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Anxiety: How can we prevent it from getting worse?

Photo by Priscilla Du Preez on Unsplash

The story reflects a real person’s experience, but her name is removed to protect her identity.

She sat on the bed, switching on the movie “Bad Boys 2” at 1am after she failed to reach her boyfriend’s phone. While watching the first 10 minutes, her mind starts to wander. She has racing thoughts and questions about her boyfriend.

“Why is he ignoring me? Did I do something wrong?”

She feels anxious after she finds out from her friend that her boyfriend is cheating on her with another woman. She also found out that he has blocked her from seeing his selected Facebook posts that he published publicly. Everyone can see his newfound romantic partner, except her.

At that moment of worrying, her heart beat faster than usual and she experienced shortness of breath. She thought she could watch a comedy to calm herself but she couldn’t. Throughout the early morning, she felt restless, nervous, and perspired even in a well-air-conditioned room. She did not sleep well. She was experiencing anxiety symptoms for the first time but she did not know.

Anxiety: Friend or Foe?

Experiencing anxiety can be uncomfortable but it is not necessarily dangerous.

In moderation, anxiety can help us deal with stressors in our lives via the fight-or-flight (sometimes freeze) response; it’s a natural reaction when our brain senses threat in our environment.

For instance, when she experienced anxiety due to issues in her romantic relationship for the first time, she did not isolate herself. Instead, it was natural for her to seek comfort from her immediate family and friends. However, her experience with anxiety became worse after the breakup.

How do we know that our anxiety is getting worse?

Anxiety gets worse especially when:

  • All the symptoms of anxiety are intensified
  • You have excessive worries and its intensity is significantly more in comparison to the actual threat
  • It affects your daily functions
  • It interferes with your life’s goals
  • It cannot be explained by other factors such as a medical problem or substance abuse

At that time, she experienced all the above along with symptoms of depression. However, no one in her family including herself recognized her mental health issues; instead, they viewed these difficult feelings as a phase that would go away. Unfortunately, she felt stuck with these mental health issues for years. Eventually, she came to acknowledge she has anxiety and depression and she needs to get proper help.

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How common is Anxiety?

According to the World Health Organization (WHO), 1 in 13 individuals globally suffers from anxiety at least once in their lifetime.¹

In the pre-pandemic world, anxiety, and depression disorders have been leading mental health issues worldwide.

Despite the fact that it is the main cause for the loss of productivity and a global economy of US$ 1 trillion each year, there is a lack of mental health facilities and capacities to provide support in most countries and this includes Malaysia.² Furthermore, many individuals tend to ignore and refuse to seek help due to social stigma, self-stigma, and lack of perceived need to seek for professional help. Factors such as a lack of affordability for professional mental health help, a preference for self-reliance, and seeking help from alternative sources such as religion/ spiritual means also play a significant role in their decision to seeking professional help.³ ⁴ ⁵ ⁶

When the Covid-19 pandemic ravaged the world and upended our lives, cases of mental health issues increased globally…

A recent study by Lancet peer-reviewed general medical journal has found that there are 129 million cases of anxiety and depression disorders added into the pre-pandemic level.⁷ The global increase of Covid-19 infection rates and full lockdowns imposed have long-lasting impact on the mental wellbeing of many, especially women and younger populations.

In their report, they found that women experience more anxiety symptoms as they are required to play many roles at home including being a caregiver, homemaker, and working full time. Domestic abuse against women have also increased. Younger populations are more vulnerable due to higher rates of financial distress, isolation, and loneliness.

Similar to the global study, there is also a significant spike of mental health issues in Malaysia especially among women and younger populations.⁸ Those who have financial issues are associated with anxiety and are more susceptible to depression. and suicide cases. Those who were infected with the Covid-19 virus have reported higher risk of anxiety, depression, and post-traumatic stress symptoms. 

Beyond Anxiety: How can mental health practitioners help?

Anxiety is treatable and should be well recognized like physical health issues. Here are some of the common psychotherapies used by therapists to address anxiety and sometimes, they may combine more than one psychotherapies to address the issue.

One of the most popular types of psychotherapy is Cognitive Behavioral Therapy (CBT) to address anxiety disorders. Many studies have shown that individuals who have undergone CBT have reported lower anxiety symptoms within 12 months after completion of the sessions.⁹

In CBT, a psychotherapist may address your anxiety through various cognitive/behavioral processes.

