Category Archives: depression

Psychosomatic Symptoms: The Mind-Body Connection

I was recently asked by a patient to explain psychosomatic symptoms.  A psychosomatic illness originates from or is aggravated by emotional stress and manifests in the body as physical pain and other symptoms. Depression can also contribute to psychosomatic illness, especially when the body’s immune system has been weakened by severe and/or chronic stress. Symptoms that my patients have experienced include unexplained swelling and pain in feet or hands, difficulty moving limbs, neck and back pain and spasms, difficulty walking, and non-epileptic seizures, which used to be known as pseudo seizures.

A common misconception is that psychosomatic conditions are imaginary or “all in the head.” In reality, physical symptoms of psychosomatic conditions are real and require treatment just as any other illness. When you go to your doctor with physical symptoms, they will generally look first for a physical explanation for your pain, which may include physical examination, MRIs, and lab tests/bloodwork. If there is no obvious physical cause that they can easily test for, coming up with a diagnosis and plan of treatment may be complex.

One of the most hurtful thing for patients who experience somatic complaints is being told that their very real distress is not based on any actual facts. When this happens, people might feel like their doctor is not taking their symptoms seriously, thinks the person is making it up (malingering), or that it’s “all in their head.” When your doctor can’t find a clear physical cause for your pain (such as an injury or an infection), they may ask you about how you feel emotionally. The hope is that if a source of stress can be identified, it can be treated (just as you would get treated for an injury or illness).

Symptoms caused by stress that you feel in your body are very REAL, they are just caused by a different mechanism that, say, if you broke a bone. For example, people with somatic, non-epileptic seizures, are often prohibited from driving. Your doctor may want you to talk to a mental health professional, but that’s not to say that your physical symptoms only need psychological treatment. It is important to learn how to effectively manage stress, but that is often a process and can take time. In the meantime, you need to treat your physical pain and other symptoms. For example, if you have severe pain in your neck or back, learning to cope with stressful triggers can certainly help prevent from happening—but the pain is not only in your mind. It’s entirely real.

While it might start in your brain, stress causes a cascade of neuro chemicals in your body that produces inflammation in the muscles of your neck, which in turn causes you pain. You may need anti-inflammatory medications, muscle relaxers, or another type of treatment, such as massage and physical therapy to manage your pain. The mind and body are inextricably and reciprocally interactive. 

Small but mighty hacks to improve your mental health

According to the World Health Organization “mental health is an integral part of health; indeed, there is no health without mental health.”

Here are a few small but mighty hacks to improve your mental health.
1. Open up and depend on others more emotionally, sharing vulnerable feelings, like sadness or fear or loneliness.

2. Check in with others regularly. Having connections, even sending or receiving a simple text or a good morning, has been shown to improve mood and decrease anxiety.

3. A change of scene or a change of pace is good for your mental health. It could be a five-minute pause from virtual learning or zoom office meetings to stretch, a half-hour lunch break at work, or a weekend exploring somewhere new. A few minutes can be enough to de-stress you. Give yourself some ‘me time’.

4. Do something you’re good at. What do you love doing? What activities can you lose yourself in? Enjoying yourself can help beat stress. Doing an activity you enjoy probably means you’re good at it, and achieving something boosts your self-esteem.

5. Helping others. Volunteering, helping an elder or neighbor, even taking the time to help a friend with tech support, pet sitting, or picking up groceries: caring for others boosts our mood, a win-win.

6. Emotional eating, in a good way. Boost brainpower by treating yourself to a couple pieces of dark chocolate every few days. The flavanoids, caffeine, and theobromine in chocolate are thought to work together to improve alertness and mental skills. Marine based omega-3 foods are also great for mood, attention, and alertness.

7. Spend some time with a furry friend. Time with animals lowers the stress hormone – cortisol, and boosts oxytocin – which stimulates feelings of happiness.

8. Set your morning foundations. Meditate, yoga, work out, check in with loved ones, check your to do list, pray, read. It creates the tone for the rest of the day.

