How Does Psychotherapy Treat Anxiety Disorders
Psychotherapy, or counseling, helps you deal with your emotional response to the illness. A mental health provider talks through strategies to help you better understand and manage the disorder. Approaches include:
- Cognitive behavioral therapy is the most common type of psychotherapy used with anxiety disorders. CBT for anxiety teaches you to recognize thought patterns and behaviors that lead to troublesome feelings. You then work on changing them.
- Exposure therapy focuses on dealing with the fears behind the anxiety disorder. It helps you engage with activities or situations you may have been avoiding. Your provider may also use relaxation exercises and imagery with exposure therapy.
How Are Anxiety Disorders Treated
An anxiety disorder is like any other health problem that requires treatment. You cant will it away. Its not a matter of self-discipline or attitude. Researchers have made a lot of progress in the last few decades in treating mental health conditions. Your healthcare provider will tailor a treatment plan that works for you. Your plan may combine medication and psychotherapy.
Endocrine Processes In Depression
A variety of hormonal abnormalities, such as altered levels of Cortisol, growth hormone , or thyroid hormones, indicate the existence of endocrine disturbances, especially dysfunctions in the hypothalamuspituitary-adrenal axis and/or the regulation of thyroid function. The consistent finding that a significant subpopulation of depressed patients hypersecrete Cortisol during the depressed state but not after recovery led to intensive investigation and analysis of the HPA system. The observations include hypersecretion of hypothalamic corticotropin-releasing hormone and inadequate glucocorticoid feedback, increased Cortisol levels, and impaired suppression of the HPA axis in response to exogenous glucocorticoid administration.- A more refined analysis recently led to formulation of the concept that impaired corticosteroid receptor signaling is a key mechanism in the pathogenesis of depression.
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The Brain’s Impact On Depression
Popular lore has it that emotions reside in the heart. Science, though, tracks the seat of your emotions to the brain. Certain areas of the brain help regulate mood. Researchers believe that more important than levels of specific brain chemicals nerve cell connections, nerve cell growth, and the functioning of nerve circuits have a major impact on depression. Still, their understanding of the neurological underpinnings of mood is incomplete.
What Is Clinical Depression
Clinical depression is a serious form of mental illness that impacts more than just a persons mood. It affects the way a person:
- Thinks
- Feels
- Manages their life
A diagnosis of clinical depression means that a person has symptoms that interfere with the ability to function at work and home, which adversely impacts the way a person is able to enjoy hobbies and leisure activities, socialization, relationships, and more.
Clinical depression involves more than just emotions, it encompasses physical symptomssuch as inability to sleep and loss of appetiteas well. Its important to note that clinical depression is a set of signs and symptoms that may reflect a chemical imbalance in the brain.
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How Is Depression Treated
Depression, even severe depression, can be treated. Its important to seek treatment as soon as you begin noticing signs. If you think you may have depression, start by making an appointment to see your doctor or health care provider.
Certain medications or medical conditions can sometimes cause the same symptoms as depression. A doctor can rule out these possibilities through a physical exam, learning about your health and personal history, and lab tests. If a doctor finds there is no medical condition that is causing the depression, he or she may suggest a psychological evaluation and refer you to a mental health professional such as a psychologist to perform this test. This evaluation will help determine a diagnosis and a treatment plan.
Common forms of treatment for depression include:
What Is An Anxiety Disorder
An anxiety disorder is a type of mental health condition. If you have an anxiety disorder, you may respond to certain things and situations with fear and dread. You may also experience physical signs of anxiety, such as a pounding heart and sweating.
Its normal to have some anxiety. You may feel anxious or nervous if you have to tackle a problem at work, go to an interview, take a test or make an important decision. And anxiety can even be beneficial. For example, anxiety helps us notice dangerous situations and focuses our attention, so we stay safe.
But an anxiety disorder goes beyond the regular nervousness and slight fear you may feel from time to time. An anxiety disorder happens when:
- Anxiety interferes with your ability to function.
- You often overreact when something triggers your emotions.
- You cant control your responses to situations.
Anxiety disorders can make it difficult to get through the day. Fortunately, there are several effective treatments for anxiety disorders.
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What Is The Link Between Smoking And Mental Health Conditions
Smoking is much more common among adults with mental health conditions, such as depression and anxiety, than in the general population.6 About 3 out of every 10 cigarettes smoked by adults in the United States are smoked by persons with mental health conditions.6 Why smokers are more likely than nonsmokers to experience depression, anxiety, and other mental health conditions is uncertain. More research is needed to determine this. No matter the cause smoking is not a treatment for depression or anxiety. Getting help for your depression and anxiety and quitting smoking is the best way to feel better.
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Why Are Anxiety And Depression Often Co
Its a cycle, says Sally R. Connolly, LCSW and therapist. When you get anxious, you tend to have this pervasive thinking about some worry or some problem. You feel bad about it. Then you feel like youve failed. You move to depression.
