Anxiety, depression, loneliness, burnout and emotional exhaustion seem to be everywhere. Why are so many people finding life difficult, and what can we actually do about it? A CBT therapist explores the psychological, social and biological factors affecting our wellbeing, and the evidence-based approaches that can help us feel better.

Something I’ve noticed increasingly in my work as a cognitive behavioural therapist is how many people seem to be struggling simply to get through everyday life.

Some are experiencing persistent anxiety. Others feel emotionally exhausted, overwhelmed by responsibilities or trapped in a cycle of negative thinking.

Many describe a loss of motivation, enthusiasm or enjoyment.

They’re functioning, at least on the surface. They’re working, paying bills, looking after families and meeting obligations.

But underneath, something isn’t quite right.

People tell me they feel disconnected, unfulfilled, lonely or permanently stressed.

Some feel guilty because, objectively, their lives appear relatively comfortable. They have jobs, homes, relationships and opportunities, yet still feel unhappy.

Others are dealing with very real financial pressures, health difficulties, relationship problems or uncertainty about the future.

And increasingly, I hear a similar question:

“Why does everything feel so difficult?”

I don’t believe there’s one simple explanation.

Our mental health is influenced by a complicated interaction of biological vulnerability, psychological habits, relationships, social circumstances and the environments in which we live.

However, I also believe there’s reason for optimism.

We’re learning more about mental health than ever before. Effective treatments exist, our understanding of psychological wellbeing continues to develop, and there are practical changes we can make that genuinely improve how we feel.

The challenge is understanding what contributes to poor mental health and, importantly, what we can do about it.

1. How serious is the mental health crisis?

The statistics suggest that the difficulties I see in therapy are part of a much wider problem.

According to the World Health Organization’s 2025 report, World Mental Health Today, more than one billion people worldwide are living with a mental health disorder.

Anxiety and depression are among the most common conditions, and the economic consequences are substantial.

The situation in England is also concerning.

The NHS Adult Psychiatric Morbidity Survey, published in 2025, examined mental health among adults in England.

Source: NHS Adult Psychiatric Morbidity Survey 2023/24.

In other words, more than one in five adults aged 16–64 in England met the survey criteria for a common mental health condition in 2023/24.

Among young adults aged 16–24, the figure was even higher, at 25.8%.

These statistics deserve attention.

However, we should be careful not to conclude that everyone is becoming mentally unwell or that every experience of stress represents a psychiatric disorder.

Increased awareness, changes in help-seeking and improved recognition may influence some measures, while the surveys also show genuine increases in particular indicators of distress.

The important question is not simply how many people are struggling.

It’s why.

2. Chronic stress: When your nervous system rarely gets a break

Stress is a normal and necessary part of life.

In manageable amounts, it can improve concentration, motivate us and help us respond to challenges.

The problem arises when stress becomes persistent and recovery is inadequate.

Consider the demands many people face.

They wake up tired, rush to work, manage competing responsibilities, deal with financial worries, respond to messages, navigate relationships and return home with another list of tasks waiting for them.

Even when they finally sit down, their minds remain busy.

They think about tomorrow’s workload, unpaid bills, family problems or things they should have accomplished.

Their bodies may be resting, but psychologically they’re still working.

Chronic stress involves prolonged activation of biological systems that help us respond to challenges, including the hypothalamic-pituitary-adrenal axis and the autonomic nervous system.

Over time, inadequate recovery can contribute to sleep difficulties, irritability, fatigue and problems with concentration.

What can help?

We need to distinguish between stressors we can change and those we must learn to manage.

If your workload is consistently unreasonable, breathing exercises alone won’t solve the problem.

You may need to establish boundaries, negotiate responsibilities or reconsider aspects of your working environment.

If you’re worrying excessively about situations beyond your control, psychological techniques may help you respond differently.

I often encourage clients to ask:

“Is this a problem I can solve, or an uncertainty I need to learn to tolerate?”

If it’s solvable, identify the next practical step.

If it isn’t, practise redirecting your attention towards what you can influence.

This simple distinction can reduce a surprising amount of unnecessary mental activity.

