The Way You Think Matters: Cognitive Factors in Depression and Anxiety Disorders
Updated: Sep 29, 2019
You probably read it a lot, it is a hype: We don’t see things as they are, we see them as we are. If we change the way we look at things, the things we look at, change. If you change your perspective, you can change your life.
Change the way you think, and become happy.
You probably come across so many motivational quotes about the way you think daily, that by now you don’t even pay attention to these words that emphasize how important your thinking actually is. It sounds trivial, maybe soppy and bubbly. But actually, deep down, you know it is true. How you think about various topics does matter, and can be quite influential on the subsequent course of events.
Not only that, but cognitive factors play a major role in whether or not you are mentally healthy. A huge body of psychological research studies exactly that: what makes certain people more vulnerable to become, or remain, mentally ill? How come two different individuals may experience the same life events, but the one develops depression or an anxiety disorder, and the other remains balanced?
The answer lies in a combination of factors, but in this article let’s focus on aspects of your thinking- because it does play a major role.
In the past 40 years, researchers have been increasingly interested in understanding the cognitive risk for anxiety and depression psychopathology. After all, the cognitive model, that claims that abnormalities in information appraisal and processing play a crucial role in causing anxiety and depression, is one of the most widely accepted in the science of psychology. Not only that, but also certain beliefs are regarded as predisposing to specific disorders, and others may be central in maintaining them.
So cognitive factors can predispose us, make us more vulnerable, towards anxiety and depression. They even predict the onset and relapse to anxiety and depressive disorders.
It has been suggested that 50% of people who have suffered depression, will experience it again at some point in their lives. One of the main reasons that formerly depressed individuals remain vulnerable to depression, is the existence of latent negative cognitions.
Whether this distorted, negative way of thinking can easily be activated, actually determines whether or not an individual will fall into depression and anxiety again.
For many, this is quite hopeful information, as it underlines the fact that we have control against depression and anxiety- our own attitude can actually make a difference in whether or not we will suffer again.
In this article the focus will be on three specific cognitive factors, that are implicated in both the development and the maintenance of depression and anxiety disorders: anxiety sensitivity, cognitive reactivity and pathological worry.
The reason for this is that those factors have been studied extensively , and links between them and the development of mental disorders are already established.
Anxiety Sensitivity: How catastrophically do you interpret your anxiety symptoms?
There’s a difference between anxiety and anxiety sensitivity. The one is what we all know, the subjective experience of anxiety before/during/after stressful and threatening situations. Anxiety sensitivity, however, is related to how a person responds to anxiety symptoms. It has to do with beliefs that anxiety causes adverse consequences and additional anxiety, or put simply, fear of anxiety sensations.
When we talk about anxiety sensitivity, we mean the physical and cognitive concerns that the experience of anxiety symptoms can bring to our mind. For instance, people make misinterpretations about the significance of increased heart rate or shortness of breath -both anxiety symptoms- and may wrongly regard them as signs of a heart or respiratory problem. The cognitive concerns of anxiety sensitivity mainly have to do with perceptions of loss of cognitive control, e.g. beliefs such as “I am losing my mind”, “I am going crazy” etc.
People with high anxiety sensitivity are more likely to misinterpret as dangerous suddenly occurring, relatively severe and unexplained physical symptoms of anxiety, because their underlying beliefs predispose them to do so- which is why is is also regarded as an "anxiety amplifier”.
Not surprisingly, anxiety sensitivity is related to psychopathology in general, and to anxiety disorders in particular. All anxiety disorders are related to this concept, with a very strong relationship to panic disorder, but also generalized anxiety disorder and social anxiety disorder. High anxiety sensitivity is also associated with major depression, especially the component of fear of loss of cognitive control. Anxiety sensitivity is therefore considered as a risk, predisposing factor for the development of anxiety disorders.
Research shows not only the association of anxiety sensitivity to depression and anxiety disorders, but in many cases it even has predictive utility; its presence predicts onset and/or relapse to anxiety and depression. In my master thesis research, I was able to confirm that anxiety sensitivity predicted relapse (reoccurrence) to anxiety disorders in general, among individuals that had suffered from anxiety disorders in the past.
