David Kay
Hypnotherapist & Anxiety Specialist

Similarly with anxiety: You may be thinking, everyone has anxiety, but that is not the same as what we refer to as an anxiety disorder. A person with an anxiety disorder experiences severe functional impairment (for example, can't go to work or socialise normally) and/or suffers an unacceptable level of distress.

To add to these common misunderstandings that occur because the same words are used to describe very different conditions, there is much ignorance, theory and hype that surround mental illness. Everyone seems to have an opinion about the matter. Sadly, it is patients who suffer most from these misunderstandings - being made to feel more alone, receiving ineffective treatment or advice, or even being made to feel that they are to blame for their illness. For this reason I have dedicated this page to countering some of the myths that abound today. (Note that each point applies broadly to three types of illness: anxiety disorders, depression, and obsessive-compulsive states.)

Myth 1. A lot of people feel depressed but they just get on with it.

This is an opinion held by many lay people, but invariably those who have not really suffered depression. Many will have gone through times of feeling sad, or simply bored, and imagined that was depression. Others may have suffered from a mild depression that permits normal functioning.

Depression of any severity impairs functioning and makes life intolerable. It can become impossible to continue with normal duties. It is not a mood you can overcome with willpower.

Myth 2. The way to overcome fear is to face up to it – make yourself do things.

Again, an opinion held by many lay people, but interestingly one also held by many sufferers of severe anxiety. This causes them to try over and over to confront their fears, forcing themselves to endure endless hours of distressing symptoms, only to discover that it doesn’t seem to work.

The evidence is that such an approach only works if the fear is mild. It will work for low-level anxieties and lack of confidence in new situations, in short, the kind of normal anxieties that are not clinical conditions. For severe anxieties, the reverse is true: Forcing yourself to remain in a situation feeling extreme fear all the way through will not make it better and may even make it worse. There is a type of treatment called behavioural exposure that involves exposure to phobic anxiety, but this has special rules that must be followed to be successful.

Myth 3. Anxiety and depression are not real illnesses – it’s all in the mind.

Another misunderstanding of mainly lay people. Anxiety disorders, depression and obsessional states each have both mental and physical components. The mental component consists of negative thought patterns, subjective fear and other emotional symptoms. The physical component includes changes in sleep and appetite, reduced immune function, neurochemical changes, and alterations in brain structure and functioning. The changes in brain structure and especially abnormal brain functioning can be seen on MRI and SPECT scans respectively.

Myth 4. You only need to start thinking positively/think the right thoughts.

This really is an extension of the last myth – that anxiety and depression are all in the mind. The advice to start thinking positively is, of course, sound advice. It is one of the steps to getting better, particularly if negative thinking has played a major part in the illness. But it is wrong to imply that this is all you have to do. Thinking positively is not always enough to provide relief – there may be other factors involved, or the symptoms may be outside of conscious influence. When the illness is severe enough it may be impossible to think rationally at all.

Myth 5. I could never get depressed – I’m too strong a person.

Well, it is true that you may never get depressed. If you happen to have few or none of the risk factors for depression, you could make a case here. The problem is that you cannot know whether, for example, your genetic makeup, things in your past that you’ve forgotten, or things in the future that you cannot foresee, will in fact add to your chances of getting ill. Actually, some people are inherently resistant to depression, others are almost bound to get it, and most of us are in between – we are not bound to get it, but could get ill if we are faced with too much adversity. But no one who has not yet had depression can possibly know which category they fall into.

Myth 6. Drugs are bad – they just suppress the symptoms.

Amongst alternative/holistic therapists and some of the general public there is a belief that medicines produced synthetically by a pharmaceutical company are somehow always bad or wrong, or that ‘natural’ (non-pharmaceutical) methods are better. This view has to be rationalised, and so the many possible side effects of drugs are listed along with ways of discounting the positives. The above myth discounts the positive effects of medication but is without foundation.

Evidence is clear that the drugs work for the majority of people who take them, and by far the majority are not seriously harmed. (Despite popular press and Internet sites, first line drugs for anxiety and depression are among the safest in modern medicine.) Most people feel better on them, and some recover completely. When successful the patient is also better protected against such issues as unemployment, relationship breakdown, and a number of physical diseases, which are the 'side effects' of untreated severe anxiety or depression.

