Sonia Cerqueira Counselling and Psychotherapy HCPC Counselling Psychologist
Holborn, near Covent Garden


-Anxiety, a necessary and commonly shared emotion

Anxiety and worry are fundamental human emotions that we all feel in certain situations. The word "anxious" is used in everyday language to mean that we are nervous about something, such as a job interview, a presentation, or the outcome of a medical examination.
Anxiety functions as an internal alarm in the face of danger and allows us to guard against it. If we did not feel anxious, we would put our lives and those around us in danger.
A certain level of anxiety allows us to mobilize our abilities. However, sometimes anxiety sets in over time and appears disproportionate. This anxiety then becomes harmful.

-When anxiety becomes a problem

Anxiety is not just a nervousness caused by an external event with obvious causes. Some people constantly experience an uncontrollable sense of worry, tension, even fear that has no rational reason.
It's as if the anxious person is looking at the world through magnifying glasses that make small problems big.
This constant worry sometimes occurs after a traumatic event or is acquired in a hostile environment that forces the individual to develop a hyper vigilance to protect themselves. As no sense of internal security has developed, there is constant distrust of the outside world.

The intensity of the disorder and the discomfort is variable according to the individuals. It may be very strong in some people, and "trivialized" in others.
In some people, anxiety will mainly affect thoughts and emotions, with great anxiety, ceaseless ruminations ... In others, it will give physical signs: fatigue, irritability, muscle tension, nausea . In all cases, generalized anxiety is a real burden that can become unbearable in everyday life for oneself as well as those around him.

If left untreated, anxiety can prevent action, cause blockages, hinder the completion of projects which causes difficulties in personal relationships and problems at work. Anxiety is often the cause of addictive behaviours to psychotropic products (alcohol, cannabis, sedatives, anxiolytics, sleeping pills) that anxious people use to subdue anxiety. When prolonged, anxiety can lead to mental exhaustion and depression. It is also responsible for many somatic symptoms and contributes to the development of functional disorders such as insomnia or functional digestive disorders and other psychosomatic disorders.

-Do you suffer from anxiety ?

The DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders used by clinicians and psychiatrists) outlines specific criteria to diagnose generalized anxiety disorder.

When assessing for general anxiety disorder, clinical professionals are looking for the following:

1) The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least 6 months and is clearly excessive (no specific threat present or disproportionate to the actual risk). The worry may be accompanied by reassurance-seeking from others.

2) The worry is experienced as very challenging to control.

3) The anxiety and worry are accompanied with at least three of the following physical or cognitive symptoms (in children, only one symptom is necessary for a diagnosis of anxiety):
-Edginess or restlessness
-Tiring easily; more fatigued than usual
-Impaired concentration or feeling as though the mind goes blank
-Irritability (which may or may not be observable to others)
-Increased muscle aches or soreness
-Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep)
-Many individuals with anxiety also experience symptoms such as sweating, nausea, or diarrhea.

If you have one or more of these symptoms, psychotherapy can help you manage and decrease your anxiety.

-When to ask for help?

People suffering from excessive anxiety are slow in asking for help and tend to minimize their suffering. Especially if they have never experienced a panic attack, they consider that their anxiety will not be taken seriously. However, the panic attack is not necessarily a symptom of anxiety.

Alongside anxiety is often added a feeling of guilt for not being able to confront situations that seem innocuous for others. This guilt lowers self-esteem and increases the fear of being judged. Asking for help to face one's fears requires courage. Starting therapy to understand your fears and go beyond them requires courage.
Do not hesitate to ask for help as soon as you feel that the worry is becoming constant or out of your control.

-How does therapy work

In the treatment of anxiety, the combination of relationship-based therapy, Cognitive Behavioural Therapy and Acceptance and Commitment Therapy all give good results.

In acute anxiety crisis, anxiolitics are often suggested to give some relief, but they do not cure the disorder in the long term and can cause addiction.
If and when anxiety is manageable, therapy is then indicated to understand and control stress and change habits.

