Climate disasters, power-hungry narcissists, fake news, identity theft, rising food prices … Has a sense of overwhelm begun to permeate as you scroll through your feed? Do you feel a certain weariness around caring? If so, you are not alone; compassion fatigue has worsened for many people post-pandemic, leading to sleep difficulty, irritability, and numbing. Many of us are at the point of “Who cares?”

Yet more than ever, faced with existential challenges, we need people who can care deeply and act. What is going on, and what can we do?

It’s vulnerable to care.

When we care, we allow ourselves to feel our desire for something to be a certain way. But as soon as we feel our longing, reality confronts us with our limits. We cannot 100 percent secure any outcome. Forces outside our will and effort always play a role in how things turn out.

The pandemic was a clear example of how our lives, indeed our world, can be upended by something as small as a virus. Certainty is a fantasy and striving for ultimate control is a strategy to deny our limits. We are indeed only human.

Faced with the pain of caring without having control, some people go into worry mode where conscious anxiety spikes and they run scary movies. But many others do not consciously feel anxious. Instead, they escape what they feel. They numb out and avoid the inner experience. And the trigger is unrest.

Is your alarm waking you or are you pressing snooze?

In my book, Embracing Unrest: Harness Vulnerability to Tame Anxiety and Spark Growth I share the key to transforming experience avoidance. Unrest is a valuable alarm inside all of us, meant to get our attention at the optimal moment for growth. When we are vulnerable, unrest speeds our breathing, tightens our muscles, and agitates our nervous system.

Unrest wants to wake us up so we can access the power of adaptive emotion to live our most authentic, resilient, and connected lives.

But there’s a catch: Unrest only works as a wake-up call if we perceive it accurately. If we do not, unrest ejects us from our inner experience. It signals us through the sympathetic nervous system and is physiologically indistinguishable from fear. If we don’t recognize the growth-promoting purpose of unrest, the alarm meant to wake us and bring us into the moment will make us shut down and press snooze on our inner lives.

We have a choice: Approach or avoid.

Unrest is a phone call letting us know we are on the cusp of a growth moment, and we need to learn our unique ringtone. We need to become aware of body sensations letting us know we’re faced with longing and limits. Even though we’re wired to avoid anything that feels like fear, unrest is a call to come home and feel in the body. We have a choice: Approach or avoid.

When we tune into those uncomfortable sensations with precision, we can soothe our nervous system. Through slowing down and really feeling our held breath and tense muscles we send a message to the body that it is not in danger. This nervous system activation is not an immediate threat to life and limb. It’s simply unrest heralding emotion, inviting us to come home and feel.

Doing what we can with what we have.

Feelings are energy meant to motivate and empower us so we can adapt to reality. We are meant to be able to accept our limits without collapsing in despair and going numb. We are meant to be able to move from the anger and grief of not being able to make things as we wish, to the place of doing what we can with what we have.

When we face our human limits, we come out the other side with the energy to care and act. We matter and feel how others matter. We feel more alive and connected. Even though we do not have ultimate control, we can still care. And that matters.

References

Brown, Brene (2015). Daring Greatly: How the Courage to be Vulnerable Transforms the Way We Live, Love, Parent and Lead. New York: Avery.

Santomauro, D.F., Mantilla Herrera, A.M., et al (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 epidemic. The Lancet, 398(10312), 1700-1712

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Some children speak abundantly and easily at home but demonstrate minimal speech in social settings outside of the home. These kids are often chatty and have good communication with people they feel comfortable with but restrict their speech when anxious. They carve up the world into distinct boundaries for who, where, and when they will speak. For example, a child may feel comfortable talking to their grandparents, but will not talk to neighbors or anyone in the community. Another child may talk to everyone in the community but exhibit no speech in school. Some kids will talk to select adults at school, but not to peers.

