Anxiety versus Fear, Depression versus Sadness: Sorting it Out and Does It Matter?

Psalm 34:18 – The Lord is near to the brokenhearted and saves the crushed in spirit.

Anxiety and Depression During Covid

Over the last two years, have you asked yourself if these numbers apply to you, because you have felt down, sad, nervous and/or worried?

Anxiety
Range of average monthly percentages of U.S. adults reporting symptoms of anxiety, April 2020–August 2021 28.2% – 37.2%

Depression
Range of average monthly percentages of U.S. adults reporting symptoms of depression, April 2020–August 2021: 20.2% – 31.1%

It is not an unusual story line. Much has been made of the mental health impact of COVID, social isolation and the unknown. However, there has been little discussion about distinctions that may be helpful as we continue to deal with “breakthrough infections”, mutations and guidance from across the political spectrum that seems to change from day to day.

Anxiety versus Fear

According to the American Psychological Association (APA), “Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.” Adapted from the Encyclopedia of Psychology

Mental Health professionals have made a distinction between anxiety and fear. Anxiety has been thought of as an emotion whose causes are hard to identify. When asked what triggers their anxiety, anxiety suffers often say, “I don’t know.” Anxiety frequently is characterized by anticipated future events, thoughts or feelings that are poorly defined. When asked what worries them about the future, people with anxiety often say, “Everything.” There is a sense of dread associated with anxiety.

Fear tends to have an identifiable focus. When asked about their triggers, people who are fearful can say, “The chances of catching COVID worry me a lot of the time.”

Depression versus Sadness:

“Depression is more than just sadness. People with depression may experience a lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide.”
Adapted from the Encyclopedia of Psychology

Depression and sadness differ in the length, strength, and frequency with which they occur. Sadness tends to be temporary, less intense and less frequent than depression. There is usually an identifiable cause, usually a loss, to sadness. Less so with depression. Sadness does not interfere with the person’s ability to care for themselves or stay involved with others, at work or in the family.

Why It Matters

Fear and sadness are generally less severe and requires less intervention than thoughts, feelings and behavior associated with a disorder like anxiety and depression. All of us have periods of sadness and fear. They are considered “core emotions” in the sense that they are universal, cutting across all cultures and generally occur under defined circumstances. Fear is a universal response to threat while sadness is usually associated with a loss of some kind. Over the last two years, the whole world has felt fear and sadness.

Fear and sadness are not the same as being clinically depressed or overwhelmed by anxiety. It may mean that we are fearful and sad about the changes that have actually occurred over the last two years or ones that have a high possibility of occurring. A quick check of how we interpret the changes in the last two years will give us clues to whether we are clinically depressed and/or anxious or sad and fearful. Do we believe:

• The changes we have gone through are temporary or permanent?
• The changes are ruining our whole life or impacting parts of our life like work, or church or going out to eat?
• The changes are all our fault or are there factors out of our control that are influencing the way we live?

Conclusion
If we do a quick mental health check by asking ourself the questions above and we believe it is fear rather than anxiety or sadness rather than depression, many self-help skills may be of value.

For anxiety, they include:

• Deep-breathing exercises to reduce stress
• Mindfulness exercises
• Recording three things a day about which you are grateful
• Reminding yourself of the temporary, limited and multi-causal reasons for the stresses of the last year.
• Grounding exercises to keep you in the here and now

For sadness not depressed:

• Recognize the trigger- usually a loss.
• Validate it and accept the loss.
• Share with a trusted other.
• Accept your humanness -0 we are all sad when we lose someone or something we value.
• Give yourself permission to be less than 100% for an uncertain amount of time

If we think our fear and sadness have gone on too long, have affected too many parts of our life and is all our fault, a visit to a mental health professional may be in order (see prior article on selecting a mental health professional). There are effective treatments for anxiety and depression, including:

Cognitive Behavioral Therapy (CBT) – focuses on teaching people to challenge their negative thoughts to use coping skills and relaxation techniques to reduce stress.

Interpersonal Psychotherapy (IPT) – focuses on the connection between onset of symptoms and current interpersonal problems, such as unresolved grief, relationship disputes, and social isolation or withdrawal.

Medication

• SSRIs are often used in conjunction with CBT and other forms of psychotherapy for more severe anxiety and depression.

Exercise – can also help ease symptoms of both depression and anxiety. Walking for as little as 10 minutes may alleviate symptoms.

Relaxation Techniques Mindfulness Meditation – can ease symptoms of anxiety and depression.

People who are religious have an added resource. In a recent review of the impact of prayer on depression and anxiety, the authors concluded:

In a 2019 article in Psychology Today, author concludes:
“In sum, prayer can have a positive impact on recovery from mental illness and also on the well-being of people without mental illness. Additionally, these studies indicate that regular prayer can be especially important for people who are lonely or socially isolated.”

In addition to the self-help strategies or participation in mental health treatment, studies suggest that regular prayer time may be helpful in managing fear/anxiety, depression/sadness. It is important to recognize that the effects of prayer, though validated by the research, is only one of a number of factors that improve mental health.

As people, we are biological, social, and spiritual creatures, so any approach to wellness must be multi-faceted and use all the tools available to us, including prayer.

Philippians 4:6 – Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God.