Six months ago, on a blistery winter morning, I sat across from my doctor for my annual visit. After a few minutes catching up about our families and work, he looked at his computer and began asking me a series of questions:
“In the last two weeks, have you felt down or hopeless?”
“Do you feel tired or have little energy?”
“Are you having trouble concentrating on things, such as reading the newspaper or watching television?”
“Do you feel on edge and unable to sleep?”
Because my doctor has known me for thirty years, I could make a face like a fed-up Larry David and shrug my shoulders. And because he’s a good guy and a third-generation New Yorker, he could shrug in response while shaking his head and say, “I know! Our president is a crook, we’re at war, and the world is on fire. Who am I kidding?”
We had a good laugh and eventually talked truthfully about how it might be a sign of healthy mental functioning to feel some anxiety and depression in this time of escalating crisis. He admitted that while he was legally required to screen me for depression, he was also experiencing it himself. I loved him for his honesty and humanness.
My doctor knows that I’m a psychoanalyst and professor of Buddhist studies and that over the years, I’ve developed an abiding respect for the truth of suffering. While Western psychotherapy and Buddhist psychology take differing approaches to our emotional struggles, they both underscore that it is fully human to suffer. Across 2,600 years and radical cultural differences, both Freud and the Buddha understood that we all have troubling doubts about our basic value and our ability to navigate life’s hardships.
The Noble Truths of Anxiety and Depression
The Buddha began his famous first teaching with the truth of suffering. This teaching on the noble truth of dukkha—variously translated as suffering, unease, or struggle—offered a pithy yet complex road map that helps us see just how pervasive our inner struggles are and challenges the shame and humiliation we so easily feel about our personal suffering.
In this way, compassion was woven into the Buddha’s teachings. It’s as if he were saying, “Don’t worry about it! We’re all a little freaked out most of the time,” and for students of this tradition, his reassurance has provided much-needed relief.
Like a deeply caring therapist, the Buddha found a way to humanize and normalize struggles that can feel like evidence of personal failure. He encouraged us to turn toward our suffering with respect, to move past our tendency to focus on symptoms and get curious about their causes. The idea, so compatible with modern psychotherapeutic approaches, was to work through the underlying roots of our suffering and access relief.
In the following noble truths, the Buddha boldly suggested that within the mind, we have everything we need to be freed from anxiety and depression. Speaking as a seasoned and caring mentor who had been through and survived comparable suffering himself, the Buddha encouraged us to trust our innate ability to address, understand, and ultimately recover from any experience that gives rise to or intensifies anxiety and depression.
I deeply appreciate the optimism offered in the Buddha’s teachings. Recent neuroscience and interpersonal neurobiology confirm that we are far more capable of radical change and healing than we typically imagine.
Negativity Bias: The Evolutionary Roots of Anxiety and Fear
The tendency to undercut our potential for well-being has something to do with our evolutionary negativity bias. It makes sense that if we’re on guard against tigers and bears, or pandemics and autocrats, we need to be ready to defend ourselves. But when this stance becomes our default mode, periods of anxiety and depression can become a way of being, and feeling low and stressed can start to feel like our lot in life. Our negativity bias is a natural, well-intentioned form of self-protection, yet it can end up camouflaging our inner resources for healing.
As we contemplate this together, let’s consider the survival function of anxiety and depression. Anxiety is a signal from the body and mind that danger is lurking. Like fear, it’s a somatic response to conditions that feel unsafe. The amygdala, our brain’s threat center, begins firing, sending out signals to release stress hormones of adrenaline and cortisol. Blood flows from the brain to our outer extremities, preparing us for action. If the danger feels life-threatening, the dorsal vagus nerve in our autonomic nervous system prepares us to duck and cover or play dead.
Nothing about this whole chain of events feels good. Nobody enjoys the anxiety that sets this all in motion. It feels dreadful, often leaving the solar plexus and jaw clenched, the stomach in knots, and the breath shallow and tight. It can also feel humiliating, because when we’re anxious, we’re often aware that others may feel differently about similar triggers. One person’s minor snafu is another person’s panic attack waiting to pounce. There’s often a sense of being uniquely undone by life, too easily untethered when other people seem to ride the proverbial waves without chronic distress.
All of this points to the primary difference between anxiety and fear. Unlike fear, which is a useful response to an external threat, anxiety is triggered by inner threats laden with subjective meaning. The body’s response is the same, but the causes are different.