These two disorders anxiety and depression have a complicated relationship:
- The chance of acquiring depression is much higher when an anxiety disorder already exists. Nearly half of those with major depression also suffer from severe and persistent anxiety.
- People who are depressed often feel anxious and worried. One can easily trigger the other, with anxiety often preceding depression.
- People with post-traumatic stress disorder are especially prone to developing depression.
- A biological predisposition for both of these conditions if often at the root of an individuals battle. This seems to be true with anxiety disorders even more than with depression. Connolly explains, Some people are just worriers and pass it down.
People with an anxiety disorder should speak with a psychiatrist, therapist or other healthcare professional about their symptoms. Treatment for an anxiety disorder should not be delayed. If not caught in time, depression may find the door wide open for moving in and setting up house in those individuals.2
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Government Of Canada’s Role
The Government of Canada is working to help Canadians improve and maintain their mental health, including coping with anxiety disorders. Within its jurisdiction, the Government of Canada works to:
- Support Canada’s researchers in finding ways to prevent and treat mental illnesses and disorders.
- Strengthen the capacity of the primary health care, home care and acute care sectors to effectively deliver mental health programs and services.
- Work in collaboration with other governments and non-governmental organizations to improve the mental health of Canadians.
- Provide high quality, reliable information to the public.
- Report on health trends in the population.
In 2007, the federal government provided funding to establish and support the Mental Health Commission of Canada. Among other goals, the Commission leads in the development of a national mental health strategy and works to reduce the stigma about mental illness.
Symptoms Of Anxiety And Depression
According to the current Diagnostic and Statistical Manual of Mental Disorders , the standard classification of mental disorders used by mental health professionals in the United States, anxiety and depression can share several common symptoms, including, but not limited to:
- Being easily fatigued
- Sleep disturbance
Other signs that a person may suffer from both anxiety disorder and depression include:
- Constant, irrational fear and worry
- Physical symptoms like rapid heartbeat, headaches, hot flashes, sweating, abdominal pain, and/or difficulty breathing
- Changes in eating, either too much or too little
- Persistent feelings of sadness or worthlessness
- Loss of interest in hobbies and activities
- Inability to relax
- Panic attacks
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What Strategies Are Often Used In Treating This Dual Diagnosis
Evidence-based research suggests that both anxiety and depression be treated at the same time.
Effective strategies often used in treating these co-occurring conditions include:
- Cognitive Behavioral Therapy CBT is often used to treat people with both disorders. Fears, anxieties and tendencies toward depression are managed by seeking out their root causes. Once uncovered, patients learn how to take control of their emotions and life.
- Antidepressant medications Often combined with CBT, these may be prescribed in treating both disorders. Selective serotonin reuptake inhibitors are new antidepressant drugs that produce fewer side effects than their predecessors.
- Exercise This can be very helpful for both disorders. Physical activity causes feel-good chemicals to be released in the body. This aids in relaxation and feeling of well-being.
- Relaxation techniques This typically involves meditation or mindfulness. These techniques can often help to remedy both disorders and improve quality of life.2
Mental Markers Of Depression
People with depression may:
- Be hopeless, assuming that nothing positive will happen in the future for themselves, for others, or for the world
- Believe it is not worth trying to think or feel differently, because of this hopelessness
- Feel worthless, as if who they are or what they do is not valuable
- Think about death due to a persistent belief that life is not worth living or that the individual is a burden on others. In cases of moderate to severe depression, more specific suicidal thoughts can be present.
In major depressive disorder , these types of thoughts are persistent most of the day and more days than not for weeks on end. If a person vacillates between a very low and very high mood state, then a diagnosis of bipolar disorder may apply. For any variant of a mood disorder, the low mood state is likely to be characterized by the type of thinking described above.
If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
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The Masking Effect Of Medical Comorbidity
The depression/anxiety comorbidity story would not be complete without emphasizing the additional complication of general medical comorbidity. Patients in primary care who have a depression or anxiety disorder diagnosis report an average of 2 to 3 concurrent chronic medical illnesses, a rate that is more than double that reported by patients who do not suffer from depression or anxiety. Conversely, patients with diagnosed general medical illnesses, especially chronic conditions, are at significantly increased risk for developing depression and/or anxiety disorders. Studies indicate that 20% to 50% of patients with many common medical illnesses will develop depression . The rates for anxiety disorders are similarly high.
Rates of Depression in Patients With Medical Illnessa
Despite these high rates of concurrent illness, the presence of a primary general medical diagnosis markedly reduces the detection rate of depression and anxiety disorders: only 1 of every 5 patients who present with depression or anxiety and medical comorbidity receive appropriate treatment for their psychiatric illness. This low detection rate is unfortunate because more than 80% of these patients, in any given year, will visit their primary care physicians. In contrast, less than 2% will see a psychiatrist or other mental health specialist without having first visited their primary care physician.
Talking With Friends And Family About Suicide
Its important to watch for signs and symptoms of depression or suicide. Dont shy away from asking if a family member or friend is feeling depressed or suicidal. It may be an uncomfortable conversation, but it is important. Asking if someone is having thoughts of suicide will not make them more likely to act on those thoughts. Your questions may help the person open up about how theyve been feeling and encourage them to seek treatment.
