Depression and Anxiety – which therapy is for you?

Besides being therapists, clinical psychologists are also meant to be diagnosticians and clinicians in clinical settings like hospitals and clinics. It is a very important distinction between us and other therapists or counsellors. I enjoy this aspect of the work and find it intellectually stimulating. But beyond knowing someone’s diagnosis, I still believe in seeing every client as an individual. To this end, I acknowledge that people need different kinds of treatments and different kinds of therapy .

Today, I want to share with you some of my understanding about depression and anxiety, as well as help you figure out if you need therapy and what sort of therapy you should get.

Very quickly – we all experience depressive moments in life. Whether it’s after a breakup, when a loved one dies or simply hormonal changes that occur in the woman’s menstrual cycle – each one of us has our “blue” days, the days we feel a bit sad and weepy, the days we might wanna stay in bed and watch rom coms rather than going to work.

But this is not what we call Clinical Depression (A Major Depressive Episode or Major Depressive Disorder). Depression is a much longer-lasting and debilitating condition that seeps into every fibre of your being and drowns out the light from every waking moment.

The subjective experience is one of utter dismay and disillusionment – like the world has lost all meaning, your life all-purpose, and you begin to say negative things to yourself. People who have depression tend to be extremely negative and punitive towards themselves. Their self-talk reflects this as they have extremely negative thoughts that they tend to ruminate (chew repetitively) on. Thoughts like “I’m a failure”, “I hate myself”, “I’m worthless” etc.

Physiologically, depressed people tend to have disturbances in sleep and/or eating behaviours (i.e. insomnia or excessive sleeping, over- or under-eating, as well as significant weight gain/loss). Depression screws with your entire endocrine system, which means your hormones including the ones in your brain (neurotransmitters) become imbalanced and out of whack.

Anxiety is also something every single one of us experiences. It is a natural and adaptive evolutionary response to a perceived threat (danger). If we didn’t have anxiety then we wouldn’t know when to run or fight in a dangerous situation.

In our modern life, the experiences of “life-threatening” stimuli have been markedly reduced from when we lived in the wild. Nowadays, the things that bring up an anxiety response in us are more likely to be subtler and threatening on a different level. Societal pressure, relationships with parents, one’s own high standards and expectations of oneself, etc., tend to be what increases our anxiety levels.

Although these events are far less life-threatening, the same automatic fear-response system is triggered. This means that physiologically, the body responds to anxious thoughts by preparing for fight or flight – the pulse quickens, the heart races, the palms become sweaty, muscles tense up, etc.

On a cognitive (thinking) level, people who suffer from anxiety will worry excessively about literally everything in their lives and also about all manner of hypothetical future events. In terms of what is considered “normal”, the amount of anxiety experienced varies from person to person and is shaped by inter/intra-personal and environmental factors.

An anxiety disorder (there are numerous, e.g. panic disorder, agoraphobia, obsessive-compulsive disorder, etc.) is ultimately different to everyone else’s garden-variety anxiety because it severely interferes with that person’s functioning. People who suffer from anxiety disorders struggle to participate in everyday life events because their anxiety is so overpowering and debilitating.

So, in a nutshell, this is what we are referring to when we speak about Depression and Anxiety. They often get clumped together because they are both disorders that stem from very normal psychological experiences that each one of us goes through in a lifetime. They are also related because they have similarities in cognitive components and the type of neurotransmitters in the brain they affect.

So what do you do about the fact that you’ve been diagnosed with either of these two disorders? (Please, if you feel you might be suffering from either or both, then you MUST consult a clinical psychologist, psychiatrist or trusted GP).

As a psychologist, I am weary of the practices of psychiatrists generally. If you don’t already know – psychologists provide therapy, and psychiatrists prescribe medication. This means that if you walk into a psychiatrist’s office (also be advised that they are about 3 times more expensive than a psychologist) and you list a certain number of symptoms that can be classified according to any one diagnosis, then more than likely you are going to walk out with a handful of pills.

Now, don’t get me wrong. I have nothing against psychiatric medication per se. I believe that many people can benefit from being on medication prescribed by psychiatrists, and I often refer my clients for a psychiatric evaluation for this very purpose. All I am saying is it is unlikely that you won’t get given medication if you do see one. In my opinion, medication is not satisfactory.

I am inclined to believe that everyone, including the healthiest of individuals, can benefit from therapy. I, therefore, strongly believe that medication alone is not sufficient in treating psychiatric/mental illnesses. If you think you have symptoms of depression or anxiety (or any other mental illness for that matter), if you’re feeling stressed, or if you’re having repeated difficulties in relationships, then you can most definitely benefit from therapy!

Therapy usually involves talking to a trained professional about yourself – your life, problems, family, feelings, etc. This is one of the only generalisations one can make because there are so many different kinds of therapies on offer, and each therapist has their particular style. For the sake of brevity, however, I will tell you about the two most common therapeutic modalities: Psychodynamic Therapy and Cognitive Behavioural Therapy (CBT).

Psychodynamic therapy is the umbrella term used to describe the therapy that is usually conjured up in people’s minds when they think of the work of psychologists or shrinks. Freud is the father of psychology in general, and he worked in a very particular way that psychodynamic therapists still echo to this day. The client does most of the talking in this therapy, and the therapist is quite passive. The therapist's job is to think about and analyse the client to find connections between their past relationships and difficulties.

As a client, you will be expected to discuss your childhood at length because a psychodynamic therapist takes a developmental approach. This approach considers the environmental factors that contribute to the development of your psyche. Psychodynamic therapists also believe that for therapy to be effective, the therapist and client need to form a strong, healthy alliance…there needs to be a relationship. This is why therapy often takes long, sometimes many years.

I think this kind of therapy is good for people who want to understand themselves with great depth and clarity and who want to find meaning. It is a very flexible, client-driven approach that may sometimes feel a bit elusive, but it can significantly help with a whole range of problems in the long run.

CBT, on the other hand, is a far newer approach. The founder of CBT, Aaron Beck, has been alive until recently. Unfortunately, there aren’t enough well-trained CBT therapists in South Africa because it is hardly taught at universities here. However, it is fast becoming the therapy of choice in the USA and UK. The reason for this is that there is a lot of research that proves that CBT is the most effective treatment for Depression and Anxiety. CBT is also a short-term option. It can be done in as little as six sessions, although the average is probably 12-20.

In CBT, the focus is less on what happened to you during childhood and more on how you think and behave right now. A good CBT therapist should aim to empower you to be your therapist. Therefore, the focus is away from the relationship and more about providing you with tools to help yourself. In this way, CBT can help you manage those unwanted and debilitating thoughts and behaviours associated with depression and anxiety. Overall, it is a great option if you want a quick solution. It is goal-orientated and works at symptom reduction rather than meaning-making.

Of course, this is just a brief outline and my take on each. So I urge you to do your research. Just remember, you are the customer. If you don’t feel right about a therapist, go to someone else…there is no shame in shopping around until you get the right fit; it is highly recommended. It needs to feel right for you. And believe me, it will be worth it because if it works, it will save your life!

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