Mental Health

Mandy Kloppers

The difference between anxiety and depression

Depression and anxiety overlap in some areas – both involve negative thinking. Anxiety often arises due to our natural tendency to want to stay safe and out of danger. Our minds work overtime in an attempt to find certainty in a world where no such thing exists. Prolonged anxiety can lead to depression – a feeling that nothing we do makes a difference, leading to a feeling of hopelessness and/or powerlessness. Anxiety is taxing on the physical body as our brains stay alert, adrenalin is released and the body isn’t meant to stay in the flight, fight, freeze state for long periods.

Anxiety often involves attempts to stay in control and disorders such as anorexia, bulimia, Obsessive-compulsive disorder, social anxiety, phobias and health anxiety are all common consequences of anxiety. They are unhelpful approaches though that often make anxiety worse rather than better.

Depression involves sadness, lethargy, frustration and a low mood that persists for weeks. Depression also involves an overemphasis of negative emotions and a decrease in the reward produced by pleasurable experiences. Chronic stress can be important in the development of depression. An inability to cope with stress causes changes in how the brain balances positive and negative information. Key structures include the prefrontal cortex, amygdala, nucleus accumbens, and hippocampus.

Psychologically, hallmarks of major depression include the overemphasis placed on negative events and emotions (negative bias), and the state of anhedonia (difficulty in experiencing pleasure). Together, these factors conspire to make the depressed subject feel as though everything is terrible and that nothing is really worth doing.

An overactive amygdala (the part of the brain that monitors danger and initiates the fight/flight/freeze response) may be one contributor to depression. But what is it about the depressed brain that causes the amygdala to be overactive in the first place? A plausible idea is that an out-of-whack stress response is to blame. Stress alone doesn’t necessarily lead to depression, however – instead it’s the ability to cope with stress that matters.

Interesting fact:

With regard to depression, neuroimaging studies in humans show that in response to viewing sad faces, the amygdala of depressed people is extremely active when compared to the amygdala of non-depressed people, yet when viewing happy faces, amygdala activity is not distinguishable between the two groups.

Changing your thoughts can change the way you feel!

The difficulty with changing our thoughts in order to change how we feel is that our thoughts are automatic. That is, you make interpretations of situations quickly and instantly. They pop into your head without any conscious effort on your part. It may feel like you had no role in forming your interpretation because it happens so quickly. The thoughts do, however, affect how you feel, so it is important to take the time to learn how to identify your thoughts and how to then evaluate them.

Your irrational, unhelpful thoughts are:

  • Automatic: they seem to pop into your mind without any conscious control
  • Distorted: they tend not to fit what is considered logical or reasonable
  • Unhelpful: they can make you distressed, which makes it more difficult to change, and may stop you from achieving what you would like
  • Involuntary: making it harder to alter them

Remember: situations or events do not in themselves produce feelings. Rather, our interpretation of the situation determines our feelings, not the situation itself.

Exercise: Identifying your thoughts

  • Think of a time when you felt bad or distressed.
  • What was going on at the time? Write this situation or event in the situation column.
  • How did you feel? Write this in the Feeling column.
  • Now think hard about what thoughts you had at the time. Write these thoughts in the middle column.
  • Try doing this for two separate occasions when you felt distressed or upset.

Having difficulty identifying your thoughts?

The following prompts may help. In any situation in which you feel unhappy or anxious, ask yourself:

  • What do you think about yourself?
  • Is there anyone else involved in the situation? If so, what do you think about them?
  • What do you think that others think of you?
  • What do you think about the situation?

More than likely, your thoughts are making you feel worse.

Would others react the same way that you did?
Ask yourself:

  • How do you think someone else would feel if they had the same thought as you?
  • How would someone else feel if you told him/her the thought you had?

Most likely, you will be able to see that not everyone would think or feel the same after experiencing the same situation or event.

Once you have had a little practice identifying your thoughts in situations when you feel distressed, it is time to start challenging your thoughts and replacing them with thoughts that are less distressing.

Avoid trying to think in absolutes. Black and white thinking (all bad or all good) would be fine if the world was black and white, but unfortunately the world is built in shades of gray!

Wishful thinking: “Everything will be wonderful”
“I don’t care anyway…”
“If I just cross my fingers everything will be ok “

You want to avoid wishful thinking, as it does not help you. Wishful thinking is not believable!

Helpful/rational thinking: “I would much prefer if…”
“I’d prefer not to do…”
“I will try my hardest to ensure…”
“If things don’t work out as I would like, I will be disappointed, but it isn’t the end of the world.”

