Tag Archives: generalized anxiety disorder


Happy ManIn America alone, over 50 million Americans suffer each year from depression.  And depression is a crippling illness.  As a Marriage and Family Therapist, I see men alone, in groups, and in couple’s counseling a lot who are clearly suffering from this affliction.  Unfortunately, men are particularly vulnerable to feelings of shame.  To them, seeking help to treat their depression is shameful because it’s an admission of mental and emotional weakness.  Seeking treatment for them is tantamount to admitting that they’re inadequate or failures in some way.

Unfortunately, men have reasons to worry that suffering from depression is a sign of weakness.  This bias is culturally sanctioned!!  In reliable survey after survey, 71% of people in the United States attribute depression to emotional weakness.  65% of Americans attribute depression to bad parenting.  45% of Americans believe that suffering from depression is a personal choice. 43% of Americans believe that depression is incurable, and finally, 35% of Americans believe that depression is a direct consequence of leading a sinful life.  In light of Men’s vulnerability to feelings of shame, it’s really no wonder that so few men seek out treatment to feel better!!

Among the many problems that depression brings to a man’s life is the inevitable demise of their relationships to their partners, girlfriends, or wives.  In fact, if one person in a romantic relationship is clinically depressed, the couple is 9 times more likely to part ways or get a divorce.  As a Marriage and Family Therapist, I’ve often heard the misconception that it’s a bad relationship that causes a man’s depression.  However, more often than not, it’s the other way around.  When A a man (or woman) suffers from clinical depression, he plays a big part in creating a bad relationship.  After all, he’s more likely to be moody, irritable, prone to rages, prone to withdrawing, filled with self-loathing, filled with irrational guilt, hopeless, etc.  Women, who are often more emotionally attuned to others than men are, can usually sense that the men in their life are depressed.  Yet when they reach out to nurture them, their male partners often close the door on their faces.  This is often because they feel so much shame and inadequacy for feeling depressed in the first place.  The women, in turn, feel isolated, afraid, and abandoned.

The truth is, depression is a real illness.  It has biological, psychological, social, and spiritual underpinnings to it.  Men ( and women) cannot will their way out of their clinical depression.  They can’t out-think it, out-wit it, or escape it by using alcohol or drugs. It’s very real, and it hurts a lot.  The good news, though, is that depression is highly treatable.  Men can take medication, for example, or supplements, exercise, see a Marriage and Family Therapist, participate in individual therapy, group therapy, etc.  As a Marriage and Family Therapist, I use all kinds of techniques and strategies to help my clients break through their depression.  I  also offer valuable insights and feedback to help free them  from the grips of their depression. Finally, I personally know of many excellent resources that I refer them to that supplements the work that we’re doing  together so that they feel healthy, happy, and whole as soon as possible.

Men, there is absolutely no shame in suffering from depression.  And there is absolutely no shame in seeking help to overcome your depression and reclaim your mental health.  The only shame there is, when it comes to depression, is when a man turns his back on treatment, thereby leaving himself and his loved ones behind.

John Boesky, LMFT


Anxiety and Depression: Its Symptoms and Treatments

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john boesky marriage and family therapist anxiety and depressionAnxiety and Depression affect millions of Americans each year. These two illnesses manifest themselves differently in terms of the degree of severity and the type of symptoms. In this article, I will touch upon the most common anxiety disorders; Generalized Anxiety Disorder (GAD) and Panic Disorder. In addition, I will address one of the most formidable mood disorders, Major Depressive Disorder.

Generalized Anxiety Disorder (GAD), afflicts more than five million adult Americans each year. While the exact cause of GAD is not fully understood, a person’s biochemistry, family history, psychological and spiritual profile all seem to contribute to the development of anxiety.

Twice as many women than men suffer from this disorder, which often develops gradually in adolescence, but can begin in adulthood as well. It is characterized by excessive, exaggerated, and disproportionate anxiety and worry about everyday life events. To GAD sufferers, the proverbial glass is always half empty. They anticipate the worst even when there is reason to expect the best. They always expect disaster, and life becomes a perpetual state of worry, fear, and dread, which interferes with daily activities and relationships.