9. Let it all out…on paper. Writing about upsetting experiences can reduce symptoms of depression. The psychologist James Pennebaker did a series of elegant studies that found that writing stream of consciousness in a journal even 10 minute a day, reduced acute symptoms of depression commensurate with taking an antidepressant.

10.  Relax in a warm bath once a week. Try adding Epsom salts to help soothe aches and pains and help boost magnesium levels, which can be depleted by stress. Taking a hot shower or a warm bath before bedtime, followed by the cooling of the body, actually mimics REM sleep, during which time your body temperature drops and creates a sense of relaxation.

11. Take time to laugh. Hang out with a funny friend, watch a comedy, or check out cute animal videos online. Laughter helps reduce anxiety.

12. Go off the grid. Leave your cell phone at home for a day and disconnect from constant emails, alerts, and other interruptions. Spend time doing something fun with someone face-to-face or alone time.

13. Take 30 minutes to go for a walk in nature – it could be a stroll through a park, or a hike in the woods. Research shows that being in nature can increase energy levels, reduce depression and boost well-being. Sunlight synthesizes vitamin D which is not naturally stored in the body. When it is depleted, it can contribute to feelings of depression.

14. Practice planning.  Try meal prepping or picking out your clothes for the work week. You’ll save some time in the mornings and have a sense of control about the week ahead. 

15. Organize. I have my clients keep a master day planner, not just Google Reminders and calendars. Using different colored pens, account for all of your activities: work, academic, social, medical, family, recreation, and self care. Having it all in one place is powerful, and a reminder to be mindful to all different aspects of life.

16. Practice my clinical strategy, stones across the river. Pay mindful attention to the small things that happen every day that can bring moments of satisfaction or joy. When they are strung together, they provide a path that doesn’t seem obvious at first, but can ford the rapids.

How to help a loved one with depression

Depression doesn’t happen in a vacuum. It causes a ripple effect that touches everyone surrounding the person. Family members and friends often feel helpless, not knowing how to reach out or what to do to help their suffering loved one.

It would be nice if the depressed person could specifically vocalize their needs, so that friends and families knew exactly what to say and do. However, the paradox of depression can be immobility and lack of motivation. Vegetative symptoms are disturbances of a person’s functions necessary to maintain life. These disturbances are most commonly seen in mood disorders, and are part of the diagnostic criteria for depression.

Vegetative symptoms in a patient with typical depression include:
Weight loss and anorexia (loss of appetite) or overeating
Insomnia or hypersomnia.
Fatigue and low energy
Inattention and memory problems
Poor communication

1. Educate Yourself About Depression and Other Mood Disorders.
You may not be able to cure your loved one. But you can better understand their condition by educating yourself about depression or mood disorder. Reading up on your loved one’s illness will help you feel more in control of the situation and give you more patience to tolerate the confusing or frustrating symptoms.

2. Ask Open-ended Questions
Do not go in with the attitude that you know better, and you know what’s going to work to help them feel better. Listen to their personal experience.

3. Help Them Identify and Cope With Sources of Life Stress
It’s no secret that stress is a significant contributor to depression. Chronic levels of stress pour cortisol into your bloodstream and cause inflammation in your nervous system and every other biological system. In a study in Scientific Reports, a neuroscience journal, stress was shown to reduce the brain’s innate ability to keep itself healthy. The hippocampus, which regulates mood, shrinks, negatively impacting our short-term memory function and learning abilities.

4. Remind Them That They’re Incredibly Strong
When you’re depressed, you don’t believe that you’re worthy of love. I call this the secret symptom of depression, the feeling that you are unimportant and don’t matter in the universe. That’s what makes relationships and communication so difficult. One way of helping is by reminding them of their strengths. Use concrete examples. Cite times in their lives they exemplified courage, stamina, compassion, integrity, and perseverance. One colleague of mine will say, remember your name, who are you?

In a series of studies that I conducted at the Catholic University of America, in Washington, DC, I found that people with depression literally do not remember positive aspects of a singular activity. For example, when shown movies that had a range of affect from joyful to traumatic, the more painful and traumatic memories in the films were later most remembered on memory tasks given to individuals identified as depressed.

