Phone: 604-377-5277

A telehealth service for British Columbia

Dr. Derek Swain

Registered Psychologist #1006


Anxiety & Depression

Are you feeling worried, tense, or irritable? Are you feeling tired or having difficulties with sleep? Do you have difficulty in concentrating or making decisions? Have you been feeling sad, down or depressed for the last month or more? Have you lost interest in things that normally give you pleasure?

If you have answered yes to any of these questions, you may be experiencing an anxiety and/or a depressive mood disorder. And you are not alone. According to a recent Health Canada report, anxiety disorders affect 12%
of Canadians and some 8% of adults will experience major depression at some point in their lives. Mood disorders are contagious in that they spread socially to affect loved ones, friends, and colleagues. These numbers are likely to rise because some 20% of adolescents now experience at least one of these disorders and will be vulnerable to relapses in adulthood. The World Health Organization claims that depression is the 4th most significant cause of suffering and disability worldwide (after heart disease, cancer, and car accidents) and is expected to reach 2nd place by the year 2020.

Anxiety and depression often result in similar symptoms, can be experienced together (as a co-morbid disorder), have similar causes, and have similar treatments. Anxiety and depression impair the ability to process life experiences, to think clearly and to act decisively in responding to what troubles you. Importantly, much of anxiety and depression is learned - and can be treated by learning new information and skills.

Anxiety and depression are not signs of weakness. Although people may experience genetic vulnerabilities to these disorders, anxiety and depression are not caused by genetics. And they are not simply caused by biochemical imbalances in the brain. Neurochemistry interacts with life experiences in a circular relationship which can contribute to these disorders - but, particularly through psychotherapy, that interaction can also improve health. Medications can help to restore brain chemistry, but they cannot change life circumstances or the ways people deal with the problems of daily living.

Social, technological, and economic changes are occurring far more quickly than our biological evolution. The rapid pace of change leads to uncertainty and fear as people find it difficult to cope with the problems of daily living in an increasingly complex world. Anxiety and depression thrive in a threatening environment in which people feel hopeless, helpless, and alone. The cognitive cornerstones of anxiety and depression are negative thoughts involving an overestimation of danger, threat, and fear, coupled with an underestimation of one's ability to cope with threats. These negative thoughts are often learned at an early age. People can learn new, sophisticated skills in thinking, behaving, and interacting which can help them better cope with life's challenges.

Treatment Options

Medication can play an important role in helping people restore themselves to health, particularly for short-term interventions when people are so overwhelmed that they lack rest, relaxation, and energy to address life's challenges. But, apart from side effects, different medications and different doses work for different people. Medication will not change personal history and experience, styles of coping and problem solving, or relationships and social support.

Physical exercise has been shown to be nearly as effective for depression as psychotherapy. Results can be seen after only 5 weeks of 3x/week aerobic exercise of 20-60 minutes duration. Exercise also helps people ‘burn off' anxious energy, stop negative ruminations, and gain a sense of self-efficacy.

Healthy lifestyle choices, particularly regarding proper nutrition, alcohol and drug use (including cigarettes and caffeine), sleeping habits, and social relationships are important to personal well-being.

Psychotherapy, particularly cognitive-behavioural therapy, is at least as effective as medication for anxiety and depression - and the effects are much longer lasting - as long as a lifetime. When people are anxious or
depressed, they have difficulty using vital skills such as thinking clearly, gathering and weighing important information, or relating positively to others. Psychotherapy can help people learn to use these skills more effectively. Many patients recover in less than 12 sessions, others do well in less than 20. Treatment is usually action-oriented, focused on the here-and-now, and forward looking.

Critical thinking can reduce panic attacks as people learn to challenge the catastrophic beliefs of immediate danger: physical ("I'm having a heart attack"); social (I'm making a fool of myself"); and mental (I'm losing control"). Further, critical thinking skills challenge the hurtful, negative thoughts, beliefs, and attributions that people mistakenly believe are proven facts. When faced with life's uncertainties and ambiguities, people use these beliefs to incorrectly interpret events as personal ("It's me"), pervasive ("It affects everything"), permanent ("It will always be this way").

People can learn to better anticipate and plan for the future; to express feelings without basing decisions on those feelings; to understand that sometimes good and bad things happen for no apparent reason; that difficulties come and go; that taking things personally is not always reasonable; and that people are not really as helpless and hopeless as they feel. Other important skills people can learn include: assertiveness; building self-esteem; tolerating criticism or rejection; realistic assessment of self and others; taking responsibility for one's decisions and errors; control of impulses; sensitivity, empathy, and tolerance for self and others; resiliency; and willingness to try something new or different.