Are You Anxious? Or Depressed?

Excerpted from
When Panic Attacks; The New, Drug-Free Anxiety Therapy: That Can Change Your Life
By David D. Burns, M.D.

Most of the lime, negative emotions don't come in pure packages. In fact, anxiety and depression usually go hand in hand. However, these feelings are very different from each other. Anxiety results from the perception of danger. You can't feel anxious unless you tell yourself that something terrible is about to happen. For example, if you have a fear of heights and you're hiking on a mountain trail with steep drop-offs, you'll probably feel gripped by panic because you'll think that you could slip and tall at am moment.

In contrast, when you're depressed, you feel like the tragedy has already happened, h seems like you've already fallen off the cliff and you're lying at the bottom of the ravine, broken beyond repair. You feel blue, demoralized, and down in the dumps. You tell yourself that you're worthless, that you're a failure, or that you're not nearly as good as you should be. You lose interest in life and in other people, and the activities you once enjoyed seem unrewarding. Nothing excites you anymore. You feel overwhelmed, and life seems like one long procrastination. The worst part is the hopelessness. You feel like things will never change and believe that you'll be miserable forever.

If you're depressed, you'll almost definitely feel anxious. And if you're struggling with anxiety, you may also be feeling depressed. Why is this? Scientists don't know for sure why depression and anxiety go together, but there are four competing theories. According to the first theory, most people can't distinguish different kinds of emotions. All they know is that they feel upset. By way of analogy, people who live in the desert have only one word for snow, because they rarely ever see it. Inuit, on the other hand, have many words for snow, because they deal with it constantly and need a more refined vocabulary to describe all the different kinds of snow they encounter.

According to the second theory, depression leads to anxiety. For example, if you've been depressed, you may worry about the fact that you feel defective, inferior, and unmotivated. You may be afraid that the depression will interfere with your work or personal life, that you'll never achieve your goals in life, and that you'll never feel happy again.

According to the third theory, anxiety leads to depression. There's no doubt that anxiety, shyness, worrying, phobias, and panic attacks can interfere with your work and personal life, especially when the anxiety is severe. This can be demoralizing and depressing. Some people have suffered from anxiety for years, or even decades, in spite of treatment with medications and psychotherapy. Eventually they start to feel demoralized and depressed because nothing has helped. Shame is also a central feature of anxiety. You may try to hide your symptoms of insecurity or panic, thinking that other people would look down on you or think you were weird if they knew how you really felt inside. The feelings of isolation and defectiveness can easily trigger depression because they make it so much harder to connect with others in a warm and open way.

The final theory about anxiety and depression is called the Common Cause theory. According to this theory, anxiety and depression share at least one common cause, in addition to their own unique causes. In other words, there could be something in the brain that triggers different kinds of emotions, such as anxiety and depression, at the same time. This theory' makes sense to me. Most of my patients have many different negative feelings at the same time, such as depression, guilt, hopelessness, anxiety, anger, and frustration.

Let's find out how you're feeling now. Complete the four sections of the following Brief Mood Survey. The survey will only take a minute or two. Once you've completed all four sections, you can interpret your scores with the scoring keys that are referenced at the start of each section. You can take the Brief Mood Survey as often as you like to track your progress while you read this book and do the exercises. Most of my patients take it at least once a week.

The Brief Mood Survey may seem simple, but it's a valid and reliable instrument that will detect the smallest changes in how you feel. This test is not like the quizzes you see in popular magazines. In fact, research studies have shown that it's more accurate than many of the instruments currently used in research studies.

You can take the Brief Mood Survey up to eight times on a single sheet of paper. The woman in the following example was severely anxious for two weeks, with scores of 16 on June 1 and 8. Her score dropped to 10 the next week, indicating significant improvement. By June 22, her score had fallen to 6, and by the following week, it was only 3. On July 5, her score of 1 indicated almost no anxiety at all. The following week, she had a relapse, and her score shot up to 11 again. This is common. Then she used the same techniques that had helped her before, and her score dropped all the way to 0 on July 19.