GAD affects the way a person thinks, but may also manifest in physical symptoms, including restlessness, muscle tension, headaches, nausea, trembling, sweating, difficulty concentrating, and being easily startled.

Biological causes can be attributed to genetics and a person’s brain chemistry. Sufferers often have an imbalance of neurotransmitters, which are chemical “messengers” that help move information from nerve cell to nerve cell. When out of balance, these “messengers” cannot travel through the brain properly, which can lead to anxiety.

Psychological and social causes are generally the result of life experiences which may result in feeling out of control. Some individuals may suffer from an unresolved trauma or abuse. Financial constraints can also trigger GAD which results in a fear that one’s material needs won’t be met. Moreover, it may be the result of one’s own unrelenting perfectionism, or perpetual fear of rejection and abandonment. It can result from a living situation where one is being constantly put down, ridiculed, or made to feel ashamed. A person may experience perpetual fear for their own safety.

john boesky marriage and family therapist anxiety and depressionSpiritual causes that may lead to GAD are more existential in nature. Many people feel unsupported in their lives. They don’t feel grounded, and feel as though they are drifting aimlessly. These individuals often feel as though their life has no real purpose and their existence has no meaning.

Psychotherapy effectively treats the symptoms of GAD by addressing the psychological, social, and spiritual variables that trigger it. Cognitive Behavioral Therapy, in particular, challenges people to confront the unconscious thoughts that often trigger anxiety, thoughts that are often distorted in nature. Therapy challenges these cognitive distortions, and counters them with more rational, reality based thoughts. Core beliefs that we hold about ourselves and the world are challenged and transformed, which in turn strengthens self-esteem and empowers people. One’s sense of helplessness and powerlessness, which often induces anxiety, largely diminishes. Finally, psychotherapy encourages individuals to stop engaging in self-defeating behavior that lead to troublesome feelings.

Medications used to treat GAD include Benzodiazepines, like Xanax and Valium and the newer antidepressants, SSRI (selective serotonin reuptake inhibitors) like Paxil and Effexor XR. These medications balance the neurotransmitters in the brain. When the brain is deficient in neurotransmitters, these newer antidepressants can help replenish the chemical messengers in the brain.

Panic Disorder is defined as recurring panic attacks or episodes of intense fear and afflicts three to six million Americans. Fear and anxiety are normal reactions to stressful events in our lives. Panic Disorder, however, strikes without reason or warning, and the fear response is out of proportion to an often non-threatening situation. Over time, an individual develops a constant fear of having another attack, which can lead to avoidance of places and situations, ultimately affecting the general quality of life.

Symptoms of a panic attack can include difficulty breathing, chest pain, choking or smothering sensations, dizziness or feeling faint, trembling and shaking, sweating, nausea, chills or hot flashes, and tingling or numbness. There is often a feeling that you are losing control or are about to die. Fortunately, panic attacks tend to be brief, generally lasting about ten minutes. Like GAD, the exact cause of Panic Disorder is unclear, however, studies have shown that the same set of biochemistry, family history, and psychological factors bring on this disorder. Social or environmental factors include stressful life events and major life transitions, such as the death of a loved one. In addition, substance abuse has been a correlative to panic disorder.

Cognitive-Behavioral Psychotherapy works on the theory that panic attacks are basically a learned response to something the patient fears. Therapy focuses on helping patients “unlearn” the physical reactions. A therapist might suggest breathing exercises or medication that can help prevent the hyperventilation that often occurs during a panic attack. Anti-anxiety medications such as Xanaz and Klonapin and anti-depressants like Paxil or Zolft have been shown to be safe and effective in the treatment of Panic Disorder. With this combination of therapy and medication, at least 70 percent of people can reduce or completely prevent future panic attacks. Many people feel substantial relief in just weeks.