Whatever your level of anxiety, it is important to take the time to find the psychotherapist who will listen to you and adapt his methods to your needs and your personality.
In a non judgemental exchange with the psychotherapist, the patient gains a sense of safety and learns to express and analyse his worries, to express the emotions little by little, without overflowing. With the support and understanding of the therapist, the patient finds his own way to reduce his anxiety.

Depressed or just sad?

What is depression?

Depression is a mental health disorder that affects mood, thoughts and body.
It is associated with a feeling of great sadness to despair. People experience a loss of pleasure even for activities that once they enjoyed. Decision-making abilities may be impaired, or affected by sleep and eating disorders. Self-esteem is diminished with a tendency to undervalue one's own worth.

As is often the case with mental illness, depression has physical consequences that are sometimes the source of depression, or at least reinforce it. It should be noted that depression and its physical consequences often reinforce each other. Hence the installation of a vicious circle that it is necessary to break. Depression can be physically experienced in the body by a backache, stomach ache, headache.

Depression usually occurs in the form of depressive periods that can last weeks, months or even years. Depending on the intensity of the symptoms, the depression will be described as mild, moderate or major.
When depression sets in over time, we talk about chronic depression.
Bipolar disorders are specific disorders that alternate phases of depression and over excitation phases.

Depression can appear with other disorders:
-Substance abuse (alcoholism, abuse of substances such as cannabis, ecstasy, cocaine, dependence on certain drugs such as sleeping pills or tranquilizers ...)
-Cardiovascular diseases and diabetes.

Possible complications related to depression:

-The recurrence of depression.
It is common since it concerns 50% of people who have experienced depression. Regular therapy considerably reduces this risk of recurrence.
-The transition to chronic depression.
-The suicidal risk.
Depression is the number one cause of suicide: about 70% of those who died by suicide suffered from depression. Depressed men over 70 are the people most at risk of suicide. The highest suicide rate in the UK was for men aged 45-49, and men account for three quarters of recorded suicides. Suicidal ideations are one of the signs of depression. Even though most people with suicidal ideation do not make an attempt, it is a warning sign. Depressed people think of suicide as a way to stop suffering.

Who can be affected by depression?

Depression is one of the most common mental health issues.
According to the World Health Organization (WHO), by 2020, depression will become the second leading cause of disability worldwide, after cardiovascular disorders.
Depression can occur at any age, including childhood, but it appears for the first time most often in late adolescence or early adulthood.

It is unclear what causes depression, but it is likely to be a mix of genetics, biology, the environment and lifestyle. Life events, loss of a loved one, divorce, illness, loss of a job, or trauma can trigger depression in those who are prone to the disease. In the weeks following the loss of a loved one, signs of depression are common, and this is part of the grieving process. However, if these signs of depression persist for more than a couple of months, or if they are very marked, consult a specialist. If you think someone you know or you have depression, I recommend that you seek help from a health professional.
It should be noted that events that are socially considered positive or innocuous can also lead to depression, such as seasonal depression due to lack of sunlight or postpartum depression. In 60% to 80% of women, a state of sadness, nervousness and anxiety manifests itself in the days after childbirth. We talk about baby blues that lasts between one day and 15 days. Usually, this negative mood disappears by itself. However, in 1 out of 8 women, a real depression settles immediately or appears in the year following birth.

Unhealthy lifestyle (smoking, alcoholism, little physical activity, excess of television or video games, etc.) and the living conditions (precarious economic conditions, stress, social isolation) are likely to deeply harm the psychological state. For example, the build-up of stress at work can lead to burnout and, eventually, depression.

-Depression or sadness?

The term depression is commonly used in everyday language to describe a state of sadness associated with the difficulties of life. Depression being characterized among other factors by a state of deep sadness, it is common to confuse the two psychological states.
Sadness is a normal emotion that everyone will experience at some point in their lives following a clearly identifiable event such as losing a job, ending a relationship, or bereavement. Over time and events, each of us experiences a range of feelings, from the saddest to the most optimistic. Sadness, discouragement and despair are human experiences that should not worry us too much, if they are not lasting. Temporary sadness, even unexplained, does not prevent you from enjoying the activities that give you pleasure, such as sharing a meal with friends, playing with your children or practicing your favorite sport.

