Counselling Twickenham, Whitton I work with:
counselling for depression
counselling for anxiety
survivors of rape
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As an experienced counsellor at Counselling Twickenham, I am frequently confronted by the profound and often contradictory relationship between anxiety and depression. Clients come to me experiencing these psychological conflicts simultaneously.
In this situation, I find that many of my clients experience their lives as an intense cycle of mood swings – struggling between the highs and lows of stress states. These mood swings create what I call ‘spikes and troughs’. For example a spike of anxiety may be triggered by a real or perceived crisis, such as being a victim of violent assault or an intense fear of being abandoned by a loved one. On the other hand, someone may also experience a deep low or trough, triggered by feelings of overwhelming distress and exhaustion at the end of a crisis, such as a long period of work-related stress or a breakdown in long-term relationships. This can often lead to intense feelings of fear and anger.
Clients who experience these spikes and troughs, tend to get locked into a repetitive cycle of negativity as their emotions yo-yo up-and-down without any sense of conscious control. As these emotions and behaviours get reinforced people become conditioned to feel insecure and increasingly lose their confidence to influence events. This repetitive cycle seems to be driven by an internal emotional conflict, as the person swings between ‘fight and flight responses’ under stress. What I have discovered through my therapeutic interactions at Counselling Twickenham, is that people find it difficult to break this cycle, even though they experience a great deal of distress, they continue to repeat negative patterns of behaviour. This is why I have set about trying to research this largely neglected area of psychological conflict from a neurological perspective.
However, the idea is nothing new in psychology. Freud quickly understood that fear and anger are primal instinctive drives, designed to help living organisms survive and adapt to their environment. Fear helps humans avoid danger, anger helps humans fight off danger. But under extreme conditions of stress or trauma, panic and fear responses can quickly overwhelm us. We become frozen, or flip impulsively between the two, unable to act decisively.
In response to normal levels of stress we trigger the sympathetic nervous system which puts our bodies onto high alert and prepares us to deal with impending danger. Chemicals such as adrenalin and cortisol flood the body's organs and muscles to prime it ready for immediate action. Physical symptoms such as a shortness of breath, heart palpitations, dry mouth, sweating, trembling, acid reflux and muscle tension in the back, neck and shoulders, prime us for ‘fight or flight’. This is why we feel tense, wound-up and agitated. At its worst it can trigger a panic attack. Action is demanded. Fear, anger and impulsive behaviours kick-in to protect us. Then, once the impending danger has passed our parasympathetic nervous system deactivates fear and relieves us of those symptoms, allowing our bodies to relax.
This inherent state of conflict also exists between our genes and the environment, which is the driving force behind our evolutionary development. We are born with a predetermined set of genes, which store inherited information to help us function effectively, but our genes also act like a complex network of switches; flipping on or off in response to environmental conditions, which help us to adapt. Under extreme environmental stress or trauma, there is either a steep learning curve for the species, or we die out and become extinct.
The problem is that human beings can be somewhat disabled by the very thing that has helped them to make great strides in our evolutionary development – the human brain. To be more precise, it is sometimes our ‘conscious awareness’ which betrays us. Because, as human beings we are consciously aware of our survival needs, we have become forward thinking and problem solving creatures to prepare us for potential crises in the future. Whilst our anxieties revolve around feelings of uncertainty our attention becomes too focussed on future events rather than assessing present level of threat. This conscious awareness and our memories of past events, causes us to make predictions about the future that are often based on negative experiences.
Thus when there is no immediate or present danger, such as an imminent attack by a tiger; our anxiety conditions us to search for potential threats way off in the future: for example, ‘If I am sexually inadequate, my girlfriend is going to leave me for another man’, or ‘If I am late for work again my boss is going to fire me’. This triggers a perpetual cycle of anxiety and a train of thoughts racing through our minds without any chance of relief. This also has a secondary dimension which most of us remain unaware of until it’s too late. We only become aware of our anxiety once the train of anxious thoughts have become unbearable. Long before that however, the sympathetic nervous system has been triggered by the emotional alarm centres in our brain (the limbic system) at a lower level of response.
Higher levels of fear, however, present us with two instinctive options in response to stress – fight or flight.