5. Make Them Smile, Because Laughter Helps.
Humor can help us heal from a number of illnesses, including depression. In Darkness Visible, the writer William Styron described his journey through severe depression. Humor was one of the things that helped him survive. Watch a favorite show or listen to a shared podcast with your depressed loved one. You don’t have to fake laughter, let it emerge on its own.

6. Let Them Know They Won’t Always Feel This Way.
This is a powerful message. When combined with helping them remember past struggles that they mastered, it shows that there is hope.

7. If You Do Only One Thing, Let It Be Listening
Listen. Suspend all judgments, save all interjections … don’t be a know it all. Do nothing more than make excellent eye contact, reflect on what you are hearing, and open your ears. It’s the most powerful wisdom.

How to help a loved one who is having mental health problems

We all go through tough times and people help us through them. Other times we have been worried about other people’s mental health. Whether they are a friend, family member, significant other, neighbor, or colleague, there are many ways to support somebody you care about.

1 in 6 people experienced a common mental health problem such as anxiety or depression in the past week.

Talking about mental health
If you are worried about someone it can be difficult to know what to do. When you are aware there is an issue, it is important not to wait. One of the saddest components of depression is that it is immobilizing. You can simultaneously know that you desperately need help, and have absolutely no energy or desire to seek it.

Waiting and hoping others will come to you for help might lose valuable time in getting them support. Openly talking with someone is often the first step to take when you know they are going through a hard time. This way you can find out what is troubling them and what you can do to help.

Eight tips for talking about mental health:

  1. Set time aside with no distractions. It is important to provide an open and non-judgemental space.
  2. Let them share as much or as little as they want to. Let them lead the discussion at their own pace. Don’t put pressure on them to tell you anything they aren’t ready to talk about. Talking can take a lot of trust and courage. You might be the first person they have been able to talk to about this.
  3. Don’t try to diagnose or second guess their feelings. You probably aren’t a medical expert and, while you may be happy to talk and offer support, you aren’t a trained counsellor. Try not to make assumptions about what is wrong or jump in too quickly with your own diagnosis or solutions.
  4. Keep questions open ended. Say “Why don’t you tell me how you are feeling?” rather than “I can see you are feeling very low”. Try to keep your language neutral. Give the person time to answer and try not to grill them with too many questions.
  5. Talk about wellbeing. Exercise, having a healthy diet and taking a break can help protect mental health and sustain wellbeing. Talk about ways of de-stressing and ask if they find anything helpful.
  6. Listen carefully to what they tell you. Repeat what they have said back to them to ensure you have understood it. You don’t have to agree with what they are saying, but by showing you understand how they feel, you are letting them know you respect their feelings.
  7. Offer them help in seeking professional support and provide information on ways to do this.
  8. Know your limits. If you believe they are in immediate danger or they have incurred injuries that need medical attention, you need to take action to make sure they are safe. More details on dealing in a crisis can be found below.

How do I respond in a crisis?

People with mental health problems sometimes experience a crisis, such as breaking down in tears, having a panic attack, feeling suicidal, or experiencing a different sense of reality (dissociation). This may include even losing a sense of time and place. You may feel a sense of crisis too, in response, but it’s important to stay calm yourself.

There are some general strategies that you can use to help:

    • Listen without making judgements and concentrate on their needs in that moment.
    • Ask them what would help them.
    • Reassure and help point them to practical information or resources.
    • Avoid confrontation.
    • Ask if there is someone they would like you to contact.
    • Encourage them to seek appropriate professional help.
    • If they have hurt themselves, make sure they get the first aid they need.

Seeing, hearing or believing things that no-one else does can be the symptom of a mental health problem. It can be frightening and upsetting. Gently remind the person who you are and why you are there. Under extreme stress, people can dissociate. Don’t reinforce or dismiss their experiences, but acknowledge how the symptoms are making them feel.

How do I respond if someone is suicidal?
If someone tells you they are feeling suicidal or can’t go on, or if you suspect they are thinking of taking their own life, it is very important to encourage them to get help.

