What’s the REAL Relationship Between Anxiety and Eating Disorders?

A photo of a woman seated at a table alone, eating soup, reading a book that she is holding in one hand and that is blocking her face.

Anxiety and Eating Disorders often co-occur. Anxiety can begin before an Eating Disorder, around the same time, or after the onset of an Eating Disorder. This chronology has led many to wonder about the real relationship between anxiety and Eating Disorders.

So, let’s unpack this. First, anxiety.

Think of anxiety as on a continuum.

On one end is minimal anxiety. On the other end is severe anxiety. As anxiety approaches the ‘severe’ end of the continuum, it becomes an Anxiety Disorder. To be a disorder means symptoms interfere with daily life and impair functioning.

There are many different kinds of Anxiety Disorders.

They include: Obsessive Compulsive Disorder, Generalized Anxiety Disorder, Simple Phobia, Panic Disorder, Social Anxiety Disorder, and Post-traumatic Stress Disorder.

To have an official disorder of any type means you meet specific criteria outlined by the Diagnostic and Statistical Manual (DSM). This is true for Anxiety Disorders and Eating Disorders. The DSM is THE official handbook that outlines and describes all psychiatric conditions.

In the DSM category of Eating Disorders, three main types include Anorexia nervosa, Bulimia nervosa, and Binge Eating Disorder.

Eating Disorder symptoms are challenging to treat. Plus, people with an Eating Disorder often have other psychological conditions too.

Guess which DSM diagnosis occurs most frequently among people with a DSM diagnosed Eating Disorder?

You guessed it: Anxiety!

Anxiety is the most common condition people with an eating disorder have.

In fact, 48-51% of people with anorexia nervosa, 54-81% of people with bulimia nervosa, and 55-65% of people with binge eating disorder are also diagnosed with an Anxiety Disorder.

Far more people with an Eating Disorder have anxiety, but to a lesser degree than someone with a DSM Anxiety Disorder.

By the way, there is little research on the prevalence of Eating Disorders among people with an Anxiety Disorder.

One of the most common forms of anxiety that co-occurs with Eating Disorders is Obsessive Compulsive Disorder (OCD). In fact, OCD usually occurs first and is considered by some a risk factor for developing an Eating Disorder.

Anorexia nervosa is the Eating Disorder than most often overlaps with OCD.

The other two Anxiety Disorders most often associated with Anorexia are Social Anxiety Disorder and Generalized Anxiety Disorder. (Social anxiety disorder is also more common in people with bulimia than in people without an Eating Disorder.)

Actually, Social Anxiety Disorder is the anxiety disorder that occurs most often among people with any type of Eating Disorder (not only Anorexia.).

Think about the implications of co-occurring Social Anxiety Disorder and Eating Disorders.

When someone has Social Anxiety Disorder, they may be that much more reluctant to seek treatment. Having Social Anxiety makes getting help for an Eating Disorder (and the for Anxiety Disorder for that matter) that much harder. And less likely.

Delaying or avoiding treatment worsens the prognosis for someone with an Eating Disorder. Or with an Anxiety Disorder. Or with both.

Let’s put the pieces together: Anxiety Disorders seem to occur more often in people with an Eating Disorder than in the general population. We also have evidence that Anxiety Disorders likely emerge before an Eating Disorder.

What does this mean?

The sequence suggests that early onset anxiety may increase the risk of developing an Eating Disorder. This is especially true of Social Anxiety Disorder.

The research on the relationship between Eating Disorders and anxiety is difficult to interpret. One reason is because of all the combinations of different Eating Disorder and Anxiety Disorder diagnoses. (As outlined in the beginning of this article.) There are methodological problems in some of the research that also makes it tough to evaluate.

So the inconsistencies complicate the understanding of co-occurring anxiety and Eating Disorders.

Regardless, though, treatment for one often benefits the other.

For example, Cognitive Behavior Therapy (CBT) is one of the treatments of choice for Eating Disorders and Anxiety Disorders.

CBT is based on the idea that psychological problems are the result of distorted ways of thinking and unhelpful behavior. Through the use of specific techniques, CBT helps people learn to cope better with everyday kinds of things. Improved coping decreases their need to use Eating Disorder behaviors. The same sort of techniques are useful in treating Social Anxiety Disorder.

Another plus to mention is that certain medications called Selective Serotonin Reuptake Inhibitors (SSRIs) can be helpful. They are often part of an effective treatment plan for Anxiety and Eating Disorders. SSRI’s were originally developed to treat depression. (They help treat depression too!)

So what is the REAL relationship between Anxiety and Eating Disorders? It depends on which research findings you read.

My professional experience is that anxiety is practically always present before an Eating Disorder develops.

Anxiety can be one of the reasons why an Eating Disorder develops in the first place.

How so? Well, in an attempt not to feel anxious, a person turns to Eating Disorder symptoms. Usually this is not conscious.

Anxiety may then decrease, but only artificially. It is still there. An Eating Disorder masks it. But, the person no longer feels as anxious. The more she relies on Eating Disorder symptoms, the less anxiety she feels. An entrenched cycle has begun.

Anxiety also occurs during an Eating Disorder. Maybe because of sneaky behaviors that are involved. Or due to malnourishment.

Anxiety also occurs after an Eating Disorder and as part of recovery. Why? Well, change can be scary. Feelings are no longer numbed by an Eating Disorder. Instead, CBT and medication provide more skillful ways to be in the world. But learning and changing take time. There is no quick fix.

Both Anxiety and Eating Disorders are treatable. To be you, without symptoms of Anxiety or of an Eating Disorder is possible. Whichever type of Anxiety Disorder or Eating Disorder you have, seek treatment that addresses both. Doing so will be one of the best investments you will ever make.