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Interaction Betweenmonoamines And Other Neurotransmittersand Neuropeptides
Three decades after its formulation, the monoamine hypothesis of depression underwent various adaptations. Although it has contributed to our understanding of the regulation of neuronal function in general, there is no doubt that a dysfunction in one of the monoaminergic systems alone does not provide an adequate explanation for the pathophysiology of depression or the mechanism of drug action. One of the intriguing problems of therapy is the fact that it takes several days to weeks before the antidepressant effect becomes apparent, although the neurotransmitter concentrations are increased within hours of a single dose of reuptake inhibitor. The results of depletion studies further support the hypothesis that a simple change in the level of one of the monoamines or their receptor affinity is sufficient to induce or alleviate depression.
Treatment Of Anxiety Disorders
Anxiety disorders can be successfully treated. The most common form of treatment is a combination of drug therapy and cognitive-behavioral therapy .
Because most anxiety disorders have some biological basis, the most common drugs prescribed are anti-depressants and anti-anxiety drugs.
CBT involves helping people to turn their anxious thoughts and feelings into more rational ones. Sometimes people will benefit from being exposed in a controlled way to the object and situation they fear. Some CBT techniques have been developed to deal with specific disorders. For example, people with panic disorder can benefit from learning new breathing and meditation techniques, which can help them deal with their anxiety.
Support groups and learning more about the disorder can also help a great many people deal with anxiety disorders. Involving family and friends who are also affected by the disorder, can help people recover or learn how to cope with their condition.
The most important first step in treatment is to get a proper diagnosis from a specialist in anxiety disorders. Many people suffer for 10 years or more before getting the right treatment.
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Biochemical Basis Of Depression
The enormous progress in the field of neuroscience in the 20th century brought us fascinating insights into the nature of mental processes. Starting with neuroanatomy and electrophysiology at the beginning of the 20th century, neuroscience now is an interdisciplinary field occupying many areas of biological investigations, ranging from molecular studies of cell and gene function to brain-imaging techniques, thus broadening our knowledge of the cellular and molecular machinery that regulates behavior. For a long time, and especially in the field of psychiatry, little was known about the biological substrates of the disorders and the work of Julius Axelrod, Arvid Carlsson, and several other Nobel Prize winners has significantly contributed to the understanding of brain function, and investigations of psychiatric disorders are now fully based in basic neuroscience.
Helping Someone With Depression
When you see a family member or friend experiencing an episode of depression, its normal to want to reach out and lend a hand. But when it comes to depression, what you can do to help isnt always clear.
Loved ones of a person with depression may remain silent, fearful of making the situation worse or alienating the person they care about. And while more people are becoming aware of depression and its effects, stigma tied to the condition persists and prevents people from discussing it.
If you think a loved one could be experiencing a depressive episode, there are ways you can offer support.
Below are some articles that offer guidance for people who want to learn how they can best support a loved one who has depression.
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Differential Diagnosis And Comorbidity
When evaluating a patient for a suspected anxiety disorder, it is important to exclude medical conditions with similar presentations . Other psychiatric disorders use of substances such as caffeine, albuterol, levothyroxine, or decongestants or substance withdrawal may also present with similar symptoms and should be ruled out.5
Complicating the diagnosis of GAD and PD is that many conditions in the differential diagnosis are also common comorbidities. Additionally, many patients with GAD or PD meet criteria for other psychiatric disorders, including major depressive disorder and social phobia. Evidence suggests that GAD and PD usually occur with at least one other psychiatric disorder, such as mood, anxiety, or substance use disorders.10 When anxiety disorders occur with other conditions, historic, physical, and laboratory findings may be helpful in distinguishing each diagnosis and developing appropriate treatment plans.
Anxiety And Depression: What Are The Possible Links
Although clearly not identical emotional states, mental health research suggests that depression and anxiety often coexist because they can be caused by the same or similar factors. According to an article published May 2020 in the American Journal of Psychiatry, those overlapping causes can include:
- Genetic Factors Genetic factors contribute to 40 percent of the predisposition to depressive and anxious symptoms, with 60 percent being attributed to environmental, noninherited factors. “Especially with anxiety, more so than depression, there often is some family history, and so therefore we think that there may be some genetic predisposition to this,” Connolly explains.
- Environmental Factors Also referred to as social factors, these include experiences like trauma or neglect in early childhood, and current stressors such as relationship difficulties, unemployment, social isolation, and physical illness. People who have post-traumatic stress disorder , an anxiety disorder, are particularly likely to also develop depression, according to the National Institute of Mental Health .
- Pain Chronic pain, and particularly disabling pain syndromes such as fibromyalgia, irritable bowel syndrome , low back pain, headaches, and nerve pain, are closely linked to psychological distress, including both anxiety and depression, notes Harvard Health. In fact, they say, research suggests that pain shares some biological mechanisms with anxiety and depression.
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