Social 

   Our modern society makes establishing and maintaining good relationships difficult even though these are at the core of our mental well-being.  Disruptions in relationships frequently lead to anxiety and depression.  In their book, “Creating Optimism”, Murray and Fortinberry² describe how human beings evolved to thrive under certain conditions whereby our relationships to each other and nature were positioned at the centre of our lives.  In contrast, modern societies emphasise work and consumerism.  The shifting emphasis over centuries has meant that at the core, life in our Western societies is essentially unfavourable to mental health, hence the unprecedented number of people currently suffering from anxiety and depression.  The following table emphasises the important differences between us and our hunter-gatherer ancestors and therefore highlights the causes of our unhappiness:

   Historical 

   People with difficult early histories may have life-long struggles with depression and anxiety.  Common issues found in the family of origin are neglect, trauma or even just a mismatch between the needs of the child and the ability of adult caregivers to understand and meet those needs. Your early childhood conditions in your family of origin, schooling, relationships with peers and authority figures contributed to the development of generalised representations of everything you know about the world.  These representations may also be called core beliefs or schemas and they help you to respond to current events and experiences according to a pre-existing framework, so that you do not have to respond to experiences as though they were new and unknown every time.

   Core beliefs have an emotional weight to them as well as a pattern of thinking, both of which shape perception of reality and give rise to habitual styles of behaviour.  When you interact with the world, you unconsciously compare what you observe with your pre-existing core beliefs and are biased to see things in the same way. Therefore interpretations of experience tend to be the similar to the original interpretation.  This can be problematic if you have learned inaccurate information about yourself or the world.  Dysfunctional core beliefs maintain depression and anxiety.  Because core beliefs are so entrenched and often central to self-identity and personality, they are more difficult to change.

   If it is the case for you that you had a difficult childhood and have been suffering from anxiety and depression all your life then you may need to view psychotherapy as a long-term, rather than a short term proposition so that you can budget and plan accordingly.

   Situational

   Situational stress, if prolonged, can have some chronic effects on your functioning even if you have had a reasonable childhood.  Stress can increase your risk of developing psychosomatic disorders such as high blood pressure, headaches or problems with the gastrointestinal and musculoskeletal systems of the body.  Cumulative stress can arise from unresolved psychological conflicts lasting over many years or it can be due to difficulties in one area of life such as with marriage or physical health that persists over a long period of time.

   Dealing with several high-stress situations at once like the death of a person close to you, the loss of a job, bankruptcy, divorce, injury or ill health can lead to anxiety and depression.  Although one or two life events every year is a common and manageable experience, a series of many of them stretching over one or two years’ time can lead to a state of chronic stress and exhaustion.