National Suicide Prevention Lifeline
Hours: Available 24 hours. Languages: English and Spanish
1-800-273-8255

COLLEGE STUDENTS AND MENTAL HEALTH

According to 2018 and 2019 student surveys from the American College Health Association (ACHA), about 60% of respondents felt “overwhelming” anxiety, while 40% experienced depression so severe they had difficulty functioning.

A 2019 Pennsylvania State University study noted that demand for campus mental health services increased by 35-40% during a period that saw only a 5% increase in enrollment.

Anxiety and depression represent only some of the prevalent mental health issues experienced by college students. Others include serious problems like suicide, eating disorders, abusive relationships, and addiction. Mental health professionals stress the importance of talking about such issues, but students may lack the time, energy, will, and/or money to seek the support they need. Outreach and education are vital.

DEPRESSION
Here are some signs of depression to look for in friends:
They are not enjoying activities they once loved
They no longer attend classes or social outings are experiencing extreme anger or sadness over a relationship in their life
They react negatively or with apathy to most things
They often talk about death or suicide

Words of encouragement show your friend you are a source of support. Avoid telling your friends to “cheer up” or “snap out of it.” Many people experiencing depression are aware of their condition, and telling them to get over it is not helpful.

If you feel your friend is at risk, gently encourage them to seek help and offer to accompany them to a student health center or a doctor’s appointment. While talking through their issues with you may be helpful, it is not a substitute for treatment.

People who have depression often feel as if they are alone and have no one to turn to. But it’s important to understand that isn’t the case, as people care and want to help. People with depression also have resources at their disposal that they may not know about.

For example, the following organizations are dedicated to providing resources for those living with depression.

ANXIETY AND DEPRESSION ASSOCIATION OF AMERICA
This organization promotes the prevention, treatment, and cure of anxiety, depression, and related disorders. Its website offers insight into understanding depressive mental illnesses, provides links for those seeking help, and identifies mobile apps designed to help people living with depressive illnesses.

ULIFELINE
This online resource is for college students seeking mental health wellness. It provides tips on how to help friends in crisis and ideas for developing better wellness habits.

AMERICAN COLLEGE HEALTH ASSOCIATION
ACHA promotes healthy campus communities and is a principal leadership organization for advancing the health of college students. The organization’s website provides helplines, brochures on different types of depression, and external links.

THE JED FOUNDATION
This foundation offers online resources designed to promote emotional health and prevent suicide among college students.

HELP A FRIEND IN NEED
This initiative identifies warning signs through social media. The Half of Us campaign promotes mental health awareness nationally through on-air and live events and connects students with healthcare providers.

ANXIETY DISORDERS
Your friend may have an anxiety disorder if they display these behaviors:
Have experienced a tragic event and do not develop healthy coping habits
Appear to live in constant fear of failure — academically or socially
Are uncomfortable and extremely anxious in social atmospheres
Have trouble concentrating or seem to have a blank mind
Seem plagued with guilt or stress
Have visible panic attacks

Avoid criticizing or belittling the severity of your friend’s symptoms and encourage them to try coping strategies that avoid causing further anxiety. Encourage your friend to visit a campus healthcare or counseling center and discuss their troubles with a professional. With their permission, you might be able to contact their parent. Some of the college student referrals I receive come from friends and roommates who got worried and told their friend’s parents about their concerns.

The following organizations are excellent resources for students with anxiety disorders.

ANXIETY AND DEPRESSION ASSOCIATION OF AMERICA
ADAA promotes the prevention, treatment, and cure of anxiety, depression, and related disorders. The association’s website offers insight into how to better understand depressive mental illnesses. Additionally, it suggests several mobile apps that cater to users with depressive illnesses.

AMERICAN PSYCHOLOGICAL ASSOCIATION
APA is dedicated to advancing the creation, communication, and application of psychological knowledge to benefit society. Its website offers insight into the differences between anxiety disorders and depression, as well as tools to help you locate a psychologist.

