An ounce of prevention for depression and anxiety

April 20th, 2017

A shocking third of Americans have been affected by clinical depression or anxiety in their lifetimes. That high number suggests that mood disorders, which were once thought of as personal problems, may be more accurately thought of as societal problems. Indeed, social and economic trends like the recession of 2008 are correlated with the prevalence of depression. And the implications are societal as well; depression cost the American economy over $200 billion in a single year, not to mention the impact on spouses, children, and friends.

Part of the problem is that most people never get treated for their depression or anxiety, despite the availability of effective treatments like psychotherapy and medication. Perhaps it is time to shift tactics and focus on prevention, suggest Patrick Steffen, Tara Austin, and Andrea DeBarros in Policy Insights for the Behavioral and Brain Sciences. The preventive approach they recommend is one that could benefit everyone: reducing stress.

Chronic stress, a persistent and overwhelming form of tension, has been on the rise for years, and there is a correlation between that trend and increasing rates of depression and anxiety. Scientists believe the connection is more than a coincidence, because common physiological pathways underly stress and mood disorders. Both alter the brain in similar ways, and there is evidence for a vicious cycle: chronic stress increases the likelihood of depression and anxiety, which alter the architecture of the brain in a way that makes it hypersensitive to new stressors, therefore making mood disorders even more pronounced. Reducing chronic stress may therefore be key to reducing depression and anxiety, Steffen and his co-authors believe.

How do you reduce chronic stress when the circumstances that cause it can be hard or even impossible to change? You teach people to cope with stressors and change the way their bodies react to them. Based on a review of research, Steffen and his colleages recommend two techniques that are less expensive than medical treatment and have no side effects: mindfulness and biofeedback.

Mindfulness is a strategy in which people pause, become aware of what they are currently experiencing, shut out other thoughts, and breathe. Contrary to popular belief, the researchers point out, “Mindfulness is not only for gurus or monks … [and] people do not have to have be religious, spiritual, or have a certain worldview.” Anyone can learn to practice it. “Mindfulness involves open, non-judging sustained moment-to-moment awareness of current thoughts and body processes,” the authors explain.

Most of us don’t approach our daily lives mindfully; we have swirling thoughts and strong emotions. That can make us more likely to focus on the negative and to ruminate, which increases risk for depression and anxiety. But regularly stopping our busy minds, checking in with ourselves, and accepting whatever is happening reduces rumination, makes us more flexible, and enables us to cope, which ultimately reduces the risk of mood disorders. Experts usually recommend that people practice mindfulness for about 20 minutes a day, not necessarily when they are experiencing something stressful. A mounting body of evidence suggests that such practice can be as effective as the most beneficial forms of psychotherapy.

Biofeedback also helps people tune in to their inner states, but in this case, their physiology. The goal is to teach people to monitor and modify their heart rate, breathing, muscle tension, and other biological processes. Using painless sensors applied to the skin, people can view their vital signs on a computer screen, and see how the numbers change when they make intentional efforts to slow down their breathing or relax their muscles. Studies show that when people are trained to breathe at approximately six breaths per minute, it helps restore the balance of their physiological processes and makes them healthier. It also equips them to better cope with stressors when they come along. Typically, doctors send patients home with small, portable biofeedback devices so that patients can use the techniques on their own. Studies have found it takes practing about 15 minutes a day for three weeks to see effects.

A major benefit of these two approaches is that they don’t have the kind of stigma too often associated with mental health treatment. Steffen and his co-authors have found that “people are more comfortable in participating in programs designed to identify and treat stress” than in taking antidepressants. And, they point out, stress-reduction techniques are cheaper and more accessible, thanks in part to technology. Smartphone apps are available for both mindfulness and biofeedback, allowing individuals to practice the techniques at their convenience. If people learn to use the tools early enough, they may never have to experience the devastating cycle of chronic stress, depression, and anxiety.

Drawn from “Treating Chronic Stress to Address the Growing Problem of Depression and Anxiety” by Patrick R. Steffen, Tara Austin, and Andrea DeBarros, in Policy Insights for the Behavioral and Brain Sciences.