Welcome to she persisted I'm your host Sadie Saxton a 19 year
old from the Bay Area studying psychology at the University of
Pennsylvania. She persisted is the Teen Mental
Health podcast made for teenagers by a team in each
episode. I'll bring you authentic
accessible and relatable conversations about every aspect
of mental Wellness. You can expect evidence-based,
Tina, proof resources, coping skills, including lots of DBT,
insights and education. In each piece of content, you
consume, she persisted Offers you a safe space to feel
validated and understood in your struggle.
While encouraging you to take ownership of your journey and
build your life worth living. So let's Dive In.
Hello, hello, and welcome back to.
She persisted. I'm so excited to hear today.
This is one of my favorite episodes that I've recorded in a
really long time. It is with one of my professors
from Pain professor, ruscio. She taught my abnormal
psychology class, and she is a practicing clinician.
She works with adults, and she just brought so much interesting
insight to the conversation, about mental illness and mental
health. That I learned so much during
this semester course, that you've probably heard bits and
pieces of in the podcast, if you've been listening It
consistently. But this episode is a really
powerful conversation. About depression, about anxiety.
We talked about the importance of skills education.
We talk about sub clinical depression.
We talked about stress, we talked about common cognitive
experiences, and depression, we talked about comorbidity and so.
So so many things that I think most people aren't aware of when
it comes to depression and anxiety.
But really are very helpful to know if you are struggling or if
you know someone that is struggling.
So I'm so glad that Professor ruscio joined me for this
conversation and I hope you enjoy it as much as I did.
Her links will be in the show notes today.
If you want to learn more about her research, but yeah, I'm so
excited to bring you into the classroom with me and learn more
about mental health and specifically, depression and
anxiety. So with that, let's dive in.
Thank you so much for joining me today on.
She persisted, I'm so so excited to have you on the show.
It's such a pleasure to be here with you, of course.
So I'm really excited for this conversation.
We're going to kind of go A little bit all over but we're
centering a lot on anxiety and depression and what lays the
foundation for mental illness and really just kind of diving
into those, not risk factors per se but talking about what
happens in childhood with teens can do to reduce risks and then
talking about how similar some of these different distress
disorders can be. So to start I'd love to talk
about why adolescent is such a critical period for depression.
It's something that most people are somewhat.
Oh, Aware of that things, develop before 1824, but there's
not a ton of understanding as to why that is.
So I would love to get your perspective there.
Oh yeah, such a good question and it's a question that mental
health professionals have been pondering for a long time.
So, you know, we for a long time.
People thought that depression really didn't start until
adulthood, and it's really been the last few decades that
increasingly psychologists psychiatrists have realized
that. Fact, depression, often begin
sooner than that. We know that there is a really,
really large increase in the rate of depression that happens
during adolescence. So prior to about age, 12 or 13,
there are kids who get depressed, but they're
relatively few, and most of those cases, don't persist into
adolescence and adulthood, but starting at around age, 12 to 13
is just a dramatic rise in the rate of depression.
So you see an increase of about three percent of kids or so
might become depressed at some point but then the rates go up
to about 17 percent by age 18, which is much more similar to
the rates that we see in adults. So why that is is really
important and interesting question.
We don't have a great understanding.
If there are sort of some indicators from research studies
as to what might be going on in the Adolescent period, that
could be contributing to the increase.
There is some thinking that this could be connected in part to
biological factors. Particularly those that are
linked to puberty. And it does seem for example,
that kids who experienced onset of puberty earlier, are
increased risk for depression, particularly girls, so there may
be something going on almost certainly something going on
related to hormones. In addition, there it appears
that there are increasing levels of stress, particularly
uncontrollable stressors that occur in adolescence compared to
Childhood. And in particular, interpersonal
stressors, especially for girls. So I don't know if we'll get
into this more Later. But there's a very long
literature indicating that there is a sex difference in
depression. Girls are about twice as likely
as boys to develop depression some point in their lives and
that sex difference in merges in adolescence.
So, something about stress, especially interpersonal, stress
may be important in helping understand why it is that
adolescents, much more so than younger kids become depressed.