Pathological Worry: Are you a "normal" or a pathological worrier?
Worry is a universal phenomenon, yet there is a certain line, that once crossed, it becomes pathological. Pathological worry is distinguished from normal worrying, as it is defined as “excessive, out of proportion to the actual problem, pervasive, present most of the time, focused on several topics (both “everyday routine life circumstances” and “minor matters”), uncontrollable, and with a tendency to interfere with functioning and cause high levels of distress and impairment”.
Pathological worriers tend to be paradoxically attracted to worry, as they tend to choose to worry about matters over avoiding worrying topics. They also tend to interpret ambiguous external information as more threatening than normal worriers.
Perhaps this is a paradoxical defense mechanism, since staying in constant apprehension and hypervigilance is often an attempt to be well-prepared and protected against threat. Yet the more we worry, the more we actually destroy potentially pleasant situations.
Similar to anxiety sensitivity, pathological worry and rumination is highly relevant to psychopathology. It is a core feature of generalized anxiety disorder, a condition during which someone just worries about anything and everything, intensely and continuously. This anxiety disorder is defined as “persistent anxiety that is manifested by, among other symptoms, apprehensive expectation, worry, fear or rumination”.
Pathological worry seems to be relevant also for depression and other anxiety disorders. In the research I conducted during my studies , it was found that pathological worry predicted onset of anxiety and depression disorders in previously healthy individuals.
Cognitive Reactivity: Interaction between mood and thought
You have probably noticed that, when you tend to feel more down and sad emotionally, also negative thinking patterns are more prone to flourish.
For example, a specific event caused you to be upset, and then “all of a sudden” the whole way you think and perceive reality becomes more negative, thus making you more irritable, vulnerable to misunderstand others, and likely to sink into a downward spiral of negative thinking and further negative emotions- that may be totally irrelevant to the event that made you sad in the first place.
This is the concept of cognitive reactivity: the degree to which a mild dysphoric state reactivates relevant negative thinking patterns.
Your thoughts and emotions are closely linked to one another, and being well-informed about cognitive reactivity can help you make sense of what is happening within you, when everything seems a bit darker. It is a chicken-and-egg situation, where emotions can cause relevant thought patterns, and vice versa.
As you would probably expect, cognitive reactivity plays a causal role in depression. The vulnerability of remitted depressed individuals for relapse may be related to the reactivation of depressive thinking styles triggered by temporary dysphoric states. It seems likely that in a person with a history of depression, reactivated negative thinking may act to maintain and intensify mild sadness, leading to a more persistent state of dysphoria and increasing the risk of future onset of depressive episodes.
Cognitive reactivity also provides an explanation and reminder as to why advice to think happy thoughts while in a depressive state simply doesn’t work so straightforward. It just is very difficult! Remember this next time you feel urged to suggest to a sad friend to “not be so negative” ; it is likely they are really unable to follow your advice, which could probably lead them to feel frustrated and misunderstood.
Rumination reactivity, that is a subcategory of cognitive reactivity towards rumination, has been found to predict both onset and relapse of depression. Rumination is the tendency to worry about past events, and its reactivity is the extend to which a negative mood state can cause ruminative thinking patterns as a result.
Rumination is a mode of responding to distress that involves repetitively and passively focusing on symptoms of distress and on the possible causes and consequences of these symptoms.
Some of the ways that rumination is considered to bring on and maintain depression, are that it enhances negative thinking, it impairs problem-solving, it interferes with instrumental behaviour and it erodes social support.
What does all of this mean? What can you do about it?
Perhaps all of this information seems expected to you, but knowing that it is also supported by research may bring on a new perspective towards the importance of your thinking on your mental health.
The concluding message is that you don’t have to be a victim of your mind. Be a king in your own mind instead!
There are things that you can actually DO right now, to improve and control the way you think, so that you may rule your mind, before it rules you.
Challenge your automatic thoughts - Employ reality testing
Do you notice that you tend to be sensitive to anxiety, like described above? Do you tend to worry too much? Maybe you tend to believe your thoughts to be true during a negative mood state…
It sounds simplistic,but give up the habit of believing in your thoughts and making assumptions and scenarios.
