By Owen O’Brien, LCSW & William Schroeder, LPC – clinically reviewed by Teri Schroeder, LCSW
Anxiety and depression can be debilitating. Both cause distress, impair your daily functioning, make it difficult for you to work toward your goals, and interfere with your sleep and appetite. Both also pull you away from the activities you used to enjoy: depression makes people too tired, sad, and hopeless to start them, while anxiety makes them too fearful. With so much overlap between the two, it is unfortunately common to experience them at the same time.
The good news is that this overlap cuts both ways. Because depression and anxiety share so much, they can often be treated together, and the path forward is simpler than most people expect. In this post I’ll cover both halves of that path: first, why it pays to understand your anxiety before you try to fix it, and second, the deceptively simple technique (behavioral activation) that research keeps showing works.
Step 1: Understand your anxiety before you try to fix it
Most people would rather send their mental baggage on vacation than deal with what’s actually there. I can’t blame them. Sitting with anxiety is hard. But there’s a strong argument for understanding it first. Anxiety looks different to everyone: some people describe it as waves that build in intensity, others as an emotional tsunami. As a therapist, my job is to help people tie into the triggers behind their anxiety and then give them tools to manage it. Basic practices like journaling and mood-tracking apps act like pre-seismic sensors: they pick up small bits of data so that, in counseling, we can spot themes and figure out which tools actually help when the tremors start.
If you’ve struggled with anxiety in the past and haven’t sought help, here are four reasons understanding it is worth the effort:
- It builds bodily awareness. Anxiety doesn’t only happen in the mind. It happens in the body. Your heart races, your breathing turns fast and shallow, you start sweating. You may notice a stomach ache, a headache, or back pain. Recognizing those bodily cues is an early-warning system: it tells you anxiety is incoming and gives you a window to do something about it.
- It gives you a chance to intervene in the moment. Anxiety snowballs: a small initial state builds on itself and can spiral. The trick is to interrupt it before it gathers momentum. Slow, deep breathing stimulates your body’s relaxation response and prevents hyperventilation. Positive self-talk (“this feeling will pass,” “I will get through this”) increases emotional comfort, and avoiding negative self-talk matters just as much. Progressive muscle relaxation, where you tighten and release one muscle group at a time while breathing deeply, can release the physical tension anxiety puts in your body.
- It helps you examine your everyday habits. Anxiety isn’t always the result of a single big event. Often it’s the quiet things (overachieving, fear of failure, people-pleasing, hunting for the perfect solution) that drive it without you noticing. Once you start to understand your anxiety, you can look at your daily patterns honestly and pinpoint where it’s coming from. From there you can change the behavior, or at least be ready when an anxiety-provoking situation arrives.
- It helps you see when anxiety is actually useful. Not all anxiety is bad. Researchers call the helpful kind eustress: moderate stress experienced as beneficial. It’s what keeps you focused before a hard test, sharp before a big presentation, locked in before a game. The students who studied furiously the night before an exam weren’t miserable; they cared, and a little anxiety pushed them to perform. Understanding your anxiety makes it easier to tell the useful kind from the kind that’s holding you back.
Building this kind of self-awareness is the foundation. But awareness alone won’t lift the cloud. At some point you have to start moving again. That’s where the second step comes in.
Step 2: Use behavioral activation to start moving again
Clients often tell me they think they need to feel happier or calmer before they can return to old hobbies or pick up new ones. The research says the opposite. Studies show that people are primarily successful in alleviating anxiety and depression by simply engaging in rewarding activities, whether past hobbies or new pastimes. Psychologists call this straightforward technique behavioral activation.
One study of individuals hospitalized with depression and anxiety disorders showed that participants who used this simple strategy reduced their depression scores by over 45 percent in just two weeks, while the control group saw only a 19 percent improvement (Hopko et al., 2003). Another study concluded that behavioral activation was as effective as antidepressant medication and more efficient than cognitive therapy in treating severe depression (Dimidjian, 2006).
Build a hierarchy of activities, easiest first
Because behavioral activation is simple and effective, there are many variations of it. My favorite is to write down a list of enjoyable activities ordered from easiest to most difficult to initiate, then work up the hierarchy (almost like ERP). For example:
Level One
- Play with the dog
- Make the bed
- Talk to a family member on the phone
- Take a shower
Level Two
- Call a close friend
- Go for a walk
- Wave to a neighbor
- Cook a meal
- Read a book
Level Three
- Exercise at the gym or yoga studio
- Go to lunch with a friend
- Meditate or pray
- Write in a journal
Level Four
- Go to dinner with a group of people
- Participate in a Spanish conversation group
- Paint a picture
- Join a volunteer group
- Go hiking and camping
Level Five
- Attend the office holiday party
- Go on a date
- Take a salsa dancing class
- Take a trip out of the country
I like this version because checking off the least intimidating tasks creates a sense of self-efficacy that makes the harder ones easier to attempt. It also mirrors one of the most effective treatments for social anxiety, systematic desensitization, where you progress through a hierarchy of social activities, beginning with the easiest (like lunch with a close, trusted friend) and ending with the most anxiety-provoking (like speaking in front of a large group).
Pairing awareness with action
The two steps reinforce each other. Awareness helps you notice the bodily cues, daily habits, and snowballing thoughts that fuel anxiety. Behavioral activation helps you reclaim the activities anxiety and depression have been telling you to skip. Together, they take you from understanding the wave to learning how to ride it.
Behavioral activation is simple, but the journey can still be daunting and confusing. To get the most out of it, and to make sense of what your anxiety is actually trying to tell you, it helps to partner with a counselor. Before long, you may find yourself rediscovering a former hobby or delighting in a new passion, while the dark cloud begins to lift.
If you’re in Austin and looking for support, you can reach out for anxiety counseling or depression counseling, or simply make a counseling appointment and we’ll help you find the right fit. Even if we aren’t the right match, we’re tied into a network of nearly 800 professionals who can help.
Related reading
- Can You Talk Your Way Into Anxiety?
- How to Cope in Our Crazy World
- Minimize Anxiety & Depression by Living in the Now
- A Holistic View on Health
For a deeper look at behavioral activation
Hopko, D.R.; Lejuez, C.W.; Lepage, J.P.; Hopko, S.D. & McNeil, D.W. (2004). “A Brief Behavioral Activation Treatment for Depression.” Behavior Modification 27 (4): 458–469. doi:10.1177/0145445503255489
Other sources:
Hopko, D. R., Lejuez, C. W., & Robertson, S. M. (2006). Behavioral activation for anxiety disorders. Behavior Analyst Today, 7(2), 212–233.
Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., & Jacobson, N. S. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74(4), 658.
Hopko, D. R., Lejuez, C. W., Lepage, J. P., Hopko, S. D., & McNeil, D. W. (2003). A Brief Behavioral Activation Treatment for Depression: A Randomized Pilot Trial within an Inpatient Psychiatric Hospital. Behavior Modification, 27(4), 458–469.