Yeah, it's also interesting because, I think a lot of the
times when adults experienced periods of stress, It's just a
period, they've navigated that before they know they can get
through it. Whereas in adolescence when you
experience academic stress or relationship stress or
interpersonal stress, it's really for the first time so you
don't have that experience to be like, okay I've coped through
this before it's going to be okay I know how to navigate this
this won't last forever. It's like the first time you're
navigating it there's not a lot of guidance there and so it
feels subjectively like that much overwhelming more
overwhelming. Yeah I think that's a really
important point when we've gone through.
Something many times before we know we can weather that we have
coping strategies that have worked for us before.
We have kind of the bigger perspective to put this
particular situation into we know we can lean on our supports
to get through it, but it's harder when you're experiencing
these things for the first time especially when you're an
adolescent and you're still trying to figure out who am I,
how do I navigate the world, who are the people in my world who I
have trusting relationships with so that definitely makes it more
challenging. Yeah.
Are there other factors that add to that gender?
Gap. In addition to girls having an
onset of puberty more earlier on there is kind of more social
tension than there is with boys. That is there anything else that
adds to that risk? For sure.
There are some of the factors that have been most studied our
cognitive or Sinking related processes.
So, girls are much more likely than boys to ruminate.
This is sort of a style of coping with stress, where girls
are more likely to sort of sit and dwell on all the bad things
that have happened. How how, how is it?
Why do I feel this way? Why do I always get into these
patterns? Why did that go wrong and the
more that people sort of sit and stew?
And that sort of negative past, Focus thinking about things that
are abstract things, I can't do anything about any more, the
less productive that can be. So generally speaking girls are
more likely to ruminate boys are more likely to engage in more
active problem-solving types of coping.
And it turns out that all of us when we ruminate feel worse and
all of us, when we engage in more active, Focus coping tend
to be sort of more successful. So, you know, I think it's
important to recognize that these are thoughts down that can
be changed an interesting, sort of related line of research is
that girls are more likely to KO ruminate meaning there are more
likely to get together with friends and dwell together on
that things that have happened. And that's also a pattern that's
associated with sort of maintaining negative emotions
over time. So, you know, one of the things
that your listeners might think about is, if they find
themselves or sitting and stewing about Out, bad things
that have happened, they really can't do anything about anymore.
Thinking about, okay, what can I do?
That is constructive right now. Something active, something that
will get me moving instead of sitting here and dwelling on bad
things. And also, if they find
themselves getting into conversations with friends,
where they're kind of feeling stuck there, they're helping
each other in a way, stay stuck by going over and over bad
things again. And again, thinking about how
can we change this conversation to be more constructive, more
future focused more. Tom, what can we do in this
situation or even like? Let's stop talking about this
for now and go and do something active and fun as a way of
breaking that negative thought cycle.
I love that and it's definitely helpful because you can hold
each other accountable. So it's not just you that's like
okay I gotta stop ruminating but together you can back.
Okay, what can we do? We're getting into this pattern
again. Are there other best practices
that people can Implement to counteract?
These risk factors that are so common in teenagers adolescents.
I'm sure there's basic things like getting outside more being
engaged in relationships, but are there other recommendations
that you like to give for sure? So I should say it's important
to qualify this by saying that I work clinically with adults, not
without a lessons. But a lot of the same strategies
I think are helpful for adolescents, as are helpful for
young adults, or older adults. So generally speaking doing
activities that are active or good.
So, exercise is always recommended as a way of
improving mood, as well as keeping you sort of healthy and
fit doing. He's that give you a sense of
Mastery and accomplishment are good, so these can be
pleasurable activities. They can also be things that
aren't about pleasurable. That gives you a feeling of
accomplishment. Like okay, did the laundry
check? Right?
You know, I ran this Aaron that had to be done check where you
feel like, okay I'm accomplishing things.
So those are good too but especially good are activities.
That give you a sense of pleasure things that you really
enjoy. That can be by yourself or with
other. People doesn't have to be a
great. Big thing could be as simple as
okay. I'm going.
