Episode 145: How Thoughts Impact Anxiety and Depression

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Dr. Melissa Smith 0:00
Can you think yourself into a depression? What about anxiety? Unfortunately, the truth is absolutely. Although of course, there are many factors that contribute to the development of these two very common mental health concerns at the root of both our thoughts that send us in a tailspin.

Dr. Melissa Smith 0:21
Hi, I’m Dr. Melissa Smith, welcome to the Pursue What Matters podcast, where we focus on what it takes to thrive in love and work. So over the past few weeks, I’ve been doing a deep dive into how your thoughts can create trouble in your life, right. So these thoughts over time can become cognitive distortions, which can then result in a triad of misery, known as the cognitive triad in which we have negative thoughts about ourselves, the world and the future. And over time, these negative thoughts can become so devastating in our lives. Because of course, the thoughts are never show up along right, the thoughts lead to painful emotions, which then leads to ineffective or undermining behaviors. And today, I want to talk about two common results of this pattern, depression and anxiety. And again, I just want to clarify again, that depression and anxiety have many factors that contribute to them. We’ll talk a little bit about that. But today, we’re really going to focus in on the role of our thoughts, how that tumbles into emotions and actions. And if we’re not careful, over time, that can contribute to both depression and anxiety. So of course, every week with a podcast, my goal is to help you pursue what matters. By strengthening your confidence to lead, I try to do that in one of three areas leading with clarity, which is all about purpose, leading with curiosity, which is all about self awareness, and leading and building a community. And today, as with the recent podcast, I’m really focusing on helping you lead with curiosity. As we understand our thoughts and our emotions and our actions, we increase our self awareness. And as a result, we increase our self leadership, which absolutely is the foundation for leading anyone else, don’t try to lead anyone else, until you know how to first lead yourself. That doesn’t mean you have to be perfect doesn’t mean you have to have everything figured out, but make a commitment to self leadership.

Dr. Melissa Smith 2:42
Okay, so let’s start by taking a look at anxiety and depression. These are the two most common mental health concerns in our society today. And of course, as a psychologist, I have dealt with lots of folks who struggle with these concerns. And they these can be devastating illnesses. So let’s take a look at anxiety. So Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults in the US age 18 or older. And that is about 18% 18 to 20% of the population every single year, is dealing with anxiety. So that’s a pretty high number. Anxiety disorders are highly treatable, but less than half ever actually received treatment. So there’s a lot of folks out there just suffering without, without professional help. And when we think about anxiety disorders, they definitely are something that warrant professional help and support. So I’ll talk a little bit more about that as we move forward. But you know, when it comes to the development of anxiety disorders, they they are a complex set of risk factors that contribute to the anxiety disorders, including genetics, brain chemistry, personality, life events. And of course, there’s not just one anxiety disorder, there are many, right we think about generalized anxiety disorder, which is the most common, we think about post traumatic stress disorder, we think about obsessive compulsive disorder, we think about social phobias, specific phobias, there are a lot that are covered in the anxiety disorders. And so when it comes to anxiety, right, it is actually a very normal part of life to experience occasional anxiety, right? As we face stressors, we have a stress response. And one of the most common stress responses is an increase in anxiety, agitation, worry, these are all very, very common, very typical of the human experience. But when you experience anxiety that is persistent, seemingly uncontrollable and overwhelming. This is when we really want to pay attention to the significance of anxiety, right and with any mental health issue, that’s what we’re always paying attention to how significant What are the concerns? How does it impact daily functioning, and so when anxiety starts to interfere with your daily activities, this is where we really start to look more at professional treatment and a little, a little strengthening of that support, but also intervention. And so anxiety that is persistent, seems uncontrollable, is overwhelming, and interferes with functioning, would be some signs to to move it to the next level of professional help. So that’s a little bit about anxiety.

Dr. Melissa Smith 5:36
So now let’s take a look at depression. So in the US, there were about 17 million adults with depression in the last year. So this is before the pandemic. And I just want to make note that the rates of depression and anxiety have both increased as a result of the pandemic, right, so that’s one of those complex factors. But we see quite a bit of depression, but not near as high as anxiety. So at any point in time, three to 5% of people suffer from major depressive disorder, which is the most common depression out there there. When it comes to depressive disorders. There are also there’s also quite a variety, right? We think about bipolar disorder, we think about post partum depression, right? The most common is major depressive disorder. At any given time, there are 264 million people worldwide, living with depression. So when we think about depression, we think about feeling discouraged, sad, hopeless, unmotivated, or uninterested in life. Those are heavy feelings. And of course, we’re in the winter months, which is where we see seasonal affective disorder, it really is a thing. And so we see higher rates of depression in the winter months, right? If there is a seasonal component, you would look towards seasonal affective disorder, as the specific diagnosis for that I think to know about major depressive disorder is, you know, just like anxiety, it, it impacts daily functioning, right.