Dr Elayne Daniels is a private practice psychologist in Massachusetts, specializing in the treatment of people with Eating Disorders and co-occurring conditions of all types.

How To Determine Your Best Treatment For Anxiety And Depression

A photo of sunflowers and a colorful sky represent the benefits of finding the right treatment for anxiety and depression

Anxiety and Depression are common and treatable. But how do you determine your best treatment for anxiety and depression? It is definitely not a one-size-fits-all kind of thing. And, there is no reliable blood test. (But, there will be one day soon.)

At least initially, anxiety and depression often present as physical ailments rather than as classic mood symptoms. No surprise that many patients turn to their primary care physicians for care. Primary care doctors really do need to be well versed in recognizing how mental health conditions manifest– and in making appropriate treatment recommendations.

Treatment absolutely can improve quality of life. But, success of treatment varies…widely. So does the length of time before you feel better. And, of course, what is helpful for you may not be for your friend.

Let’s talk about the good news and then the less than good news.

The good news in the treatment world for anxiety and depression:

1. Treatment for anxiety and depression can be similar.

Cognitive Behavior Therapy (CBT) is a highly effective therapy for both conditions. CBT has considerable scientific evidence that its methods actually lead to improvement in mood and functioning. Its core principles have to do with changing thinking patterns. CBT tends to be short- to moderate-term. Its focus is on the present.

Psychopharmacology (medication) is another common treatment, and often the same medication (e.g. a Selective Serotonin Reuptake Inhibitor or SSRI, or a Selective Norepinephrine Reuptake Inhibitor or SRNI) is helpful for anxiety and depression. Examples of SSRIs include Prozac, Zoloft, and Paxil. Effexor and Cymbalta are examples of SNRIs.

There are other types of medications to treat depression alone, or anxiety alone.

There is some evidence that combining psychotherapy and medication works best for treatment of depression.

For anxiety disorders, CBT, antidepressant medications and anti-anxiety medications (e.g. Buspar) are helpful. Some research suggests psychotherapy is more effective than medications to treat anxiety, and that adding medications does not significantly improve outcomes from psychotherapy alone.

2. Many people find treatment helpful.

The benefits of therapy vary. For both disorders, CBT is the most effective form of psychotherapy.

The benefit of medication depends on lots of factors. One is the severity of the depression or anxiety. In general, the more severe the symptoms, the more likely the medication will help. In other words, antidepressants are more effective in treating chronic, moderate and severe depression. They don’t help much in mild depression.

Keep in mind…

3. If one treatment does not help, there are many other treatment options.

Lots of research on evidence based treatments is available. We know that sticking with the approach(es) is necessary to evaluate if what you are doing is helpful.

4. Techniques you can do on your own will help.

The kinds of things you can do are helpful throughout life, even when not suffering from anxiety or depression. These include journaling, exercising, meditating, doing yoga, doing a hobby, or playing an instrument.

5. Support groups are helpful, and exist in many local communities as well as nationally. Just make sure the groups are led responsibly by a licensed mental health provider.

The less good news:

  1. Trial and error are often required to find the best medication for you.

    This can be time consuming, especially when you are not feeling yourself. Finding a therapist who is a good fit for you can also be challenging. The ‘chemistry’ and expertise have to feel right.
  2. Insurance companies sometimes encourage medication over psychotherapy.

    Why? Because it is less expensive. This may be appropriate at times, but often psychotherapy is clearly indicated.

3. If you’re like many people, and you seek help from your primary care physician for anxiety and depression, know that treating mental health problems in a primary care setting can be less than ideal.

Primary care clinicians have time pressures and lots of conditions that warrant attention in every patient interaction. Their evaluation and treatment of mental health disorders may fall short of the ideal.

As with most health conditions, finding and accessing treatment is not necessarily easy. In the case of feeling anxious and depressed, pursuit of care can be extra difficult.

If you have no improvement after 4-6 weeks of treatment, discuss other options with your provider. Also, be sure to disclose any alcohol or other drug use. Both are linked to anxiety and depression, and are important to mention – especially if you are on medication.

How to determine your best course of action for anxiety and depression is specific to each individual.

In general, concrete steps to consider include:

  1. Contact therapists and psychopharmacologists who are on your insurance plan. Check out their website. Ask about their services. Consider looking at referral sites for names of providers who may be helpful.
  2. Consult your PCP for referral to a therapist and/or psychopharmacologist
  3. Consider using telehealth services if available.
  4. Read reputable articles to help you assess your symptoms, your needs, and the next best steps FOR YOU.
  5. Get moving! Whether cardiovascular, or strength training, exercise helps. Make it fun by dancing to music. Taking a Zumba class. Or how about yoga?

Suffering from anxiety and depression is not uncommon, especially in this post-Covid world.

There is no one-size-fits-all recommendation for how to approach treatment, or for which treatment to land on.

The two basic options are therapy and/or medication. For therapy, CBT is the treatment of choice. For meds, the treatment of choice is typically an SSRI. (There are lots of factors that determine specific treatment recommendations.)

CBT is often considered better than medication at preventing relapse. It is tends to be short term, and empowering to the person who learns it. As a psychologist, I love teaching CBT an do have a lot of respect for how helpful anti-depressants can be. If they help, it is because they are remedying a chemical deficit in your brain.

I am a MA licensed psychologist in private practice. If you’re struggling with anxiety and depression, and would like to learn more about working with me, please contact me here.