To go for a walk with a friend. I'm going to spend some fun time
with a sibling. I really enjoy, you know,
reading this particular author. I'm going to go and to the
library and get a book. I really enjoy reading your, all
of those are good things. It definitely makes me think of
why a lot of teenagers experience like a shift in
mental health, when they go to college because all of these
things whether it's building Mastery or doing activities, you
enjoy being active on a team are really built into your schedule
in high school and then in college.
Up to you to maintain those. So if you don't build those into
your schedule if you don't prioritize those, it makes
sense. Why your mental health would
struggle as a result? I think that's absolutely right.
All of us, experience a change in routine when we go to
college, right? Yeah.
Your routine is completely completely unattended.
And in addition your, you're making your way with new
relationships, your this structure that's built into your
life in terms of when you eat and when you sleep.
And so on is changed and a lot more is put on the student too.
To place those structures in place, right for them.
They're our parents, they're saying, okay, time to go to bed,
right? Or what did you eat for
breakfast? You serve have to do those
things for yourself. And so it requires establishing
new routines and routines that are healthy and productive for
you. Yeah.
One of the questions that I've gotten most frequently recently
which I hadn't had a lot of questions about before was like
high functioning or sub syndrome will depression that isn't
necessarily completely derail any activities or EPS but it's
definitely there. I would love to hear kind of
what that clinical definition is and then why it's still
important to try and either get help utilize resources or at
least attempt to problem. Solve shift, your behaviors and
routines even if it's not at the point where it's like, this is
completely interfering with my quality of life.
Yeah, that's such an important question.
So we know that many many more individuals experience
subclinical levels of depression and then those who, It's
clinical levels of depression. For some of those individuals,
those symptoms escalated over time and can turn into a major
depressive episode that might need clinical attention, you
know, all of us experience ups and downs.
So, it's important to recognize that having a few bad days.
Doesn't necessarily mean you have a disorder or that, this is
something even Ducks concerning, but it's good to be attuned to
how your mood is, and how your behavior is, and if you're
finding that your day after day, you're feeling very low.
Motivation to do things that are important or things that you
usually enjoy or your mood is really low consistently.
Then it's a really good idea to do something to attend to that.
There are lots of things that can be done.
One of the things that can be done, it's to seek help from a
treatment professional either, Psychotherapy.
Or if you feel it's necessary in your provider recommends, it
some kind of medication, and it's also possible to do other
things that are less intensive. But that will be helpful.
All to your mood, some of those things can be as simple as some
of the activities we talked about, but it also, there are
self-help books, there are at based or internet based
interventions that are less intensive than doing what's a
individual psychotherapy but that can be quite helpful.
So looking into those resources, can be good and of course,
talking with friends and family who can be helpful to you as
well. I also loved reminding listeners
that the skills that are working for people that are like
severely severely. Best.
If those are working to lift that level of depression,
there's a very high chance that those same skills are going to
work if you're having an off day.
So if there's one person that like physically cannot get out
of bed and the skill that will work for them is doing the
opposite of what they're feeling and lowering their physical
physiological, emotional intensity.
And asking for help and distracting from the emotion.
Those same things will likely work if you're like, I just
cannot get to school today. I'm feeling so overwhelmed and
feeling unmotivated like those. Those skills transfer and you
don't have to get to a certain level of distress to The Quay.
Now we use the skills. Like if it's feeling
uncomfortable, if it's bothering, you use the skills
and it'll be easy to use them because the emotional intensity
is lower than that. Like, life interfering
life-altering, super bad depression.
That some people experience. I agree completely say to you're
absolutely right. Those skills are useful because
they're like a good life skills, right?
So I cannot avoid it, things that are making you
uncomfortable Or you've nervous is always a good skill.
Like staying, active is a good skill examining.
Thoughts that are unproductive and substituting more
constructive. Helpful.
Thoughts, those are all great skills that can and should be
used, even when you're let's say, more Motley distressed
compared to being clinically depressed.
I feel like that's one of the biggest ways that I've seen
stigma show up. It's like that emotional
thought, block where people are like, well, it's not that bad.
We don't need those skills. That people would learn in
therapy, and it's It's like, you're not even engaging in
treatment, you're not even getting a diagnosis.
