Category Archives: depression

How to ask for help without feeling weird

‘I Have Your Back’

Reaching out for support is a skill we’re somehow expected to know, yet it’s never taught and rarely modeled for us. When you need help -no matter the kind of help you need, or the person you need it from -to simply state “Can you help me?” can be fraught with tension.

A seemingly simple request for help can bring huge implications with it. You may have been raised in a family where asking for help, or letting others know that you need support, was considered a sign of weakness and was frowned upon for suggesting a lack of privacy regarding personal difficulties.

Asking family members, colleagues, friends, community, and partners for help may reflect a larger cultural dynamic of communication and give-and-take.

Saying, “Can you help me?” speaks powerfully to an instinctive desire to be of service to other people and to receive reciprocal attention. But “Can you help me?” also makes you vulnerable.

What I say to patients: please practice asking for help.
For many, it’s a new activity, and it feels rusty, like anything novel.  Yet, so many people have recently lost their livelihood, had physical health problems, financial hardship, and even loss of home and identity. More than ever, asking for help is an art form that we need. As a society, we don’t always have the experience to ask for help. In my belief, that needs to change, but requires self compassion and practice.

Where to start:
1. Make a list of what you need help with: particular errands, chores, some cooking, walking the dog, getting food or groceries, yard work, job recommendations, assistance with letter or email writing, changing filters, moving furniture, tech support, maybe even a shoulder to cry on.

2. Write down the names of friends, colleagues, and relatives who have offered to help in the past.

3. Match people with tasks based on their interests, their strengths, their time flexibility and your comfort level with them, given the intimacy of the particular task. One friend may really enjoy cooking, another may check in on you via regular texts, another might upgrade your computer, or walk your dog.

4. Pick just one thing off the list and contact the person you’ve chosen. Be direct. See the next few points, below.

5. I always talk about timing and dosage. If you’re not sure whether or not it is a good time, just ask. You can say, “I’ve love to ask for your help with something. Is there a time that’s good for you to talk?”

6. Don’t be defensive. Instead, say what you can’t do.
Instead of saying, “I need to add a few graphic elements for a major key point power point presentation, say, “I’m concerned a few of my slides for my seminar look terrible.” You don’t have to emphasize how ‘important’ you are. Just ask for the help that you need.

7. Show respect. Without actually saying it, you’ve already said, “You know more than I do.” You’ve said, “You can do what I can’t.” You’ve said, “You have experience (or talent or knowledge) that I don’t have.”

Learning is not diminishing yourself.

8. Show trust. You’re vulnerable. You admitted to a weakness.And you’ve shown the other person that you trust them with that knowledge. You’ve already said, “I trust you.”

9. Show you’re willing to listen. Instead of saying exactly how the other person should help you, you give them the freedom to decide.

By showing you respect and trust other people and by giving them the latitude to freely share their expertise or knowledge, you don’t just get the help you think you want. You get more.

10. Be grateful. Acknowledge the help you received. Even though you might feel embarrassed that you needed help, don’t pretend like it never happened. Directly acknowledge that you appreciate what the other person did for you.

11. Be sincere. When someone is helping you, it’s okay to be a little bit vulnerable. The other person might appreciate knowing that they are genuinely helping you during a difficult time.

12. Gain credibility by helping others. People will be more likely to agree to help you if you have been known to help others. Build a reputation as a helpful person. You will draw others to you who share that same sentiment.

Least Helpful Things to Say to Someone With Depression

Sackler Gallery, Washington DC, 2019

Lighten Up!
Why can’t you just act happy. You’ll feel better.
Things are not that bad.
You become what you think.
You do not need to take those pills. You’ll just get addicted to them.
Just chill, bruh.
Just have gratitude.
A hot bath always helps.
Get a job. It will keep you busy.
Smile and the world smiles with you.
Your face looks like you’re upset all the time.
You don’t look depressed.
You have gained weight.
You have lost weight.
You always think about yourself.
Your life is so easy.
You are being selfish.
Everyone goes through depression, it is not a big deal.
You are an attention-seeker.
Everyone goes through a rough patch, so that is normal.
Depression is not a disorder, it’s in your head. 
A person of your age should be having fun right now.
You know, you become what you think.
You brought this on yourself.
Stop acting like a child.
Think about others who are really suffering.
This bad attitude won’t help.
Stop thinking about it.
Just stay busy.
Get a life.
Your face is so sad that it makes me depressed.
You need to give yourself time.
Have you prayed on it?

Emergency Hotline

Eight tips to fight loneliness during holidays

Tis the season when we presumably spend our days sipping hot cocoa, eating delicious food, gifting, and doing all sorts of holiday fun-ness with our loved ones, these days, virtually. It’s the jolliest time of year. At least, that’s the lovely picture we’re all marketed for the holidays. The unfortunate reality is this sentimental holiday scenario is anything but the norm.

