Anxiety and Depression--First Cousins, At Least (Pt 3 of 5)

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The Negative Beliefs That Fuel Anxiety and Depression

It's possible that certain chemical imbalances can trigger anxiety and depression regardless of your thoughts about yourself. But more than anything else, I'd argue that what gives rise to these two mental/emotional disorders are deficits in your self-image and sense of personal resources. And I'd add that your thinking--day-to-day, and even moment-to-moment--can itself have a major impact on your brain chemistry.

I proposed in Part 2 that both anxiety and depression represent the "flight reaction" to stress. So it only makes sense to explore the negative beliefs that might compel you to "back off" in situations where staying pro-actively engaged would not only make you more effective in life but also result in your having a more positive view of yourself. Further, the more you avoid or withdraw from what's stressful to you, the more things will become stressful to you. Or, to put it a little differently, the more vulnerable you see yourself, the more things will make you feel vulnerable. And this, to me, is a perfect example of a downwards vicious cycle.

It's been said many times that your perceptions or beliefs create your reality. But whether this subjective reality is a reliable--or distorted--representation of what's actually "out there" obviously depends on how accurately it reflects what's external to you. I wouldn't deny that, to some degree at least, your "hard wiring" at birth influences your thought patterns and processes. However, I'd suggest that ultimately it's your relationship with your family and, secondarily, your affiliation with your peers that principally determines how you see yourself and the world around you.

So if, for example, in growing up you weren't able to experience your environment as safe, you're more likely than others to view various circumstances as threatening. And if, moreover, the messages you regularly received from your caretakers (and possibly from others as well) was that you didn't have the strength, intelligence, or resilience to effectively cope with anything difficult, then you probably were left feeling ambivalent about confronting life's challenges. The net result of such a negatively discouraged, externally derived attitude about self might be to make you feel too insecure, too vulnerable or scared, to take on those risks that all of us need to face if we're really to feel good about ourselves.

Now, of course, these descriptions are generalizations, just on the border of being simplistic. As such, they're hardly meant to characterize your personal circumstances with surgical precision. But if you've had a lifelong susceptibility to both anxiety and depression, it could be valuable to explore what maladaptive--and typically unconscious--beliefs link to your heightened sense of vulnerability, which in turn may have made it so difficult for you to be pro-active in your own behalf.

What I'd like to do next is to offer for your consideration a list of many of the assumptions and beliefs that, cognitively, tie together the mental/emotional disorders of anxiety and depression. In this respect, I'd venture to say that any talk therapy likely to succeed in helping you overcome these "twin" disturbances--not simply in the present but in the long-term as well--needs to go far beyond dealing with your initial motive for seeking therapy (i.e., to alleviate overwhelming distress). Rather, truly effective therapy for anxiety/depression must address longstanding issues relating to your self-confidence--and, more generally, to a variety of deficits in your self-image. Only such a comprehensive approach will enable you, going forward, to feel sufficiently empowered to confront life's many challenges.

So what exactly are some of the negative beliefs that might make you susceptible to anxiety and depression? Over the years I've collected over 150 such beliefs from my clients, and my sense is that the more of them you harbor about yourself, the likelier you are to suffer from these related disorders. After selecting some of the more common items from my extensive list, I'll endeavor to provide additional examples of how negative thoughts about yourself (particularly in relation to those around you) can propel you in the direction of both anxiety and depression.

There's little doubt in my mind that both problematic states of emotion, mood, or consciousness derive from kindred "sets" of personal beliefs. And I might add that many writers have noted that effectively treating a person for clinical depression frequently reduces their level of anxiety, too--and vice versa. And if you think about it, how could this not be the case when one and the same belief (or slightly varying forms of that belief) may have set off their depression and/or anxiety in the first place?

Admittedly, substantial overlap exists among the different items in the six categories below. Further, some items included in one cluster might fit just about as well in another. But as long as it's understood that (almost necessarily) my classification system is somewhat arbitrary, it may be useful to group separately these many complementary beliefs. As you review the items in each category, consider the ways that each one might have fostered in you feelings of anxiety or depression . . . or both. Also, consider the times you may have sabotaged yourself--and which of these deep-seated beliefs may have caused this self-sabotage (such as "I will fail," "I can't get what I want," or "I don't deserve to succeed"). Here's the list:

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Sense of Inadequacy, Defectiveness, Shame, and Failure

