Understanding Anxiety and Low Mood: The Body's Alarm, the Philosopher's Question, the Evidence for Treatment and the Power of Relationships

This article is general information to aid understanding. It does not replace diagnosis or treatment. If anxiety or low mood has made daily life hard for more than two weeks, please see a doctor or mental health professional. If you are thinking about harming yourself, contact your local emergency number or a crisis line right now (in the US, call or text 988).

Anxiety is an alarm, not a malfunction

When the brain detects danger, an alarm centred on the amygdala goes off: the heart speeds up and muscles tense. Cannon (1915) called this the fight-or-flight response, and it is a normal function that prepares us for danger.

The trouble starts when the alarm goes off too often and too loudly. If it keeps sounding without real danger and life shrinks as you try to avoid it, that can be an anxiety disorder. The best-supported treatment is cognitive behavioural therapy (CBT), especially exposure, which means facing feared situations step by step. In Hofmann and Smits’s (2008) meta-analysis, CBT clearly outperformed placebo for adult anxiety disorders.

There is also research you can try in daily life. People who relabelled pre-speech jitters as “I am excited” instead of “I am anxious” actually performed better (Brooks, 2014). The bodily arousal is similar; the trick is to interpret it as a challenge rather than a threat.

Anxiety in philosophy: the dizziness of freedom

In The Concept of Anxiety (1844), the Danish philosopher Kierkegaard called anxiety “the dizziness of freedom” — the vertigo we feel before the possibility of choosing. In The Courage to Be (1952), the theologian Tillich spoke not of removing anxiety but of the courage to live with it.

This view can offer the comfort that “being anxious doesn’t mean something is wrong with me.” But it is a philosophy of life, not a treatment. If anxiety is breaking down your daily life, the treatments above come first.

Low mood is not the same as depression

Everyone has sad, listless days. Depression (major depressive disorder) is narrower. Under DSM-5, it is diagnosed when five or more symptoms, including depressed mood or loss of interest, last nearly every day for at least two weeks and clearly interfere with life.

The evidence for treatment is substantial.

• Antidepressants: in a large network meta-analysis comparing 21 drugs, all were more effective than placebo (Cipriani et al., 2018). Effects are moderate, and the right drug differs from person to person.
• Psychotherapy: CBT and other therapies help adult depression, though a reanalysis applying strict quality criteria found the effects smaller than first reported (Cuijpers et al., 2019).
• Exercise: even after correcting for publication bias, exercise reduced depressive symptoms (Schuch et al., 2016). It works best alongside treatment rather than instead of it.

Rather than deciding “medication or therapy” on your own, it is better to choose with a professional according to how severe the symptoms are.

Is the “dark night of the soul” the same as depression?

The “dark night of the soul” comes from the poem and commentary of St John of the Cross, a 16th-century Spanish friar. It describes a religious journey through spiritual dryness, when the comforts of faith seem to vanish, towards a deeper faith.

Durà-Vilà and Dein (2009) interviewed clergy and members of religious orders and found that they distinguish the dark night from depression. In the dark night, spiritual meaning remains; in depression, symptoms such as changes in appetite and sleep and self-blame are prominent. So putting off treatment for depressive symptoms because they are “part of spiritual growth” can be dangerous.

People are the hardest part — and the greatest strength

Relationships are the most common source of stress, yet also the strongest protective factor.

• Stress buffering: Cohen and Wills (1985) reviewed research showing that feeling you have someone to lean on reduces the impact of stress.
• Health and longevity: in a meta-analysis of 148 studies, people with stronger social relationships had about a 50% greater likelihood of survival (Holt-Lunstad et al., 2010).

When relationship stress is high, the research fits better with protecting one or two people you can rely on and adjusting your distance from difficult relationships than with cutting everyone off.

Summary at a glance

Topic	What research says	Watch out for
Anxiety	A normal alarm; for disorders, CBT and exposure work	Avoidance makes the alarm louder
Anxiety in philosophy	Understood as the experience of freedom and choice	A comfort, not a treatment
Depression	Lasts 2+ weeks; medication, therapy and exercise all have evidence	Decide with a professional, not alone
Dark night	A religious journey, distinct from depression	Don’t delay treatment if symptoms are present
Relationships	Biggest stressor and biggest protector	One or two reliable people matter

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References

• Cannon, W. B. (1915). Bodily Changes in Pain, Hunger, Fear and Rage. Appleton.
• Hofmann, S. G., & Smits, J. A. J. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69(4), 621–632.
• Brooks, A. W. (2014). Get excited: Reappraising pre-performance anxiety as excitement. Journal of Experimental Psychology: General, 143(3), 1144–1158.
• Kierkegaard, S. (1844). Begrebet Angest (The Concept of Anxiety).
• Tillich, P. (1952). The Courage to Be. Yale University Press.
• American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Cipriani, A., et al. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder. The Lancet, 391(10128), 1357–1366.
• Cuijpers, P., et al. (2019). Was Eysenck right after all? A reassessment of the effects of psychotherapy for adult depression. Epidemiology and Psychiatric Sciences, 28(1), 21–30.
• Schuch, F. B., et al. (2016). Exercise as a treatment for depression: A meta-analysis adjusting for publication bias. Journal of Psychiatric Research, 77, 42–51.
• Durà-Vilà, G., & Dein, S. (2009). The dark night of the soul: Spiritual distress and its psychiatric implications. Mental Health, Religion & Culture, 12(6), 543–559.
• Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357.
• Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7), e1000316.