If this sadness persists and invades all spheres of your life, then it can be the beginning of depression. A person with depression may have every reason to be happy, yet they have lost the ability to feel joy or pleasure. In sadness, you may feel regret or remorse for something you said or did, but you will not feel any long term nor profound sense of worthlessness or guilt as you would with depression. Finally, non-depressive sadness is not the cause of self-aggression and suicidal tendencies. Those who suffer from severe depression may have thoughts of self-mutilation, death or suicide or have a suicide plan.

-Are you depressed?

The DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders used by clinicians and psychiatrists) outlines specific criteria to diagnose clinical depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either depressed mood or loss of interest or pleasure.

1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.

If you suffer from many of these symptoms, psychotherapy can help you get out of depression.
It is especially important to consult a specialist if you have suicidal thoughts. If a loved one tells you about uicidal thoughts, advise him or her to call or call yourself a health professional to ask for help.

-When to ask for help

Does depression prevent you from living, working, loving?
When the negative consequences of depression invade your life and become as difficult to bear as the symptoms of depression, it is time to ask for help.
If you feel isolated and that the feeling of being judged pushes you to retreat even more, it is advisable to seek help from a psychotherapist. The person who suffers from depression feels pretty often judged. While it would not occur to anyone to question the struggle of someone suffering from a somatic condition, it is often considered that depression is caused by a lack of courage and will. The person who suffers from depression will often hear: “Get on with it, pull yourself together, make an effort”. Will alone is not enough to cure depression. Sometimes, the family feel so worried and want to help by pushing the person to resume activities. These attempts to motivate him or her are perceived by the depressed person as an attack and a reproach, which reinforces their feelings of guilt and helplessness.
If you think that financial or family problems arise from your depression, it is time to ask for help.
Depression has consequences on all activities of everyday life: intellectual performance decreases, conflicts increase, professional results are affected. Depressed people may lose their jobs during their illness.
If the suffering is such that you use uncontrolled substances or legal or illicit means to calm you down (alcohol, tobacco, cannabis, drugs, food ...), I strongly recommend that you contact a psychotherapist.

-How does therapy work?

Depression can be treated. Therapy can achieve a significant improvement of the symptoms and a return to well being. The duration of psychotherapy is variable and depends on the severity of the depression, the number of relapses, and the situation of the person.
In the case of mild depression, psychotherapy may be sufficient but in the case of chronic depression, taking antidepressant medications alongside therapy may speed healing. Studies have shown that antidepressants are more effective if you follow psychotherapy at the same time. It is sometimes necessary to try several antidepressants in order to find the one that suits you.

One of the aims of therapy is to help the client to rebuild his social references which he has gradually cut.
With the help of the therapist, the client will reintroduce a daily routine and organize activities that expose him to the others. For example, the therapist will discuss with the client groups or individual activities in accordance with the client's personality and situation. These activities should help regain pleasure and a rhythm of life favorable to the resuming of relationships with others.

The personal situation of the client is essential for the success of the treatment. A client supported by those around him will have a better chance of getting out of the depression quickly. Do not hesitate to ask the help of your entourage. If your relatives feel lost and unable to help, your therapist can, with your agreement, advise them on the best way to support you.

Whatever the sources of your depression, it is important to take the time to find the therapist who will listen to you and adapt his methods to your situation. In a benevolent exchange with the psychotherapist, the client learns to express his suffering without feeling judged or diminished. With the support and understanding that the therapist brings, the patient will find his own way out of the depression. This is a progressive path that will require adjustments and on which the therapist will encourage you with patience and warmth.

If you feel depressed, or if you want to know how to help a depressed person, call the Samaritans on 116 123 or your GP, or anyone you trust. Beginning to talk about your depression without being incapacitated by shame is what matters. It is the crucial first step.

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