Why Anxiety and Depression are different sides of the same coin and why we must adopt a mind/body approach to our education, treatment and management of these mental health conditions.

“But what are you thinking Dad?”

I would persist as I perched on the end of the bed as he lay slumped there, staring at the ceiling, “nothing” would be his whispered response, “I just feel numb”. My Dad has lived with clinical depression for 25 years and he is still trying to understand why he has it and how it works.

As a psychologist, trained and working in Cognitive Behavioural therapy or CBT, I tried desperately to help him to identify his irrational thoughts so we could uncover some of his core beliefs. But he gave me nothing to work with - if there are no thoughts, what can we do? There was nothing to analyze!

Over the last 25 years I have played a massive part in Dad’s mental health journey, there have been moments I have been dismayed and horrified at the treatments that have been offered to him and times I have been overcome with gratitude for the love and care he has been shown by some of our medical professionals.

I have also worked professionally in mental health and have been faced with my own periods of anxiety, burn out and depression. There are many wonderful techniques we can learn and practice to nourish our psychological wellbeing (such as CBT) and for some, they may well be enough to stop and even reverse experiences of anxious and depressive responses to life’s challenges.

There is however, one big gaping hole in the way we treat and talk about mental health.
This gaping hole is the body.

When we think of mental illness, we can think about broken brains. How much do we really know about the role of the body, when it comes to depression and anxiety? Surely there is wisdom in the word “depressed”, it sounds quite like “deep rest” to me (Jim Carey) – could it just be that it is our body asking for some down time?

Did you know, more information travels up from the body to the brain than the brain to the body? And, as the primary job of the brain is to make meaning out of things, we often create stories (usually based on our past experiences) around the information that is coming up from our body.

“Tight chest? Must be nervous about x, y or z”.

“Churning tummy? It must be that this job/person/experience is not safe”.

Sometimes these body messages are spot on (they can point us to our values and our intuition) but other times they are very inaccurate. They can be a result of unresolved past experiences playing out in unhelpful ways in the present. If our past has been unsafe in some way, we, through no fault of our own, may unconsciously interpret that threatening email from a client as a life-or-death situation or that sideways glance from a stranger as a threat to our safety. In response to these events and our thoughts about these events, our body switches on its survival response (fight/flight) and because we are often completely unaware of it, we don’t turn it off. Many of us live weeks, months or years in this anxious survival state, until one day (depending upon our history and our genetics) it all comes crumbling down and we slide (or crash!) into clinical depression. The body has come to our rescue and slowed us down for us. It has slammed on the breaks and said “OK, REST! Now!”.

We must start including the body in meaningful ways when it comes to diagnosis, education and treatment for depression and anxiety. We need to learn how to accurately interpret these messages from the finely tuned (albeit sometimes out of whack) instrument that is our body.

As the body’s language is feelings, we must be educating ourselves and our children in this ancient language.

Intellectually, it makes absolutely no sense that those of us who experience anxiety are also more prone to depression – I mean they seem like the opposite thing! One is up, the other is down. One is future-focused, one is past – focused. Anxiety often carries with it thoughts like:

“What will happen if I fail?”

“It has to be perfect”

“It’s all going to go wrong!”

Whereas thoughts associated with depression are more along the lines of:

“I don’t care - what’s the point anyway?”

“I can’t believe I said/did/wore that!”

“I am so hopeless; I will never get anywhere/fit in”

Opposites, right? Yes, but intimately connected by one very cool system in our body – our autonomic nervous system (ANS) and specifically the vagus nerve. It is no coincidence that the pharmacological treatment for anxiety is often the same as that for depression. A very clever human by the name of Dr Stephen Porges has been able to explain to us, for the very first time, why anxiety and depression go hand in hand. His theory is the Polyvagal Theory and I encourage you to do some of your own research into his work.

Without getting too technical (to be honest I am still learning it all myself!), we have two branches of our ANS, both very important for our survival and thriving. The balance of these two branches may well be one way to define “wellbeing”.

The first branch is called the sympathetic nervous system or SNS, this is responsible for the very important survival or fight/flight response. Many of us perfectionists out there are very familiar with this branch, it is the one that keeps us alert and go, go, going. It can make us “buzzy” and incredibly productive, it can be fun and rather addictive spending time here. We need this system to survive (like to get out of bed and get going!) and stay safe (like jump out of the way of an oncoming bus) but unfortunately, for some of us (due to trauma, genetics or modelling by our primary caregivers) this system is stuck on “on” and we find ourselves in a perpetual state of stress and anxiety, not just in our brains (racing thoughts) but in our body (tight heart, brick in tummy, short breath) too.

The second system is the parasympathetic nervous system or PNS. This fabulous piece of artwork is responsible for the “rest and digest” functions in the body. When we are in a PNS dominant state we sleep well, heal well and digest well. We respond instead of react and we recover quickly from the inevitable challenges life throws at us.

The bit of new information that we are only just now understanding is that the PNS has two of its own branches, both are important but sometimes inappropriately used; I’m going to call them the “Connect” and the “Disconnect” branches. Both help slow and settle a frazzled system, but they do it in different ways.