For this reason, when we’re anxious, we typically feel alone, stuck in some private suffering that no one else fully recognizes or understands. We don’t all carry the same inner conflicts or interpersonal histories, so when anxiety is stirred, isolation is also mobilized. This whole process makes anxiety a very lonely experience
Repression, Insecure Attachment, and the Tyranny of Shoulds
Theories about anxiety developed from the very beginnings of psychoanalysis, the tradition that later gave birth to psychotherapy. Freud changed his theories over time, but in each iteration, he linked anxiety to repression. This made intuitive sense—if there’s something we have lived through that feels unbearably shameful or too awful to consciously acknowledge, anything that threatens to pull it back into our awareness will set off the inner alarm bell of anxiety.
Other theorists later weighed in, offering helpful insight into our profound connection with our caregivers early in life. If our caregivers are suffering in ways we cannot manage or understand, anxiety will ensue. More subtly, anxiety can also arise when the caregiver depends on the child for emotional support or cannot tolerate the child’s anger, neediness, or fear. In those situations, the child learns to monitor and suppress anything that might upset the caregiver, because the stability of that bond feels at risk. The threat is not external but relational; anything that might endanger the connection becomes a source of anxiety.
The German psychoanalyst Karen Horney, who discovered Buddhism when she met the Buddhist scholar D. T. Suzuki in the early 1950s, suggested that anxiety is multidetermined. When we’re unconsciously driven by the expectation to be something or someone we cannot be in order to accommodate the emotional needs of others—especially those we depend on early in life—we will suffer acute anxiety. She called this “the tyranny of the shoulds.” Horney also suggested that when there are conflicting cultural values we cannot square, anxiety will be there waiting for us. For instance, when there are injunctions that you should “be your brother’s keeper” and “be the best in a dog-eat-dog world.” Caught between these opposing demands, which do you choose? Do you opt for kindness and understanding at work, then feel like a soft failure? Or do you seek conventional forms of success, and then feel selfish and narcissistic?
Depression is sometimes thought of as anxiety’s cousin. When we’re faced with something threatening and feelings of powerlessness or extreme vulnerability set in, depression often results. John Bowlby, the father of attachment research, rightly suggested that we experience anxiety when our childhood bond with our parents is threatened or cut, and when separation cannot be rectified, despair sets in. First there is anxiety, then protest and anger, and eventually resignation, despair, and other feelings of depression that can be tenacious and life-shaping.
Western Psychology: Clinical Methods to Heal Anxiety and Depression
Consistent with Buddhist teachings, modern psychotherapy implicitly asserts that compassion is the necessary starting point for healing.
After Horney met D. T. Suzuki, she realized that psychotherapy can’t offer the relief it promises until the patient feels genuine self-compassion. Without respect and care for your own suffering, exploring it will feel too treacherous. The fear of discovering something about yourself that is too terrible to know about or expose often shuts down curiosity and openness and thus interferes with the healing process. For this reason, clinicians often work to normalize suffering and create a sense of safety, emphasizing the need for caring treatment and potential change through various interventions.
We are fortunate now to have multiple clinical modalities that address the impact of anxiety and depression on the body, offering insight into how the body and brain generate and hold our emotional suffering. The research of psychologist Stephen Porges on the autonomic nervous system has led to several highly effective therapeutic modalities that help the body work through stress and trauma, both personal and intergenerational.
There are times when behavioral therapies, including ERP (exposure and response prevention) and DBT (dialectical behavior therapy), are exactly what’s needed for someone suffering from severe anxiety and depression. At other times, psychiatric interventions may provide the biological protection required to steady the edgiest and most debilitating forms of anxiety or depression. And at still other times, a deeply patient psychotherapeutic inquiry into a person’s inner life and history may allow them to feel more reflective, less reactive, and better seen.
Support comes in many forms, and working through the various causes of our suffering often requires more than one approach or modality. Knowing this can help us patiently explore our options for care as we turn toward and stay present with the truth of our suffering.
Buddhist Psychology: Heal by Exploring the Nature of Mind
In Buddhist psychology, we care for our mind and spirituality in order to find relief from states of distress and despair. In this tradition, the mind is regarded as our ultimate source of healing. Of course, it is also acknowledged that certain states of mind create suffering, generating repetitive doubts, fears, and frustrations. So, in our practice, we begin by recognizing these struggles, learning to bear witness to whatever is happening in the mind without letting our customary criticism and evaluation swoop in.