Like it's not close to what you think of stigma preventing
people from doing. And yet their stats still that
emotional block of like, well other people have it worse or I
don't need that help yet. And it's like well why not
targeted early? So like you said it doesn't get
worse over time and develop into severe.
Major depression. You're absolutely right.
And these are skills I use all the time and it's actually look
one of the best things I think. About being trained in
Psychology is if you learn these great skills that are helpful
for everybody and I tell everyone I know about them
including healthy people. Yes.
So these are just they're just sort of good coping strategies
that all of us can benefit from and you don't have to get to a
certain level of severity to use them.
And in fact, using those skills will help prevent you from
getting to that point. Yeah, I remember being an
intensive treatment and being surrounded 24/7 by people that
were like highly trained in DBT and use Seeing it in every
single aspect of their life. Both at home, and in practice,
there is therapist they were the community.
They weren't called Community residents but they were the like
psychology students that were getting their hours in in
practice and they would do daily activities with us.
And then there was the Educators and then, of course, all the
kids and teens themselves were using these skills.
And I remember leaving being like, why is everyone being so
ineffective? Like, where is the dear man?
Where is the emotion regulation? Like guys, this could be so much
easier and it was And just like regulating anxiety and
depression. It was just basic functioning
and asking for help when you need it and advocating for an
objective. Like, these are all things that
if you're functioning, well, you're probably already doing.
And if you're not there skills to address it, that's exactly
right. I think these are often skills
that people who are doing really well, high functioning and
achieving the important goals they've set for themselves.
Those are skills that they're doing intuitively and you're
absolutely right like interpersonal, Effectiveness.
That's It's always something you want to do, right?
Emotion regulation. That's always a good go.
Like, use those skills. It's actually, it's a gift to
have that knowledge and using it in a regular basis, can make you
flourish. Even when you are sort of
emotionally doing really well. It just strengthens everything.
Yeah and then when you do have those low points which everyone
dies, you know, the skills, you know, how to get them they
worked before and that's one less block to getting out of
that low point because you are skilled and Knowledgeable and
how to navigate The Challenge. Exactly.
And having practiced those skills again.
And again means that when you most need them, they'll be there
for you. I love that this week's episode
is brought to you by teen counseling.
If you've heard of better help teen counseling is their Branch
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Treatment can be for both depression anxiety, and other
mental health issues. And one proven way to depression
and treat anxiety is therapy and Psychotherapy.
And so, a great way to get access to therapy is teen
counseling. What you do is you get a teen
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So maybe it is depression, maybe it's anxiety, maybe it's
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So another thing that I wanted to touch on related to
depression, which I think is so interesting, which is again, not
something that is, commonly known as the relationship
between stress and depression. So kind of stress generation in
the kindling hypothesis which if you don't know what those mean,
we will explain. Don't worry.
But I would love to kind of hear your perspective there because
it's a really interesting. Love thought that isn't always
something that comes to mind when people are struggling but
it can be very helpful to be aware of if you are navigating
depression. Yeah, absolutely.
So the basic principle of stress generation was introduced by
Connie Hammond, an a depression researcher and what you
discovered in her research is that many individuals who are
depressed seem to be engaging in behaviors that almost got in
their own way that were making things more difficult for them.
And so, these were Events that rather than sort of completely
random acts like, you know, I got, let's say, you know,
there's a hurricane, for example, you know, that's
something that I have no control over.
I did nothing for this hurricane to happen.
I'm unfortunately, sort of stuck in the wrong place at the wrong
time that would be a an independent stress.
Some things independent from me. But I what you found was that
many individuals depression were engaging.
Also in what she called or experiencing what she called
dependent stress so dependent. An example would be like
frequent arguments with a boyfriend or girlfriend.
This is something that I contribute to in somewhere
potentially contribute to our might have a very quarrelsome
boyfriend or girlfriend, but I also may be a person who is
through repeatedly doing things, that's causing arguments to
happen or contributing in some way to this dress.
This has been a first at least. This was a controversial idea
because we don't want to blame the victim.
We don't want to say you like you know, people who Are
depressed, are doing like bad things for themselves.