Challenge your thoughts, instead of passively letting them affect you!
Start developing the habit of questioning yourself, once you become conscious of any of the undesired aforementioned mind tricks.
Is this a fact, or is it an opinion?
Facts are tangible proof, things you know, information.
Opinions are everything else; your interpretation of situations, or explanations about what is really happening. An opinion may very well be true, but you don’t know it until you actually do.
What is the evidence I have for this thought , and what is the evidence against it?
Looking to find the evidence for an against a specific dysfunctional thought or worry will help you gain a clearer grip on reality at the moment.
For example, if you worry about your tachycardia signaling an upcoming heart attack, think of all those other times when tachycardia was just that- an anxiety symptom, or simply a result of physical hyperarousal, and did not result in you dropping dead to the ground.
If you are a worrier, you can become a warrior of your worry…
By allowing the worst-case scenario to come to life in your mind, and construct ways to act, should it come true.
Control your levels of worry
Do you tend to worry a lot? In this case, practicing techniques such as establishing a Worry Period, or storing your disruptive and destructive thoughts safely away in an imaginary Container as described in a previous blog post, may help you gain a sense of control over your worry.
Becoming mindful and conscious of your own thinking pattern and vicious circle between thoughts and emotions is of core importance. The better you learn yourself, the more aware you become, the better you can cope with distress.
For instance, if a familiar thought/emotion pattern emerges, you may employ a curious, mindful and welcoming attitude towards it, instead of a resistant one.
“Oh here we go again, this is familiar. So I feel panic/despair/sadness and I tend to ruminate/worry/catastrophize/go numb (you name it). It is not the first time that it happens, this too shall pass, it does not have to consume me though. I can let it go, and go on with my day”.
This mindful coping is more helpful than becoming all guilty and angry at yourself for not being able to control your thoughts better; it takes the focus off blame and onto self-compassion.
Developing a set of positive affirmations, or self-help statements for times of distress may also help tremendously. Write them down if you want, so that you may have better access to them when required.
Practicing relaxation and grounding techniques or mindful breathing will also contribute in controlling your worry.
Turn your focus from your mind, to your body
*AKA “Lose your mind and come to your senses” ~Fritz Perls
or simply: “Stop thinking , start feeling”
Have you ever said to yourself (or had a friend tell you) to just.stop.thinking.so.much?
The mental chatter that the “monkey brain” creates can be too exhausting, even debilitating, at times. And this monkey will not stop banging its plates unless YOU stop it. Don’t you just wish that you could switch off your thinking sometimes?
An effective way to accomplish this is to turn your attention to your body, to your senses. It is hard to maintain dual attention both on physical stimuli and on whatever is going on within your head; even if your thoughts intrude your effort to focus on your senses at first, if you persist, they will eventually leave you alone.
Employ mindfulness techniques, such as mindful breathing, in order to realize how you breathe, and what effect this can have also on how you feel and think. Try out various grounding techniques, to become grounded once again and to absorb all of those minor body sensations that you normally disregard or completely ignore.
Another way to become more powerful towards your mind, is to consider what your Ideal Self would do. What would it be like if you could control your thoughts more? What would it feel like? What actions would go along with it, how would you see this change manifest in your life? Is it possible to employ some of these findings about your Future Self into action now?
Practice is absolutely vital in all of these techniques. That’s the way you learn and adopt improved lifestyle and behaviours; every roadbloack and every new achievement in your attempts to start thinking differently consists an invaluable lesson. This is how you build new coping skills.
Essentially, this is how you show self-care, because with every little step towards a better mental health, you actually enhance your well-being.
If you need help in keeping your thoughts under control and developing healthier ways of thinking, I am here for you.
We can start exploring your Youniverse together.
Contact me here.
Reference / Inspiration:
Pantazi, J. (2011). Prediction of anxiety and depressive disorders’ onset in individuals with no psychiatric history and relapse in remitted patients by the cognitive constructs anxiety sensitivity, pathological worry and cognitive reactivity: A 2-year longitudinal study. Unpublished Master Thesis, Leiden University, Leiden, The Netherlands.