• I'm not worthy (or worthless)
• I'm inadequate (incapable)
• I'm incompetent (inept)
• I'm inferior
• I'm behind the curve ( . . . 8-ball)
• I'm defective (broken; flawed)
• I'm not smart enough (slow; stupid)
• I'm lazy
• My feelings are stupid
• I'm not good enough (There's something wrong with me)
• I can't be good enough
• I'm bad
• I'm guilty (&/or shameful)
• I'm contemptible (pitiful)
• I'm a fraud
• I'm permanently damaged
• I'm ugly (my body is hateful)
• I'm ashamed of my body
• I'm ashamed of my sexuality (desires, feelings, sensations, etc.)
• I'm dirty (soiled, impure, disgusting)
• I'm a loser
• I'm a failure (will fail)
• I'm hopeless
• I can't do anything right

Sense of Non-Deservingness (cf. Self-Rejection)

• I don't deserve love
• I don't deserve respect
• I don't deserve to be happy (or enjoy myself)
• I don't deserve to succeed
• I don't deserve forgiveness
• I don't deserve anything
• I deserve criticism (or disapproval)
• I deserve pain (or punishment)
• I deserve only bad things
• I deserve to be miserable
• I deserve to be abandoned
• I deserve to die

Sense of Social Disapproval, Rejection, and Alienation

• I don't belong (don't fit in)
• I'm left out
• I'm not taken seriously
• I'm a non-entity
• I'm all alone
• I'm not likeable
• I'm not lovable
• I'm not acceptable
• I'm not normal
• I'm different [in a bad way]
• I'm a disappointment
• I'm an annoyance
• I'm looked down upon
• I'm made fun of
• I'm seen as a bad person
• I feel humiliated
• I'm a burden to others

Sense of Subjugation or Self-Sacrifice

• I can't set limits on others (don't have the authority to. . . .)
• I have to be responsible for others
• I have to defer to others
• I can't stand up for myself
• I can't be myself
• I have to please others (or be perfect)
• I can't disappoint others
• I can't have my own wants (&/or needs)

Sense of Vulnerability

• I can't trust myself
• I can't trust my perceptions
• I can't trust my judgment
• I can't trust my authority
• I can't trust others
• I'm cowardly
• I'm lost (don't know who I am)
• I can't be intimate
• I'm not safe (can't feel safe)
• I'm trapped
• I'm a victim
• I'm weak
• I'm powerless (or defenseless)
• I'm helpless
• I can't protect myself
• I'm not in control
• I can't stand it

Sense of Dependency / Lack of Self-Sufficiency

• I feel like a child (am not really an adult)
• I can't afford to be vulnerable ( . . . to take risks)
• I'm not enough for myself
• I'm empty
• I'm insecure
• I can't think for myself
• I have no authority
• I have to depend on others

To exemplify briefly how your early programming can explain your susceptibility to both anxiety and depression, consider the negative belief, "I'm not in control" (or "I'm out of control"). Not only does such a powerless self-regard (generally based on a compilation of childhood experiences) set you up to more readily react to situations as threatening or overwhelming, but such a defeatist attitude also fosters feelings of hopelessness virtually synonymous with depression.

Similarly, the negative notion, "I can't trust myself," serves to explain the passivity, indecisiveness, and inability to follow through on plans commonly observed in both anxiety and depression. And the procrastination, inaction or immobility resulting from such a lack of confidence generates even more self-doubt about being able to make the right choices. Needless to say, both anxiety and depression are de-motivating, which serves only to confirm a negative bias that may actually be quite at odds with what--potentially--you could achieve if you were able to change such antiquated ideas about yourself.

Aware of it or not, when you're anxious or depressed your thinking is invariably negative. You don't have a "can do" but a "can't do" attitude. Such a pessimistic orientation leads either to your being afraid to confront a problem (anxiety), or to despair of ever being able to solve it (depression). And regardless of whether your self-reflections eventuate in anxiety or depression, the ultimate belief about yourself can be reduced to "I'm not good enough"--though if your thinking is primarily anxiety-driven, it might be more accurate to say, "I'm afraid I won't be good enough." But aside from your underlying self-evaluation, if you're afflicted by the anxious habit of avoidance, you're destined to conclude that you simply don't have what it takes to succeed . . . which, inevitably, will make you feel depressed as well.

Note: For those of you who missed the two earlier segments of this multi-part post, Part 1 outlined the broad distinctions usually made between anxiety and depressive disorders, while Part 2 described the many crucial similarities between the two syndromes. Part 4 will go into the research findings and theoretical speculations on this subject; and, finally, Part 5 will deal with various therapy considerations in treating those who suffer from a combination of anxiety and depression.

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