It is well known that anxiety and depressive disorders have a high comorbidity. For example, according to the DSM-5 individuals with generalized anxiety disorder are likely to have unipolar depressive disorders. This connection is not a mere correlation without causation. But, what is remarkable is that it is also not a causal connection; that is, one whereby anxiety causes a person to become depressed.
If this sounds curious, it is because psychology ordinarily looks for the causes of psychological phenomena. That’s because it’s a social science, and all (empirical) sciences look for the causes of things. However, in addition to correlations and causes, there is a third possibility, namely logical connections. What I want to maintain is that the connection between depression and anxiety is, indeed, a logical one.
Logical connections are conceptual ones. For example, if you had an equilateral triangle (a triangle with three equal sides) and made one side larger, what would you get? The answer is an isosceles triangle (a triangle with just two equal sides). You do not have to conduct an empirical investigation to find out if this is true. You do not have to examine numerous cases of equilateral triangles where one side is lengthened to see that, every time, you will end up with an isosceles triangle. The transformation can be known just by understanding what equilateral and isosceles triangles are.
In this blog, I submit that anxiety and depression are close conceptual relatives much like the relationship between equilateral and isosceles triangles. One can lead to the other, and conversely by certain conceptual alterations, and once these conceptual alterations are made, the transformations are completed. And it is the person experiencing anxiety who is in charge of making these conceptual changes!
First, all emotions—and anxiety and depression are emotions—have emotional objects. An emotional object is that object the emotion is about. For example, you can be anxious about the possibility of losing your job, not being accepted by your peers, not doing well on an exam, or your partner breaking up with you. (In the case of Generalized Anxiety Disorder (GAD), the emotional objects are a number of revolving possible events or activities).
Notice that each of these objects is about the future. Anxiety is a future-oriented emotion, which means that it is always about some future possibility. Here the term “possibility” signifies another aspect of anxiety: it is about a future uncertainty.
Further, when the emotional objects of anxiety are fully articulated, they turn out to be conditionals (if this then that). For example, if you are anxious about the possibility of your partner breaking up with you, then you are anxious about what will happen if s/he breaks up with you. For example, it is possible that if s/he breaks up with you then you will never find anyone else and be alone the rest of your life.
Typically, the consequent (“then” part) of the emotional object of strong anxiety will be something perceived to be of catastrophic proportions—like a 9 or 10 on a 1 to 10 “bad scale.” Thus, if you end up alone for the rest of your life, then this would be horrible.
As such, you would be drawing an inference from a set of premises that looks a lot like this:
This is the logic that drives the anxiety of someone who is anxious about a possible breakup. In the jargon of logic, this inference is called a pure conditional argument. It has two conditional premises and a conditional conclusion: If p then q; and if q then r; therefore, if p the r.
Here there is a kind of conditional gloom and doom. Now here’s the kicker! If you should remove this conditionality, either because you have already convinced yourself that your partner will (definitely) leave you; or if this has, in fact, already happened, then your anxiety will lead to depression (subclinical if not accompanied by the other conditions of Major Depressive Disorder).
So, here’s the logic of how your anxiety could lead to depression:
As you can see, the above depressive reasoning removes the iffyness, that is, the uncertainty of anxiety reasoning. Anxiety is therefore, in a sense, depression waiting to happen!
To be clear, this does not mean that all anxiety that loses its element of uncertainty turns into depression. The anxiety that does this involves emotional objects that are perceived to be extremely bad, that is, ones that are perceived to make one’s existence meaningless, hopeless, or devoid of significant value if they happen. As such, there is an existentially damning element involved in anxiety-depression comorbidity.
Further, the anxiety is comorbid with the depression, which means that the conversion to depression does not mean that the anxiety disappears with the emergence of the depression. Rather, the focus of the anxiety may now be on different conditional, catastrophic emotional objects. “Now that I am alone forever, what else is going to go wrong!” Consequently, in a vicious cycle, the anxiety affixed on new conditional, catastrophic objects can feed even deeper, darker depression!
Understanding the logic of anxiety-depression comorbidity and its inherent vicious cycle, is not a minor point. Cognitive behavior forms of therapy, particularly the logic-based one that I invented, can help expose the self-defeating premises from which people deduce catastrophic conclusions. Understanding how different forms of logical reasoning drive and connect emotions can be empowering because one can, so to speak, “look under the hood” to see what’s going on. The first step in making constructive change is, indeed, insight into what needs changing.
So, what can be done to overcome this vicious degenerative process once it is exposed?
The Logic-Based Therapy (LBT) stresses that anxiety-depression is mired in metaphysical insecurity, and that aspiring to reach a state of metaphysical security can be a powerful antidote to it. This means becoming secure about reality itself, especially its imperfections. This, in turn, means acceptance of uncertainty in the world; the realization that things do not always go the way one wants; and that bad things can and do happen.
Being metaphysically secure means living comfortably with probabilities, not certainties; with reasonable hopes rather than pie-in-the-sky optimism. It stresses that what’s true of the part is not necessarily true of the whole, so that despite the bad things in the world, this does not make the world itself a bad place; nor does it mean that one’s life is devoid of positive value or hope. To the contrary, the metaphysically secure person sees the uncertainty in the world as an opportunity for positive growth; for s/he realizes that a world without risks is one without the opportunity to cultivate character traits such as courage, temperance, and prudence in confronting human challenges. A metaphysically secure person therefore frames the bad things in life in the context of the wider whole that admits the possibility of character building and constructive change. Indeed, from such an empowering perspective, without the imperfections of the world, there would be no incentive to do better, and no opportunity to make contributions to the world. It would be a stillborn universe.
In contrast, the person ensconced in a vicious cycle of anxiety-depression inhabits a world riveted on catastrophe and the perception of uncertainty as a precursor to gloom and doom. Exposing the structure of the reasoning that pilots the interplay of anxiety and depression, based on these self-destructive premises, can thus provide an opportunity to intervene with the forward looking, rational aspiration of metaphysical security. The inherent iffyness of anxiety reasoning sets the stage for the descent into the gloom and doom of depression through the actual or perceived elimination of this conditionality, which in turn sets the stage for further anxiety, and intensified outlooks of gloom and doom. However, one’s happiness need not dangle on such a thin metaphysical thread; for the perceived imperfections of the world—its uncertainty, its misfortunes—can be cast in their broader context of a world rich with opportunity for positive change and growth.
Realizing how anxiety can be depression waiting to happen provides the opportunity to intervene cognitively, emotionally, and behaviorally to overcome the self-defeating premises (as exhibited above) that drive the vicious cycle; and, instead, to reframe and redirect toward greater metaphysical security.