4 Facts To Consider If You’ve Been Diagnosed With Comorbid Anxiety And Depression

The image of a woman who appears to have been diagnosed with comorbid anxiety and depression

Anxiety disorders and mood disorders are common. They affect people of all ages and walks of life. When someone suffers from anxiety and mood disorders at the same time, they’re diagnosed with comorbid anxiety and depression.

Four common questions about co-occurring anxiety and depression are:

  1. How often do they co-occur?
  2. Why do they co-occur?
  3. What’s the prognosis?
  4. What’s the treatment?

In general, comorbid conditions of all types are common.

One study found that about 50% of American adults with any psychiatric diagnosis have 2 or more disorders.

Co-occurring anxiety and depression are even more common than that.

Both conditions co-occur more often than the lifetime rates of either depression (16.6%) or anxiety (28.8%) alone. More specifically, about 60% of people with depression have comorbid anxiety, and 60% of people with anxiety have comorbid depression.

A natural next question is why anxiety and depression commonly co-occur.

Researchers do not know what puts someone at risk for comorbid anxiety and depression, compared with either condition by itself.

Theories range from biological explanations to situational life events. Another possibility is overlapping symptoms, such as insomnia, link the two disorders.

Some experts suggest that having one of the disorders is a risk factor for having the other.

Identifying causes for the co-occurrence is difficult. One reason for this is the different types of anxiety and depression.

For example, Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) are highly comorbid. They also share four symptoms:

  • Trouble sleeping
  • Difficulty concentrating
  • Being easily fatigued
  • Restlessness

MDD and GAD are considered to have to similar genetic factors.

MDD and other anxiety disorders, such as Panic Disorder, are not considered to be linked genetically.  They are less often comorbid.

Gender may be another risk factor. Females have a higher rate of each condition than males. And a higher rate of comorbid anxiety and depression too. (This could also be due to bias toward diagnosing women more often than men with the disorders.)

Age is yet another factor. Onset for anxiety disorders is much earlier than for mood disorders (11 years old vs age 30 years of age). Whether this affects comorbidity is unknown.

What is the prognosis for comorbid anxiety and depression?

Another version of this question is how comorbidity affects treatment outcome.

Remember that when anxiety and depression co-occur, they’re usually harder to treat. Why? Because the symptoms tend to be more persistent and intense when combined.

The prognosis for people with comorbid anxiety and depressive disorders is poorer than that for either disorder alone.

The more intense symptoms include increased risk of suicidality, more chronic symptoms, and more everyday impairment.

So, people with depression and anxiety have a worse response than people with depression or anxiety alone. Their illness tends to be more chronic.

So how do you treat the conditions when they co-occur?

Unfortunately there is no single best treatment.

Experts even disagree whether to treat one condition first and then the other (aka sequential treatment). Or, to treat both at the same time (aka simultaneous treatment).

Further, clinicians can recognize one mental illness relatively easily. But, it’s much harder to recognize comorbid illnesses. And to distinguish comorbid conditions from conditions such as Bipolar disorder or Substance Use disorder.

However, it is not all gloom and doom!

Medication-wise, selective serotonin reuptake inhibitors (SSRIs) are the treatment of choice in treating depression and comorbid anxiety disorders. 

In general, the SSRIs and the Selective Norepinephrine Reuptake Inhibitor (SNRI) venlafaxine are first-line medications used in the treatment of both anxiety and depression.

Examples of SSRIs include sertraline, fluoxetine, citalopram, fluvoxamine, paroxetine. They’re preferred due to their treatment effectiveness.

One downside to SSRIs is they can intensify anxiety among already anxious patients. Clinicians thus tend to start patients at a low dose and then increase the dose over the first few weeks of treatment. 

The most common psychotherapy approach is cognitive behavioral therapy, or CBT for short.

CBT is a here-and-now, solutions-oriented approach. It’s based on the idea that thoughts, feelings, and perceptions influence behavior. One of the cool things about CBT is that it is an effective treatment for either disorder. And for both when they occur at the same time.

With comorbidity, treatment providers have to make sure both disorders are being treated. For example, antidepressants may help a person’s mood, but not their anxiety. A next step may be to add CBT. Or to change the medication.

There’s still a lot to learn about recognizing and treating conditions that present at the same time. Especially in the case of anxiety and depression.

While treatment has more challenges when dealing with comorbidity, success is possible.

I am a clinical psychologist in private practice in MA. To learn more about co-existing anxiety and depression, please contact me here.

The Pros And Cons Of Anxiety And Depression Support Groups

A photo of a tree being held up by aa hand made of wood as a symbol of support for anxiety and depression

If you have anxiety or depression, you may wonder if a support group would be helpful to you. First step? Consider the pros and cons of participating in anxiety and depression support groups.

Being part of a support group provides an opportunity to be with people with similar concerns.

To be in the presence of others who talk about their challenges can feel like a breath of fresh air. Especially because mental health challenges can be isolating.

In a support group, you’re likely to understand one another. And also recognize that not everyone is exactly the same. The main focus is on sharing experiences without focusing on the negative feelings of depression or anxiety.

Problem solving, sharing, and empowering each another can feel incredibly supportive. And really help to improve your symptoms of anxiety and depression.

In a group environment, members generate ideas for themselves and each other. The group setting is a safe place to practice skills that you can then more confidently practice in your every day life.

Many benefits of participating in a support group for anxiety or depression make it an appealing option. And well worth the effort.

For example, being in a support group may help you feel less isolated in your depression and anxiety. Recognizing that other people feel similarly to you can be such a relief. That you really are not alone.