This predicament can be overwhelming and stressful for both kids and parents alike. It is easy for parents to feel uncertain about how to navigate this scenario and resort to short-term solutions that inadvertently maintain the problem. For example, parents and teachers may answer for the child when he is asked a question, rescuing him from his anxiety in the moment. Over time, rescuing by adults leads to an over-reliance on gestures to communicate and an even lower likelihood the child will respond verbally.

What can parents, teachers, and other concerned adults do to break this cycle? Here are some specific evidence-based guidelines for working with your anxious child to break the sound barrier.

Resist Asking Abrupt Questions at the Start of a New Interaction

Give your child time to warm up in any new social setting without prompting them with an immediate question. For example, when you arrive at the birthday party, don’t encourage your child to say “Happy Birthday.” Instead, explore the birthday area with your child, giving them freedom and positive attention without expectation or demand.

Provide Positive Attention and Let Your Child Lead

Use specific statements that demonstrate positive attention to the child’s actions and speech. That is, narrate your child’s actions and reflect any speech you hear. For example, “I see you checking out the birthday presents. Wow, those are some really colorful packages.” When you hear your child speak, repeat back what she shares with you. “Ahh, you are telling me you think there are Legos in that package.”

Many parents and teachers initially feel it can be awkward or uncomfortable to converse with children without leading, instructing, or asking questions. But with a little practice, this approach starts to feel natural and intuitive.

Consider Your Physical Proximity to Others

When your child has warmed up, start asking questions at a distance from the others present. The goal is to make it easy for your child to respond verbally because they are focused on talking to YOU and having fun. “Do you think Max’s cake will be vanilla or chocolate? I wonder if there will be a clown or magician?” Once your child is consistently answering your questions, start to move your conversation closer to others at the party. As your child becomes more comfortable with other adults and peers overhearing them speak, the likelihood they will answer others directly will increase.

If your child is still silent, take him to a quieter area (this may only need to be a few steps away or with your body blocking the visual view of others) and prompt again. When your child answers verbally, share your child’s response with others. “Ben said he would like the chocolate cupcake. Thanks, Ben for letting us know.”

This action is what psychologists refer to as “shaping” a behavior. When a child is having difficulty demonstrating a preferred skill or behavior, we often work towards the desired behavior by approximating it or developing it in smaller steps. Saying the words verbally at a distance or whispering into the ear of the parent is an approximation of the ultimate goal, that of full speech with the adults and peers at the party.

Praise and Reinforce All Verbal Behavior

There is a general rule in child behavior that whatever we give our attention to will increase in frequency. When a child responds verbally, it is important that this behavior is attended to and praised. You can reinforce speech by using both a reflection (repeat back what your child said) as well as specific praise (compliment aspects of her sharing). For example, your child says that she wants the chocolate cupcake. You say, “You want the chocolate cupcake. Thank you for letting me know what you want.”

It is important that any praise is natural, specific to the situation, and delivered in a manner that is comfortable for the child. Instead of saying, “Good job!” try statements such as, “I really like that idea. Thanks for telling me”, or “It is so helpful when you tell me what you want. Now I know just what to do.” Also, consider whether your child appreciates praise delivered calmly and nonchalantly or more enthusiastically. Many anxious children prefer praise that is relaxed and not too dramatic.

What Are My Next Steps?

Helping children work through a pattern of non-speech in community and school settings takes energy, time, and attention from all involved. If you are struggling to make progress and/or these concerns are causing distress to you and your child, consider seeking an evaluation from a mental health professional.

Children who speak expressively and easily in situations where they are comfortable, but display minimal or a lack of speech in situations when they are anxious, often meet the criteria for an anxiety disorder known as Selective Mutism (SM). Children with SM are speech-phobic and typically hyper-attuned to their social environment. They may feel frozen or panicky when speech expectations are present. Additionally, they often display broader self-conscious and socially anxious behavior, feeling easily embarrassed and disliking being the center of attention.