Under threat and in response to fear, we do not have time to think, we need to respond immediately to danger and the brain is wired up to compensate for this. The limbic system (or emotional alarm centre) overrides our prefrontal cortex (our logical, conscious, thinking brain) and calls us to respond automatically with swift and decisive action – we either flee the scene or fight off danger. Unlike most of us believe, we are not very rational animals at all. We are more impulsive than we think. Under most stressful conditions, our brains are wired up to respond to emotional inputs, much more sensitively than any logical thought processes which are useless in an immediate crisis. Imagine the time spent thinking through a logical plan of escape, when faced with an angry bear in your face. You need to act instantly. The problem is in modern life, there aren’t many bears to contend with, but we are faced with making tens of thousands of decisions every day. The stress is still there, because we are still wired up the same way. We just don’t notice stress as often, because we become better at suppressing our emotions, compartmentalising them and burying them. Until that is, we are confronted by a crisis which becomes unmanageable and our emotions threaten to overwhelm us.
Essentially, our emotional response to extreme stress forces us to make instant choices and triggers contradictory behaviours. If we have a history of being traumatised and vulnerable in stressful situations, especially as a child and little emotional support by a caregiver, then we are more likely to respond to threat with an act of avoidance, flight or withdrawal. However, if our conditioned responses to threat are guided by memories of success after addressing problems or confronting them, then we are more likely to respond with an impulse to fight off danger. Later on, this can become generalised into a pattern of fearful avoidance or angry confrontation. If either fear or anger become disproportionate to the level of threat and the patterns of behaviour conditioned, then we have a problem. On the whole, people with high levels of anxiety are more likely to respond to stress with a pattern of ‘fight responses’ (the fear is suppressed); whereas people who are more prone to depression are more likely to respond to stress with a pattern of ‘flight responses’ (the anger is turned inward). Some people, however, suffer from experiencing a repetitive cycle of both - switching between anxious and depressive states. This is probably the most distressing position to be in psychologically.
As fighters, when anxiety is triggered, such people tend to throw themselves willingly into a crisis with all the spirit of a raging bull. In fact they enjoy the rush of excitement and are addicted to risk-taking and other extreme behaviours. That is not to say they do not experience fear; just that their response to it, is to be seduced by the rush of adrenalin or sensation it brings. But these intense feelings are often difficult to control and such people find themselves powerless to regulate emotions once they are triggered. The emotions build up to the point of climax and finally collapsing out of exhaustion.
Once such people are overwhelmed and exhausted, depression kicks in and they often sink into despair. At this point, withdrawal becomes the only option available, as they take on a more protectionist stance. In the protective position, people consciously avoid taking risks or withdraw from confrontation with an apparent sense of passive submission. Even fatigue or illness can occur. In fact they may congratulate themselves, on their ability to detach themselves from events or rationalise their behaviour from an intellectually objective position. They will believe that showing fear and anger is a weakness, rather than a natural human response to danger. That is not to say they don’t experience both fear and anger; just that their response to it, is to suppress it, turn anger inward and judge themselves and others in a harsh light.
This is the twin agony and ecstasy of people who switch between cycles of anxiety and depression. We may find this expressed as a damaging set of impulsive behaviours: for example in bipolar disorder (manic depression), schizophrenia, Obsessive Compulsive Disorder, Phobias and even at the polar extremes of Generalised Anxiety or Depression.
There are of course, much more therapeutic ways of responding to anxiety and depression that teaches people to deal more effectively and compassionately with their issues:
Early response – responding to anxiety before it overwhelms you
Self-awareness – noticing what triggers your anxiety and pausing to pay attention to it or reflect on it
Noticing the symptoms - becoming more sensitive to your bodily sensations and emotional responses, than fixating on thoughts and behaviours
Interventions – using various techniques to self-regulate emotions in a crisis
Crisis management – evaluating more effective decisions and choices once the intense emotions have subsided
This is the therapeutic objective of the counselling at Whitton and Twickenham: to help you with empathy, understanding and non-judgemental support, so that you learn to self-regulate your emotions, rather than bounce through the polar extremes of ‘spikes and troughs’. On the one hand mindfulness and self-awareness are the key to helping you making sense of your emotional processes before you learn anything else. Next, relieving yourself of anxiety with mindfulness practice and breathing, help you self-regulate emotions; while simultaneously, using physical activity (not punishing exercise) or creative activities to relieve you of stress hormones and tension in the body. This is designed to empower you with self-awareness and independence. To give you a set of tried and tested techniques you can use in a crisis. To hone your ability to act decisively and consciously under stress, rather than go into automatic pilot and carry on regardless, locked into cycle of debilitating anxiety-depression.
Credit Photo: Ally Aubry @ Flickr