The guidelines of the group are important and should be clearly stated from the very beginning. Basics include confidentiality, expectations (e.g.re being on time; missing sessions; safety protocols; outside of group contact), and participation. Even having an agreement or contract for all group members to sign, agreeing to the group rules, may be helpful.

The “what’s said in this room stays in this room” guideline is especially essential in order for people in the group to feel safe.

And to really be able to utilize the group fully. You want to be confident that what you are sharing in the group does not find its way outside of the group.

Expectations are also important to state at the beginning. Such things as attendance and participation. And whether group members need to be in individual therapy alongside the group therapy.

There can be disadvantages too in support groups for anxiety or depression. Especially if the group is not run well. For example, poor boundaries in the group may cause members not to feel safe. Or if there is a victim vibe, “poor me” atmosphere. Another challenge may be handling other people’s emotions.

Ideally, group members feel lighter, less burdened, more connected to others and to themselves after a group session.

So, if you want to feel less alone, and challenge yourself to go outside your comfort zone, consider an anxiety or depression support group. As is true for nearly everything in life, there is no guarantee participating in a group will help. But an open mind and a well run group may be an ideal addition to individual therapy.

I am a MA licensed psychologist, specializing in working with men and women who know they could be deriving more – pleasure, meaning, and purpose – in their lives. To learn more, please contact me here.

Suffering From Depression And Anxiety? 25 Things To Help You Start Feeling Better

A dog sitting on a leather sofa appearing like he is feeling depressed or anxious and is looking for what to do

Depression zaps you of joy and energy. Anxiety keeps you on edge. At some point, we all struggle with some form of depression and anxiety. Emotions are part of being human. If you are suffering from depression and anxiety, you may wonder if there are things you can do to help you start feeling better.

Spoiler alert: Yes!

Some techniques are for the “here and now”, and others help over the long term. Some are action driven, and others are about changing your thoughts.

Here are 25 things to help you start feeling better:

Strategies for the here and now if you are suffering from depression or anxiety:

  1. Bring awareness to your breath
  2. Check your posture
  3. Move your body
  4. Get outside with nature
  5. Laugh
  6. Turn up the corners of your mouth
  7. Sing and dance to music you like
  8. Opposite action
  9. Talk to someone you trust
  10. Drink water

Strategies for the longer term:

  1. Zoom out the lens. Take a step back for a different perspective
  2. Experiment with a meditation practice
  3. Journal your feelings
  4. Change your relationship with your thoughts
  5. Prioritize sleep
  6. Regularly exercise
  7. Seek Psychotherapy
  8. Refer back to a list you made of all the times you overcame depression or anxiety. Remind yourself you have felt the emotions before, and that they didn’t last forever.
  9. Help someone in need
  10. Join a support group online
  11. Read inspirational, motivational quotes
  12. Read dark humor
  13. Listen to podcasts
  14. Find playlists of interest or create your own
  15. Take a Values Assessment

Here are 5 quotes to help you feel better if you are suffering from anxiety or depression:

“You say you’re ‘depressed’ – all I see is resilience. You are allowed to feel messed up and inside out. It doesn’t mean you’re defective – it just means you’re human.”–David Mitchel

Those who have a ‘why’ to live, can bear with almost any ‘how’.
–Viktor E. Frank

Character cannot be developed in ease and quiet. Only through experience of trial and suffering can the soul be strengthened, ambition inspired, and success achieved.” —Helen Kelle

“That’s the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end. The fog is like a cage without a key.” –Elizabeth Wurtzel, author

Mental pain is less dramatic than physical pain, but it is more common and also more hard to bear. The frequent attempt to conceal mental pain increases the burden: It is easier to say ‘My tooth is aching’ than to say ‘My heart is broken.’ –C.S. Lewis, author

Even though anxiety and depression are part of life, you don’t have to suffer.

Recognize that all feelings are part of shared humanity. They come and then they go. And they too shall pass.

I am a clinical psychologist dedicated to helping people find meaning and purpose in their lives. To live authentically in a world where suffering and pain exist is no easy task.

Please contact me if you want to talk about any of these ideas.

You don’t have to go it alone.

Why Loving Someone With Anxiety And Depression Can Make You Depressed (& How To Stay Healthy)

A foggy window with a small heart on it represents that it is hard to love someone with anxiety and depression, and how important it is to stay healthy

To watch someone you love suffer is painful – whether the suffering is physical or mental, or a combination. When someone you love has anxiety and depression, you may feel particularly helpless and wonder how to offer support. Especially because their pain is not visible in the way it would be with a physical wound or injury.

It is natural to wonder if loving someone with anxiety and depression could make you depressed. And to wonder if you’re selfish to even be thinking about how to stay healthy.

The hard reality is that relationships are complicated. And both you and your partner have quirks and problems of different kinds, sizes, and manifestations. You know that everyone struggles in some shape or form.

In the case of anxiety and depression, people’s suffering can be short, medium, or long term. The symptoms can manifest as a single episode or multiple. Regardless, professional help is essential. That includes psychological treatment and possibly medication. (Definitely for your loved one and maybe even for yourself.)

One thing consistently recommended is to be sure you don’t take on your loved one’s problems as if they’re your own. Because they’re not yours. Making them your own will ultimately not be helpful to your loved one. And could make it hard for you to stay healthy. It’s a lose-lose.

So what can you do to help a loved one with anxiety and depression?

Here are 4 general suggestions:


1. DO set boundaries with a loved one with anxiety and depression. If you don’t, your own health will suffer. Mentally AND physically. Instead, discuss the importance of finding a balance between supporting your loved one and carving out time for yourself.