And the other hand, I think it's really important to recognize
when we are doing things that are making things harder for us
so that we can take steps to try to improve the situation.
And so, the basic idea behind stress generation is that to
some extent. All of us contribute or can
contribute to the stress we experience and the opposite side
are flip side of that is that we all have the opportunity to
reduce our stress levels by You can go hard.
Look at what are we potentially doing that may be increasing
stress for us. So I'll give you maybe a minor
example. If I'm a person who's
chronically late. I just like I can't get myself
on schedule. Yeah, myself to write.
So you know, if I'm a person who's always late, then I'm
going to be generating some stress for myself, right?
I'm going to, let's say, pay a bill late and as a result, I'm
going to have a fine. And I'm going to have to pay our
let's say I'm going to arrive late.
To a meeting. And as a result, I'm going to be
taken less seriously. By the people.
I'm supposed to be meeting with her.
I'll miss some important information.
So maybe for students like maybe I because I'm over sleeping all
the time I'm missing class or late for class and then I miss
information, I need to know in order to do well in exams if I
recognize that I am contributing to the stress that I'm
experiencing by not managing my time.
Well, then by improving my time management skills, I can
actually reduce stress in my life, that's an on interpersonal
example but One thing to note is that kind of Hammond observed
that most of the dependence, Fasteners that she observed,
especially in the women in her sample, were interpersonal in
nature. So the women were engaging in
behaviors that were increasing the likelihood of others in
their life's or arguing with them leaving them.
You know where relationships were more unstable or ending or
just a more stressful more, you know in their lives.
So thinking very hard about what are the Ways in which I may be
contributing to difficult relationships.
And, and, and that includes selecting people to have
relationships with, who may not treat us the way we deserve to
be treated. Yeah.
I think that's a huge thing
that. I mean it's very very valid
stress to experience. And with depression, a huge
thing is having a support system and a group of people that can
support you and if your support system is doing the opposite of
that either like you and is she getting that or them?
Initiating, those conflicts that can add to how difficult it is
to come out of that depression. Ask for help, utilize resources,
and all of those things. In addition to kind of creating
stress in different relationships.
There are some like, neurobiological emotional
cognitive experiences that are pretty Universal in people that
experience, depression. What are some of those that
listeners can kind of listen for, and kind of observe that
might be happening. I think it's a great way.
It can to hear things that can be really validating, because
depression can be so isolating. And yet, like you'll highlight
in these Universal things, it can be very relatable, and
again, Universal in the experience, even though it is so
internal and feel so subjective. Yeah, great question.
So I can highlight a few of them.
So, what is kind of on a neurobiological level?
What is has been seen? As often happening in
depression? As individuals who have a
heightened sensitivity to stress, And and heightened
reactivity to stress. So, areas of the brain that are
in the sort of the limbic part of the brain, particularly the
olympique De le are sort of heightened an individual with
depression. So, a tendency to experience
negative emotion to react, very strongly distressed.
And we see that prefrontal cortex areas of the brain that
are involved in planning. And in self-control,
self-regulation, are reduced activity in those areas are
reduced and the routine. Those aren't even fully
developed, so that's exactly right.
Right more susceptible, that's exactly right.
And in terms of the Cross talk between the limbic system and
the prefrontal systems of the brain, they're sort of less
tamping down of emotion by those frontal regions of the brain.
And so people with depression, kind of a universal feature is
the sort of heightened, sensitivity, and hind
reactivity. When stressors occur, and all of
us experienced an increase in distress and increase in sort of
that cortisol response when we're stressed.
That isn't normal. It's actually very adaptive.
What seems to happen in depression is that people have
trouble shutting that process off in a prompt way.
So, you know, it's good that we react strongly want to stress or
first occur so we can Marshal our resources and deal
adaptively with that stressor. We don't want to ignore the
stress, right? There's it's there for a reason
to warn us that something's going on environment, we need to
deal with. But then once the stressor has
resolved, we need to be able to bring our bodies back down and
back to a regular Our stable State and often individuals with
depression have trouble coming back down in a timely way and
they're sort of more sensitive and more sort of hyper aroused
for for a period of time beyond what healthy individuals might
experience. And maybe I'll talk about each
of these Universal, and then we can talk about it.