Dr. Melissa Smith 7:21
So it is severe enough that it impacts daily functioning it, these symptoms persist for at least two weeks. And it’s also important to know that this is also very treatable. Both of these are very treatable. And so I just want to make a note, of course, with the podcast, I’m not trying to diagnose or treat anyone with a mental health concern or other health concern that really just want to educate you about how depression and anxiety can sometimes show up. And specifically today, we really want to pay attention to the role of our thoughts, recognizing that there are several factors. So when we think about some of the common symptoms of depression, we think about overwhelming sadness, loss of interest, and pleasure and usual activities, you can have a decrease or increase in appetite, insomnia, or hypersomnia, psychomotor, agitation or retardation, right. So we see kind of both ends of the spectrum. When it comes to depression, there can be constant fatigue, feelings of worthlessness, guilt, recurrent thoughts of death, or suicidal thinking, and lots of cognitive difficulties, which is one of the things we’re going to be talking about today. And so, you know, these, like I said, can be devastating illnesses. And unfortunately, they often go hand in hand. So nearly half of those diagnosed with depression are also diagnosed with an anxiety disorder. So just because you have depression doesn’t mean you don’t also have anxiety. It’s not a given, right, it’s about half. But it’s something that we always want to pay attention to. And then, of course, both the rate both rates for anxiety and depression have increased with the pandemic, as our networks of support have been challenged, and our stressors have greatly increased. So of course, most of us are pretty familiar with that, at this point. So now let’s think about how the cognitive triad makes anxiety and depression more likely. So if you remember, from a few podcasts ago, I talked about the cognitive triad that was the triad of misery. And these are negative thoughts about yourself, the world and the future. And this cognitive triad really can lead to very painful emotions, which then leads to very ineffective or undermining actions. And so it’s a bit of a domino effect there. And the most undermining thing that happens when distortions run the show is of widens.

Dr. Melissa Smith 10:00
Okay. And so this moves us to kind of the core of both anxiety and depression. So underlying, both anxiety and depression is avoidance. So as a psychologist, when I’m doing clinical work with someone, I’m always talking about avoidance, because it is just such a hallmark feature for folks with anxiety and depression. So at the heart of both of these illnesses is avoidance in the face of our painful thoughts, emotions and actions, what do we do, we hide, and I think it’s really understandable that you would hide because these thoughts, emotions, and actions are deeply painful. And we may feel like we don’t have the resources we need to help ourselves. And I think even if you haven’t struggled with depression, or anxiety, I think most of us can relate to these experiences of wanting to avoid something that feels challenging, right, you don’t have direction, you don’t know what to do, you feel a little helpless. And it just, it feels easier to avoid. And so instead of facing these thoughts, emotions and actions head on, we actually run from them. So we avoid challenging our cognitive distortions. And we avoid giving ourselves compassion for our painful emotions, right? That’s what we need, when we come face to face with these painful emotions. And we don’t take responsibility for our actions.

Dr. Melissa Smith 11:29
So sometimes we make choices that are very helpful to us, or we make choices that harm others. And instead of taking responsibility for our actions, and correcting whatever the concern is, we avoid that responsibility. We shirk away from that. And so of course, this creates a domino effect of greater suffering, and larger negative consequences in our life. So it really is quite a storm. So from mindfulness, we get this simple equation, I just love it, I think it’s so helpful. And that is pain, plus resistance equals suffering, okay, so you can think about resistance, you can interchange that with avoidance, that’s we’re talking about the same thing. So pain is a reality of life. Right? Because life is challenging. And so pain is part of that equation. And life will always include some amount of pain, unfortunately, right. And, you know, that’s, that’s just a reality. But when we add resistance, or avoidance to pain, the the result is suffering. And suffering. Not always, but often is optional. And it comes about as a result of our avoidance. So let’s talk a little bit more about this. And the paradox of painting. That’s what I call it. So in the short term, we get to avoid what’s troubling us. Right. And that feels good there. That brings us a sense of relief, right? So our pain is lessened for, you know, a few minutes, a few days, whatever the case may be. But here’s the here’s the sticky, hard truth, we haven’t really dealt with the issue at hand. So the challenge, the stressor, the conflict, whatever it might be, we haven’t truly dealt with it, we’ve just pushed it aside. And so over time, that stressor, and our fear and pain related to that stressor, or that challenge build up, right, because we haven’t actually addressed it. And so long term, the result is that we are less able to cope and less able to problem solve. Because when we face challenges, instead of engaging our problem solving, and developing the confidence and the skills to tackle challenges head on, we hide we avoid. And so now let’s take a look at what this looks like for both depression and anxiety. The foundation of both are very, are really the same, but they show up in kind of unique ways. So when we think about depression, what are some of the core thoughts about the self right?