For many people, this time of year can be a painful reminder of the things they’re not surrounded by. Loneliness happens. And the painful feeling may grow, until you’re convinced you’re destined to be a lonely hermit whom no one wants to be around.

Part of that reason is simply because of our cultural expectations around what the holidays SHOULD be like. When we set our expectations to be one thing, and the reality is something different, we can see it as less than.

Think, for instance, about all of those holiday Hallmark family films that focus on the heartwarming ~feels~ that come from quality time with the fam.

The reality is, though, your IRL or virtual version could easily not match what you see on the screen or with what your neighbors with their beautiful lights and decorations might be experiencing. Coping with the loneliness and holiday blues can be challenging.

Mental health tips:

Recognize how much stress you might be under
Since the holiday season is short and goes quickly it creates a sense of urgency and overwhelm, making you feel like there’s so much to do and so little time to get everything done. Expectation is also a huge cause of stress during the holidays. Everything from holiday decorating to shopping and gift giving come with expectations that are most often unrealistic which causes you to stress about measuring up to those expectations whether they are your own or ones held by family and friends. When people get stressed or feel overwhelmed they can begin to feel alone in their struggles.

Comparison is the thief of joy
People can feel less than, especially when they see everyone else seemingly ‘happy’ and having everything under control. Social media can be a huge culprit of making it seem that everyone else has it all together except you with those happy/perfect pics. Even though social media is for “connecting” with others it can actually do the opposite and make you feel less connected and more alone especially when you compare your life to those you see. Try limiting time on social media.

Don’t isolate yourself, no matter how tempting
When people feel lonely, sad or are struggling they may tend to isolate themselves or feel unmotivated to reach out or interact with others. They may also feel unworthy of someone’s time and that they would burden or inconvenience others by asking them to participate in an activity or by sharing their feelings. They get caught up in their low self-esteem and negative thoughts, and choose to isolate instead of virtually socialize or reach out. The best way to stop and change negative thoughts is by choosing to see them for what they are-as mental distortions, rooted in fear, self-doubt and low self-esteem. Their purpose is to keep us from pursuing relationships and opportunities.

Self compassion
Please ask yourself if this is a kind thought you are telling yourself. Flip the negative self statement to a positive thought, for example if you are struggling with worth and feelings of deserving ask yourself “Who am I not to deserve this?” Start repeating “I am worthy” multiple times throughout the day and you will begin to believe it and act from a place of feeling worthy and deserving. The more you practice positive thinking, the more empowered and less lonely you will feel. I actually have my patients write this down on index cards and carry it around to look at throughout the day. 

Process and be in your feelings
It’s okay to feel sad and to let yourself feel lonely. Everyone has bouts of loneliness at times and often it’s because family may be far away or maybe right now you don’t have a significant other or kids. Spend some time fully feeling your feelings until they dissipate. You can do this by practicing mindfulness. Mindfulness teaches you how to be aware of your feelings, to feel them in your body and to allow and accept them without creating a narrative around them. It is OK to cry or feel an intensity of emotions, and in accepting and inviting these feelings to be present they dissipate and more calm and peace prevails.

Engage in the practice of opposite action/emotion
Practice opposite emotion and action, derived from Buddhism, to change your mood by engaging in behavior that is opposite to what your current emotion is pulling from you. For example, if you are angry and feel yourself tensing up, then try to open your posture and uncross your arms. Stretch your body for release. Similarly, if you are feeling sad and lonely and want to withdraw, then make a point to reach out to friends or watch a funny or well loved movie to help mitigate sadness.

The theory behind the skill I teach in my clinical practice to patients that I call OPPOSITE EMOTION is that every emotion is accompanied by an urge to engage in certain behaviors and these behaviors perpetuate the emotion. For example, the most common action urge for anxiety is avoidance. The more you avoid something you fear, the more intense your anxiety will become, and so approaching what you fear will help reduce anxiety both because you learn the situation is okay and because you aren’t continuing to reinforce your fear by avoiding the situation. It is important to note that the goal is not to push away your emotion or suppress it, but rather to work on cultivating another emotion.

Community service and volunteering
Use your energy and resources on behalf of people who need your help. Volunteer to tutor students, as many are struggling with virtual learning; help at a homeless shelter or soup kitchen, make food for an elderly neighbor, or volunteer at an animal shelter.

Appreciate what you have
Send cards or a personal note to everyone who means a lot to you. Thanksgiving is about showing gratitude. Make your holidays a spiritual growth time, such as creating a personal ritual, prayer, meditation, or virtual gathering with close friends. I have several friends who have a personal altar at home, and engage in prayer to their ancestors and loved ones who are not present. Find something for you that is meaningful. 