A full evaluation can determine whether your child meets the criteria for SM and support in the development of treatment goals and a specific plan to address it. The strategies presented above are part of an evidence-based program known as Parent/Child Interaction Therapy for Selective Mutism (PCIT-SM). Many children with SM and their parents benefit from working with a specialist to learn the techniques and strategies in a systematic way that is consistent with best practices and most likely to lead to success.

It is important to note that a full evaluation should also assess for other conditions that may be contributing to or explain the lack of speech. For example, developmental delays, deficits in receptive or expressive language skills, a social communication disorder, or struggles with second language acquisition, all can impact speech behavior. Understanding why your child is not speaking is an important precursor to having a treatment plan that works for your child. When children have other comorbid conditions, or the lack of speech is due to another reason, other interventions may be warranted and/or most appropriate. This post specifically covered tips and strategies for developing and increasing speech in children with primary anxiety.

The post Empowering Your Anxious Child’s Voice appeared first on My Blog.

In the hustle and bustle of modern life, anxiety has become an all-too-familiar companion for many individuals. The constant pressures and uncertainties can leave us feeling overwhelmed, disconnected, and lost in a whirlwind of worries. Fortunately, there’s a lifeline that can help us regain control and find calm amidst the storm: grounding techniques.

Understanding Anxiety and Grounding

Before diving into one very specific and powerful technique, let’s grasp a deeper understanding of anxiety and how grounding can help us manage it. Anxiety is a natural response to stress, but when it becomes chronic and overwhelming, it can interfere with our daily lives and well-being. Grounding techniques are designed to anchor us in the present moment, pulling us away from anxious thoughts and redirecting our focus to reality.

When anxiety strikes, it often triggers a fight-or-flight response, flooding our bodies with stress hormones. Grounding techniques activate our senses and create a sense of safety, counteracting the fight-or-flight response and inducing a relaxation response. By engaging with our immediate environment, these techniques help lower stress levels, regulate emotions, and foster a sense of control over anxious thoughts.

The Power of Progressive Muscle Relaxation: Statistics and Findings

Progressive Muscle Relaxation (PMR) is a relaxation and grounding technique that involves systematically tensing and then releasing different muscle groups in the body. The process typically starts from the feet and moves upward to the head. By deliberately tensing and then relaxing muscles, individuals can become more aware of physical tension and learn to relax their muscles effectively. Regular practice of PMR is believed to reduce stress and anxiety, and promote overall relaxation and well-being.

Studies suggest that PMR is a popular technique for grounding and reducing anxiety levels. For example, in a study by Carver & O’Malley (2015), trainee nurses practicing PMR experienced significantly reduced anxiety compared to a control group. PMR has been tried with larger samples and specific populations, such as Covid-19 patients and people with schizophrenia, showing reductions in acute and chronic anxiety and improved sleep quality (Cougle et al, 2020; Liu et al, 2020; Chen et al, 2009).

Regarding counseling or psychotherapy, Mander et al (2019) found that PMR, mindfulness, and ‘treatment as usual’ all led to lowered anxiety levels, raising the question of whether clients can be helped to feel less anxious before starting a session.

In a study comparing anxiety reduction techniques including PMR, deep breathing, an adapted dive reflex technique, and using a weighted object, all four interventions were shown to reduce anxiety (Keptner et al, 2021). Another recent study by Steffen et al (2021) investigated the use of breathing techniques in psychotherapy, revealing clear physiological benefits in subjects using controlled breathing rates and soothing rhythm breathing compared to controls.

Overall, various forms of grounding techniques, like PMR and controlled breathing, appear effective in reducing immediate anxiety states.

Where Anxiety Comes From

Anxiety is a natural and adaptive response to stress or potential threats. It is part of the body’s survival mechanism, often referred to as the fight-or-flight response. When faced with perceived danger, the body releases stress hormones like adrenaline and cortisol, preparing the individual to respond quickly to the threat.