3. Financial insecurity: You cannot think your way out of every problem

Financial pressure is one of the most significant stressors people experience.

The cost of housing, energy, food, childcare and transport can create an ongoing sense of vulnerability.

When someone is worried about paying their rent or mortgage, it’s understandable that they may struggle to relax, sleep or concentrate.

Financial insecurity also reduces our sense of control.

And perceived control is closely associated with psychological wellbeing.

It’s important not to overpsychologise these difficulties.

Someone experiencing poverty doesn’t necessarily need to think more positively about their circumstances.

They may need better financial support, affordable housing, employment opportunities or practical assistance.

Psychological therapy can help people manage anxiety, problem-solving and feelings of helplessness, but it cannot replace material security.

A practical approach

Separate financial worries into three categories: immediate problems requiring action, longer-term issues that need planning, and hypothetical worries about events that may never occur.

Then focus on one manageable action.

This might involve reviewing expenses, seeking benefits advice, contacting a debt charity or exploring employment opportunities.

Even small steps can help restore a sense of agency.

4. Loneliness: The hidden epidemic of disconnection

One of the most striking contradictions of modern life is that we have more ways to communicate than ever before, yet many people feel profoundly lonely.

We can message friends instantly, follow hundreds of people online and participate in digital communities.

But none of these guarantees meaningful emotional connection.

The WHO Commission on Social Connection reported in 2025 that approximately one in six people worldwide experiences loneliness.

Among adolescents and young adults, the figure is around one in five.

Loneliness isn’t simply about being physically alone.

It’s about the gap between the social connection we want and the connection we experience.

You can be married and lonely.

You can have colleagues and acquaintances but nobody you feel comfortable confiding in.

You can attend social events yet feel disconnected from everyone around you.

Why loneliness affects mental health

Humans are social beings. Supportive relationships can provide reassurance, practical assistance, companionship and a sense of belonging.

When these connections are absent, people may become more vulnerable to depression and anxiety.

Loneliness can also encourage withdrawal.

Someone feels disconnected, begins assuming other people aren’t interested in them and gradually stops making social efforts.

This reduces opportunities for connection and reinforces the original belief.

What can help?

Don’t wait for meaningful friendships to appear spontaneously.

Create repeated opportunities for connection.

Join a walking group, volunteer, attend a class or reconnect with someone you’ve lost touch with.

Focus on consistency rather than immediately finding a best friend.

Relationships often develop through repeated, ordinary interactions.

And remember that connection doesn’t have to be romantic to be meaningful.

Friendships, family relationships, neighbours, colleagues and community groups can all contribute to belonging.

5. Social media: Comparison, overstimulation and the illusion of perfect lives

Social media isn’t inherently harmful.

It can provide connection, education, entertainment and support, particularly for people who feel isolated.

However, it can also expose us to a continuous stream of carefully selected images of other people’s lives.

We see holidays, beautiful homes, successful careers, happy relationships and apparently effortless achievements.

We rarely see the arguments, financial difficulties, loneliness, insecurity or ordinary disappointments happening behind the scenes.

The result can be a distorted comparison.

Someone might be reasonably satisfied with their life until they spend half an hour scrolling through images of people who appear wealthier, more attractive or more successful.

Suddenly, their own circumstances seem inadequate.

Psychologists refer to comparing ourselves with people we perceive as doing better as upward social comparison.

Sometimes this can inspire us.

But when the comparison feels unattainable or unfair, it can contribute to dissatisfaction and lower self-esteem.

What does the research suggest?

The relationship between social media and mental health is complex.

Some studies identify associations between heavy or problematic use and poorer psychological wellbeing, especially among vulnerable young people.

Other research finds relatively small average associations and emphasises that the effects depend on what people do online, their existing mental health and the quality of their experiences.

It’s therefore misleading to claim that social media is responsible for the entire mental health crisis.

Nevertheless, it makes sense to examine how our online habits affect us individually.

Ask yourself:

“Do I usually feel better or worse after using this platform?”

“Am I connecting with people or simply comparing myself with them?”