Men and mental health

In my practice, the majority of my clients are male. Overall, three times as many men as women die by suicide, according to a World Health Organization (WHO) comprehensive report from 2018. The American Foundation for Suicide Prevention also cited 2018 data, similarly noting that in that year alone, men died by suicide three and a half times more often than women in the United States.

Mental Health America, a community-based nonprofit, collected data suggesting that more than 6 million men in the U.S. experience symptoms of depression each year, and more than 3 million experience an anxiety disorder. Despite these figures, the National Institute of Mental Health (NIMH) reported that men are much less likely than women to have received formal mental health support.

In a study from Canada, published in the Community Mental Health Journal, in 2016, more than one-third of the participants in the study admitted to holding stigmatizing beliefs about mental health issues in men. Significantly more male than female respondents said that they would feel embarrassed about seeking formal treatment for depression.

BIPOC men face additional challenges when it comes to looking after their mental health. According to the American Psychological Association (APA), in the U.S., Black and Latinx men are six times more likely to be murdered than their white peers. Indigenous American men are the demographic most likely to attempt suicide in this country and Black men are most likely to experience incarceration, based on statistics gathered by the American Psychological Association. The consequences of these disparities on the mental health of people of color and of diverse ethnic and racial backgrounds is exponentially challenging.

Depression symptoms often manifest differently in men than women, perhaps based on these disparities. Some men with depression hide their emotions, and may seem to be angry, irritable, or aggressive, while many women may seem overtly sad or express sadness verbally.

For men, some symptoms of depression are physiological, such as a racing heart, digestive issues, muscle tension, bodily aches and pains, or headaches, and men are more likely to see their doctor about physical symptoms than emotional symptoms. Additionally, self-medicating with alcohol and other substances can be a common symptom of depression among men and that this can exacerbate mental health problems and increase the risk of developing other health conditions.

It is not easy for men to be open with others about mental health struggles. In fact, many of the male patients that I see have never spoken about their struggles until they come to my office, often not until they have experienced dire difficulties. Often, their pain is palpable.

As a mental health community, and as a society, we have to teach men to not mask their emotions. Instead, we need to encourage men to speak up, not man up. Talking saves lives; let’s normalize mental health.
(statistics from the American Psychological Association and NIMH). 

Smiling Depression

The term “smiling depression” – appearing happy to others while internally suffering significant depressive symptoms is receiving more research attention. While smiling depression is not a technical term that psychologists use based on ICD or DSM criteria, it is certainly possible to be depressed and manage to successfully mask the symptoms. The closest technical term for this condition is “atypical depression”. In fact, a significant proportion of people who experience a low mood and a loss of pleasure in activities manage to hide their condition in this way.

These people might be particularly vulnerable to suicide.

It can be very hard to spot people suffering from smiling depression. They may seem like they don’t have a reason to be sad – they have a job, popularity, and maybe even children or a partner. They smile when you greet them and can carry pleasant conversations. In short, they put on a mask to the outside world while leading seemingly normal and active lives. Tony Bourdain and Robin Williams are good examples.

Inside, however, they feel hopeless and down, intermittently having thoughts about ending it all. The strength that they have to go on with their daily lives can make them especially vulnerable to carrying out suicide plans.

Although people with smiling depression put on a “happy face” to the outside world, they can experience a genuine lift in their mood as a result of positive occurrences in their lives. For example, getting a text message from someone they’ve been craving to hear from, volunteering or doing community service to help others, or being praised at work can make them feel better for a few moments.

Other symptoms of this condition include under or overeating, substance abuse, irritability, feeling a sense of heaviness in the body, insomnia, and being easily hurt by criticism or rejection. People with smiling depression are also more likely to feel depressed in the evening, also known as sundowning, and feel the need to sleep longer than usual. Smiling depression is exhausting, because a great deal of mental effort is required for them to put forth the semblance that everything is fine.

Recently, Women’s Health magazine captured the essence of smiling depression – the façade – when it asked women to share pictures from their social media and then to recaption them on Instagram with how they really felt in the moment they were taking the picture.

It is difficult to determine exactly what causes smiling depression, but low mood can stem from a number of things, such as work problems, financial hardship, relationship breakdowns, and feeling as if life doesn’t have purpose and meaning. It is very common. About one in ten people are depressed, and between 15% and 40% of these people suffer from the atypical form that resembles smiling depression.

Such depression can often start early in life and can last a long time.If you suffer from smiling depression it is particularly important to get help. Sadly, though, people suffering from this condition usually don’t, because they might not think that they have a problem in the first place – this is particularly the case if they appear to be carrying on with their tasks and daily routines as before. In short, they get used to feeling bad. More than ever, it’s very important to check in with people who seem like they’re doing well, during difficult times.

The way is through, not around.

How to persist in hard times through mindful writing.