What could be done about it? So, cognitive, great.
So cognitively, what we often see is people tending to respond
in ways that heighten the stress, by doing things, like
blaming the stress. On themselves and unstable
things that can't be changed as opposed to looking for outside
reasons why this dresser might have happened or recognizing the
stressors come and go that they can be temporary rather than a
stable feature of me. So, if I believe that when I
encounter stressors, it's because something is inherently
bad, about me, it's unavoidable and it's always going to be
around. I'm going to be much more likely
to stay depressed. And if I recognize that
stressors also are, you know can be Things that are temporary
that are outside of me and that can be controlled emotionally.
We often see high levels of sadness and distress but also
low levels of positive emotion. So what seems to happen is that
people are feeling sore, very sad, very hopeless.
But in addition, they can feel just a really difficult time.
Feeling pleasure and enjoy and connection to other people that
really contributes to the difficulties of this disorder
and an Personally, oftentimes people withdraw from others,
they isolate themselves rather than reaching out and connecting
with other people. And that can make it very
difficult for the depression to stop in part because when we're
alone, were more likely to ruminate and we're less likely
to talk to people who can help distract us from what's going
on, can help give us A New Perspective that might be
helpful and help us lift our mood.
So all these universals I think in terms of thinking about how
to address them M. An important.
First step is to recognize that, you know, one stressors occur.
All of us are going to react. What we have some control over
is, how are we going to respond? And so, if we know that we're a
person, who, when we experience a stress or tends to be, you
know, could react really strongly, which is actually very
common. Not just among people with
depression and thinking about hey, what can I do now to deal
productively with this. So talked earlier about active
problem-solving types. Copying what I brought about the
situation is sort of out of my control and it's like, I need to
let go of that. And what part of this can I do
something about? Let me actually make a plan for
how we're going to address this taking, kind of concrete steps,
and having a plan in place to address the things that can be
addressed cognitively. Emotionally interpersonally,
rather than kind of withdrawing and isolating myself and
thinking about all the ways in which things are going wrong.
Can I, can I instead approach? So instead of To avoid.
I'm going to go approach, I'm going to reach out to people who
I trust and who I love who I know will help me get through
the situation. Give me something else to do,
encourage me to try something different.
Can I sir think about activities that I can engage in that are
going to lift my positive emotion and will help me curtail
that negative emotional experience.
It's so interesting. I remember one of the biggest
skills that I utilized initially and DBT was opposite action.
It sounds so counterintuitive because it's like, you're going
to do exactly the opposite of what your emotions are telling
you to do and it's almost it is on Instinct that we listen to
our emotions that we lean into those urges because they're
there to Keep Us Alive. Its evolutionarily something
that's very beneficial. And yet when you have struggled
with depression for a while and that's kind of skewing these
emotional cues and it's not serving you to listen to them.
You have to reteach yourself to not, listen to them.
And then at some point, What you kind of go back to listening to
your emotional cues as they get more balanced, but it can be
very counterintuitive, especially initially, that's
exactly right. And I think, you know, it's very
natural that we want to avoid situations that give us pain,
emotional pain, or physical pain.
It's, you're absolutely right. That, when you've been depressed
for a long time, sometimes those emotions, don't serve us very
well. And we tend to want to avoid
everything including things that are potential sources of
pleasure. And I meant for us and so doing
the opposite sort of encourages us to approach, rather than
avoid in ways that can be very helpful.
Yeah, but you did touch on this little bit of avoidance as
something that can show up a lot with anxiety with OCD.
With other mental illnesses. There is a pretty high level of
comorbidity of depression with other mental disorders.
What are your thoughts there? Is it something that like the is
it like depression is the first thing that causes these other
things to pop up or Do these other stressors and overwhelming
emotions and lead to this feeling of depression.
I think it's probably both, you're absolutely right.
That rates of comorbidity or co-occurrence of depression.
With other mental disorders is very high in teens very often.
The co-occurring conditions are other anxiety disorders they can
be eating disorders substance use disorders.