ANXIETY RESOURCE CENTER
ARC is a nonprofit dedicated to offering assistance to those who have anxiety disorders. Its website features a lengthy list of education materials, a newsletter, and a blog to help visitors stay updated on breakthroughs in research and trends.

SOCIAL ANXIETY ASSOCIATION
This nonprofit maintains resources for people with social anxiety. Its website provides links to support groups, information on how to find health professionals, news and updates on the disorder, and extensive information on treatment options.

STUDENTS AND SUICIDE
Suicidal people may talk about feeling trapped, feeling as if they are a burden to others, feeling like they have no reason to go on, and ending their lives.

What to watch for if you feel your friend or roommate is at risk:
If a person talks about:
Being a burden to others
Feeling trapped
Experiencing unbearable pain
Having no reason to live

Specific behaviors to look out for include:
Increased use of alcohol or drugs
Looking for a way to kill themselves, such as searching online for materials or means
Acting recklessly
Withdrawing from activities
Isolating from family and friends
Sleeping too much or too little
Visiting or calling people to say goodbye
Giving away prized possessions
Aggression

People who are considering suicide often display one or more of the following
Depression
Loss of interest
Rage
Irritability
Humiliation
Anxiety

ADAA recommends these steps to take if you suspect someone you know is suicidal:
Ask them directly, “Are you considering killing yourself?” This may seem blunt. However, according to ADAA, studies show that this question does not increase the likelihood of suicidal thoughts, and it’s an important foundation for the next steps.

Make safety a priority. If they answer positively to step one, ask them if they have a plan. While it may not be easy, removing lethal objects and items in the dorm or home, such as guns, can also make a big difference.

Be there for them. Sometimes the most you can do for someone is simply to be there for them when they need you. Listen to what they have to say. Acknowledge and talk to them about the realities of suicide. According to ADAA, this can reduce suicidal thoughts.

Give them the tools to help themselves. Save the National Suicide Prevention Lifeline’s number — (800) 273-8255 — in your phone. If possible, also save this number in your friend’s phone.

Remain in contact. Staying in contact makes a big difference and can potentially save the life of an at-risk person.

Reopening: Community Mental Health Clinic

Dear Friends:

This week, I reopened the community mental health clinic I’ve been running for over 18 years, started by my previous beloved mentor, Dr. Neil Schiff. We have been closed since March for safety reasons. I am indebted to the community in Washington DC and Maryland for giving me the trust that they have all of these years. As we maintain extreme precautions, I am also grateful for again seeing the local community that I care for deeply.

While gratitude helps me through each day, my gratitude is tempered with outrage. Longstanding and deeply rooted health care inequities—based on race, ethnicity, and income—have been thrown into relief by the COVID-19 pandemic that cannot be minimized. Everyone is suffering, but communities of color are suffering more. The shortcomings of our system with respect to caring for the elderly are painfully visible. The risks associated with incarceration are vivid. While none of these problems originated with this pandemic, the crisis has exacerbated these injustices in devastating and tragic ways.

I am striving in joining with others to do the urgent work needed to dismantle the barriers to health that persist for so many. As you know, while this has been a long-term focus of mine, this crisis presents an opportunity to design and demand real change. These barriers threaten all of us, not just those who face them directly. COVID-19 has indubitably demonstrated that fact. None of us are untouchable.

A few years ago, the gifted Vermont artist Stephen Huneck, who suffered from chronic pain, died by suicide. He was soon thereafter followed by his wife, Gwen.

He ran a beautiful chapel near the Canadian border in Vermont, called Dog Mountain, in honor of dogs and love. His artwork graces my office. In 2015, my English Lab, Asia, and I hiked the mountain to pay homage. It was a moving experience.

In 2019, there were 1.5 million suicide attempts in the United States, that were documented. On average, there are 132 suicide attempts per day, with notably numerous ones listed as ideation and undoubtedly more that are not documented at all.

Please visit the American Foundation for Suicide Prevention for more info and suicide statistics.

  

6 Big Takeaways Regarding the Restaurant and Bar Industry

This morning I had the pleasure of meeting with government officials from the DC Department of Health and the DC Council. We discussed anxiety and coping strategies for the many service Industry employees heading back to work. Also included were local restaurant leadership/owners, business leaders, and legal experts. It was very informative, and more info to come.

