Why Anxiety and Depression Can Exacerbate Each Other — And What You Can Do About It
Experiencing this cycle now doesn't mean you will forever. Cognitive behavioral therapy can help.by Ashley Broadwater
First, you can't get out of bed. Maybe life seems meaningless, or you feel meaningless. But then, you think about all the things you need to get done.
Maybe you have to take care of your kids, go to work or clean the house. Your to-do list is endless, and you feel an urge to check off boxes right this second, but you still can't get out of bed.
As a result, you feel horrible about yourself. Self-hatred consumes you and you don't know how to escape it.
How anxiety and depression exacerbate each other
But how does this upsetting cycle happen? According to Ebony Butler, Ph.D., a licensed psychologist, the similarities in the two illnesses make it easy for them to worsen each other.
She explained how the amygdala, the emotional response part of your brain, is an active piece of both disorders. When one disorder activates the amygdala, the other disorder's symptoms become triggered.
"The amygdala's coordination of trigger responses, especially those related to fear and anger, could lead to an exacerbation in depressive symptoms," she said. Triggering one part sends the amygdala into overdrive, making you unable to cope as effectively. In turn, you feel depressed.
Your environment can also play a significant role.
"When anxiety becomes overwhelming and affects different areas of functioning, [such as] time with friends, work life, relationships, school, et cetera, this can lead to depression about having these anxious feelings," said Nekeshia Hammond, Psy.D., a psychologist, author and speaker.
"Similarly, when someone is depressed for a period, this can contribute to anxiety about the stress and events that caused the depression."
Why cognitive behavioral therapy helps
However, experiencing this cycle now doesn't mean you will forever. Cognitive behavioral therapy (CBT) is especially helpful for both disorders.
CBT is a problem-solving therapy that acknowledges the chain reaction from a thought to an emotion to a behavior. The idea: changing your thoughts can lead to more value-driven behaviors.
This type of therapy helps people identify the problematic part of the chain so they can then identify healthier, happier behaviors, says Steven Lucero, Ph.D., a licensed psychologist.
"As [individuals] identify alternative value-driven behaviors that help them to stop avoidance, and to start approaching the sources of meaning and activity that were once so important to them, the individual begins to notice a lightening of depression and anxiety," he said.
"The key here is that the individual takes action to disrupt the spiral of avoidance that worsens the disorder."
CBT techniques recommended by psychologists
While practicing CBT with a therapist is best, it's a route many can't take or benefit from to the same degree because of financial constraints and other barriers.
But don't worry — CBT is a therapy you can practice on your own. Below, find psychologist-recommended skills that help with anxiety- and depression-based cognitive distortions.
1. Cognitive restructuring with exposure therapy
Cognitive restructuring entails writing your thoughts, then listing your arguments "for" and "against" the thought. Does it have a basis in truth? This activity helps you form a more helpful and accurate perception.
You can also add in exposure therapy by listing your anxious thoughts about a certain activity, doing it, then seeing how many of your anxieties did and didn't come true.
According to Butler, this CBT skill helps you test a thought in real life.
"Cognitive restructuring with a component of exposure therapy is helpful because it provides a real-life experience of reality testing of thoughts," she said.
"If thoughts are fear-based, irrational or distorted, exposure therapy provides the opportunity to reality test and gather real-life data to support a more balanced thought.
Decatastrophizing is a similar technique. According to Hammond, catastrophizing is when you believe the worst (and a highly unlikely) outcome will occur. It's a common symptom of both depression and anxiety.
You can treat this symptom by "decatastrophizing," or restructuring those thoughts.
"To work on 'decatastrophizing,' individuals can start to write down a list of their top stresses and worries, then discuss the likelihood of these events happening," Hammond said. Through this technique, individuals can see how the probability of their concerns occurring is lower than they'd imagined.
3. Behavior activation and successive approximation
If you've struggled with finding motivation to complete the many items on your to-do list, behavior activation is a great next step. You'll engage in behaviors you value, realizing action often leads to motivation, rather than the other way around.
"We find ways to take small actions. As we see ourselves successfully completing those, it becomes motivating to take on larger actions," Lucero said.
"So, we must accomplish small wins along the path to larger success."
And that's what successive approximation is: breaking overwhelming tasks into smaller, more achievable steps to help you gain confidence with each one.
Accountability as an overall best practice
Regardless of which technique you try and whether you practice it at home or with a therapist, remember this: Accountability can be a crucial part of staying on track and getting better.
"The most important aspect is accountability with other people in our lives who can help encourage and support us in taking value-driven action in areas that might feel overwhelming or impossible before we start," Lucero said.
"When we have the safety of those relationships to take solace when we do inevitably encounter some failure, we are more willing to take those risks in the first place … For most of us, experience tends to win out over fear."