Sometimes depression is a response or reaction to having
those other conditions. So for example, if I'm really
anxious the depression May almost be like a demoralization
reaction it. So I'm so tired of struggling.
So much life is really really hard.
Other times. Depression can actually
contribute to these other disorders.
So for example if I'm feeling really down and depressed, I
might use substances to try to make me feel better and that can
lead to a substance use problem and then very often, there's
some third Factor that's Rebooting to both the depression
and the other disorders. So if I have a lot of stress,
for example, that might increase depression, as well as anxiety
or substance use disorders. If I tend to engage in kind of
problematic coping strategies that are causing problems for
me. I may I may give rise to
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The last thing I want to touch on which I thought was So
interesting, one of my favorite things we learned this semester
was about the idea of distress disorders and how similar
generalized, anxiety disorder and depression can be because if
I were to think about it, going in blind at be like, well,
they're completely opposite like one is completely dampening.
Your emotional expression in your mood and the other one it's
like heightened arousal and yeah, as you explained, they can
be so similar. And it's almost like how you're
interacting with your environment and causal factors
that can kind of create. Create the difference of how
you're presenting. So, I'd love to hear your
thoughts there about the similarities and the differences
of generalized, anxiety and depression.
Yeah. So this is an area that I study
and I find this so fascinating. So, one of the things we talked
about in class is that actually the genetic research suggests
that genetically generalized anxiety disorder and major
depression are the same disorder.
It's so interesting and we look at the clinical features of
these disorders. They do have a lot of features
in common, right. So both Writers, for example,
have involved difficulties with sleep involve difficulties with
concentration and decision-making, involve
difficulties with mood, especially high levels of
negative, mood negative emotion, but there are some important
differences to in GA day. Of course, we see heightened
levels of worry and anxiety and depression.
These are not Central features although we know that depression
is very heterogeneous and there are many divisions with
depression who actually are quite anxious.
And very Very, very restless have difficulty falling asleep
and so on it has a very kind of anxious depressed mixed
presentation, although worry has traditionally been thought of,
as a feature of anxiety, not depression.
We now know that rumination and depression and worry and gadd
are close cousins. They're not the same exact thing
but they are very, very similar both involve this process of
thinking in an abstract, uncontrollable fashion about
things that Bad about me. And that I for the most part
cannot change. And worry is for future-focused
elimination is or cast focused. But other than that, there's not
too many things that distinguish worry from elimination.
So one of the possibilities, my students and I have been
actually studying is perhaps that tendency to get stuck and -
repetitive patterns of thinking actually is a shared
vulnerability factor for gadd and major depression and there
are active Treatments for depression and anxiety.
Have a lot of shared features, many of the same.
Strategies are helpful in Psychotherapy, for JT and major
depression. And many of the same
pharmacological treatments are effective or GED and major
depression. So they're definitely seem to be
a lot of commonalities there for us to think about there are some
differences between D and m d d. If they're hard to find anxiety
disorders have been described in the literature as disorders.
People are primarily concerned about threat, very sensitive to
detecting potential threats in the environment.
And I don't mean just threats like a spider, you know, a
snake, those Arts of threats, but that's where I perceive.
There's some potential for negative outcome.
For me, in GA D, this tends to take the form of thinking about
all the bad things that could happen to me in the future.
And why I think I'm not going to be able to cope with those bad
things, if they happen to me, right?
And we'd have found some evidence that threat sensitivity
is higher in GA D than in major depression, however, major
depression tends to show higher threat, sensitivity than people
who have no Psychopathology at all.
So it might more of a matter of degree than really a complete
difference. Exactly.
And sort of conversely for major depression, we've been pursuing
the possibility that in depression with distinguishes it
from JD and from other anxiety disorders, is that low positive
emotionality Difficulty finding pleasure and joy in life and
enjoying rewarding experiences when they happen.
And we have found some evidence that yes, reward sensitivity
word responding is lower in depression than in gadd.
But once again, people with deity show lower, reward
responding than healthy individuals who have no
Psychopathology. So again, a matter of degree, so
interesting. And again, going in blind, you
would not pick up on those things like.
