Anger, Anxiety and Depression
Making the Connection
Presented by: Dr. Dawn-Elise Snipes
Executive Director, AllCEUs
Objectives
Define the transdiagnostic and transactional theories
Define anger and anxiety
Explore types of threats and threat assessment techniques
Explore intervention techniques
Define depression
Examine the connection between depression, anger and anxiety
Identify transdiagnostic interventions
Transdiagnostic & Transactional Approaches
~Transdiagnostic Model
~Asserts that many symptoms are common to many disorders such as
~Changes in sleeping patterns
~Changes in eating patterns
~Irritability
~Fatigue
~Transactional Model
~Asserts that there is a reciprocal interaction between everything.
~Transactions can be positive or negative
What are Anger and Anxiety
~Emotional labels assigned to physiological responses to a perceived threat.
~Threats
~Death
~Rejection/Isolation
~Loss of Control
~The Unknown
~Failure
Anger
~The fight response because
~It is a threat you can conquer
~You are trapped and have no choice
~Types of Anger
~Rage/Anger/Irritation
~Jealousy/Envy
~Guilt
~Hate/Resentment

Anxiety
~The flight response because
~You choose not to use the energy to fight
~You do not believe you can win
~Types of Anxiety
~Worry/Fear/Terror
~Stress
Threat Assessment
Threat Assessment: General
Threat Assessment: BreakUp
Examine the Triggers
~How many anger and anxiety triggers is the person experiencing on a typical day
~Is there a relationship between the number of triggers and the intensity of the reaction?
~Is there a particular threat those triggers relate to?
~What automatic Beliefs are supporting that threat
~What are some alternate beliefs the person could use to dispute the unhelpful ones?

Examine the Impact
~What is the impact of the emotional/behavioral reaction on the person and his or her environment?
~Emotions
~Thoughts
~Physical comfort and energy
~Relationships
Depression
~A sense of hopelessness and helplessness
~Most people with depression have (or had)
~High levels of anxiety/anger
~Inability to change the situation or eliminate the threat

Transactional Analysis
~Threat Response System is triggered
~Person attempts to fight or flee
~Attempts are unsuccessful
~Threat Response System continues to protect the person
~Sleep is impaired
~Hormones regulating sleep and feeding are impaired
~Irritability increases as the stress load increases
~Exhaustion sets in
~Lack of quality sleep and continuation of stress response causes neurotransmitter imbalance
~Excitatory neurotransmitters go into conservation mode
~Concentration becomes difficult
~Motivation wanes (Apathy, Lack of pleasure)
~Hopelessness and helplessness sets in (Depression)

Where to Intervene
~Sleep
~Sets circadian rhythms (sleep/eat/wake (cortisol))
~Balances neurotransmitters and other hormones
~Will help with
~Eating disturbances
~Exhaustion
~Irritability
~Low libido
~Interventions
~Create a sleep routine
~Identify reasons sleep is difficult
Where to Intervene
~Nutrition
~Provides the building blocks for mood (neurotransmitters) and health (libido, pain perception)
~Blood sugar issues, IBS, Chrons and excessive use of caffeine can all intensify or prolong the stress response and negatively impact sleep and hormone balance.
~Dehydration contributes to difficulty concentrating and fatigue
~Interventions
~Limit caffeine, especially 8 hours before bed.
~Try minimize sugar
~Aim for a dairy, protein, whole grain and fruit or vegetable at each meal
Sample Food Options
Where to Intervene
~Thoughts
~Memories alert the brain to threats
~The more often a memory is triggered, the stronger it is (autopilot)
~Repeatedly FAILING to successfully CONTROL a threat can intensify hopelessness and helplessness
~Interventions
~Identify the thoughts maintaining the threat
~Identify evidence for and against each thought
~Examine the possible responses
~Choose
Thought Response
Thought Response Example: Breakup
Ultimate Goals
~Identify goals (hopelessness)
~Empower the client to:
~Identify unhelpful thoughts and behaviors maintaining stress response
~Make more effective choices (helplessness)
~Prevent Vulnerabilities
~Sleep
~Nutrition
~Stimulants

Summary
~Anxiety and Anger are responses to a perceived threat.
~Identify the threat
~Identify and examine the thoughts maintaining the perception of threat
~Explore alternative thoughts and reactions
~Choose a response.
~When people are vulnerable they are more reactive to threats.
~Identify vulnerabilities
~Eliminate
~Accommodate
Summary
~Depression is a state of hopelessness and helplessness that occurs (generally) after the stress response system is exhausted.
~In order to adequately treat depression
~Address depressive symptoms
~Address underlying “threats” which caused the stress response system to overload.
~Identify and address vulnerabilities which are preventing the person to rebalance and restore