How do we manage anxiety and depression?

Feeling stressed, worried, or sad is a normal part of life, and most of the time we can manage it. Occasionally, however, these emotions become so intense that they can make living life normally difficult or impossible. In these cases, they may constitute anxiety and/or depression, and they are some of the most common mental health concerns — often occurring simultaneously. In this article, we shall introduce what these mean and some key approaches to managing them.

Anxiety is an intense feeling of worry about the future with a number of key qualities. The worry is either about possible events, or about having more anxiety itself. By comparison, depression is an intense feeling of sadness, hopelessness, and/or worthlessness. Anxiety and depression are self-perpetuating; when we have the feelings, we tend to fixate on them and related thoughts (such as the idea that we are hopeless or the fear of what may happen), which sustains them and may also lead us to inadvertently make choices that make the situation more difficult, or even make our feared event happen, which itself also sustains the feeling. Especially when these experiences have significant impacts on us, including when they may lead to some embarrassing or otherwise uncomfortable situations, the fear of it happening may be enough to make us hesitant to live our lives.

These experiences may be accompanied by a number of symptoms, of varying severity. They may manifest in the form of headaches, nausea, fatigue, loss of appetite, trouble sleeping, or difficulty concentrating or remembering. Anxiety may be accompanied by an increased respiratory or heart rate, perspiration, dizziness, or even fainting in extreme cases. Some people seek short-term relief of the symptoms via self-soothing activities such as the use of recreational drugs, the intensive usage of media and electronic devices, over-eating, shopping, or similar. Mentally, it tends to be associated with thoughts of impending events, often called “catastrophising” because they assume that the worst possible outcome will happen. Common examples may be “I know this will happen, and when it does, there will be no coming back from it”, and “there is no way that this can get better”. With those thoughts come emotions: fear, dread, helplessness, and even anger or irritation. These thoughts and feelings may influence what choices we make — for example, choosing not to socialise because we are fearful of how people might treat us and how that may make us feel. Choices based on anxious or depressed thoughts or emotions are less likely to be helpful to us, and when they do not yield a reassuring outcome, they act as confirmation that our thoughts were accurate, which encourages them to continue. This creates a cycle.

Anxiety and depression often result from adverse experiences, such as challenges in major relationships. However, it also occurs in people who have had stable lives. Some contend that they are “not real illnesses”, “all in your head”, or otherwise malingering, but these are myths. While small amounts of these emotions are normal for everyone, more severe cases are not “imaginary” in the sense that we can not simply “think our way out of them”. In these states, the brain literally responds differently to how it does when calm and is impeded in its ability to conduct the basic processing that is needed to make decisions and execute tasks — abilities that we normally take for granted because they happen subconsciously. When a person who experiences anxiety or depression reports that, for example, they “could not think of what to say” in a conversation, this is often the case literally; their brain was so occupied with the worry that it had no capacity left to make any other decisions. While these experiences are distressing, they are actually quite understandable in the context of our survival. If our brains were to focus on all manner of information at once rather than on that which was most important, we could not survive, because achieving specific goals requires focus. So it makes sense that if we believe a threat is imminent, our brains focus just on the threat so that we can take action to avoid being harmed by it.

There are a number of approaches to therapy for anxiety and depression, but perhaps the most common (and sound) are cognitive and behavioural therapies. These approaches work by challenging our thoughts (the cognitive aspect) and modifying our choices (the behavioural aspect) to ultimately change the nature of our experiences. As an example of challenging our thoughts, consider someone who believes that they are not performing well in their university class. They reason that since their peers ask more questions during lectures, those peers must be more engaged and are therefore studying more and will be graded more highly. Challenging that thought involves asking whether their peers indeed ask more questions (by having the person take notice of this during an actual lecture), and if so, asking what other meanings this fact may have. It could mean that the person in question is already engaged and needs to ask fewer questions to understand the content. It could also involve acknowledging that this person does not know what grades those peers achieve, and so this is assumed rather than known. Changing decisions often involves confronting what we avoid, usually in the context of our daily life. For example, if we would normally avoid socialising because we fear how other people may judge us, confrontation would involve socialising despite fearing it or not wanting to do it. 

If we engage in this therapeutic activity persistently, it works on a number of bases. First, it helps us build tolerance for situations that stimulate our depression or anxiety, so that we are more able to engage with them unimpeded. Second, it “rewrites our narrative”; by demonstrating to ourselves that we can do something even though we did not believe we could, we are modifying our mindset to one which is more likely to encourage action. Third, it interrupts the cycle so that even at times at which we do feel anxious or depressed, we can still do what is good for us, minimising the impact on our life.

Anxiety and depression are real experiences, and managing them requires sensitivity to our needs. At Aly’s Place, we understand the importance of this. We provide you with a non-judgemental environment and stand with you as an ally to help you learn the skills to manage your own situation, in your own way and at your own pace.