Simple yet challenging mindfulness meditations can cultivate new ways of responding to the mind’s many emotional and psychological struggles. We begin with calm abiding, or shamatha meditation, a practice of gently returning attention to a single anchor—often the breath—so the mind can settle and the nervous system can regulate. Then, naturally, we open into a new understanding of the mind through insight, or vipashyana practice, which invites us to observe thoughts and feelings as they arise and pass, revealing their impermanent and conditioned nature.
These methods can help us access and understand feelings that may have been hiding behind the more obvious states of anger, frustration, or despair. Potentially, these forms of meditation can help us appreciate just how dynamic the mind is, always shifting into new states and feelings that come with buried treasures of memory and longing. Over time, we begin to notice there is no state of distress that is truly permanent. Everything in the mind comes and goes.
This may come easily for some practitioners, but for many of us, cultivating this insight and way of being in relationship with the mind takes time. It involves building up some tolerance for real discomfort, learning to stay with moments of distress, aloneness, or disappointment when we most want to bolt. Yet for those who stay the course, something remarkable can happen. In between moments of feeling, memory, desire, and anticipation, deeper layers of the mind come into view.
In the Buddhist canon of psychology known as the Abhidharma, this part of the mind is referred to as “main mind” or “the mind of clear seeing.” It is the foundation of mind that by its nature is free from obstacles and distorted perception. All our neuroses, angst, and repetitive struggles are seen as merely surface experiences that have no inherent qualities embedded in the mind.
It can be helpful to picture the mind as designed to offer an unfailing inner safety net of clarity and spaciousness. When we start to observe this state of mind and notice a sense of increased safety and ease, even in fleeting moments of meditation, we develop trust in our mind’s inherent ability to help us reduce suffering and enjoy life.
All of this can be a game-changer when it comes to dealing with anxiety and depression. When we begin to see that between all the ornate fears, shoulds, and memories are moments of simple, bare awareness, the feelings of aloneness that are sometimes the worst part of anxiety and depression start to diminish. For some meditators, these feelings can even drop away for stretches of time.
Practice: Discover the Mind Beyond Anxiety and Depression
The Buddha suggested that when we allow our mind to settle into its natural state, our very sense of self becomes a little more fluid. This is the heart of shamatha practice, and if we give that settling some time—getting more familiar with just being, breathing, and observing—our sense of being fundamentally separate from others starts to shift and potentially diminish.
When we allow the mind to access its ability to feel truly open and safe, our need to experience ourselves as protected through fundamental separateness naturally softens. Of course, we still have our unique personhood—all our identity markers are there waiting for us—but when we move into awareness without the need to evaluate, judge, or critique our experience, we begin to touch the insight of vipashyana, and we no longer have to carry the burden of our selfhood in the same way. This is a huge relief.
If this all sounds appealing but a bit elusive, it’s worth trying some simple yet effective methods for helping the mind and body find a place of increased ease.
Bringing awareness to the rhythms of your breath, then allowing the breath to settle into a slower cadence, even for five minutes, can send cues to the autonomic nervous system that you’re safe enough to take this brief respite from your worries or losses. To deepen the benefits of this simple mindfulness of breath, you can add in three to four seconds of holding the breath at the top of the inhalation and at the bottom of the exhalation, so that you offer yourself increased energy alongside decreased stress. These methods tone the vagus nerve that supports your social engagement system, helping you access a visceral and embodied experience of relative safety.
It’s often the uncomplicated interventions that help us restore just enough equilibrium to recover and carry on. But I’m not suggesting that working through the complexity of anxiety and depression is easy or straightforward. For most of us, it’s a process requiring patience, discernment, and support from trusted friends, mentors, and clinicians. Yet the contemplative methods of breathwork and mindfulness are always-available resources that can nourish the mind and body, readying us for the deeper dive into needed reflection.
Settling the mind can help us notice what we’re feeling in a given moment; it may be some residue of stress from a recent interaction with a loved one, or worries about the future, or desire for something painfully elusive. When we offer the mind some intentional care, it provides an experience similar to being with a caring friend or mentor. At times we uncover insights that were quietly resting in the hidden recesses of the mind. The Buddha taught that this inner clarity is always available to us.
I would add that when we engage in this curiosity and patient exploration with another person—a doctor, therapist, teacher, or friend—it gradually becomes internalized as a way of being with ourselves, one that offers a sturdy sense of safety. We can sit together, not knowing how life will play out, shake our heads, and lift our palms to the sky with all our unanswerable questions, while laughing at the human condition. When this happens, we have gone a long way toward turning the anxiety of being human into the shared potential joy of being human.
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