The origins of anxiety can be complex and multifaceted, involving a combination of genetic, environmental, and psychological factors. Some common contributors to anxiety include:

1. Genetics: Research suggests that individuals with a family history of anxiety disorders may be more susceptible to developing anxiety themselves, indicating a genetic predisposition.
2. Traumatic Experiences: Traumatic events, such as abuse, loss of a loved one, or accidents, can trigger anxiety. The memory of these events may lead to heightened fear and apprehension about similar situations in the future.
3. Environmental Factors: High levels of stress in the environment, such as financial difficulties, work pressure, or relationship problems, can contribute to the development or exacerbation of anxiety.
4. Personality Traits: Certain personality traits, such as being highly sensitive, perfectionistic, or having a tendency to worry excessively, may increase the risk of experiencing anxiety.
5. Chemical Imbalances: Imbalances in neurotransmitters (brain chemicals responsible for transmitting signals) may play a role in anxiety disorders.
6. Cognitive Factors: Negative thought patterns, such as catastrophic thinking or a tendency to overestimate the likelihood of negative outcomes, can contribute to the experience of anxiety.

It’s essential to remember that anxiety is a treatable condition. Seeking support from mental health professionals, such as therapists or counselors, can provide valuable strategies and coping mechanisms to manage anxiety effectively and improve overall well-being. With the right guidance and support, individuals can learn to navigate and reduce the impact of anxiety on their lives.

References

Carver, M. L., & O’Malley, M. (2015). Progressive muscle relaxation to decrease anxiety in clinical simulations. Teaching and Learning in Nursing, 10(2), 57-62.

Chen, W. C., Chu, H., Lu, R. B., Chou, Y. H., Chen, C. H., Chang, Y. C., … & Chou, K. R. (2009). Efficacy of progressive muscle relaxation training in reducing anxiety in patients with acute schizophrenia. Journal of clinical Nursing, 18(15), 2187-2196.

Cougle, J. R., Wilver, N. L., Day, T. N., Summers, B. J., Okey, S. A., & Carlton, C. N. (2020). Interpretation bias modification versus progressive muscle relaxation for social anxiety disorder: a web-based controlled trial. Behavior Therapy, 51(1), 99-112.

Keptner, K. M., Fitzgibbon, C., & O’Sullivan, J. (2021). Effectiveness of anxiety reduction interventions on test anxiety: a comparison of four techniques incorporating sensory modulation. British Journal of Occupational Therapy, 84(5), 289-297.

Liu, K., Chen, Y., Wu, D., Lin, R., Wang, Z., & Pan, L. (2020). Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complementary therapies in clinical practice, 39, 101132.

Mander, J., Blanck, P., Neubauer, A. B., Kröger, P., Flückiger, C., Lutz, W., … & Heidenreich, T. (2019). Mindfulness and progressive muscle relaxation as standardized session‐introduction in individual therapy: A randomized controlled trial. Journal of clinical psychology, 75(1), 21-45.

Steffen, P. R., Bartlett, D., Channell, R. M., Jackman, K., Cressman, M., Bills, J., & Pescatello, M. (2021). Integrating breathing techniques into psychotherapy to improve HRV: Which approach is best?. Frontiers in Psychology, 12, 624254.

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When your emotions are rocky, this single word can right the ship.

• Forbearance has been shown to reduce depression and improve relationships.
• Forbearance is not submission but shows a willingness to move on.
• Forbearance helps you see the bigger picture and wisely act in accordance with a greater understanding.

Have you ever been the target of unwanted, unwelcome, and unkind words? Or maybe you find yourself in a distressing situation or relationship at home or work that seems untenable at times. If this leaves you feeling stuck, depressed, or hopeless, it’s understandable.

But, believe it or not, there’s a mindfulness practice for that—and to our special word for today: forbearance.