  • Cognitive therapy helps to identify, challenge and reframe your existing unhealthy thoughts with more objective and realistic ones. There are at least ten (10) types of negative automatic thoughts that may have contributed to your anxiety.
  • Behavioral therapy examines your unhealthy and self-defeating behaviors that may have contributed to your anxiety.

Acceptance and Commitment Therapy (ACT) has shown to be effective to address anxiety as well.¹⁰ The therapist-guided internet-based ACT is especially effective among individuals with generalized anxiety disorder.¹¹ The therapy includes various behavioral techniques from CBT. Acceptance strategies and mindfulness practices that encourage people to face their issues, thoughts, and emotions head-on instead of avoiding them. The technique promotes clients’ psychological flexibility so that they can live a life consistent with their committed personal values.

Group Psychotherapy has shown to be beneficial for clients to work with others with similar anxiety issues.¹² This helps them to develop better self-awareness, new problem-solving skills, socialization, and communication skills. Group psychotherapy can also be combined with individual therapy.

Beyond Anxiety: Her Experience.

When she first sought professional help from a counselor, she stopped after the first session. She thought the counselor was supporting her ex more than her.

Most of the therapies she went to did not seem to work. In hindsight, it did not work out because she was not ready for therapy, and neither did she want any change for herself. When she became more ready for a change, eventually, the next counselor she sought managed to help her cope with her anxiety and depression better. It was effective when she was able to identify the negative automatic thoughts, understand her emotions and reactions that have contributed to her mental health issues. The therapist used CBT and group therapy to help her to cope better.

To date, she acknowledges that her experience with anxiety still happens from time to time. However, she is more aware and mindful of the issues and she is still working on them, with and without a therapist.

Need to vent your problems to someone who would not impose their unsolicited advice to you when all you need is for someone to listen to you? Or, are you curious to learn more about yourself? Make an appointment today to see one of our Board-Certified Counsellors or Clinical Psychologists. If you are not sure what to expect from our psychotherapy session, check out our article on How to Prepare for a Therapy Session.

[1] Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.

[2] Iman, K. (2021). The sad reason why Malaysia faces a shortage of mental health counsellors… again.. CILISOS – Current Issues Tambah Pedas!. Retrieved 10 October 2021, from

[3] Hassan, M., Hassan, N., Kassim, E., & Hamzah, M. (2018). Issues and Challenges of Mental Health in Malaysia. International Journal Of Academic Research In Business And Social Sciences, 8(12).

[4] Ibrahim, N., Amit, N., Shahar, S., Wee, L., Ismail, R., & Khairuddin, R. et al. (2019). Do depression literacy, mental illness beliefs and stigma influence mental health help-seeking attitude? A cross-sectional study of secondary school and university students from B40 households in Malaysia. BMC Public Health, 19(S4).

[5] Heinig, I., Wittchen, H., & Knappe, S. (2021). Help-Seeking Behavior and Treatment Barriers in Anxiety Disorders: Results from a Representative German Community Survey. Community Mental Health Journal.

[6] Aguirre Velasco, A., Cruz, I., Billings, J., Jimenez, M., & Rowe, S. (2020). What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review. BMC Psychiatry, 20(1).

[7] Santomauro, D., Mantilla Herrera, A., Shadid, J., Zheng, P., Ashbaugh, C., & Pigott, D. et al. (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet.

[8] Bahar Moni, A., Abdullah, S., Bin Abdullah, M., Kabir, M., Alif, S., & Sultana, F. et al. (2021). Psychological distress, fear and coping among Malaysians during the COVID-19 pandemic. PLOS ONE, 16(9), e0257304.

[9] van Dis, E., van Veen, S., Hagenaars, M., Batelaan, N., Bockting, C., & van den Heuvel, R. et al. (2020). Long-term Outcomes of Cognitive Behavioral Therapy for Anxiety-Related Disorders. JAMA Psychiatry, 77(3), 265.

[10] Swain, J., Hancock, K., Hainsworth, C., & Bowman, J. (2013). Acceptance and Commitment Therapy in the treatment of anxiety: A systematic review. Clinical Psychology Review, 33(8), 965-978.

[11] Kelson, J., Rollin, A., Ridout, B., & Campbell, A. (2019). Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review. Journal Of Medical Internet Research, 21(1), e12530.

[12] Barkowski, S., Schwartze, D., Strauss, B., Burlingame, G., & Rosendahl, J. (2020). Efficacy of group psychotherapy for anxiety disorders: A systematic review and meta-analysis. Psychotherapy Research, 30(8), 965-982.

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