You should be able to see when you read the thoughts above that helpful or rational thinking is the healthiest. It will leave you feeling the most satisfied and content. Helpful or rational thinking does not involve trying to fool yourself into believing the unbelievable (this would be wishful thinking), nor does it leave you with unattainable goals or situations (such as in the absolutes of unhelpful or irrational thinking).

Use these prompts to help you:

What is the evidence for what you thought?

  • What would others say if they knew what you were thinking?
  • Would they think it is a reasonable thought?

What alternatives are there to what you thought?

  • Are there any other thoughts you or others could have instead?
  • Is your thought the only plausible or possible one?

How likely is it?

  • What is the actual probability that your thought will happen?
  • Has it ever happened before to you? How many times?
  • Have you ever been in the same situation and your fear didn’t come true?

What is the effect of thinking the way you do?

  • Is the way you are thinking helping you to achieve your goals?
  • Or does it cause an obstacle for you?

How much would it really matter?

  • What if your depressive thinking is correct?
  • What is the worst that could happen?

Depression

People who are depressed tend to think very negatively about themselves, the future and the world around them. It can be like seeing life through “gloomy specs”

Everything is hopeless – nothing can change
I’m useless, worthless
It’s all my fault
The world is a terrible place – everything goes wrong

Because of the tiredness, difficulty sleeping and eating, and negative style of thinking, we tend to do less and less. We stop doing the things we used to do and enjoy. It could get so bad that we can’t even go to work, or do things at home. We want to stay in bed, or stay at home doing very little. We might isolate ourselves from friends and family.

 

Breaking the cycle of depression

Activity & Physical Exercise

When we’re feeling depressed, we tend to do less and less because of the tiredness, difficulty sleeping and eating, and negative style of thinking. We stop doing the things we used to do and enjoy. It could get so bad that we can’t even go to work, or do things at home. We want to stay in bed, or stay at home doing very little, and we might isolate ourselves from friends and family.
Just increasing our activity and exercise levels can make an enormous impact on our mood by:
 Making us feel better about ourselves
 Making us feel less tired
 Motivating us to do more
 Improving our ability to think more clearly
 Helping us think about something other than focussing on our unhelpful thoughts
 Using up the adrenaline resources created by anxiety and anger
 Increasing motivation
 Giving us a sense of achievement
 Enjoyment
 Being with other people
 Stimulating the body to produce natural anti-depressants
 Making us generally more healthy
 Stimulating our appetite

Activity scheduling to minimise depression

Activity scheduling is a technique to assist you in scheduling various activities into your day-to-day lifestyle. It is often the case that when you are depressed, it is easy to stop doing the things you used to do. Unfortunately, doing less can make you feel more depressed, creating a vicious cycle as the more depressed you feel, the less you feel like doing.

Changing the way you feel by changing the way you behave

  • The problem with depression is that the symptoms that make up depression also make it difficult for you to start doing something to help yourself. Feeling fatigued, tired and listless makes it difficult to be motivated to help yourself.
  • Unfortunately it is a vicious cycle – if you feel too tired or listless to do things, you do less and then get upset for doing less. This only makes you feel worse, emotionally and physically, and reduces motivation further.
  • It is much like training for a marathon. Running a marathon will seem impossible for most people, but with consistent effort, it is attainable in small, incremental steps.

WARNING: Do not take on too much too early. Like training for a marathon, you must do it step by step. Master each stage before moving onto the next

The way you think affects the way you feel – for anxiety and depression

Looking at the way you think will allow you to assess whether it is the most helpful way of thinking about your difficulties. Unhelpful or unrealistic thinking often underlies depression. This can be changed, leading to more logical and helpful thinking.

Example 1:
Imagine the following situation: You are waiting to be picked up from work by a friend. He is 10 minutes late. Depending on how you interpret the situation, it may cause you to feel differently.

Event or situation: You are waiting to be picked up from work by a friend. He is 10 minutes late.
Thought (your interpretation of the event or situation): He has forgotten me. I am going to wait and wait, and I know he has forgotten to collect me. He doesn’t really want or like me.
Feeling (your reaction to your thoughts): most likely you feel upset and let down, maybe even depressed and anxious.

It is often assumed that a situation or event produces a feeling or emotion. However, it is not that simple. Events or situations do not produce emotion. There is an intervening step that affects how we feel. We place our own interpretations on the events that happen around us. We also bring our beliefs and values to our interpretations of the situations and events that occur around us. It is this interpretation, based on our own beliefs and value systems, that produces the emotions resulting from situations.

That is, an event produces a thought, which in turn produces a feeling.

Event or Situation –Thought –Feeling

Imagine what you would feel if you replaced the above thought with the one below.

Example 2:
Event or situation: You are waiting to be picked up from work by a friend. He is10 minutes late.
Thought (your interpretation of the event or situation): The traffic is always heavy at this time of the day. My friend is probably just stuck on his way here.
Feeling (your reaction to your thoughts): most likely you will feel calm and relaxed and wait patiently for your friend.