“Is this activity replacing sleep, exercise or meaningful social contact?”

If the answers concern you, experiment with changing your habits.

You don’t necessarily need to abandon social media. You may simply need to become more selective about how you use it.

6. Work, burnout and the pressure to keep performing

Work can be enormously beneficial for mental health.

It can provide structure, purpose, financial independence, relationships and a sense of accomplishment.

But unhealthy working environments can have the opposite effect.

The World Health Organization identifies excessive workloads, job insecurity, discrimination, low control and poor working conditions as important risks to mental health.

Globally, an estimated 12 billion working days are lost annually because of depression and anxiety.

That’s an extraordinary figure.

In my therapy work, I often encounter people who feel they must constantly demonstrate their value through productivity.

They work longer hours, take on additional responsibilities and struggle to say no.

Even when they’re exhausted, they feel guilty about resting.

Eventually, activities they once enjoyed begin to feel like additional obligations.

Burnout or depression?

Burnout is specifically an occupational phenomenon associated with chronic workplace stress that hasn’t been successfully managed.

It commonly involves exhaustion, increased mental distance or cynicism towards work, and reduced professional efficacy.

Depression, by contrast, can affect almost every aspect of someone’s life, including mood, pleasure, sleep, appetite and motivation.

The two can overlap, but they aren’t interchangeable.

What helps?

Workplace wellbeing requires more than teaching employees resilience.

Organisations need to address unreasonable demands, poor management, inadequate support and unsafe working environments.

Individuals can also benefit from setting boundaries, taking meaningful breaks and learning to separate their self-worth from their productivity.

One question I often ask clients is:

“If you weren’t constantly trying to prove your worth, what would you do differently?”

The answer can reveal how much pressure they’ve been placing on themselves.

7. Sleep deprivation: The overlooked mental health factor

Sleep and mental health have a complicated, two-way relationship.

Anxiety can interfere with sleep.

Depression can cause insomnia or excessive sleeping.

And inadequate sleep can make it harder to regulate emotions, concentrate and cope with stress.

According to US national survey data, 30.5% of adults reported sleeping less than seven hours per night in 2024.

When we’re sleep-deprived, everyday difficulties can feel more overwhelming.

A minor disagreement might seem devastating.

A busy day might feel impossible.

Our ability to respond thoughtfully rather than react emotionally may be reduced.

How to improve sleep

Consistent waking times, regular daylight exposure, appropriate exercise and a comfortable sleep environment can support healthy sleep.

It’s also important to avoid becoming excessively anxious about sleep itself.

People with insomnia sometimes develop a secondary problem: worrying about not sleeping.

They monitor the clock, calculate how many hours remain and become increasingly frustrated.

This creates additional arousal and makes sleep even more difficult.

For persistent insomnia, cognitive behavioural therapy for insomnia (CBT-I) is a recommended first-line treatment.

The aim is to rebuild a healthier relationship with sleep rather than trying to force it.

8. Physical inactivity: We underestimate the mental health benefits of movement

Our bodies and minds aren’t separate systems.

Physical activity affects sleep, energy, stress regulation and emotional wellbeing.

Yet the WHO reported that approximately 31% of adults worldwide were not meeting recommended physical activity levels in 2022.

The evidence for exercise as a mental health intervention is increasingly compelling.

A 2024 systematic review published in The BMJ analysed 218 randomised trials involving 14,170 participants with depression.

The researchers found that activities including walking, jogging, yoga and strength training reduced depressive symptoms compared with control conditions, although confidence in some findings was limited by study quality.

What does this mean in practice?

You don’t need to become a marathon runner.

Find movement that you genuinely enjoy.

Walking, swimming, dancing, gardening, cycling and strength training can all contribute to physical and psychological wellbeing.

If you’re depressed or exhausted, start small.

A ten-minute walk is a perfectly reasonable beginning.

The important thing is to create a sustainable routine rather than setting unrealistic expectations and then criticising yourself when you cannot maintain them.

9. Our thinking patterns can make difficult lives feel even harder

As a CBT therapist, one of the most significant patterns I observe is the way people interpret their experiences.