 

Write It Out
Did you ever write an emotional e-mail to an ex when you felt angry but then deleted it? Chances are you still felt better though you didn’t send it. If you’ve suffered an upsetting event, writing about it can actually make you feel better. That’s in part because writing organizes your thoughts, which makes the experience feel less chaotic. Writing also can offer you an emotional release, insight into yourself and the feeling that you can be more in control. Clinical psychologist, Dr. James Pennebaker, found that writing for 10 to 15 minutes per day reduces clinical depression, commensurate with taking medication.

Set aside 15 minutes a day to write about the event or the day, and how it made you feel.

Write in a journal, laptop, or phone, whatever feels most accessible to you personally.

Don’t worry about grammar or artistry. It’s called stream of consciousness. This is just for you. But get it down.

Stick with it. At first writing about an upsetting experience may be painful, but over time it can help you get past the upset. I have a friend who is a writer, who created a very popular blog and a successful writing career that evolved, starting from his own past losses and grief.

How To Start
Write down the problems or thoughts involved. On paper they may seem more manageable than swirling in your head.
Do not be your own critic. Just get it out, and you can edit it as much as you want later.
Make it a practice. Neuropsychology research shows that new neural pathways are formed by practicing an activity or exercise for at least a minimum of 21 to 28 days.

Don’t get discouraged if your first attempt at writing is not to your satisfaction. It’s the action, not the product.

As a published writer has told me, write about both the what and the why. It trains your brain to think about both.

Reference, Pennebaker, James, The power of expressive writing: https://journals.sagepub.com/doi/10.1177/1745691617707315

Election Hangover Symptoms

Vermont, 2016

Here’s some of what you might be feeling today (or into the next several weeks), from the psychological perspective.

Fatigue – Constantly thinking about politics and worrying about the outcome of the election can give you tunnel vision. We just don’t have the cognitive and emotional energy to expend any more thought or emotions without an effect on mental health.

Anxiety Having feelings of anxiety is common. Anxiety is an ancient response, stemming from uncertainty and a sense of threat. Give yourself space, but seek professional help if it feels extreme.

Gloominess – This is also a direct result of uncertainty about what the future will hold.

Mental fog – Constant, chronic, and building stress can cause mental fogginess. It interrupts concentration. So does high anxiety. Plus, sometimes, the fogginess can have a more simple cause: You stayed up too late watching the election returns, you forgot to eat or hydrate, and your brain is just wiped.

How to Recover
Some hangovers (including election hangovers in 2020) can take a little longer to shake than others. But there are a few things you can do to recover a little quicker this time around.

Remember that you did your part. You turned out to vote and hopefully encouraged your friends and family to do the same. Reminding yourself that you played an important role in a historic election and the democratic process can help give you a mental boost.

Distract yourself. If you feel especially anxious about the election results, That could mean reaching out to family and friends, reading a book, or binge-watching Netflix.

Consider disengaging with social media. Avoid aggressive and negative conflicts, drama, and toxic situations.

Get some sleep. I know getting quality shut-eye when you’re stressed can be a tall order. Try winding down your brain before bed with a (non-political) book, podcast, or listening to some calming music. 

Squeeze in a workout. Find time for some form of exercise. Moving your body helps release endorphins, which can help you feel more positive and alert. Even walking your dog is helpful.
Find some perspective. It can feel extremely difficult right now, but remember that no matter what the outcome, life will continue after the election. Just give yourself a little compassion. You’re hungover, after all.

At Embolden Psychology, we have put forth a number of recommendations for managing feelings like stress, boredom, anxiety, depression, fear, and loneliness during social distancing, including:

Shifting the mental framing of social distancing- believing that one is “safe at home” versus “stuck at home” can have a profound effect on sense of agency, and reduce feelings of helplessness and fear. Agency matters.

Maintaining remote social contact with friends and colleagues can help limit feelings of loneliness. Text, FaceTime, call.

Enjoying simple physical comforts, like a hot shower, sipping a hot beverage, cuddling a companion animal, or wrapping oneself in a blanket may reduce feelings of loneliness.

Please spend time outdoors. Our bodies cannot store vitamin D, and we need this essential nutrient for mental health and wellness. Whether it’s taking a walk down your street or sitting on your deck, sunlight is essential.

Keeping to routines. Go to bed at the same time, wake up at the same time, as much as possible. Make sure you eat at regular time intervals. Keeping to a schedule helps maintain mental health.

Resources that rock:
1. SAMHSA Disaster Distress Helpline: 24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters–call 800.985.5990
2. 7 Cups: A free online text chat service that connects individuals with a trained listener for emotional support and counseling – visit: www.7cups.com
3. National Suicide Prevention Lifeline: Those who are experiencing suicidal thought and impulses can call 800.273.8255 or text HOME to 741741 for support

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.

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.