Dr. Melissa Smith 14:19
So these are these cognitive distortions? Well, one very common one is AI, the problem which leads to the emotion of fear, which leads to the action of hiding from life. So there we see that avoidance when it comes to anxiety. One of the thoughts about myself is I can’t handle life, which results in fear, right? That’s pretty frightening if you don’t feel like you can handle life. And instead of hiding from life, although there’s lots of avoidance when it comes to anxiety, tons of avoidance. One of the common approaches with anxiety is to control troll life. Right? So depression might hide from life. Anxiety is a little more likely to control life, although there’s plenty of avoidance as well. So let’s think about depression thoughts about the world, what are the thoughts about the world, the world is dangerous leads to fear leads to hiding. And this hiding shows up, it looks like isolation. There’s no pleasure in previously enjoyed activities. There’s all or nothing thinking because it’s all or nothing thinking helps us to simplify uncertainty. And I talked about that when we talked about cognitive distortions a few episodes ago. So what are the anxiety thoughts about the world? So one of the core thoughts is I can’t handle a life, which leads to a feeling of overwhelm, also fear. And so if we don’t feel like we can have a life, we’re overwhelmed. One of the responses, one of the actions is to control. So those are anxiety ton to scan the horizon for dangers. And everywhere they look, they see danger, there’s a tendency to micromanage. Because if I can, if I can micromanage and control the uncertainties of life, then I can be safe. So they try to reduce uncertainty, they avoid anything that might be risky. So you can see how life gets smaller. There’s a whole lot of perfectionism, because it’s all about that controlling, right? These folks might be called control freaks. So their response to fear about the world is around control. Think about obsessive compulsive disorder, think about PTSD.

Dr. Melissa Smith 16:38
Now, PTSD has a lot of control. It also has a lot of avoidance, which we also see with depression. So when it comes to thoughts about the future, the thoughts of depression and anxiety are very similar. And that is all is lost. There’s helplessness and hopelessness. And so what are the actions? What does that look like? Folks stop trying, their life gets smaller and smaller and smaller. When it comes to depression, you might see suicidality, unfortunately, when it comes to anxiety, you might see worsening panic, you might see panic attacks, you might see an OCD, or an eating disorder worsening over time. And so the underlying belief with all of these is, is that life is dangerous, the world is dangerous, and fear, laces, everything. Okay? So hopefully that helps you to understand the role of thoughts, and how those thoughts contribute to emotions and actions, that if left unchecked, can really be a big contributing factor to depression, anxiety, it’s not the only factor. But it’s certainly something to pay attention to. And so let’s finish up by learning a little bit more about what to do about anxiety and depression. And so I’m speaking to you as if you’re a loved one. But this is also speaking to you as though you’re struggling with anxiety or depression. So, my recommendations, I’ve got three recommendations here for you. And they should apply to you whether you’re the one struggling with some of these symptoms, or whether you love someone or supporting someone with these concerns. So the first recommendation, take it seriously. don’t minimize your own experience, don’t minimize others experience, seek professional help. These are significant health concerns, they need a serious intervention. Think about crisis support lines, they have hotlines, they also have warm lines in many states where it’s not a crisis situation. But perhaps you need an objective third party to talk to. Sometimes there can be a lot of guilt associated with these concerns. And so there’s a little bit of a reluctance to reach out to loved ones of course, we want to overcome that barrier. But it’s important to know about hotlines and warm lines as an additional source of support. And so that’s the first recommendation take it seriously, both for yourself and for others. The second recommendation is to listen and learn. So be compassionate with yourself. Be compassionate with others, learn all you can without overwhelming yourself. So understanding can make a big difference. Because these illnesses can be very isolating you feel like you’re the exception you feel so set apart from everyone else. And so learning and understanding that there are names for what you’re experiencing can make a big difference. Some of the places to look for understanding include readings, articles, websites, on CBT, which is cognitive behavioral therapy, this really helps you to attack cognitive distortions, the cognitive triad, and it uses the ABC model.