Two people can encounter a similar situation but respond very differently because of what they tell themselves.

Imagine receiving criticism at work.

One person thinks:

“That’s disappointing, but I can learn from it.”

Another thinks:

“I’m useless. I’m going to lose my job. Everyone must think I’m incompetent.”

The second person may experience considerably more distress, even though the external event is the same.

Our brains are constantly generating predictions, assumptions and interpretations.

And unfortunately, those interpretations aren’t always accurate.

Common thinking errors include catastrophising, mind-reading, black-and-white thinking, personalisation and discounting the positive.

The CBT approach

Rather than automatically accepting your thoughts, begin questioning them.

Ask:

• Is this thought based on evidence or assumption?

• Am I predicting the worst possible outcome?

• What alternative explanations might exist?

• Am I underestimating my ability to cope?

• What would I say to a friend in this situation?

This isn’t about pretending that problems don’t exist.

It’s about responding to reality rather than unnecessarily frightening interpretations of it.

We cannot control every event in our lives, but we can develop greater flexibility in how we interpret and respond to those events.

10. Avoidance: The behaviour that keeps anxiety and depression going

This is another pattern I see repeatedly.

People feel anxious, overwhelmed or depressed, so they begin avoiding things.

They stop socialising.

They postpone difficult conversations.

They put off applying for jobs.

They withdraw from activities they previously enjoyed.

Initially, avoidance can feel helpful because it reduces immediate discomfort.

But over time, it can create additional problems.

Someone who avoids social situations may become lonelier.

Someone who postpones important tasks may become increasingly stressed.

Someone who stops enjoyable activities may experience fewer opportunities for pleasure and accomplishment.

The result is a self-reinforcing cycle.

The way out often involves gradual behavioural change.

Rather than waiting until you feel motivated, begin introducing small activities that support your values and wellbeing.

Motivation frequently follows action.

11. Trauma, childhood experiences and emotional vulnerability

Not all mental health difficulties originate in current circumstances.

Early experiences can influence how we interpret the world, relate to other people and respond to stress.

Someone who experienced repeated criticism during childhood may develop a persistent belief that they’re inadequate.

Someone who experienced unpredictable caregiving may become particularly sensitive to rejection or abandonment.

Someone who experienced trauma may develop heightened vigilance towards potential threats.

These responses can be understandable adaptations to difficult circumstances.

However, strategies that once helped someone survive may become less useful later in life.

For example, constantly monitoring other people’s moods might have been necessary in an unpredictable childhood environment.

In adulthood, the same behaviour may contribute to anxiety and relationship difficulties.

Can these patterns change?

Yes.

Trauma-focused CBT and EMDR are evidence-based treatments for post-traumatic stress disorder.

Other psychological approaches can help people explore attachment patterns, emotional regulation, self-esteem and relationship difficulties.

Treatment should be tailored to the individual’s needs and should not assume that every current problem is caused by childhood trauma.

The important message is that our past can influence us without having to determine our future.

12. Biology, hormones and physical health also matter

Mental health isn’t simply a matter of thinking differently.

Genetics, hormonal changes, neurological processes, medications and physical illnesses can all contribute to psychological symptoms.

For example, thyroid disorders, anaemia, chronic pain, sleep apnoea and certain medication effects may contribute to fatigue, poor concentration or mood changes.

Hormonal transitions, including perimenopause and menopause, can also affect sleep and emotional wellbeing.

People living with chronic health conditions may experience additional psychological burdens associated with pain, uncertainty, treatment demands and reduced independence.

This is why a comprehensive mental health assessment should consider physical as well as psychological factors.

If someone develops persistent or unexplained changes in mood, energy or cognition, a medical review may be appropriate.

Psychological therapy can be extremely helpful, but it shouldn’t replace necessary medical investigation.

What actually works? Evidence-based treatments for mental health difficulties

The encouraging news is that we have several effective approaches to treating common mental health conditions.

There isn’t one treatment that works for everyone, and treatment choice should depend on symptoms, severity, preferences, previous experiences and individual circumstances.