For example, if you’re both planning to join friends for dinner, let your partner know in advance that you’ll still go even if your partner isn’t up to it when the time comes. Remind your loved one that you won’t force him/her to go, and that you want to follow through with plans because it is important to you.

2. DO Listen when a loved one with anxiety and depression talks with you. Sometimes, it is all you can do. Resist the urge to give advice. Also, guilt can be part of depression and anxiety. When your loved one’s anxiety or depression takes hold, it’s not realistic or helpful for them to pretend they’re fine. Avoid making them feel guilty about it. They already feel bad enough. More guilt just adds to their anxiety and depression.

3. DO NOT try to “fix” the anxiety or depression your loved one has. Or try to “fix” your loved one. Your loved one’s therapist and medication provider are the professionals assigned to treating anxiety and depression. After your loved one has established a solid relationship with the therapist, offer to join them for a session to learn more about how to be helpful.

4. DO NOT assume you know what your loved one with anxiety or depression is feeling. Let them know that you care about them and want to be there for them. Ask them how they’re feeling and how you can support them.

There is no one size fits all list for how to help a loved one suffering from anxiety and depression. Educate yourself about anxiety and depression through websites, podcasts, and other sources. Be a good listener. And, for your own well being, make sure you have a life outside of helping your loved one.

For more information, please contact me.

5 Surprising Inspiring Facts About Anxiety and Depression

A large rainbow balloon in the treetop, against a blue sky, suggesting there is surprising and inspiring facts about anxiety and depression

Did you know that anxiety disorders are the most common mental health problem in America? About 40 million Americans have a diagnosed anxiety disorder. Depression is also common, affecting about 20 million adults in this country. Despite being so common, anxiety and depression aren’t often talked about. Here are some inspiring and surprising facts about anxiety and depression you may not know.

1. Both anxiety and depression affect how you feel and think. And how you handle daily activities, such as sleeping, eating, or working.

Most of us feel overwhelmed and even panicky at times. Especially lately, with the global pandemic.

Uncertainty tends to cause unsettling feelings. So does focusing on bad things that could happen in the future. I call future oriented thinking “What if’ing”. “What if’ing” easily leads down a rabbit hole of negative, catastrophic thoughts. And can cause anxiety or depression to skyrocket.

For our cavemen and cavewomen ancestors, “what if’ing” had major survival benefits though. It allowed our species to continue! Assuming or predicting the worse possible outcome kept our ancestors safe. As in better safe than sorry.

2. For some of us, anxiety or depression is temporary. For others, episodic or constant.

Another fact about anxiety and depression is that they show up in different forms. Examples of anxiety disorders include OCD, Phobias, Post traumatic Stress, Generalized Anxiety, Social anxiety, or some combination of any of them. Depression can be chronic and low grade, intense and episodic, related to a medical condition, or some combination thereof.

3. The good news is anxiety disorders and depression are completely treatable. Unfortunately, only about a third of people receive treatment.

Depression and anxiety are different, but symptoms of both can easily overlap. Feeling irritable, having trouble concentrating or sleeping, and being nervous are common in both.

Depression or anxiety don’t cause the other, but many people suffer from both.

Psychotherapy, medication, or a combination of both are effective ways to treat anxiety and/or depression. Certain lifestyle behaviors, such as spending time in nature, help with anxiety or depression.

4. So what are the facts about anxiety or depression that are surprising or inspiring?

Well, anxiety can actually help to keep you safe. (Kind of like it did for our ancestors.) For example, say you go for a run alone in the park. Anxiety helps keep you alert to any threat in your surroundings. So if a large, unleashed dog were to run toward you, for example, anxiety would kick in and help you stay safe. Another example is when you are preparing for a presentation, exam, or concert, feeling anxious motivates you to prepare.

As for depression, a benefit may be in what it is communicating to you. For example, maybe it is telling you that something in your life needs to change. Feeling miserable due to work or in your relationship alerts you that it’s time to make some changes.

Be aware though that there is no such thing as a geographic cure. Sometimes the cause of depression is not due to something outside of you, like a job or relationship, but due to pent up feelings.

Anxiety and/or depression are also a normal, understandable response to stressful events – like with what is happening in the world right now with the global pandemic. Anxiety doesn’t have to take over though. Nor does depression. Healthy outlets to express anxiety and depression keep them from festering.

5. Is it anxiety or ‘just stress’? Is it depression or ‘just sadness’?

Distinguishing between normal, everyday feelings and more serious conditions is not easy. Especially if feeling anxious or depressed seems like it’s just who you are.

One way to tell the difference is to keep a feelings journal for at least two weeks. Look back on it and see if there are any themes or indicators to help you recognize patterns.

If you have a family history of anxiety or depression, you’re more likely to experience either or both. However, you don’t necessarily have these conditions, nor are you are destined to suffer.

There are things you can do if you have anxiety and/or depression to help yourself feel better. Exercise, yoga, having a pet, time in nature, and being in therapy are ways people help themselves out of the abyss of depression or the whirlwind of anxiety.

Finding the balance between recognizing all feelings are normal and welcome can be tricky. Feeling anxious or depressed is a natural reaction to what life has in store at times. If however the anxiety or depression last more than two weeks, cause problems in your relationships, health, and/or career, please seek professional help.

You deserve to feel better and live a higher quality of life.

For more information about anxiety or depression, please contact me.

3 Signs It’s Time For You To Seek Psychotherapy For Depression And Anxiety

A sillhouette with her arm raised in victory after discovering the signs of anxiety and depression and starting therapy as a result.

How do you know if it’s time for you to seek psychotherapy for depression and anxiety?

What are key signs for you that it’s time to get help for depression and anxiety?

