Understanding and managing depression and anxiety are the two biggest reasons that adults, students, and children seek counseling. Many people are mystified as to why we get these disorders. Sometimes circumstances can explain their causes and other times they cannot. The on/off switch or volume knob analogy is a simplified way of understanding how depression and anxiety commonly show up and how they are treated using cognitive behavioral therapy (CBT).
Depression and anxiety are known as something called “ego-dystonic” which is a nerdy way of saying that we know when they are present because we don’t feel like ourselves. This makes them easier to treat from a therapist’s point of view, as opposed to personality disorders or other “ego-syntonic” states which feel right at home with the client in spite of causing them a great deal of trouble.
Anxiety and depression are both treated best using cognitive behavioral therapy (CBT) and often a type of medicine known as an SSRI (prozac, zoloft, etc).
However, the commonalities often stop there. Depression presents more as “on/off” switch, and anxiety as more of a volume knob that can be dialed up or down. Why?
Depression: More of an on/off switch
True depression is a pervasive state of low mood with accompanying symptoms of hopelessness and apathy that last for at least two weeks. However those experiencing a depressive episode or even dysthymia (low grade depression for 2+ years) still usually report having days where they don’t experience their symptoms, such as days where they can sleep and function well and experience their lives from a non-depressed state of mind.
Even if you’ve never been clinically depressed, you know what it feels like to have a bad day, or ruminate on a particular depressing topic or incident, or experience situational depression where we may feel one way in one environment (work or school) but feel okay the rest of the time. Thus, the on/off switch.
The on/off switch is helpful image for clients to use with CBT because this type of therapy identifies thoughts we have about ourselves, the future, and the world around us. If we can do an activity like a CBT thought chart most days, there will inevitably be a moment when we can capture beliefs about ourselves (or whatever might be part of our depressive thinking) and learn to challenge them. Think of it as bottling up our beliefs about ourselves and the world around us from a non-depressed perspective in order to use them during one of our lower moments. We can also set plans of action and identify self-compassions statements to be used during the times when a depressive episode is at its worst.
Eventually, treating depression using CBT, the “productive” thoughts about who we are and how we want to live are able to overcome the inner critic or depressive thinking, and we get back to being ourselves.
Anxiety: More of a volume knob
When was the last time you were over-caffeinated? Imagine being over-caffeinated, but from the moment you wake up — or, being over-caffeinated when also stuck in a meeting, traffic, or on an airplane running late? This is the best example I can give of what it is like to experience an episode of anxiety. Your body is revved up and your mind is latching onto repetitive and ineffective worries.
However, most of us have bodies and minds that respond to our day with our minds and bodies than can regulate emotions, process caffeine, get the wiggles out — whatever it takes to get your nervous system back to a state of stability and turn that volume knob of anxiety down. But if you have anxiety, you may experience everything from a low-grade buzzing of stress to full blown panic attacks where it feels like you might pass out.
Conquering anxiety is therefore a matter of learning how to regulate (read: chill) at a mind-and-body level throughout the day, and respond to stressors throughout your life without short-circuiting the brain or causing undue stress on the body. Anxiety treatment requires behavior change throughout the day and using CBT to carefully restructure the thought process to not produce more stress. It’s like training the brain to run a different maze when a stress-producing thought arises. You have to keep an eye on that volume knob.
CBT with anxiety is especially important because anxiety can often be attributed to a fairly legitimate cause or origin: thoughts about an upcoming test, climate change, relationship stressor, physical symptom, etc.. Anxiety says “Pay attention to me. Worry about this.”
However those with anxiety do not process their worries productively. They ruminate, they dither, they seek reassurance, they avoid…many behaviors designed to cope with anxiety actually keep that volume knob in control.
When you can understand that you cannot just “hurry up and relax” when suffering from anxiety, it helps you make choices to set your body and mind on a course towards better management of stress and worry.
This on/off switch and volume knob analogy is a generalization of these common disorders; each person’s experience of depression and anxiety is unique. But when clients can understand why they might either experience such rapid dives in mood and mindset (depression) or why they feel the buzz of stress all the time (anxiety) then they can set about using CBT to control their switch or knob for better well-being.
