Health: How to handle stress, anxiety and depression

Each day, I counsel patients suffering from stress, anxiety and depression. They are overwhelmed with emotions often triggered by circumstances — a stressful home situation, difficulties at work, financial distress, relationship problems, a series of negative events, or illness.

The initial focus is on their unhappiness and what is wrong in their lives. We can get stuck there. We’ve all had difficult emotions that are hard to shake. In many cases, we cannot easily change the conditions of our lives.

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When we perceive that we have lost control, we experience a state of helplessness that begets anxiety. This can evolve into hopelessness that begets despair. Early in life — long before medical school, I learned that we have three choices in any difficult situation. We can leave it, change it or reframe it.

This commonsense advice is easy to understand but difficult for most to apply. We can’t easily leave a bad job or home situation if we are in a position of dependence. When we are responsible for others, we cannot abandon our duties and responsibilities.  In some cases we can make changes. If we are fortunate, we may voice our concerns to those who can assist us, but sometimes our voices are not heard.

The third choice — reframing — can be the greatest of challenges. Yet it can be just as empowering. When we cannot leave or change our circumstances, we can look at them from a different angle. We might consider a difficult coworker or partner with more empathy and consider things from the other’s point of view. We may start seeing our current state as a stepping stone to a better future; we just have to persevere and ride it through. We can look at our past and the mistakes we have made from a perspective of learning and growth.

As a first step out of stress and despair, I ask my patients to take stock of their resources — what is good in their lives. This may include their support — their positive relationships and their personal qualities. Sometimes we have to dig deep into their past to remind them how they were able to overcome other difficult times in their lives.

Though we tend to personally attribute our moods to our circumstances (or biochemistry), they are largely thought dependent. In turn, our thoughts are largely influenced by our moods.  When we are anxious, we overemphasize danger and risk. We catastrophize and imagine worse case scenarios. We minimize our own ability to cope.  When we are depressed, we see the negative in others, in our selves, our world and our future. We overlook what is good and beautiful all around us and in our selves.

Thankfulness can be therapeutic. By taking stock of the positives in our lives, we may feel stronger, more supported and hopeful. The cup is no longer half empty. The cup may in fact be overflowing when we remember those who have helped us in the past, the people in our lives today and who we may help in the future.

Dr. Davidicus Wong is a family physician.

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