Kate’s Anxiety and Depression

Anxiety and Depression

It has been said that depression is distress about the past and anxiety is distress about the future. When difficulties happen, it’s not uncommon to experience both. We are going to look at a difficult situation with “Kate”, and see how to help her. You may have had a similar experience, or may be experiencing anxiety and depression over something different. Either way, the techniques we will use can be applied in many different contexts.

Multi-level approach

To overcome your anxious and depressed feelings, it is often helpful to address your feelings through a multi-level approach. That is, emotional problems often require different layers of intervention. Effective interventions for anxiety and depression may include physical (your biology and biochemistry), cognitive (what you think), behavioral (what you do), environmental (the situation), and spiritual (your faith). In this article, we will focus in on the cognitive level: how your thoughts affect your mood. If you can change how you think, you can change how you feel. To do this, we’re going to look at Kate.


Kate is a 30-year-old single woman, with a good job and a good social network, who’s been in a relationship with Jeff for six months. They’ve had several good dates, have had a lot of fun together, and she has even met his parents. He’s mentioned a few things about their possible future together. Recently, however, Jeff has been more reserved in their interactions, easily distracted on their dates, doesn’t call her as much, and doesn’t mention anything about the future of their relationship. He’s just seems checked-out. When Kate has asked him what’s wrong, Jeff gets defensive and denies that anything is wrong. Kate internalizes this situation, blaming herself.

Helping Kate think differently

To help Kate, we’ll need to break down what she is thinking and feeling. Remember, it is her thoughts that are driving her emotions. The following is “cognitive” intervention used in cognitive behavioral therapy (CBT) that is helpful for people having difficulty with anxiety and/or depression.

  1. Identify the situation that is contributing to her negative mood (e.g., anxiety or depression) and the thoughts she is having about it.

    The situation is that Kate’s relationship with Jeff isn’t going so well. Given this situation, she may be thinking “Did I say or do something wrong?”, “Am I not attractive enough?”, “Is he cheating…has he found someone else?”, “There must be something wrong with me.”, or “What if I’m single my whole life?”.

  2. Rate how much her mood is affecting her on a scale of 1-100, with 1 being not affected and 100 being severely affected.

    Given these thoughts, she is likely feeling depression at around 70 and anxiety at around 60.

  3. Of all the thoughts mentioned in step one above, there is usually one thought that is more predominant than the rest. We’ll call this the “hot thought”. Find evidence for and evidence against Kate’s “hot thought”.

    We’ll say that Kate’s “hot thought” is, “There must be something wrong with me.” First, let’s see if there is any evidence to support this “hot thought”.

    • Jeff acting like he doesn’t like her could be some evidence to support the “hot thought”, but even that leaves much unknown.
    • She is still single, but that by itself isn’t enough to say there must be something wrong with her.

    Now, let’s see if there is any evidence that may contradict the “hot thought”.

    • Jeff liked Kate for six months. If there was something wrong with her, he would have likely noticed it already.
    • Jeff has never said there is anything wrong with Kate.
    • Jeff may have his own baggage, or something major going on in his life that he is distracted from the relationship.
    • He may have done this to dozens of other women.
    • Jeff may be afraid of commitment.
    • Kate has lots of friends and is successful in her career. Unlikable people would have a hard time accomplishing that.
    • Jeff is just one person. It’s not that lots people have “checked-out” from Kate. Just this one guy.
  4. Help Kate come up with an alternative, more balanced thought to replace her “hot thought”.

    Given the evidence against Kate’s “hot thought”, it may be good for Kate to replace it with something more accurate, like, “While there may be some things I can work on in relationships, it’s very unlikely that the problem is all me, and since I really don’t know what is going on with Jeff, it’s also likely that he has some issues that I am unaware of.”

  5. Re-rate, on a scale of 1-100, how much her mood is affecting her now having examined the evidence and created an alternative, more balanced thought.

    At this point, Kate’s depression has likely lessened to about 35 and her anxiety to about 25.

Putting it together

Anxiety and depression are often connected to our thoughts. If our thinking is making us depressed or anxious, we should examine our thoughts to see if they are valid, or if there may be a more balanced way of thinking. Read more about the different thought errors we can make that can influence the way we feel.

You have just read one CBT strategy that can be used to combat anxiety and depression. Read more about facing anxiety and depression, and about the various types of anxiety disorders.

Facing anxiety or depression on your own is not easy. Sometimes you’ll find that you need the support of a trained therapist who can listen and provide feedback on what’s been going on.

I work with adults, adolescents, and children in Southlake and surrounding areas who are struggling with anxiety or depression. Feel free to contact me any time to discuss your specific situation.

Dr. Michael Messina

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