There are a few things I do when working with a client who is affected by anxiety and depression. First of all I work with the client to separate out the two aspects so they can really explain each one separately as they can feel very different. Being able to spend some time describing and discussing each one in a safe place with an empathic practitioner can be revealing for the client in what they notice about their experiences of each.
Being able to explain what is happening physically and cognitively when anxiety and depression is occurring is important for the client. Exploring behavioural manifestations with the client is also key because they are being their own witness/observer and noticing how anxiety and depression happens to and for them.
Psychoeducation regarding how the nervous system works in relation to the sympathetic and parasympathetic systems, their imbalance and how breathing is a critical part of regulating those systems is also part of the work. The limbic system, and in particular the amygdala, is discussed due to it being the behavioural and emotional centre of the brain, particularly when the amygdala is active and aroused, as it is the source of the anxiety and depression. Educating ourselves on our physiology is key to understanding our experiences of ourselves and therefore starting to know what to do when we are activated. Two things are critical when we are at our most aroused, getting more oxygen into the blood and remembering that we are in the present. Box breathing and grounding techniques are part of the exercises I encourage clients to do which we practice in the session. If a client can do the exercises consistently and intentionally they will notice that they are able to overcome and get back in control instead of feeling that they are being controlled by their physical and cognitive experiences which is what anxiety and depression can feel like.
This is obviously just the very start of the work as the journey into a lifelong relationship with anxiety and depression can take time to witness and fully understand but I believe that unless the client feels stable and safe enough to explore then the work will feel threatening so starting slowly and intentionally can help. Other techniques that can prove helpful are from Paul Gilbert’s Compassion Focused Therapy that sees us operating in 3 systems which can be very useful to the client when explained and utilised, as well as Dan Seigel’s Window of Tolerance, which the client can research and get a greater appreciation of the Fight, Flight and Freeze system and its implications.
Many experiences related and unrelated to a client’s anxiety and depression are discussed along the way but asking the client if they are able to retain and utilise some of the approaches allows discussions about what they may now be noticing, signifying a shift in how they now relate to their own anxiety and depression.