I think, the way that we're aware of them as a society, they
seem so different. And yet, when you really do,
look at the presentations and when you look at the the
presentation in compared to a normal presenting person,
they're very similar. And there's a lot of things that
overlap and again, like even from the treatment perspective,
things that are effective on both fronts, which is great if
you are struggling with comorbid depression, Shouldn't and
anxiety. I think, that's right.
And what we know about generalized, anxiety, and major
depression, is that they usually go together.
It's very hard, especially in clinical settings.
It's very hard to find people who have one and not the other.
They often go together and individuals who have both
generally have sort of the most emotional distress.
The most reactive to stress and sometimes over time, their the
individuals who are going to be sort of more have a more chronic
course of illness. So those Are the individual we
see, as where it's, especially important, that they seek help
and learn and use the strategies regularly to manage their
emotions and to cope successfully with stress.
Yeah, if there is one piece of research or literature, or a
statistic that you wish, the general population was more
aware of relating to depression, anxiety, and mental health.
What would it be? I know that's hard one.
So I think that I don't know if this is a statistic for say,
maybe I'll give you two things if it's okay.
Yeah, so one thing that we talked about in class a semester
and for me, is sort of the most blunt mind-blowing statistic
about mental illness is a. Most of us will develop a mental
disorder at some time in our lives.
So general population, surveys in the US have shown that
approximately half of the adult population, the us will have a
mental disorder at some time in their life.
That's probably an under estimate because that number it
comes from studies of people who are living out in the community.
And we know that people who are let's say in institutions for
example in prisons or an inpatient hospitals or people
who've died prematurely due to Suicide or accidents have an
elevated rate of Psychopathology relative to others in the
population and it's also the case that when we ask people,
have you Your life experience, dot dot dot, sometimes people
forget. And they are, they any proper
stigma in our society, right? Under that, people would under
report and that's the other thing that people may be
reluctant to report. Especially since these surveys
are usually done with lay interviewers, who are strangers.
And these are sensitive things to talk about, especially with
some stranger, who's come to your right?
And so when people are followed forward, in time, we actually
see rates as high as 70 or even 80 percent of people, will
eventually develop A mental disorder.
Now, that's really important and hopeful in a way because it
tells us that it need not be stigmatized to have a mental
disorder. In fact, the more rare and
unusual situation is the person who reaches, you know, the age
of 80 or 90 having never had a mental disorder.
I think we have a lot to learn from those individuals.
Like, are you okay? I know exactly how did you do
that? That normalizes at some point in
our lives, for going to go through rough patch.
The might be really rough for some individuals, there will be
recurrent problems or chronic problems.
And for others, the problem will be resolved and not recur.
So I think it's just important to recognize that mental illness
is all around us and one form or another and that having
experienced this, we're not alone, we're actually in the
majority. So that's that's really
important to note. And then I'll pair that with the
second observation I want to share, which is that.
Effective treatments exist. We have some really effective
treatments out there and the real heartbreak for me, is that
so many people who struggle and suffer don't know about these
treatments or don't have access to be treatments.
So I think if you're a person who is struggling with
depression with anxiety because I know that's the focus of
today's conversation, we have effective treatments, you know,
it's so important to get help because those treatments can be
extremely helpful and given that these are problems that can
persist To become chronic or recurrent over time the earlier,
you seek help the better because learning those skills will help
you. Not only deal with the current
episode of depression but prevent future episodes from
happening in your life. I love that.
I think that's the perfect note to end on and it's relevant to
anyone and everyone whether you yourself have struggled in the
past currently struggling, May struggle in the future are
trying to support, someone who is struggling.
It really. Is something that is universally
important to know and be aware of Of and it just, it really
just makes me wonder again how we have so much stigma.
When again, the majority of us do struggle or will struggle at
some point. Yeah, I think that so often we
don't talk about these things because we feel like we're
alone, we feel ashamed. And I think if we open up the
dialogue and are open with one another about this, both
discover that, in fact, many other people are dealing with
very similar things. Yeah, yeah.
Well, thank you so much for joining me today.
I'm so glad we got to do this me.
Me to thank you so much for inviting me.
It's been such a pleasure Sadie, of course.
Thank you so much for listening to this week's episode of she
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