If you want to be in therapy, go ahead! For any reason! Just think about what you are looking for from therapy, and find a therapist!

You don’t need to be in dire straits to seek psychotherapy.

People are in psychotherapy for tons of different reasons, from personal development and growth to addressing an acute or ongoing problem.

Psychotherapy, by the way, includes many different approaches. Some are more effective than others, depending on the kind of depression and anxiety you have.

But what if the question is how do you know you should seek psychotherapy for depression and anxiety?

Mental health professionals refer to the Diagnostic and Statistical Manual — the ‘Bible’ of psychiatric disorders — to distinguish between feeling sad or stressed on occasion to having symptoms of a clinical disorder such as depression or anxiety.

The general standard for when it’s time to seek psychotherapy for depression and anxiety is if your symptoms are present for

1. More than two weeks, and

2. Interfere with living your life, and

3. Impair how you function. 

So taking these three criteria into account, how do you know if it is time for you to seek psychotherapy for depression and anxiety?

Depression

First, keep in mind that symptoms of depression vary from person to person, and even over time in one person.

No two people have exactly the same symptoms or severity of depression. This fact makes it impossible to say specifically when it is time for you to seek psychotherapy for depression and anxiety.

There is no blood test or other objective marker that it is time to seek psychotherapy for depression and anxiety.

The diagnosis of depression is based on self-report and on what other people may notice/comment about your thoughts, feelings, and day to day decisions.

There are different kinds of depression, some associated with other situations. Postpartum depression is an example. So are dysthymia (a two plus year, low grade depression with a couple of other symptoms) and Seasonal Affective Disorder (SAD). SAD occurs during winter months, when there is less sunlight, and naturally lifts around spring time, year after year.

Symptoms of depression, according to the DSM, include:

  1. Persistently sad or “empty” mood. Irritability is also common in children/teens
  2. Loss of interest or pleasure in hobbies and things you used to enjoy
  3. Feeling guilty, worthless or helpless
  4. Hopelessness
  5. Decreased energy
  6. Moving or talking more slowly than usual
  7. Trouble concentrating, remembering, or making decisions
  8. Difficulty sleeping, such as disrupted sleep, early-morning awakening, or oversleeping
  9. Appetite and/or weight changes (up or down)
  10. Aches or pains, headaches, or digestive problems with no physical cause

    Remember, the diagnosis of depression means symptoms have lasted at least two weeks, have caused additional problems, and interfere with how you function.

Here are some important facts in considering psychotherapy for depression and anxiety:

Depression is one of the most common mental disorders in the U.S and is highly treatable.

Ongoing research suggests depression is caused by genetic, biological, environmental, and psychological factors. Depending on the cause, different treatments may be more helpful than other treatments.

There is no one size fits all treatment for depression, for adults or children. As more is learned about depression, the better we will be able to match the treatment with the symptoms.

So now what about Anxiety?

Anxiety

Anxiety, like depression, varies in form and severity from person to person, and even over time in the same person.

As is true for depression, anxiety can occur for many different reasons, and it can present in different ways. It can also happen alongside other conditions.

Many forms of anxiety are described in the DSM.

Examples include Post traumatic stress, panic, phobias, obsessions, social anxiety, and generalized anxiety. Each anxiety based condition in the Anxiety Disorders chapter is unique, except some form of anxiety is part of each of them.

The common threads of anxiety of various forms include:

  • Worrying about the future, such as focusing on negative ‘what if”s
  • Bodily tension, such as fidgeting
  • Autonomic reactivity, including dry mouth, lightheadedness, sweating, rapid heart rate

Like depression, anxiety is an expected part of life. Whether before an interview, or while having a medical procedure done, feeling anxious at times is normal.

However, an anxiety disorder is so much more than temporary worry or fear.

With an anxiety disorder, anxiety does not go away easily. It may worsen over time, and can get in the way of living your life.

Psychotherapy for depression and anxiety can provide a very useful way to understand yourself. Especially your moods, coping style, and ways of thinking. The duration of therapy varies and works best the more you apply what you learn.

Think of therapy as an investment in yourself. And if depression and anxiety are what led you to therapy, you have firsthand experience of a silver lining!

I work with men and women from adolescence through adulthood who have different levels of depression and anxiety, for different reasons, and in different forms. My bias is that psychotherapy is super powerful and something to consider even if you don’t ‘have to’.

PLEASE NOTE: If at any time you are in acute distress and need to speak with someone, please contact:

Lifeline (suicidepreventionlifeline.org); 1-800-273-8255 (CHAT)

If you are concerned about someone’s safety, please contact:

NIMH » Suicide Prevention (nih.gov); 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741).

Both services are free and available 24 hours a day, seven days a week.

How To Keep The Physical Symptoms Of Anxiety And Depression From Derailing Your Life

A woman wearing a red hat and holding her hand up to stop the physical symptoms of anxiety and depression.

There is nothing wrong or unnatural about feeling anxious or depressed. If you are a human being, you inevitably experience anxiety and depression.  That is life.

Anxiety and depression have physical symptoms associated with them. Knowing how to keep the physical symptoms of anxiety and depression from derailing your life is an important part of well being. And of life in general. Otherwise, symptoms can take over, and your quality of life will suffer. How? Socially, interpersonally, health-wise, and in all other ways you can think of.

Let’s take a closer look at anxiety, starting with a definition. 

Anxiety occurs when you feel nervous or stressed about something.

Maybe before an exam, or on a first date, you notice feeling slightly agitated or restless? Or worried, and/or a preference to avoid whatever is stressing you out?

Feeling anxious can be uncomfortable, even to the point you may wonder why the feeling exists.

