Anxiety, PTSD, and Depression

It’s a normal part of life to experience occasional anxiety and depressed mood.

But you may experience anxiety and depressed mood that is persistent, seemingly uncontrollable, and overwhelming. If it’s an excessive, irrational dread of everyday situations, it can be disabling. When anxiety interferes with daily activities, you may have an anxiety disorder.

It is worth noting that when anxiety occurs in children and adolescents, this leads to an increased risk for other mental health problems and, if left untreated, anxiety often persists into adulthood (Albano, Chorpita, & Barlow, 2006).

ANXIETY

The term “anxiety disorder” includes generalized anxiety disorder (GAD),  panic disorder and panic attacks, agoraphobia, social anxiety disorder, selective mutism, separation anxiety, and specific phobias.

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are closely related to anxiety disorders, which some may experience at the same time as depression.

Depression is a condition in which a person feels discouraged, sad, hopeless, unmotivated, or disinterested in life in general for more than two weeks and when the feelings interfere with daily activities. Major depression is a treatable illness that affects the way a person thinks, feels, behaves, and functions. At any point in time, 3 to 5 percent of people suffer from major depression; the lifetime risk is about 17 percent.

Did You Know?

  • Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18% of the population. (Source: National Institute of Mental Health)
  • Anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment.
  • Anxiety disorders cost the U.S. more than $42 billion a year, almost one-third of the country’s $148 billion total mental health bill, according to “The Economic Burden of Anxiety Disorders,” a study commissioned by ADAA (The Journal of Clinical Psychiatry, 60(7), July 1999).
    • More than $22.84 billion of those costs are associated with the repeated use of health care services; people with anxiety disorders seek relief for symptoms that mimic physical illnesses.
  • People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders.
  • Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.

Anxiety and Depression

It’s not uncommon for someone with an anxiety disorder to also suffer from depression or vice versa. Nearly one-half of those diagnosed with depression are also diagnosed with an anxiety disorder.

Find out more about depression.


FACTS

Generalized Anxiety Disorder (GAD)
GAD affects 6.8 million adults, or 3.1% of the U.S. population.
Women are twice as likely to be affected as men.

Panic Disorder
6 million, 2.7%
Women are twice as likely to be affected as men.
Very high comorbidity rate with major depression.

Social Anxiety Disorder
15 million, 6.8%
Equally common among men and women, typically beginning around age 13.
According to a 2007 ADAA survey, 36% of people with social anxiety disorder report experiencing symptoms for 10 or more years before seeking help.

Specific Phobias
19 million, 8.7%
Women are twice as likely to be affected as men.
Typically begins in childhood; the median age of onset is 7.

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are closely related to anxiety disorders, which some may experience at the same time, along with depression.

Obsessive-Compulsive Disorder (OCD)
2.2 million, 1.0%
Equally common among men and women.
The median age of onset is 19, with 25 percent of cases occurring by age 14. One-third of affected adults first experienced symptoms in childhood.

Posttraumatic Stress Disorder (PTSD)
7.7 million, 3.5%
Women are more likely to be affected than men.
Rape is the most likely trigger of PTSD: 65% of men and 45.9% of women who are raped will develop the disorder.
Childhood sexual abuse is a strong predictor of lifetime likelihood for developing PTSD.

Biofeedback and Neurofeedback are emerging treatments for PTSD. For a recently randomize controlled trial (RCT) that demonstrated the effectiveness of neurofeedback for treating the symptoms of PTSD click here. For a new experiment using neurofeedback for PTSD click here. For an excellent review of PTSD and the various treatment options available, see Dr. Bessel van der Kolk’s book, The Body Keeps Score: Brain, Mind, and Body in the Healing of Trauma:

We offer a number of the treatments modalities described in this book including trauma-based psychotherapies, neurofeedback, and trauma-sensitive yoga (coming soon).

Here is a short video clip on the use of neurofeedback for veterans with Posttrauamtic Stress Disorder (PTSD):

Major Depressive Disorder
The leading cause of disability in the U.S. for ages 15 to 44.3
Affects more than 15 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.
While major depressive disorder can develop at any age, the median age at onset is 32.5
More prevalent in women than in men.

Persistent depressive disorder, or PDD, (formerly called dysthymia) is a form of depression that usually continues for at least two years.
Affects approximately 1.5 percent of the U.S. population age 18 and older in a given year. (about 3.3 million American adults).
The median age of onset is 31.1

Related Disorders
Many people with an anxiety disorder also have a co-occurring disorder or physical illness, which can make their symptoms worse and recovery more difficult. It’s essential to be treated for both disorders.