The ancient principle of patience and forbearance, khanti paramita, is one of Buddhism’s “perfections.” Perfections as it is used here, however, doesn’t mean perfectionism or being perfect. Rather, it’s about cultivating a more enlightened and helpful means of living.

Forbearance is a cornerstone practice found in many wisdom traditions. It’s ideal just for those times when you’d be better off “letting it go” and refraining instead of reacting and escalating conflict.

A recent research article explored how practicing forbearance helps to moderate difficult emotions, especially those depressive emotions that arise when you face adversity of various kinds.

The Truth About Forbearance

Forbearance might just be one of the least cultivated and misunderstood practices in our comparison-oriented, quick-serve culture.

Forbearance is about reducing harm by making an enlightened choice to take a step back and offer grace to others. It’s kind of the opposite of reacting or forcing your opinions on others.

If you believe that forbearing or “letting it go” means that you are being weak and submissive, think again. In truth, forbearance is about understanding when it is wiser to surrender, let it be, and accept. The practice of forbearance is definitely not giving up or submitting, which means you have no choice or free will!

Forbearing is a powerful act of grace and compassion offered willingly and intentionally.

This is not to say you need to always forbear. There are times you might decide to stand up and times you might forbear. For example, let’s say that your partner has a strong preference about something. Yes, you can fight to make a point or get your way. Or, you could make the enlightened decision to forbear for the benefit of the relationship.

Besides, have we not all been faced with the kind of criticism or events that prod us to react—either with anger or otherwise? A historical example of this was when the Buddha and his monks were the target of unkind rumors while staying in a particular village. They could barely get enough food from community offerings. The Buddha’s trusted aid Ananda exhorted the Buddha to leave and seek a town more to their liking. The Buddha refused the request, saying,

No, Ananda, there will be no end in that way. We had better remain here and bear the abuse patiently until it ceases and then move on to another place. There are profit and loss, slander and honor, praise and blame, pain and pleasure in this world; the Enlightened One is not controlled by these external things; they will cease as quickly as they come.

To sum up, forbearance helps you see the bigger picture and wisely act in accordance with a greater understanding of the situation. Forbearance is a kind of grace that is given to others. It’s a sign of patience and wisdom to know when your message will be heard and appreciated. You might refrain, for instance, from telling someone who just lost her or his job about the incredible promotion you received. By being in the present moment, you can learn to trust the feeling in your body to help you decide when the time is right for speaking.

3-Part Forbearance Practice

Keep in mind that forbearance does not mean ignoring your feelings. If anything, it’s a mindfulness practice that helps you notice your feelings, but without having to pay a price that ends up hurting yourself or others.

1. Notice those times when you feel impatient with your situation or with others. Tune in to what you are feeling and give it a name, such as “I’m feeling anger”; “I’m feeling sadness”; “I’m feeling frustration”; and so on.
2. Take a deep belly breath and exhale slowly. As you exhale, feel yourself letting go of any expectations of others or the situation. Take a second calming breath.
3. Now, reflect on the way things really are—not the way you want them to be. Ask your wise self if this is the best time to speak or whether it’s better to refrain and give grace to another and the situation.

If you frequently experience impatience and have high expectations for yourself and others that are causing problems, then practicing forbearance will help. If you want to know more, my book Clearing Emotional Clutter explores forbearance as a means of enlightened living. Above all, be compassionate and kind with yourself as you bring forbearance into your day.

The post One Special Word That Lessens Depressive Emotions appeared first on My Blog.

Brittney Chesworth Ph.D., LCSW

With health anxiety, we tend to overestimate the likelihood of severe disease. Learning how to challenge thinking errors is critical to see the probability of a threat more accurately. Examining the evidence is a cognitive behavioral therapy technique to help reframe thoughts.