Did you know that you, like everyone else, are wired to experience anxiety as a protective mechanism?

Anxiety is protective? Say what? 

Anxiety is adaptive when facing challenges. So, we don’t want to get rid of it completely.

Back in the day of our cavemen and cavewomen ancestors, feeling anxious when lions approached was a good thing. Our ancestors’ anxiety helped them to fight off the animals or run for safety. 

Anxiety kept them alive by activating the fight-or-flight mode. The same mechanism remains today as part of our brain. It prepares you for action and safety. In many cases, the fight or flight activation is a ‘false alarm’, because there are no lions or their equivalent chasing you. The threat in the present is more benign, like a first date or arriving late to an appointment. Much less is usually at stake than being attacked by a ferocious beast, but your nervous system doesn’t distinguish. 

Without the safety mechanism of anxiety, humans would not have survived.

So, you can actually thank your anxiety for the evolution of our species. 

Despite the benefits of anxiety, uncomfortable physical symptoms often occur in the body when you feel anxious. 

Remember, anxiety is normal and something most of us experience. The severity can vary, from mild to severe.  

Anxiety is considered a disorder depending on how long it lasts, how much distress it causes, or if it interferes with your life in other ways.

Physical symptoms of anxiety include:

  1. Nausea or stomach pain
  2. Rapid heart rate (maybe even feeling your heart pound)
  3. Shortness of breath (to the point where it may be hard to breathe)
  4. Fatigue
  5. Muscle tension
  6. Shaking
  7. Sweating

There are about ten different categories of anxiety, many of which have overlapping physical symptoms. Examples of the categories include Phobias, Generalized Anxiety, Social Anxiety, and Post Traumatic Stress. 

Depending on the severity of the symptoms, professional help may be the best next step. 

Here is some good news: You can take steps on your own to manage your anxiety and physical symptoms.

Five of the best ways to keep the physical symptoms of anxiety from ruining your life include:

  1. Physical activity, be it formal exercise, walking in the park, dancing in your room to favorite music, or some other movement – it all counts as being physically active. 
  1. Find time to be outside every day. 
  1. Aim to avoid or at least limit alcohol and caffeine. Avoid nicotine. All worsen anxiety.
  1. Make sleep a priority. Anxiety and sleep problems go hand in hand. Getting enough sleep is important; it may reduce anxiety AND can help you cope with symptoms if you do become anxious. 
  1. Relaxation techniques actually work. There are many different types. Discover what works for you. Maybe yoga? Guided meditation? Pick something that calms you and be sure it does not add to anxiety.

Up next is depression. Let’s define it and describe what it feels like to be depressed. 

Feeling sad is normal. We all have losses and challenges, and sadness is a natural emotion. 

Most everyone knows what feeling ‘off’ is like. Or feeling blue, sad, down in the dumps. Having these feelings on occasion is completely normal. With more moderate depression you may feel joyless and disinterested in what you usually like to do. Low energy and a bad mood can accompany depression too. 

As with anxiety, depression levels range in severity from mild to severe.

Depending on how long depression lasts, how much distress it causes, and how it interferes in your life, you may have more than ‘just’ feelings of depression.

Feeling helpless and hopeless can also be a part of depression.  This can become so central that suicidal thoughts may occur. (If this happens, call your local emergency room asap. The Samaritans are also available to talk to for support. ) Seeking professional help from a therapist and possibly a medication prescriber (aka a psychopharmacologist) is important, so that the symptoms do not become debilitating or lead to thoughts of suicide.  

Physical symptoms of depression can include:

  1. Aches and pains, such as back or joint pain
  2. Headaches
  3. Lethargy,
  4. Sleep problems, such as insomnia or awakening a lot during the night
  5. Changes in appetite
  6. Slowed speed and movement, or agitated speech and movement
  7. Digestive problems

Fortunately, there are tried and true ways to keep physical symptoms of depression from ruining your life.

The same strategies to keep physical symptoms of anxiety from derailing your life also apply to depression. These include: physical activity, time spent outside, limiting or avoiding caffeine, alcohol, and nicotine, prioritizing sleep, and practicing relaxation techniques.

Two additional recommendations for improving physical symptoms of depression are less well known. They target the sense of meaninglessness and lack of pleasure that can accompany depression.

  1. Engage in daily activities for mastery.

The bar for what is considered mastery may be low. That is ok. Even if making your bed is a mastery activity, great! The point is to do something that you really don’t feel like doing because of depression, and give yourself credit for having done it. Voila! Mastery.

This type of activity can be helpful to offset feeling like you can’t do anything right, or that you are too glum to do anything.

2. Engage in daily activities for pleasure. 

Pleasure is often absent when feeling depressed. Even if it feels like just going through the motions, purposely plan and do something each day that brings you some sense of joy, pleasure, or peace. Examples include using your favorite body cream after showering, cuddling with your pet, or lighting a candle and listening to your favorite music.

There is a lot you can do to help yourself keep the physical symptoms of anxiety and depression from ruining your life. They are all forms of self care. 

Unfortunately, self care has gotten a bad rap. Self care, ironically, is essential to well being. Rather than self indulgent, self-care helps to keep the physical symptoms of anxiety and depression away.

Self care each day may just keep anxiety and depression away!

Even if it doesn’t, self care will help you manage the physical symptoms of anxiety and depression. There is no down side to self care!

In my private practice I teach teens and adults how to navigate anxiety and depression. Please contact me if you would like more information.

Four Breathing Exercises for Anxiety and Depression

How can something as easy as breathing exercises for anxiety and depression be helpful? Almost sounds too good to be true, right?

