responsibilities of family life. Maybe we’re worried about our health or perhaps our relationships are going through a difficult patch, or money is tight.

These are obviously difficult situations, but sometimes we’re able to manage pretty well. This is because stress is the result not just of difficult situations, but of our reaction to them: stress is what we feel when we believe we can’t cope with the demands facing us.

Typical symptoms of stress include:

• Feeling anxious and tense
• Feeling unable to cope
• Thinking that you’ve got too much to do
• Feeling under pressure from other people
• Being irritable and grouchy
• Feeling lonely or isolated
• Feeling tired
• Worrying about the future
• Having problems relaxing or sleeping.

Because stress is all about our response to potential problems, our ability to cope often depends on how we’re feeling at the time. If we’re tired or low, we’re more likely to think we can’t manage and therefore to be much more stressed. A situation that might make us extremely stressed when we’re feeling down may hardly affect us when we’re well-rested, positive and happy.

Many hundreds of thousands of people in Great Britain suffer from work-related stress every year, with millions of working days lost as a result.

Alcohol problems

Wine is a turncoat; first a friend and then an enemy. HENRY FIELDING

Human beings have been drinking alcohol for tens of thousands of years – and it’s no wonder: for many people, alcohol is a great way to relax, helping us forget our worries and making socialising much easier.

But drinking too much can lead to all manner of physical and psychological problems. In moderation, alcohol can be a source of great pleasure; in excess – and without wanting to sound too preachy – it can cause huge unhappiness.

Judging whether or not you have a problem with alcohol can be hard. Ours is a culture, after all, which regards drinking – even in great quantities – as normal. Many people do drink more than the recommended limits. These are:

• 3–4 units per day for men
• 2–3 units per day for women
• 21 units per week for men
• 14 units per week for women.

It may be time to consider abstaining or cutting down if:

• You regularly drink more than the recommended limits
• You find it difficult to stop drinking once you’ve started
• You aren’t able to do what’s expected of you because of alcohol
• A friend or relative has expressed concern about your drinking.

EATING PROBLEMS

There are three main types of eating problem:

• Overeating
• Binge eating
• Undereating

Let’s look at each of these in turn.

Overeating

More of us than ever before are overweight. Indeed, in 2009 a staggering 61 per cent of adults and 28 per cent of children in England were overweight or obese.

Our weight is the product of a combination of factors, from our genes and metabolism to our socio-economic group. Sometimes weight problems can be caused by physical factors, such as thyroid disease or some types of medications (for example, the contraceptive pill), but it’s the fact that we eat so badly and exercise so rarely that’s led to the recent rapid rise in the number of overweight people.

Most of us are just carrying a few extra pounds, but even so there are lots of good reasons to slim down. Losing just a little weight can make us feel happier, healthier and more energetic. And we’ll also reduce the risk of developing serious illnesses such as cancer, heart disease, diabetes, strokes and arthritis.

Binge eating

In the mid 1970s doctors began to notice a new type of eating problem. The people affected – and they were almost all women – were prone to regular bouts of frenzied, uncontrolled eating. After these binges, they would attempt to compensate by vomiting, taking laxatives or other medications, dieting, fasting or exercising excessively. The behaviour seemed to be driven by a preoccupation with weight and appearance.

This problem is now known as bulimia nervosa, and it’s very much at the severe end of the binge-eating spectrum. There are many people who don’t meet the criteria for a diagnosis of bulimia but who still sometimes binge eat and vomit, while others binge eat but don’t try to undo the effects of the food in some way afterwards.

It’s estimated that at any time 5–10 per cent of women binge eat, with approximately 4.5 per cent of women between 18–24 suffering from bulimia.

Undereating

Most of us know what it’s like to diet. The pressure on everyone, and especially women, to control our weight by eating less is arguably greater than ever. There are plenty of good reasons to maintain a healthy weight, but dieting isn’t usually the answer, at least in the long term. Neither does it do much for our happiness, especially if – as usually happens – the weight just goes right back on when we stop dieting.

For a very small percentage of people – usually young women – the desire to be thin results in them consistently eating less than they need to maintain their normal body weight. And this behaviour continues even when they are seriously underweight. This is anorexia nervosa, and it can lead to serious health problems.

Like bulimia, anorexia is fuelled by the belief that what matters most is one’s appearance – that self-esteem comes from slimness and self-control. About half of people with anorexia are also prone to bulimia-type behaviour.

SEXUAL PROBLEMS

Our culture is so saturated with sexual images and references that it’s easy to believe there’s something wrong with you if you’re not constantly either having wonderfully fulfilling sex or thinking about it. But remember: whatever the state of your love life, it’s only a problem if you – or your partner, if you’re in a relationship – feel it is.

That said, when things aren’t working out well in the bedroom life can seem pretty miserable. Sex, after all, is potentially a source of great pleasure, fulfilment and self-esteem and sexual problems can cause difficulties in relationships – which, as you’ll remember from Chapter 8, are perhaps the most important source of happiness in our life.

Here’s a brief summary of the most common sexual problems:

• Absence of desire – losing interest in sex. In any year, 40 per cent of women experience a loss of sexual desire that lasts at least a month.
• Arousal problems – though we want to have sex, our body doesn’t respond accordingly. Over the course of a year, around 9 per cent of women will experience this problem for at least a month.
  In men, arousal problems are known as erectile dysfunction: the inability to develop or maintain an erection. Short-term difficulties are very common, but for around 15–20 per cent of men it’s a persistent, significant problem. The risk increases with age.
• Difficulties having an orgasm. This is the most frequent reason why women seek sex therapy. Each year 14 per cent of women are unable to achieve an orgasm for at least a month. For 4 per cent, the problem lasts for six months or more.
• Pain – either during sex or even at the thought of it. This is generally a problem affecting women rather than men. Pain during intercourse is a persistent problem for around 12 per cent of women each year.
• Premature ejaculation is the most common sexual problem experienced by men. It’s defined as consistently ejaculating sooner than you’d like. Around a third of men say that they ejaculate too quickly at least half the time.

HOW TO GET HELP

If you’re struggling with any of the problems listed in this chapter, take heart: effective treatments are available for all of them.

One potentially valuable source of information and advice is self-help material – books, CDs and websites. There are many excellent self-help guides for all the problems we discuss in this chapter, and you can find some of them in the Further Reading section on pp. 157–8.

If you’d like to take things further, start by seeing your family doctor. Just chatting things over with your GP can be a huge help. If you think psychological therapy (also called ‘psychotherapy’ or ‘talking therapy’) might be useful, your doctor should be able to guide you through the options and make a referral. There are various types of psychotherapy but CBT is the one that’s been proven to be most effective for these problems. Medication is also an option in some cases.

Incidentally, the UK’s National Institute for Health and Clinical Excellence (NICE) produces guidelines on how best to treat psychological (as well as physical) problems. They’re aimed primarily at health professionals, but there’s no reason why you shouldn’t consult them too. You’ll also find summaries of the guidelines written specifically for the general public on their website: www.nice.org.uk.

And remember, emotional and psychological problems are normal. They’re as much a part of life as any physical problem. Whatever you’re going through, you can be certain that someone you know has had exactly the same problem at some stage of their lives. They came through it, and so will you.