It is well-known among health anxiety researchers and clinicians that people with health anxiety tend to overestimate the probability or likelihood of getting a serious disease. This threat bias, as it is often called, can make one miserable because the threat of serious disease seems to be everywhere. This leads them to interpret bodily sensations and symptoms as threatening when they are often not. Many bodily sensations and symptoms are due to other causes besides serious disease:

• body noise or normal, regulatory physiological processes that maintain the body’s homeostasis
• the anxiety or stress response
• benign and non-serious medical conditions

However, to the health-anxious person, every bodily sensation or symptom is seen as a potential catastrophe, and the cycle proceeds like this:

• They experience a symptom
• Overestimate the threat of this symptom (rather than assume the more likely causes of body noise, anxiety, or benign issues)
• They experience significant distress
• They consult with loved ones, go to the doctor, and Google symptoms

This continuous cycle takes them (and their loved ones) on an emotional roller coaster every week, making life quite challenging.

How do we learn to see threats more accurately?

One of the goals of treating health anxiety with cognitive behavioral therapy (CBT) is to see the threat of serious disease more accurately. When one learns to stop inflating the statistics (that is, the likelihood of getting a serious disease), one will not be as threatened by every bodily sensation or symptom. Here is a technique that can help you reshape how you see this threat, called examine the evidence.

The examine the evidence activity

Examining the evidence is a great exercise for analyzing automatic thoughts that may be distorted. Recall that we tend to assume all of our thoughts are valid when many are not. We move through our day just accepting our thoughts as facts and, thus, react to them as though they are facts.

For example, you notice a funny taste in your mouth and you recall a Facebook post about a family member who was diagnosed with a brain tumor after experiencing strange tastes and smells. You conclude that you have brain cancer and begin to experience the sadness and anger that accompanies this new reality. The problem is that a lot of unnecessary suffering is taking place. If you do not learn to examine the validity of your thoughts, you will spend a lot of time and energy reacting to fiction.

An example from my own life

I smoked on and off from the age of 21 to 26. My smoking escapades would haunt me for many years after I quit. For about a decade, I was vigilantly on the lookout for any signs of lung disease. Once, I was walking up the staircase in my house and I had to catch my breath at the top of the stairs. Huh, that is weird, I thought. Why would I be out of breath from—uh oh. It hit me. This is it. Lung cancer. My time has come.

I unwisely pulled my phone out and began the Google search: shortness of breath and lung cancer. I am instantly flooded with information from the American Cancer Society to every university website that ever existed, all talking about shortness of breath being one of the key symptoms of lung cancer. Engaging in this safety behavior, of course, only further inflated my estimation of this health threat.

Fortunately, having been in therapy for health anxiety, I had a few helpful techniques to pull out of my CBT toolbox. First, I was able to recognize my thinking errors in this case, which were jumping to conclusions and catastrophizing. Next, I completed examining the evidence to help me reassess the likelihood that I had lung cancer.

Examining the evidence for the thought: I have lung cancer

The technique is simple. You divide the page into two columns:

• Divide the page into two columns (evidence for the thought and evidence against the thought)
• After you list out all of the evidence, reframe or challenge the evidence for the thought, as some of these points might be based on faulty or biased assumptions (given that the anxious brain tends to overestimate threat and underestimate coping)
• When completed, take a look at everything. Ask yourself, if you had 100 amazing argument points to divide between the two columns, how would you divide them? Is it 50/50, 80/20, or 60/40? Which side is the big winner?

In the table, you will see a detailed example of how I completed this activity to address my anxious thoughts about having lung cancer.

Don’t be shy about writing down every piece of evidence in the evidence-for section, even when you know it is unrealistic or even silly. You need to acknowledge all the reasons you feel convinced that this thought is true. By acknowledging it, you bring the discussion out into the open and allow yourself to challenge any distorted thoughts. If you pretend they aren’t there, you miss out on the opportunity to reframe them. They will, most definitely, return at some point later, such as when you are in another vulnerable anxious state.