Well, first, keep in mind the utterly amazing fact that your body automatically knows how to inhale and exhale. Even when you are asleep.  Breathing is one of many cool things your body automatically does to keep you alive.

You don’t need to think about it. Breathe in. Breathe out. Voila. Breath just naturally happens.

But, breathing in a helpful way when you are anxious or depressed feels neither easy nor automatic.

In fact, you may inadvertently worsen the anxiety or depression symptoms depending on how you are breathing.

Modern day scientists discovered and fine tuned what Eastern masters knew long ago: Breathing affects health.

That is, breathing well goes hand in hand with feeling well. And with even feeling better than just ‘well’. 

So, it is safe to say that breathing exercises for anxiety and depression have been used effectively for thousands of years. As such, they have stood the test of time.

Further, a ‘fun fact’ about breath is that it is under both voluntary and involuntary control. In other words, breath is automatic, yet you can also intervene to intentionally change your breath in order to change your mood and physiology.

Thank you, autonomic nervous system!

Over the last decade or so, breathing exercises for anxiety and depression have become more widespread. And the techniques go far beyond the classic “just breath into a paper bag”. (Which is controversial at best.)

Breathing exercises designed for anxiety and depression actually work. And can be done anywhere, anytime, without any tools or pills. 

If you have ever had anxiety or depression, you know how awful every moment of existence can feel. Often, the two conditions occur at the same time. Talk about a double whammy.

The most highly recommended breathing exercises for anxiety and depression share some overlap. But, they are also different in many ways.

Breathing exercises to decrease anxiety and depression work because of how they affect heart rate and the mind. And whatever affects the mind affects the body. And vice versa.

Let’s break this down a bit. 

First up: Anxiety

Most everyone will experience anxiety at some point in their lives. The intensity varies from mild to moderate to severe. 

When you feel anxious, you experience changes in your body. For example, you may panic, hyperventilate, and/or breathe shallowly and quickly. Or your mind may start to race, and you suddenly feel woozy, nauseous, or as if you are going crazy. 

Anxiety is generally associated with breathing more shallowly and more quickly. This happens even if you are trying to do the exact opposite.  Hyperventilation can result, so less oxygenated blood flows to your brain. 

The most straightforward technique is simply to lengthen your exhale. 

Let’s call this technique the Exhalation Emphasis breath. 

Here is how to do the Exhalation Emphasis breath, either standing, sitting, or laying down:

  1. Before taking a breath in,  breath out. Push as much air out of your lungs as possible through that one exahalion. 
  2. Let your lungs naturally take in breath to fill the lungs. Do not force it. 
  3. On your next inhales/exhales, spend more time on breathing out than on breathing in. Some people count to do this. They may breathe in to the count of 3 and out to the count of 5. 
  4. Continue with the inhalation and the longer exhalation for at least a minute or so.

My favorite breathing technique to help with anxiety is called Alternate Nostril Breathing. 

The Sanskrit term is Nadi Shodhana. 

Practicing this breath will help you calm your nervous system. Just one minute of alternate nostril breathing can decrease stress and clear your mind! 

You can also try this technique when you’re feeling especially stressed or on edge.

The instructions sound complicated, but the practice is actually straight-forward. 

To do this, you will be breathing in and out through your nose only.

  1. Sit in a comfy position, perhaps with legs crossed.
  2. Place your left hand on your left knee.
  3. Bring your right hand to the area between your eyebrows.Place your index finger there.
  4. Exhale fully. 
  5. With your right thumb, close your right nostril.
  6. Inhale through the left nostril
  7. Close the left nostril with your ring finger.
  8. Open the right nostril and exhale through it.
  9. Inhale through the right nostril
  10. Close the right nostril and exhale left.
  11. Inhale through the left nostril.
  12. Close left nostril with your ring finger.
  13. Open the right nostril and exhale.
  14. Repeat for 1 or more minutes. 
  15. Finishing with an exhale on the left is recommended. 
Feeling anxious is not fun. Knowing that you can regulate  your breath in deliberate ways to help you manage anxiety is empowering. 

Depression

Depression is another psychological state that involves a lot of suffering. Breathing in particular ways can help to diminish depression. Skeptics are especially welcome to give it a try!

Cardiovascular exercise helps improve depression. Exercise creates hormonal changes associated with feeling better. However, when depressed, exercise is a big ask. It is probably one of the last things most depressed people want to do or feel capable of doing. 
Researchers have discovered that deep breathing that happens in cardiovascular exercise can be simulated through deliberate deep breathing.  

This is not your yoga teacher’s breathing. It is not chill, Zen, or about ohming. Nor is it the same as the types of breathing recommended to manage anxiety. 

Deep Breathing

Breathe in super deeply, as if you were about to go underwater. Start with your belly. Expand your lungs.  Imagine you have gills, and you are widening at your ribcage. Exhale. By doing this 20 times, you will derive similar benefits as with cardiovascular exercise. 

Equal Breathing

Research has also demonstrated that breathing in equal duration helps to alleviate depression symptoms.

Simply inhale through your nose for a count of 4 and exhale through your nose for a count of 4.

Breathing is not a panacea for anxiety or depression. However, the way you breath can  contribute to these conditions, and the use of breathing exercises for anxiety and depression can help you to feel better.

As with most things, the more you practice, the more natural what you are practicing feels. Over time, with practice, you may notice that breathing exercises for anxiety and depression occur naturally, often to the point they do not require deliberate effort. 

And that certainly can bring you a sigh of relief! (Long exhale please.)

Dr Elayne Daniels is a psychologist in private practice specializing in the interfacing of mind-body techniques to improve psychological well being.

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