13. Cognitive behavioural therapy (CBT)

CBT helps people understand the relationships between their thoughts, emotions, physical sensations and behaviours.

It is recommended for a range of conditions, including depression and anxiety disorders.

In therapy, we might explore how catastrophic predictions increase anxiety, how avoidance maintains fear or how self-critical beliefs contribute to depression.

Treatment involves developing more balanced thinking and testing new behaviours in everyday life.

For example, someone with social anxiety might gradually practise initiating conversations rather than avoiding social situations.

Someone with depression might begin rebuilding routines that provide accomplishment and enjoyment.

The goal isn’t simply to feel better during therapy sessions.

It’s to develop practical skills that continue helping after treatment ends.

14. Behavioural activation: Doing before feeling

Behavioural activation is particularly useful when depression has led to withdrawal, inactivity and reduced motivation.

It focuses on helping people gradually re-engage with meaningful and rewarding activities.

NICE recommends behavioural activation among the treatment options for adult depression, including individual and group formats.

A person who feels depressed might initially struggle to do anything beyond essential responsibilities.

We might begin with small, achievable goals.

Perhaps getting outside each morning.

Contacting a friend.

Preparing a meal.

Returning to a hobby.

Completing one postponed task.

Over time, these actions can create opportunities for pleasure, achievement and renewed confidence.

15. Acceptance and Commitment Therapy (ACT)

ACT encourages psychological flexibility.

Rather than attempting to eliminate every uncomfortable thought or feeling, people learn to respond differently to their internal experiences.

They identify what matters to them and take meaningful action even when anxiety or uncertainty is present.

For example, someone might value relationships but feel frightened of rejection.

ACT can help them recognise that anxiety doesn’t have to prevent them from pursuing connection.

The aim isn’t to become fearless.

It’s to build a life guided more by personal values than by avoidance.

16. Medication: An important option for some people

Medication can play a valuable role in treating mental health conditions.

Antidepressants may be recommended for depression or certain anxiety disorders, particularly when symptoms are more severe or persistent.

For some people, combining medication with psychological therapy can be beneficial.

NICE guidance recommends considering symptom severity, personal preferences, potential side effects and previous treatment responses when choosing an approach.

Medication isn’t a failure or a shortcut.

Nor is it always necessary.

The best approach is an informed, individualised decision made with an appropriate healthcare professional.

Medication should be reviewed regularly, and antidepressants shouldn’t be stopped abruptly without medical guidance.

17. Other effective psychological treatments

Different problems may benefit from different therapeutic approaches.

There is no need to regard one therapy as universally superior.

Good treatment involves matching the intervention to the person’s needs, goals and circumstances.

18. Does therapy actually help? The numbers are encouraging

NHS Talking Therapies provides psychological treatment for people experiencing anxiety and depression in England.

According to its May 2025 published outcomes, 50.9% of eligible referrals completing treatment met the service’s definition of recovery.

This doesn’t mean that half of all people seeking therapy recover, nor does it capture every meaningful improvement.

Some people experience substantial symptom reduction without meeting the formal recovery threshold.

Others require longer-term or more specialised treatment.

Nevertheless, the results offer an important message.

Mental health difficulties are treatable.

People can learn new skills, change longstanding patterns and experience meaningful improvements in their quality of life.

A practical guide to improving your mental health

Understanding the causes of poor mental health is useful, but knowledge alone doesn’t necessarily create change.

We also need to translate that understanding into everyday action.

19. Seven foundations for better mental wellbeing

20. A seven-day mental wellbeing reset

If you’re feeling overwhelmed, don’t attempt to transform your entire life overnight.

Try focusing on one manageable action each day.

This isn’t a treatment programme or a substitute for professional support. It’s simply a way of introducing small, potentially helpful changes into everyday life.

If you miss a day, continue with the next one.

Consistency is more valuable than perfection.

21. When should you seek professional help?

It’s worth considering professional support if anxiety, low mood or other psychological symptoms persist, interfere with everyday functioning or significantly affect your relationships, work or quality of life.

You don’t need to reach a crisis point before asking for help.