Virginia is starting phase 2, Maryland is 1.5, and DC is taking a slower and more measured approach, even though throngs of protesters certainly make that a challenge.

6 Big Takeaways Regarding the Restaurant and Bar Industry

1. You can and should call in sick if you need to. You cannot be penalized or retaliated against by employers.

2. Similarly, if there are health practices in your business establishment that make you uncomfortable, you are protected as a whistle blower.

3. My point: Restaurant leadership needs to inform patrons about the procedures and protocols. Often, people who seem to have bad behavior, simply don’t know what they are supposed to be doing and not doing. Information needs to be readily available on websites and in restaurants.
People are excited to go back to restaurants, but this is not a one-sided deal. Respect those who feed you. 

4. The biggest concerns that front line restaurant and bar workers expressed to me:
–  The trade-off between potential financial hardship and risking your life and your family’s on a daily basis to do your job. Remember, that patrons do not wear masks while eating, talking, and drinking. There is inherent risk.
–  The complete uncertainty of what’s going to happen next. There could be another shut down in the near future, and there is no way to predict what’s going to happen. Business is certainly going to proceed at a lowered capacity.
–  The porous lines between Virginia, Maryland, and DC. Workers and patrons going back-and-forth, making it harder to control safety regulations. 
– The pivot. 20% of restaurant jobs, and likely restaurants that are privately owned, will be gone. How does one transfer the considerable skills that restaurant folks have to other fields?
– The importance of communication and feeling heard. I suggested that every restaurant have a team of people that are assigned to work with front of the house and back of the house workers as emotional coaches.

5. Mental health is just as important as physical health. During the pandemic, clinical depression hit the highest national average recorded, in May 2020. That month, 50% of Americans met the criteria for major depression. ( US Census Bureau)

6. Self-care is crucial. In the best of times, the industry is one of the highest for levels of stress. Sleep well, eat healthy, exercise, meditate or follow personal spiritual practices, rest, and have a strong social support network.

Seek therapy or teletherapy when needed. Resources are available.

Some thoughts on depression – Q&A

I was honored to be recently named as a Top Doc. It’s always gratifying to be recognized for good work, and this kudo comes with the bonus of having an active Q&A section on their website, where readers (and potential patients) can anonymously ask questions.  I’ve tried to find time to answer a bunch of these, and thought it might be helpful to share some of those questions, and answers, here.

This first batch all deal with depression.

Will my depression go on its own?
Hello, it really depends on how long you’ve been depressed, and what the other circumstances are that may be occurring. If you’ve had recurrent episodes- Therapy, possible medication consultation, and a self care regimen are absolutely essential to address it. The good news is that there are proven strategies that do work to help with distress and symptoms.

Can social workers suffer from depression?
Yes absolutely. Mental health workers have some of the highest burn out and that includes rates of depression, substance abuse, and anxiety. Self-care is crucial. It used to be done that social workers and psychologists were required to be in therapy as part of their training, and although that cannot be mandated by programs, I believe it’s a good thing to be in treatment at various stages of our own professional and personal lives.

Will my depression go on its own?
Hello, it really depends on how long you’ve been depressed, and what the other circumstances are that may be occurring. If you’ve had recurrent episodes- Therapy, possible medication consultation, and a self care regimen are absolutely essential to address it. The good news is that there are proven strategies that do work to help with distress and symptoms.

Can a divorce drive people toward depression?
In psychology there is a list of daily stressors or daily hassles. Going through a divorce or separation is one of the top stressors. Unfortunately, divorce is usually also combined with financial stress, location changes, shifting of social groups, family related issues, and at times issues related to children. It’s essential to make sure that you fit in time for self-care, and do some consults with a therapist to come up with a plan for coping and support.

There are many more questions on the site, on a variety of topics including stress management, OCD, anxiety and more. I’ll share more of those here, sometime in the near future.