In conclusion

This exercise helped me to see the alleged threat a bit more realistically. Yes, it is possible that my shortness of breath was, indeed, the first symptom of lung cancer. It is also possible that tonight I slip, hit my head, and drown in the bath, or that tomorrow I get shot while shopping in the toy aisle at Target. Many threats are possible but how many of them are probable?

And seeing all of the evidence for and against my having lung cancer allows me to better grasp this low probability. In CBT sessions with my clients, we regularly whip out Google documents to examine the evidence of their anxious thoughts about their health. On almost every occasion, we find that the evidence-against column looks robust and meaty, while the evidence-for column looks empty and hollow.

Anxiety leads us to inflate the numbers. Use this exercise to help you see the probability of serious disease more accurately.

The post Health Anxiety: Inflating the Likelihood of Serious Disease appeared first on My Blog.

When a person experiences two or more illnesses at the same time, those illnesses are considered “comorbid.” This concept has become the rule, not the exception, in many areas of medicine, and certainly in psychiatry. Up to 93% of Medicare dollars are spent on patients with four or more comorbid disorders. The concept of comorbidity is widely realized but unfortunately not well-defined or understood.

In mental health, one of the more common comorbidities is that of depression and anxiety. Some estimates show that 60% of those with anxiety will also have symptoms of depression, and the numbers are similar for those with depression also experiencing anxiety.

While we don’t know for certain why depression and anxiety are so often paired together, there are several theories. One theory is that the two conditions have similar biological mechanisms in the brain, so they are therefore more likely to “show up” together. Another theory is that they have many overlapping symptoms, so people frequently meet the criteria for both diagnoses (an example of this might be the problems with sleep seen in both generalized anxiety and major depressive disorder). Additionally, these conditions often present simultaneously when a person is triggered by an external stressor or stressors.

While clinicians can typically recognize one mental illness relatively easily, it’s much more difficult to recognize comorbid disease. They must pay careful attention to symptoms that could suggest other disorders such as bipolar disorder and look for other factors such as substance abuse. This requires time with the patient, possibly their families and other collateral sources of information. The health care system today makes this level of assessment difficult, but not impossible.

Unfortunately, most research today focuses on patients with one illness, and treatments are then guided by this research. In result, there are many well-researched treatments available for mental illnesses, but not for comorbid mental illnesses. There is a lot that we still need to understand about how we recognize and treat conditions when they present at the same time.

There are several things we do know about comorbid anxiety and depression, however, and they underscore this need for accurate assessment. When anxiety and depression present together, these illnesses can often be harder to treat. This is because both the anxiety and depression symptoms tend to be more persistent and intense when “working” together.

This means that those experiencing both anxiety and depression will need better, more specialized treatments. Professionals and caregivers providing treatment may need to get creative, like adding one treatment onto another to make sure that both underlying disorders are responding. For example, if antidepressants are helping improve a person’s mood, but not their anxiety, a next step would be to add cognitive behavioral therapy to the treatment plan.

More research is needed to fully understand why some patients experience comorbid conditions and others do not. Until then, it is vitally important that those experiencing one, two or multiple mental illnesses engage in treatment early, and find a provider they can work with to reach their goals. While treatment may have more challenges when dealing with comorbidity, success is possible.

Mary E. (Beth) Salcedo, MD, Medical Director of the Ross Center for Anxiety and Related Disorders, is a psychiatrist with expertise in diagnostic assessment and psychopharmacologic management of anxiety and mood disorders in adults. She completed her Psychiatry Residency at The George Washington University School of Medicine and Health Sciences, where she was Chief Resident in her fourth year. She has been the Medical Director of The Ross Center since 2002, and has been with the center since 1997. She has consistently been named in Washingtonian Magazine’s “Top Doctors” since 2010. Dr. Salcedo is the President of the Anxiety and Depression Association of America (ADAA) having been an active member since 2004 and a board member since 2014. A 20-year member of the American Psychiatric Association, Dr. Salcedo was awarded the title of Distinguished Fellow in 2015.

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