In England, adults can often refer themselves directly to NHS Talking Therapies without first seeing a GP.

A GP can also help assess physical contributors to symptoms and discuss treatment options.

If you’re experiencing thoughts of suicide or feel unable to keep yourself safe, seek urgent help. In the UK, you can contact NHS 111 and select the mental health option, call Samaritans on 116 123, or call 999 if there is immediate danger.

Seeking help is a practical step towards improving your wellbeing.

22. Why I remain optimistic about mental health

Despite the concerning statistics, there are several reasons I remain hopeful.

First, we’re talking about mental health more openly than previous generations.

Although stigma hasn’t disappeared, many people are increasingly willing to acknowledge anxiety, depression and emotional difficulties.

Second, we have effective psychological treatments.

CBT, behavioural activation, trauma-focused therapies and other evidence-based approaches can help people make meaningful changes.

Third, mental health is not necessarily fixed.

Our habits, environments, relationships and ways of responding to difficulties can change throughout life.

People can learn to manage anxiety more effectively.

They can develop healthier boundaries.

They can recover from depression.

They can build meaningful relationships after years of isolation.

They can change careers, rebuild confidence and rediscover enjoyment.

And perhaps most importantly, improvements don’t always require dramatic life changes.

Sometimes recovery begins with something remarkably ordinary.

Getting out of bed at a consistent time.

Taking a walk.

Having an honest conversation.

Applying for a job.

Learning to challenge a self-critical thought.

Accepting an invitation.

Asking for help.

These actions may seem small, but they can create opportunities for larger changes.

Final thoughts: We need healthier lives, not just better coping strategies

When we ask why so many people are struggling with their mental health, we need to look beyond individual psychology.

Yes, our thinking patterns, behaviours and coping strategies matter enormously.

But so do financial security, relationships, working conditions, physical health, social support and access to treatment.

We cannot expect people to remain psychologically healthy indefinitely in environments that are persistently stressful, isolating or unsafe.

Improving mental health therefore requires both individual and collective action.

We need workplaces that respect wellbeing.

Communities that encourage connection.

Healthcare systems that provide timely, effective support.

And individuals who are equipped with the skills to manage difficult thoughts, emotions and experiences.

But I also want to leave readers with something encouraging.

The way you feel today doesn’t have to be the way you feel forever.

Your current circumstances may be difficult.

You may feel overwhelmed, anxious, exhausted or uncertain about the future.

You may have developed habits of avoidance, negative thinking or self-criticism that seem almost impossible to change.

But change is possible.

You don’t have to solve every problem immediately.

You don’t have to become endlessly positive.

You don’t have to be productive every moment of the day.

And you certainly don’t have to live up to everyone else’s expectations.

Start by asking yourself what would make your life a little healthier, more meaningful or more manageable.

Then take one small step in that direction.

Because mental wellbeing isn’t about achieving a perfect life without stress, sadness or uncertainty.

It’s about developing the resources, relationships, flexibility and confidence to navigate life’s difficulties while still finding moments of pleasure, connection and purpose.

And even when life feels particularly difficult, there is often more possibility for change than we initially imagine.

Research and references

1. World Health Organization (2025). World Mental Health Today. WHO report.

2. NHS England (2025). Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/24. Full survey.

3. World Health Organization (2025). WHO Commission on Social Connection. Report and findings.

4. World Health Organization. Mental Health at Work. Fact sheet.

5. Noetel, M., et al. (2024). Effect of Exercise for Depression: Systematic Review and Network Meta-analysis of Randomised Controlled Trials. BMJ, 384. Read study.

6. Singh, B., et al. (2023). Effectiveness of Physical Activity Interventions for Improving Depression, Anxiety and Distress: An Overview of Systematic Reviews. British Journal of Sports Medicine. Read review.

7. NICE (2022). Depression in Adults: Treatment and Management (NG222). Clinical guidance.

8. NHS England. NHS Talking Therapies: May 2025 Outcomes. Treatment outcomes.

9. US National Center for Health Statistics (2026). Short Sleep Duration and Sleep Difficulties Among Adults: United States, 2024. Read report.