We are born with an undeveloped “Connect” branch, we need to build it from scratch. We build it through interaction with our environment – from the modelling of our primary caregivers, from their touch, facial expressions and tone of voice. When they smile and speak softly and calmly, we are soothed and settled and we start to internalize the belief that the world is safe and, as we grow up, we can calm ourselves and recover quickly from stressful events. Awesomely, it can be toned through activities such as meditation and other mind/body approaches (yoga, breath practices, chanting etc.) as well as building meaningful relationships (which, cruelly, can be hard if we have had an unsupportive environment in our childhood). If our primary caregivers were stressed out themselves, our own development of this calming, soothing “connect” branch may be compromised.

The “Disconnect” branch of the PNS, also known as the “shutdown” branch is wired into us from birth, it is our “default mode” and evolution has shown us that it is necessary for our survival. When we cry as babies, and our cries are regularly not attended to - what do we do? We shutdown. We switch off and we go to sleep. Our Disconnect PNS comes in and short circuits our over-activated SNS (fight/flight or stress) in an effort to help us to survive. It is like our “off” switch. Having this “off” switch activated some of the time is no big deal, in fact, we want it to be on a little bit, but we certainly don’t want it to be the dominant branch of the PNS as we certainly don’t want to be switched “off” all the time. This is often referred to as the “freeze” response. Frozen is certainly what depression can feel like for many of us. When we are in this state, we stop thinking (we get a fuzzy head), feeling, tasting, smelling, digesting, connecting with others and we can tend to either under or over-sleep.

And that, my friends is why my dear old Dad has no conscious thoughts when he is clinically depressed.

The “Disconnect” branch of his PNS comes on and his system goes into “shutdown” and, as far as his unconscious mind and his beautiful body is concerned, this is an issue of life or death. After a period of intense stress, his body is trying to help him to get out of fight/flight by slamming on the “freeze” function – it is trying to help. And this has been his unconscious habit for around 76 years. He disconnects for his very survival. This is not his fault or his choice, his body chooses for him. It is like pressing the “eject” button of a crashing plane, he just leaves his body. His body has needed to choose for him to keep him safe while growing up with an anxious/angry father and then choosing (unconsciously of course) adult relationships that kept him in this state of fight/flight. Sadly, we seem to choose the familiar over the healthy. He was always loved but his system never felt safe. Not as a child and not as an adult.

So, this is the missing piece to my puzzle. This information changed everything for me when it comes to understanding why anxiety and depression often go hand-in-hand and why cultivating a sense of connection is such a powerful ally on our journey to wellbeing.

Cultivating a sense of connection is such a powerful ally on our mental health journey

So what can we do to support ourselves and our loved ones to build capacity to self-sooth through engaging the “Connect” side of the PNS? We can do a lot! It takes time to tone the nervous system, but it can be done. Here are some ideas that continue to help me and I am sharing with my clients (and my dear old Dad):

- Mindfulness – we need to spend time getting to know ourselves, our mind, our body and our hearts. Mindfulness is the loving light of awareness and through simply paying clear and kind attention to our internal and external experiences, we can make wiser choices to support ourselves and manage our stress response (and perfectionistic tendencies…just as an example!). We can become aware of our automatic thoughts and start to disentangle these from our emotions and our bodies. We can start to live in the beauty of the present rather than be at the mercy of the memories of the past.

- Meditate – we have the science now that shows us that meditation fundamentally changes the way our mind/body/heart function. It, of course is not a silver bullet but it is an important part to our healing as it supports us to create our own internal place of safety and connection, our own refuge from the inevitable storms of life. We can become our own friend and we can remember the strength and sovereignty that is our birthright.

- Body practices – do what works for you and do it consciously; yoga, tai chi, swimming, running – we have to come back to the power of the body and start to listen to her whisper. We can learn from her wisdom and start to heal the patterns we may have learned or inherited that are no longer serving us.

- Relationships – “Connection, the ability to feel connected, is neurobiologically wired, that is why we are here” (Brene Brown). The quality of our relationships is the strongest predictor of happiness and wellbeing for us humans. This has been well-documented many times over. We now know why; through the “connect” branch of the PNS, other humans soothe our frazzled nervous systems and bring our bodies/minds/hearts back into balance. We move from buzzy and fuzzy to clear, calm and connected. In this digital world, we MUST make time to cultivate love, belonging and connection.We can also create a sense of deep connection within ourselves through mindfulness, meditation and self-compassion practices.

Dad’s relationships have always been strong, he has swathes of friends as he is a beautiful human who is funny and smart and loving. These relationships continue to be important to him and I have no doubt have been a powerful medicine to him over the years. My deepest wish for him is that somehow, someday, he can feel self-love. A love deep in his bones and one day feel a deep sense of safety and peace.

This article is the tip of the iceberg, there is so much more for all of us (me included!) to learn but what we can do NOW is practice. We can love ourselves and each other madly and deeply, we can remember we belong to something bigger than ourselves and that actually, at the end of the day connection is all that matters.

Check out my free meditations on Insight Timer and the YOU ARE LOVED podcast (via Apple podcasts and Spotify) – reminding us all that love is always available to us, if only we stop and connect to it.

Read