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Critically discuss similarities and differences between anxiety and depression. Refer to the effect this might have on clinical practice.
Anxiety and depression are both considered to be the most common mental health issues across the world. Anxiety is often associated with nervous behavior and the individual feeling a significant amount of discomfort in certain triggering situations thus invoking nervous types of behaviors or reactions such as panic attacks or pacing back and forth. Depression is known as a state of a low mood which may affect an individual’s thoughts, feelings and behavior as this mental health issue is often accompanied with low self-esteem, feelings of inadequacy and most often, strong thoughts and feelings towards committing suicide. Both of these mental health issues are separate diagnoses, however sometimes both anxiety and depression may overlap in terms of some individuals being diagnosed with both issues as they share a few similarities regardless of being two different issues. They are both mainly treated with similar treatments such as the same medication can be given for both anxiety and depression, as well as the fact that both mental health issues are approached with CBT therapy. In this essay, the similarities/differences between the two mental health illnesses and how these similarities/differences may affect clinical practice will be discussed.
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Generalised anxiety disorder (GAD) is primarily characterised by fear whereas depression is characterised by prolonged sadness that affects the individuals lives. Generally, depression and anxiety are similar in terms of their main defining symptoms in terms of their mental symptoms such as thoughts and feelings as well as the fact that they are both caused by chemical changes in the brain due to low serotonin levels as well as a change in dopamine and epinephrine levels. However, they both have physical manifestations which may possess a number of differences between the two conditions. Depression is defined by two main symptoms which is having a low mood or a loss of interest in the individual’s normal day to day activities. A person with depression may also experience, hopelessness, low confidence and feeling worthless, indifference, prolonged sadness and thoughts of death or suicide, they have to experience five or more of these symptoms over a period two weeks in order to be diagnosed with depression. Similarly, GAD centres on two main symptoms as well, this can be associated with excessive anxiety and worry, and difficulty controlling these feelings of anxiety which may cause a more severe outcome. Other symptoms are associated with irritability, feeling restless and uneasy as well as prolonged sadness and in order to be diagnosed they have to experience these symptoms on most days in the period of six months or more. Also, both mental health disorders have similar physical symptoms such as fatigue or tiredness, low concentration, being fidgety or unable to stay still, headaches, slow responses and thinking and lastly difficulties sleeping. However, while having similar physical symptoms they also possess their own distinguishing symptoms, for example the physical effects of anxiety may include dizziness, sweating, bowel issues, hyperventilation, shaking and restlessness, whereas with depression the physical symptoms include slow movements, weight changes due to a drastic change in appetite, excessive sleeping, lack of energy or emotion as well as painful cramps. All of which can potentially be signs of a number of other issues regarding an individual’s physical health.
There are a number of psychological models which propose the cause of development for these conditions due to different factors. In terms of depression, the behaviourist theory suggests the importance of the environment in shaping the individual’s thoughts, feelings and behavior, meaning that it is caused due to observing/learning behavior due to their interaction with the environment. Classical conditioning insinuates that depression develops through associating certain stimuli with negative emotions. While, operant conditioning states that depression is caused by the removal of positive reinforcement from the environment (Lewinsohn, 1974). Certain events, such as losing a loved one, induce depression due to the fact that it reduces the source of positive reinforcement, in this case being the company of that loved one. Another model is the cognitive model which focuses on the individual’s thoughts and beliefs where it is believed that depression is due to negative bias regarding an individual’s thinking processes. As proposed by (Beck et al, 1967), he identified the “Cognitive Triad” composed of the three forms of negative thinking that are common in individuals with depression, known as negative thoughts about self, the world and the future, this means they often scrutinize themselves as inadequate or worthless, while also interpreting the world as a negative aspect in their lives and as an obstacle that they can’t overcome. Lastly, they see the future as hopeless due to their inadequacy with no possibility of improving them or their situation. These components interacting affect the individuals cognitive processing thus leading to impairments in their cognition and the development of depressive states. Beck (1967) also believed that individuals with depression identified with negative self-schemas, which is negative beliefs of themselves that may be a result of a traumatic event such as the loss of a loved one, bullying or parental neglect/abuse thus predisposing them to depression. Lastly Beck proposed that depressive individuals are prone to making logical errors in their thoughts.Beck identified a number of systematic negative bias’s in the processing of information where the individual chooses to only focus on the negative aspects of things while ignoring other equally relevant information which is known as these logical errors. Thus, causing them to feel more worthless and negative and invoking depression in the individual. In terms of anxiety, the Emotion Dysregulation Model (Mennin et al, 2004)suggests that worry functions as an avoidant response to distressing emotion, it proposes that individuals with anxiety disorder experience their emotions more intensely, have a limited understanding of emotions, negative attitudes towards emotions thus believing that there are negative consequences towards experiencing emotions and lastly they also struggle to even experience emotions as well as manage or control their emotional responses due to deficits in their emotional regulation. Additionally the cognitive avoidance theory (Borkovec et al, 1994) of worry which proposes that fear is acquired through classical conditioning and supported through operant conditioning. This theory suggests that the worry focuses on possible future situations that the individual wants to avoid. As the supposed threat exists only in the future, they are unable to respond to it instantly, thus the only way to deal with it is to worry which serves as an avoidant function for the individual and the negatively reinforcing the emotion as well as preventing normal emotional processing and affecting their emotional cognitive responses negatively. This emotion can be reinforced with certain stimuli in which the individual has a negative association with, thus turning into a trigger for developing anxiety disorder. In terms of the similarities both conditions are based off of classic and operant conditioning in terms of negative reinforcements being the cause of both conditions as well as the fact that both focus on emotional experience and exposure such as the cognitive avoidance theory for anxiety and the behaviourist model for depression. In terms of differences, the cognitive model for depression focuses on cognitions whereas the emotional dysregulation model for anxiety focuses on emotions.
One clear similarity between the two conditions is their treatments. Both conditions have two key categories of treatment: psychological therapies and medication, these are also known as transdiagnostic treatments as they can be used for anxiety and depression. Psychological therapies involve talking through your thoughts and feelings with a qualified professional. The most common is cognitive behavioural therapy, which aids in identifying the point at which the individuals’ negative thoughts, behaviours and feelings intersect as well as aiding them in modifying their negative behaviour and feelings. Additionally, antidepressants are used for both conditions. The most common antidepressant is called selective serotonin reuptake inhibitors (SSRIs), which increases the amount of serotonin in the brain in order to aid with their mood issues. The only main difference in terms of these conditions is the fact that hospitalisation or electroconvulsive therapy (ECT) is used for depression with individuals who don’t respond to medication or feel suicidal.
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In regard to clinical practice, the similarities between anxiety and depression have been shown to be effective in terms of aiding the individuals while also being cost effective due to the fact that transdiagnostic treatments allow a wide range of psychiatric conditions to be treated including individuals who may develop both conditions. However, there is a disadvantage to their similarities due to the fact that it might not allow the conditions to be properly investigated as individual issues due to the fact that they withhold many similarities and therefore it could lead to an error being made in someone being diagnosed. In terms of the differences having an impact on clinical practice, I believe that it allows the two conditions to be separated and made their own distinctive condition instead of them being collectively identified, this allows more research onto both of the conditions thus allowing improved methods to be found to aid individuals with anxiety and depression.
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