Both of these anxiety disorders are often accompanied by depression which is a serious medical illness, much like diabetes or heart disease. It is estimated that 19 million Americans suffer from depression each year. If left untreated, depression can worsen symptoms or other illnesses, lead to disability and increase the risk of suicide. Untreated or improperly treated depression is the number one cause of suicide in the United States. Conversely, proper treatment relieves symptoms in most depressed patients.

The shades of depression are many, ranging from mild depression (Dysthymia) to Major Depressive Disorder. Anyone, regardless of age, gender, race, or socio-economic status can suffer from this very serious disorder.

The most common symptoms associated with Major Depressive Disorder are trouble sleeping, loss of interest in activities, weight loss or gain, difficulty concentrating, feelings of worthlessness and hopelessness, or preoccupation with death or suicide. The risk factors that lead to depression include a deficiency of the neurotransmitter, serotonin, in the brain. Family history of mood disorders, chronic health problems, divorce, and occupational stress can bring on depression. Experts estimate that women experience depression twice as often as men. Over the course of a lifetime, nearly one in four women will experience a major depressive episode. Women are more likely to act in, and experience guilt, weight gain, eating disorders, and increased sleep, while men tend to act out their unrecognized and denied feelings of depression. They are apt to experience deep seeded feelings of shame for having fallen prey to the disease. They experience anger and hostility toward others or numb their feelings with alcohol or drugs.

john boesky marriage and family therapist anxiety and depressionWhile depression is increasingly more common, only a small percentage of individuals will seek help. This is a tragedy, since with proper treatment, four out of five patients will improve. Even still, only one in five women suffering from depression will get the treatment they need. Men often worry that depression is a sign of personal weakness or a character flaw and choose to “tough it out.” Without treatment, depression can last for weeks, months or years.

Effective treatment for depression, much like anxiety, is a combination of psychotherapy and medication. There are three classes of anti-depressants: MAOI inhibitors, trycyclic anti-depressants, and SSRI. All three classes of medication work to correct the imbalance of certain chemicals in the brain. SSRI’s are prescribed most often because they have fewer side effects.

Psychotherapy can take place in individual or group sessions. As in the case with anxiety, psychotherapy targets the psychological, social, and spiritual variables that lead to depression. It is aimed at helping a person develop new ways to identify and cope with their depression.

Many of the psychological and social issues leading to depression center around grief and loss. This includes not only the loss of others, but can be the loss of oneself. People often choose to abandon parts of their true selves to ensure survival. Some may abandon their true nature by learning how to take care of others, while some become helpless, self-effacing, and apologetic. Others will become inflated, grandiose, and narcissistic. While these adaptations may ensure self-preservation, it can bring on feelings of loss, grief, and ultimately, depression.

Depressed individuals often have low self-esteem and may believe they are unlovable and inadequate. While these individuals already feel unlovable they are likely to seek out negative experiences that will only reinforce these beliefs. The unlovable woman, for example, will seek out a partner who is abusive and degrading. That way her experience in this relationship will reassure her that she is right to believe that she is indeed unlovable. After all, if she was lovable, her partner wouldn’t find reasons to degrade her.

As is the case with anxiety, a spiritual deficit can lead to depression. In our culture there seems to be a one-sided pursuit for enlightenment, to the point of exclusion of the darkness. Spirituality that is understood in its appreciation of psychological opposites is called “grounded” spirituality. It is my belief that “ungrounded” spirituality can lead to self-denial and depression, while “grounded” spirituality leads to self-acceptance, self-compassion, and a genuine sense of well-being.

Cognitive Behavioral Therapy helps a person counteract negative core beliefs and find new adaptive coping techniques, which help them reclaim their authentic self. Ultimately their depression lifts as their self-esteem rises, and feelings of hope and optimism settle into their heart and mind.

In conclusion, I want to strongly emphasize that while anxiety and depression are illnesses that are almost as pervasive in our culture as the common cold, both can be treated successfully. The combination of medication and psychotherapy can effectively target the biological, psychological, social, and spiritual variables that often bring on troubling states of mind and body. Individuals who suffer from anxiety and/or depression stand an excellent chance of not only overcoming these illnesses, but moving on to experience inner peace and deep joy, while leading productive and fulfilling lives.