Read on to learn more about the co-occurrence of anxiety and these disorders:

Children 
Anxiety disorders affect one in eight children. Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance abuse.

Anxiety disorders also often co-occur with other disorders such as depression, eating disorders, and attention-deficit/hyperactivity disorder (ADHD).

Older Adults
Anxiety is as common among older adults as among the young. Generalized anxiety disorder (GAD) is the most common anxiety disorder among older adults, though anxiety disorders in this population are frequently associated with traumatic events such as a fall or acute illness. Read the best way to treat anxiety disorders in older adults.

Treatment Options
Anxiety disorders are treatable, and the vast majority of people with an anxiety disorder can be helped with professional care. Several standard approaches have proved effective:


DEPRESSION

Most people feel anxious or depressed at times. Losing a loved one, getting fired from a job, going through a divorce, and other difficult situations can lead a person to feel sad, lonely, scared, nervous, or anxious. These feelings are normal reactions to life’s stressors.

But some people experience these feelings daily or nearly daily for no apparent reason, making it difficult to carry on with normal, everyday functioning. These people may have an anxiety disorder, depression, or both.

It is not uncommon for someone with an anxiety disorder to also suffer from depression or vice versa. Nearly one-half of those diagnosed with depression are also diagnosed with an anxiety disorder. The good news is that these disorders are both treatable, separately and together.

Read on to find out more about the co-occurrence of anxiety and depression and how they can be treated.

Depression is a condition in which a person feels discouraged, sad, hopeless, unmotivated, or disinterested in life in general. When these feelings last for a short period of time, it may be a case of “the blues.”

But when such feelings last for more than two weeks and when the feelings interfere with daily activities such as taking care of family, spending time with friends, or going to work or school, it’s likely a major depressive episode.

Major depression is a treatable illness that affects the way a person thinks, feels, behaves, and functions. Depression is one of the most common mental disorders in the United States. In 2014, around 15.7 million adults age 18 or older in the U.S. had experienced at least one major depressive episode in the last year, which represented 6.7 percent of all American adults. At any point in time, 3 to 5 percent of adults suffer from major depression; the lifetime risk is about 17 percent. As many as 2 out of 100 young children and 8 out of 100 teens may have serious depression.

Screen yourself or a loved one for depression.

Types of Depression

Three main types of depressive disorders—major depression, persistent depressive disorder, and bipolar disorder—can occur with any of the anxiety disorders.

Major depression involves at least five of these symptoms for a two-week period. Such an episode is disabling and will interfere with the ability to work, study, eat, and sleep. Major depressive episodes may occur once or twice in a lifetime, or they may recur frequently. They may also take place spontaneously, during or after the death of a loved one, a romantic breakup, a medical illness, or other life event.

Some people with major depression may feel that life is not worth living and some will attempt to end their lives.

Persistent depressive disorder, or PDD, (formerly called dysthymia) is a form of depression that usually continues for at least two years. Although it is less severe than major depression, It involves the same symptoms as major depression, mainly low energy, poor appetite or overeating, and insomnia or oversleeping. It can manifest as stress, irritability, and mild anhedonia, which is the inability to derive pleasure from most activities.

People with PDD might be thought of as always seeing the glass as half empty.

Bipolar disorder, once called manic-depression, is characterized by a mood cycle that shifts from severe highs (mania) or mild highs (hypomania) to severe lows (depression).

During the manic phase, a person may experience abnormal or excessive elation, irritability, a decreased need for sleep, grandiose notions, increased talking, racing thoughts, increased sexual desire, markedly increased energy, poor judgment, and inappropriate social behavior.

During the depressive phase, a person experiences the same symptoms as would a sufferer of major depression. Mood swings from manic to depressive are often gradual, although occasionally they can occur abruptly. Learn more about bipolar disorder.

Depression and Anxiety Disorders: Not the Same

Depression and anxiety disorders are different, but people with depression often experience symptoms similar to those of an anxiety disorder, such as nervousness, irritability, and problems sleeping and concentrating. But each disorder has its own causes and its own emotional and behavioral symptoms.

Many people who develop depression have a history of an anxiety disorder earlier in life. There is no evidence one disorder causes the other, but there is clear evidence that many people suffer from both disorders.

*Adapated from the Anxiety and Depression Association of America (ADAA.org)


WHAT IS EVIDENCE-BASED PRACTICE?