Anxiety Toolkit

1.  Mindfulness Exercise
Start by taking a few deep breaths … breathing in through your nose … and then out through your mouth … in through your nose … and then out through your mouth. Then, while you continue to do so, gradually try to make yourself aware of:

  • 5 Things You Can See:  For example, the table in front of you, the nice painting on the wall, the fridge magnet that your daughter made, the clear blue sky outside, and the leafy green tree across the road.
  • 4 Things You Can Feel:  Once you’ve gotten in touch with five things you can see, then – while you continue breathing in through your nose, and out through your mouth – try to bring awareness to four things you can feel. For example, the chair that’s holding up your weight, your dress against your legs, the soft carpet beneath your feet, or a loose strand of hair brushing against your face.
  • 3 Things You Can Hear:  Next, bring awareness to three things you can hear. For example, the ticking of a clock, a bird chirping outside, or the sound of your children playing in their bedroom.
  • 2 Things You Can Smell:  Then, try to get in touch with two things you can smell. If you try but don’t find yourself able to smell anything, then try to summon up your two favorite smells. For example, the scent of freshly cut grass, or the aroma of a steaming mug of hot chocolate.
  • 1 Emotion You Can Feel:  Lastly, be mindful of one emotion you can feel.

Put all together, this 5-4-3-2-1 grounding exercise is really helpful for when you’re trapped in the “depression fog” and sinking deeper and deeper. It does this by getting you out of your head and in touch with your surroundings – thereby creating some separation between you and your racing thoughts and thus calming you down. Not only that, but it can be used as a preventative exercise too, for the purpose of helping you relax a little bit before something difficult – such as a job interview you’re really nervous about, or meeting someone who’s capable of triggering your depression or anxiety.

2.  Grounding Exercise with Picture Frames
If you find yourself somewhere, where you cannot do a full mindfulness exercise, this is a strategy that works almost anywhere. Find a picture on the wall, or any rectangular framed objects, such as a mirror. In school, and office, classroom, or home, you will usually be able to find something. Walk over to the framed picture. Look at the framed object, and note  the four corners.  While breathing in through your nose slowly, and out through your mouth slowly, mentally count the four corners of the picture. Keep repeating until you find yourself feeling calmer.

3.  Give yourself a timeout
When you’re trapped in the “depression fog”, it’s extremely helpful if you can calm yourself down and put a stop to your racing thoughts. As an alternative to a grounding exercise, another effective way of achieving this is through relaxing self-care practices – for example, by going for a walk, getting lost in your favorite video game, playing with your dog, taking a hot bubble bath, listening to your favorite playlist, reading a good book, watching your favorite series on Netflix, or doing anything else that mellows you out.

4.  Journaling
When you feel yourself suffocated by negative thoughts, worry, fear, or any other difficult emotions associated with “depression fog”, then another way of dealing with them is to try to “release” them. This is not only extremely cathartic – and therefore likely to calm you down – but also, when you have a healthy way to release your pent-up emotions, you’re also able to distance yourself from them, which makes it much easier for you to be able to gain clarity over those thoughts and be able to work through them.

A great way to do this is by journaling. Start with a pen and a blank piece of paper, take a few deep breaths, and then, just write what you feel (you could type your thoughts up on a computer as well, but using a pen and paper is generally recommended since it doesn’t come with distractions like Facebook and your email). Like I said, the process of writing down your thoughts is likely to relax you a little bit, and by “getting them out there” instead of keeping them trapped inside your head, you’ll find it easier to sort them out and gain some control over them.

Write down your thoughts without editing. It’s been shown to be very cathartic.

5.  Talk to an emotion buddy or coach
Just like journalling, talking to someone who you feel comfortable with and trust can also be really cathartic when you’re experiencing “depression fog”. Not only that, but someone you’re close with can also give you a new perspective on the thoughts or the situation that you’re struggling with. This can be particularly helpful, because when you’re in the midst of “depression fog”, your perspective is often negatively distorted, so talking with someone can often result in you seeing things in a more positive or less catastrophic light.  Find one or two trusted people you can talk to in times of trouble.

Embolden Psychology
Embolden

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

Thank you for contacting us.