You can see that although the situation was the same in each example, the way you interpret the situation or event affects the way you feel.

Unfortunately, in example one, if you are worried you have been forgotten, the longer the friend takes to get there the worse you will feel. It is a vicious cycle, where you get stuck in the middle of a whirlpool, where your thoughts affect how you feel, and how you feel affects your interpretation of the situation, creating a spiral effect (see below for an example of this).

Example 3:
Event or situation: You are waiting to be picked up from work by a friend. He is10 minutes late.
Thought (your interpretation of the event or situation): He has forgotten me. I am going to wait and wait, and I know he has forgotten to collect me.
Feeling (your reaction to your thoughts): most likely, you feel upset and let down, maybe even depressed and anxious.
Thought (your interpretation of the event or situation): Everyone must think I am a loser as I am just waiting here but no one is coming to pick me up.
Feeling (your reaction to your thoughts): You will probably feel pretty anxious and distressed.
Thought (your interpretation of the event or situation): Everyone really is staring. They must be able to see that I am sweating and distressed.
Feeling (your reaction to your thoughts): You will probably feel pretty anxious and distressed, heart begins to beat faster, feel hot, sweaty and anxious.

Anxiety

Although you might feel alone in your struggle against anxious moods, the reality is that many people experience these moods either from time to time, or on a more regular basis. In fact, it is estimated that 1 in every 5 experience significantly anxious mood at some time in their life.
Anxiety can effect any kind of person at any stage of their life, whether they are an introvert or an extrovert, socially
active or shy, youthful or elderly, male or female, wealthy or poor. Whatever your distinction, you can become anxious.
That means that any person you know is also fair game. So remember, you are not alone.

Understanding Anxiety

Feeling afraid is very much a part of the experience of being human. It occurs in response to realistically anticipated
danger and therefore is a survival instinct. For example, if a ferocious animal confronted us it is likely
that we would respond with fear. This response is important because it initiates a whole series of physical and behavioural
changes that ultimately serve to protect us.
In this example, when confronted by an animal, the feeling of fear would probably lead us to either run for our lives or
become sufficiently ‘pumped up’ to physically defend ourselves. As you can see from this example, the experience of fear is part of a process of survival.

 

What Causes Anxiety?

The combination of factors which result in an individual developing an anxiety disorder differ from person to person.
However, there are some major factors that have been identified, which may be common to sufferers. These factors can be effectively divided into biological and psychological causes.

Biological Factors

A genetic factor has been linked to the development of anxiety disorders. For example, in obsessive-compulsive
disorder, about 20% of first-degree relatives have also suffered from the condition. Overall, based on family
studies, it has been suggested that individuals may inherit a vulnerability to developing an anxiety disorder.

Psychological Factors

Having this genetic vulnerability does not imply that those individuals will develop an anxiety disorder. A great deal
depends on the lifestyle of that person, the types of life stressors they have encountered and their early learning.
For example, if we were taught to fear certain neutral situations as a child it can become difficult to extinguish
these learned patterns of behaviour. Therefore, we may have developed certain patterns of thinking and behaving
which contribute to the development of an anxiety disorder.

Grounding techniques to ease anxiety

Turning off your biological ‘alarm system known as the amygdala (found in your brain) is the first step in reducing anxiety. Always start with your body before you move to the cognitive aspects (your thinking and behaving).

The box breathing method works exceptionally well. It gets your brain to question the fight, flight, freeze state because deep breathing is a contradiction to this tense anxious status. The beauty of deep breathing is that you can do it anywhere, at any time.

 

Mindfulness

  • Intentionally living with awareness in the present moment. (Waking up from automatic or rote behaviors to participate and be present to our own lives.)
  • Without judging or rejecting the moment. (Noticing consequences, discerning helpfulness and harmfulness—but letting go of evaluating, avoiding, suppressing, or blocking the present moment.)
  • Without attachment to the moment. (Attending to the experience of each new moment, rather than ignoring the present by clinging to the past or grabbing for the future.)

 

What Are Mindfulness Skills?

  • Mindfulness skills are the specific behaviors to practice that, when put together, make up mindfulness.

What Is Mindfulness Practice?

  • Mindfulness and mindfulness skills can be practiced at any time, anywhere, while doing anything. Intentionally paying attention to the moment, without judging it or holding on to it, is all that is needed.

 

References:

https://qbi.uq.edu.au/brain/brain-diseases/depression/depression-and-brain#:~:text=With%20regard%20to%20depression%2C%20neuroimaging,distinguishable%20between%20the%20two%20groups.