However, it is true that for certain individuals several types of psychotherapy (including hypnotherapy) can work just as well, and certain individuals benefit more from therapy than from drugs. Others definitely need the drugs on board, and many people with a severe illness do best with a combination of therapy and drugs.

Myth 7. Therapy can’t work if you’re taking medication.

Generally, this is not true and seems to be an outgrowth of the feeling that ‘drugs are bad’. In the case of antidepressants, it only applies if the patient is so sedated that they cannot think clearly, or cannot achieve hypnosis. Otherwise, they may even be helpful. For example, they may help the patient to put into practice what they are learning in therapy and get better results. Certain styles of therapy we use, especially cognitive and solution-focused therapy, work particularly well with antidepressants.

Benzodiazepines work differently and can sometimes interfere with certain kinds of therapy that require access to emotional memory or learning from new experience. This is more likely at higher doses. But there are always things we can do. Benzodiazepines can be successfully incorporated into behavioural and solution-focused therapy.

Myth 8. All anxiety is caused by…(a single cause is referenced).

Anxiety, depression and obsessional states do not have a single cause. They arise from many factors, including genetics, personality, brain abnormalities, neuro-chemical imbalance, childhood experience, diet, trauma, socio-economic status, occupational stress, negative thinking patterns, and probably some things we don’t even know about yet. These all interact to produce the final result – the symptom pattern. But no single factor can be shown to be the root, or the first cause as such.

What sometimes has happened is that pioneers in the field have discovered one of the factors, and successfully treated a number of patients. They naturally assumed that they had found the (single) cause and solution to the problem. But by the 21st Century, several hundred such theories and their corresponding treatments had arisen!

Myth 9. Therapy X is the single best method to treat anxiety.

This is often an extension of the last myth, and may be very persuasive when presented in theory. In practice, there is no single best method to treat anxiety or depression. It depends on the individual, the balance of factors that are causing the problem, and the severity of the problem. Certain individuals discover that one particular method works best for them. More often it is a combination of methods. But no method or combination will be the best one for everyone.

Myth 10. Eliminate fear, cure depression, in minutes!

This is a kind of advertisement that appears from time to time, usually a sponsored (paid for) link on the Internet. The site will talk about a new revolutionary method, better than anything else, and able to deliver a cure within a very short time…if only you will purchase their product. Invariably the site is full of sales hype and suggestive statements: "Would you like to just switch off your fear forever - no drugs, no therapy?" or such like. These serve to attract sales and distract you from the real question: "What proper evidence is there that this method or product will work for me?"

I have encountered many of these promotions since the Internet became mainstream. Some are apparently big business, others seem to be small fly-by-night enterprizes. But I've not found one that could ever deliver what was promised; because there simply is no such thing as an easy cure-all for anxiety or depression.

Do not be influenced by impressive testimonials. Any treatment will help certain people because of the placebo response. (The placebo response is when a person gets better because they believe they’re being treated, although the treatment itself has no action against the condition.) Testimonials can also be fabricated. In fact, most of the major hypnotherapy and psychotherapy organisations prohibit the use of testimonials on their members’ advertisements and websites.

Therefore, pass over these advertisements and stick to mainstream evidence based treatments and practitioners who are realistic in their advertising.

Myth 11. You don’t need any treatment – you just need God.

This kind of response is promoted in certain church or religious circles, where there may also be a certain scepticism towards modern psychology or medicine. Taken at face value, the statement may be true. For those who believe, there is the possibility that God can bring joy and healing into your life, which would effectively eliminate fear and depression.

The problem with this is that such a transformation must take place in the subconscious if it is to have a genuine healing effect. Even strong conscious belief or fervent religious practice is generally not enough by itself. In this case only a miracle will help, which has no doubt happened to some people but is generally not the norm. Many are disappointed when they try their utmost, through prayer and religious observation, to ‘receive’ their healing, only to discover that the healing doesn’t come, or that initial relief is short-lived (typical of the placebo response).

The key here is to accept yourself as you are right now. If you have a faith that is meaningful to you, this can be a good and wonderful thing. But if you remain ill, simply accept that at this stage in your life you still need physical or psychological help.