Anxiety and depression are the most common diagnoses in psychotherapy. About twice as many women as men are affected by depression. It is estimated that about 15 to 30% of the adult population in the western world suffers from depressive symptoms that require treatment. In some cases, alcoholism or other addictions are in the foreground, but these are basically an expression of a basic depressive disease. Anxiety and depression practically always occur together.
The causes of severe anxiety and depression are both psychological and biological. The treatment approaches are correspondingly different. While light to moderate anxiety can affect everyone in the course of their lives, chronical severe anxiety is a complex disease pattern with a major impact on quality of life and requires professional treatment.
Fear means a lack of feeling of security in the world. The world and people in it are experienced as threatening and unpredictable. The affected person does not feel up to the challenges of life. Contact disorders and loneliness play an important role. A good relationship with an intimate partner and family as well as a reliable circle of friends are the best way to prevent these problems. Accordingly, therapy also aims to restore this "social network". The self-esteem of the person concerned and social factors (workplace, social climate) are important aspects.
Depressive symptoms almost always occur in the course of an anxiety disorder. Depressive symptoms mean: a feeling of low mood and discouragement, lack of drive, the feeling that everything is pointless, powerlessness, excessive exhaustion and increased need for sleep, but also problems falling asleep and sleeping through the night. Everyday errands can become so tedious that those affected can no longer lead a regular everyday life.
Phases of anxiety may alternate with phases of depression, possibly in short intervals. . Affected people often are blocked to feel emotions and impulses, such as anger. Feelings often seem hidden. Yet they finally find their expression in a neurotically distorted, often self-destructive and negative way. Such conflicts are almost always related to conflicts in the partnership and/or with one's own parents.
Here, as in therapy in general, a change in the condition of the affected person can only be expected if the concrete circumstances of his/her lifestyle have changed in such a way. An uninvolved third party should be able to recognize that something has changed. It is therefore not enough to change certain thoughts and beliefs. The changed way of thinking should lead to a change in behaviour that can be recognised from the outside.
This mostly concerns anxiety disorders in which various fears occur alternately or together, for example fear of public appearance together with fear of exams, general self-insecurity and contact disorders.
Here, too, the causes are often complex and aspects of the patient's personal history as well as the circumstances of the current lifestyle play a role. Here, as in therapy in general, a change in the condition of the affected person can only be expected if the concrete circumstances of his/her lifestyle have changed in such a way that an uninvolved third party can recognize that something has changed. It is therefore not enough to change certain thoughts and beliefs. The change in thinking must also lead to a change in behaviour that can be recognised from the outside.
The classic example of this type of anxiety is a phobia of spiders. The affected person has no particular problems in life, but if a spider appears, then a massive, no longer controllable fear or panic reaction occurs. Other examples are fear of height, fear of wide spaces or fear of narrow spaces, such as an elevator.
Many other fears are described in literature. In therapeutic practice, however, it rarely happens that someone only has this one problem. Often there is general anxiety. In difficult living conditions and stressful events, the special symptoms become apparent. Experience has shown that difficult partnerships, overstraining work/child education and a lack of a social network are factors that play a role in the formation of an isolated phobia. The most frequent topics are fears in connection with public appearance (speech anxiety), e.g. exam anxiety, general self insecurity and fears of travelling (especially fear of flying). In many cases, behavioral therapy is the method of choice. These disorders are generally easy to treat. They have a good prognosis with an average severity.
Depression is an expression of a lack of life energy and lust for life. Everything seems pointless and empty, everyday tasks become tedious and difficult to handle. The sufferer is in a profound conflict between his or her inner desires and the perceived fears and moral inhibitions. Depression occurs in very different forms. In extreme cases, the person concerned is completely unable to participate in normal everyday life and must be admitted to hospital, if necessary also because of suicide risk. Basically, the same connection is assumed as for anxiety.
Strongly dependent on the person and the closer circumstances, from trivial to very strong impairment.
In principle, all essential forms of therapy are possible. For isolated problems, e.g. clearly defined fears and phobias, cognitive behavioural therapy is often very efficient.
The duration of the treatments varies greatly. For isolated phobias (e.g. spider phobia) a few sessions may suffice, for some depressions years of treatment are necessary.
Health insurance companies, both private and public, usually cover the costs of treatment without any problems, provided that a disease-worthy disorder has been diagnosed.