Dr. Melissa Smith 20:10
So if you’ve been listening to the podcasts in recent weeks, the weeks these terms should all be familiar because we’ve been talking about CBT, which is the most, the the most popular approach to depression and anxiety. It’s got tons of research support. And of course, the other resources I’m going to give to you also are, have strong evidence base for them, they’ve been found to be quite effective for these illnesses. And so we’re talking about learning all you can. So I just talked about CBT. And then there’s Act which is Acceptance and Commitment, therapy. And this is similar to CBT. It’s not the same, but it is helping you to recognize that you are not your thoughts. It helps you to live to your values, despite the pain of depression and anxiety. And that in that process, depression and anxiety begin to fall away as you are engaging in purpose driven living and choices. And so resources on act can be very, very helpful. And then the other topic that you could learn about is DBT. And this is known as Dialectical Behavioral Therapy. So when we think about DBT, it’s really learning to overcome avoidance, it’s doing the opposite of what you feel, which can feel very challenging. But there’s some really great support and structure built into DBT. There’s also a big focus on emotional regulation, and communication skills, asking for what you need, getting support that can be helpful. So as part of listening and learning, you can ask what does support look like? You can ask that for yourself, you can ask that for someone you love. What does support look like? How can I help you here? How can I help myself here. So we think in terms of accountability, and encouragement, so you can invite connection you can check in, but do so without pressure, let’s not have if your loved one, let’s not let your anxiety or your worry, get in the way of what might be helpful for the other person. So we want to invite we want to check in but do so without pressure. Okay. And now the third recommendation that I have for you, is to prioritize self care and coping skills. And this is for you, if you’re struggling with either of these. This is also for you if you are a loved one, because anxiety and depression takes a toll on everyone. Okay, so when we think about the basics, we think about ADLs. These are activities of daily living. So think about sleep, think about hygiene, showering, laundry structure, a flexible schedule, that helps you to get moving to help shoot that to help you to overcome the paralysis of anxiety to help overcome the hopelessness of depression. So these daily activities are really, really important for everyone involved. We think about balanced movement exercise can really help with these illnesses, we think about a mindfulness practice to help you gain some distance between your thoughts. And yourself, that can be incredibly helpful. We also want to pay attention to a strong social connection. Right? So we’re thinking about love and affection, being able to cry with someone being able to laugh with someone having a relationship where you have permission to feel. We also think and this is related, but we think about community, what religious and spiritual communities do you have access to? Spirituality can make a really big difference when it comes to overcoming and coping with these illnesses? We think about professional communities. Do you have friends at work? We think about personal communities, what does your neighborhood look like? Do you get together with your friends, and sometimes you have to force yourself to do that. And you know that that can be good, right?

Dr. Melissa Smith 24:20
We force ourselves to spend some time with others. And then we give ourselves a break and recovery period after that. And that can be very helpful that in in that were showing up with compassion, but we’re also nudging ourselves past that avoidance. Creative expression can be very helpful. So engaging in a hobby, learning a new skill that’s not too taxing, but can be fun can give you a break from the burden of your thoughts. We think about time in nature, thinking about rituals, simple rituals that require some Attention, and can give you a break from that intensity of the negative thoughts. And then remembering right as part of this third recommendation to take one day at a time. And sometimes you just need to take one minute at a time, one hour at a time. Don’t get too far ahead of yourself, right? We don’t want to get into future tripping. We just want to stay present. And so I hope that this podcast has been helpful for you in terms of really understanding how thoughts can impact depression and anxiety to kind of help you see that foundation that is underneath both anxiety and depression around avoidance and how we can help to challenge some of those, some of those cognitive distortions. And then of course, I talked about three recommendations for yourself or for someone you love when it comes to anxiety and depression. And so I’ll review those again. The first one is take it seriously. The second one is listen and learn. And third is prioritize self care and coping skills. So head on over to my website to check out the show notes with the resources for this episode at www.drmelissasmith.com/145-thoughtsondepression one more time, that’s www.drmelissasmith.com/145-thoughtsondepression. So of course if you are not feeling safe, call 911. Reach out to someone let someone know if you’re having a hard time and know that there is hope and there are many resources for you and for those you love. So, in the meantime, I’m Dr. Melissa Smith. Remember love and work, work and love. That’s all there is. Until next time, take good care.

Transcribed by https://otter.ai