When people look for mental health treatment for themselves or a loved one, it is common to search for a psychotherapy provider who may have availability in their schedule, desired fees, or is covered by a specific insurance plan. However, it is essential that people in search of treatment also get specific information about the type of treatment that a mental health care provider will offer.

Not all mental health treatments are equally efficacious, and consumers must be educated when searching for a therapist. Some therapies may work better than others.

Mental health care providers (i.e., psychotherapists, such as psychologists, social workers, psychiatrists) may subscribe to different ‘schools of thought,’ or philosophies on how to effectively reduce psychological symptoms. Some of these philosophies are based directly on scientific evidence that indicates the best routes to symptom relief. However, other mental health care providers may offer treatment that is not based on strong scientific evidence, or for which no evidence is available to date. Adherence to psychological approaches and techniques that are based on scientific evidence is referred to as “Evidence-based Practice” (EBP).

Unfortunately, many members of the public are unaware that evidence-based practices exist. Consequently, patients may remain in long-term psychotherapy for months, or even years, without realizing that evidence-based options are available. Note that EBP therapies are listed as ‘Best Practice’ and ‘preferred’ approaches for psychological symptom treatment both the American Psychiatric Association and the American Psychological Association

What are EBPs ?
EBPs are treatments that are based directly on scientific evidence suggesting that strongest contributors and risk factors for psychological symptoms. Most EBPs have been studied in several large-scale clinical trials, involving thousands of patients and careful comparison of the effects of EBPs vs. other types of psychological treatments. Dozens of multi-year studies have shown that EBPs can reduce symptoms significantly for many years following the end of psychological treatment – similar evidence for other types of therapies is not available to date.

The most commonly used evidence-based practice approaches for the treatment of psychological symptoms involve cognitive and behaviour therapies (CBT). The efficacy of CBT has been demonstrated for a wide-range of symptoms in adults, adolescents, and children.

Adapted from The Association for Behavioral and Cognitive Therapies (ABCT; http://www.abct.org)


What is Cognitive Behaviour Therapy (CBT)?

Cognitive Behavioural Therapy (CBT) is the term used for a group of psychological treatments that are based on scientific evidence. These treatments have been proven to be effective in treating many psychological disorders.

Some people have an inaccurate view of what psychological therapy is, perhaps because of the old-fashioned treatments shown on TV or in the movies. Cognitive and behavioural therapies usually are short-term treatments (i.e., often between 6-20 sessions) that focus on teaching patients specific skills. CBT is different from many other therapy approaches by focusing on the ways that a person’s cognitions (i.e., thoughts), emotions, and behaviours are connected and affect one another. Because emotions, thoughts, and behaviours are all linked, CBT approaches allow for therapists to intervene at different points in the cycle.

There are differences between cognitive therapies and behavioural therapies. However, both approaches have a lot in common, such as:

  • The therapist and patient work together with a mutual understanding that the therapist has theoretical and technical expertise, but the patient is the expert on him- or herself.
  • The therapist seeks to help the patient discover that he/she is capable of choosing realistic thoughts and adaptive behaviours.
  • Treatment is often short-term. Patients actively participate in treatment in and out of session. Homework assignments are included in therapy. The skills that are taught in treatment require practice.
  • Treatment is goal-oriented to resolve present-day problems. Therapy involves working step-by-step to achieve goals.
  • The therapist and patient develop goals for therapy together, and track progress toward goals throughout the course of treatment.

Adapted from The Association for Behavioral and Cognitive Therapies (ABCT; http://www.abct.org)


What is Acceptance & Commitment Therapy (ACT)?

Developed within a coherent theoretical and philosophical framework, Acceptance and Commitment Therapy (ACT) is a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior-change strategies, to increase psychological flexibility. Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.

Adapted from the Association for Contextual Behavioral Science (ACBS; https://contextualscience.org/act)

One of the leading proponents of ACT is Dr. Russ Harris. He notes that ACT gets it name from one of its core messages: accept what is out of your personal control, and commit to action that improves and enriches your life.

The aim of ACT is to maximize human potential for a rich, full and meaningful life. ACT does this by:

a) teaching you psychological skills to deal with your painful thoughts and feelings effectively – in such a way that they have much less impact and influence over you (these are known as mindfulness skills).

b) helping you to clarify what is truly important and meaningful to you – i.e., your values – then using that knowledge to guide, inspire and motivate you to change your life for the better.

Adapted from Dr. Russ Harris’ website.

To see behavioural and ACT principles in action, watch the clip below or see Changing Your Mind from The Nature of Things: