I have anxiety, chronic depression, and excoriation disorder – I’m also a master’s level psychotherapist with my own private practice.

My life story and diagnosed mental disorders contradict the general public’s idea that a psychotherapist is some sort of “Buddha-like creature” that has mastered the art of suffering while also helping others through their pain.

I think one of the most beautifully difficult things about being a therapist with mental illness is that I haven’t mastered my own mental health. Yet, I’m still able to help others through their suffering. I don’t know if I’ll ever fully overcome the disorders and struggles I’ve been given, but I’ve learned how to use my own pain and trauma to help my clients through theirs.  

RELATED GOODTHERAPY ARTICLE: Coping Skills: How to Develop Them for Your Daily Life

It Can Be a Long Road 

The amount of pain, energy, time, and money involved in mental illness and its treatment can be incredibly overwhelming. I’ve been in individual therapy since the age of 13, received inpatient psychiatric treatment at the age of 19, and I’ve tried over ten different medications for depression.

Two years ago, I attended a ten-week-long self-compassion course in hopes that I’ll stop trash-talking myself 24/7.

I’ve undergone countless blood tests and a sleep study to try and address my chronic fatigue.

At 25, I attended group therapy in addition to my individual therapy to help me learn just how powerful relationships can be in terms of triggering my anxiety and feelings of inadequacy due to my anxious attachment style.

Just recently, I completed eight weeks of Transcranial Magnetic Stimulation (TMS) for both anxiety and medication-resistant depression.

I’ve spent hundreds of dollars on skin care products and scar gels to try and erase the fact that my entire body is covered in scars from over a decade of compulsive skin-picking.  

 My Experiences Help My Clients

When I read the above paragraph, I feel a sense of profound sadness and grief from what I’ve endured, but my difficult experiences have made me a better therapist.

Because of my anxiety, I know that sometimes, no matter how much cognitive challenging and deep breathing I do, I still could respond from a place of pure panic and make the situation worse.

Because of my depression, I understand how you can feel so unwanted and repulsive that you want to die, and no amount of uplifting words from others can take that pain away.

I’m able to recognize that replacement behaviors or distractions for compulsive behaviors oftentimes don’t even make a dent, so we have to brainstorm quite a repertoire of potential interventions. When clients ask me for answers, begging for ways to end their pain, I simply sit with them because sometimes sitting with them is all you can do. 

I realize that what worked, or didn’t work, for me and my mental health is not applicable for everyone. I draw from my own hardships because it helps me makes sense of the things I continue to experience on a daily basis despite my many years of pursuing healing.

I think the most profound thing I’ve learned as a therapist with mental illness is that sometimes we get so caught up in our ultimate goal of being healed that it actually stops us from healing. There is a romanticized idea of healing that is portrayed as someone constantly being at peace or no longer feeling intense pain, but that’s not what healing is.

Healing is a lifelong process that takes consistent time, effort, and courage because we will never be free from suffering in this life, but we can also find comfort in knowing we are never truly alone in our pain. We can learn to still experience joy, freedom, love, and all of the wonderful things in life while acknowledging that moments of suffering are inevitable.  

RELATED GOODTHERAPY ARTICLE: When Is It Time to Find a Therapist?

Take Care of Yourself While Caring for Others 

Being a psychotherapist is a difficult career that requires a lot of self-awareness and self-care. Not all therapists have mental illness or trauma, but we all experience pain and feelings of inadequacy, and making sure we take proper care of ourselves is one of the most important parts of our job.

The concepts of self-awareness and self-care as a therapist become even more vital when you have your own disorders or difficult life circumstances going on. My countertransference is often very strong in sessions because of my past experiences, but I’ve learned to use it as a therapeutic tool that allows me to stay empathically attuned to my clients.

I’m also aware that I have to be careful and take time to process my countertransference with the help of ongoing supervision and personal therapy to make sure my own emotions aren’t negatively influencing my practice. It’s about finding a balance between using our experiences as a point of reference, but not becoming blinded or consumed by them. 

If you’re a therapist with mental illness, I see you and I understand you. If you’re a therapist with no mental illness, but you’re stressed out of your mind and feel inadequate, I see you too. Life is hard and we picked a hard job to go along with it – there’s a lot of power in being open about this and our common humanity.

We can use our pain to help us become better clinicians only if we take the time to address it and care for it. You can’t expect your clients to trek and wade through the depths of their suffering if you haven’t done it yourself. No matter what your story is, take the time to explore it. It has the power to become your strongest asset as a clinician. 

by Jennifer Leff, Licensed Clinical Social Worker, in New York, NY
Co-Chair, Behind the Scenes Mental Health/Suicide Prevention Initiative Steering Committee

What’s Going On Behind the Scenes? Mental Health and the Entertainment Industry

No doubt, the pandemic has impacted most industries. However, the entertainment industry was the first to shut down and will be the last to fully re-open. Entertainment industry workers, specifically those behind the scenes, have long experienced mental health challenges and stereotypically, haven’t easily accessed services. The pandemic has only further shed a light on individuals in the entertainment industry, and with this, a strong call for mental health professionals who are equipped to provide support and tailor their clinical practices for those working behind the scenes.

The Need

According to NAMI (National Alliance on Mental Health), one in five adults will experience or has experienced a mental health struggle. In 2019, this individual represented 19.1% of U.S. adults – that is to say about 47.6 million living with a mental illness. Now, triple that number. Individuals working in the entertainment industry — actors, musicians, stage production, roadies — those in front of and behind the set/stage — are approximately three times more likely to struggle with mental health challenges. Moreover, there is a disproportionate struggle with substance misuse in this population. While Arts and Entertainment can transcend emotions and benefit our well-being, it’s somewhat ironic that production and tech workers — the ones we don’t see — are, in fact, suffering. Behind the Scenes, a nonprofit foundation that provides support to entertainment technology professionals, created the Mental Health and Suicide Prevention Initiative to support entertainment industry workers and promote mental health and psychological safety.

The Unique Pressures of Technical Workers

The rigors and unique stressors of entertainment industry work have a negative impact on well-being and mental health. Common industry threads include financial instability, irregular hours, transient work and its impact on relationships, and lack of permanency. Bullying, harassment, and intimidation can occur, and leaders often don’t know how to provide support. This can make people even more vulnerable. It’s also not uncommon for those working in the entertainment industry to lack insurance that covers behavioral health costs.

We Need Therapists Who Get It

It is vitally important to have a cadre of therapists who are familiar with the industry, cognizant of how anxiety, depression, and PTSD are triggered in these workplaces, and willing to adjust their practices to meet the needs of this population (for example, by incorporating sliding scales). Behind the Scenes is passionate about helping industry workers and their families access support and find mental health professionals who get it — and we’re excited to partner with GoodTherapy to help make those connections.

The old adage “the show must go on” is exactly that — old. The show can’t go on if a show’s production — sound, lighting, costume design, and more —  comes to a halt. We’ve seen an uptick in the entertainment industry talking about mental health and wellness; the pandemic has further fueled this discussion. If we continue this conversation and this cultural shift in the way we view mental health, the show can go on in a way that is healthy and sustainable for all.

Mental Health Trumps Reputation

If you go behind the scenes, “reputation” is ubiquitous. Industry workers don’t want to jeopardize their reputation or perceived reliability should they take time off or admit to needing support. It’s okay to not be okay, and it’s human to need help.

Let’s not wait for Suicide Prevention Week or Mental Health Month to highlight mental health or encourage permission to address mental health needs. Check in with friends and colleagues. Next time you’re watching TV, enjoying a music festival, or sitting in a theater audience, think of the rigger or the lighting tech and recognize their work and challenges. If you’re in the industry, know you’re not alone. Support is available for you.

Ready to find a therapist who gets it? Search for therapists near you, then filter your results by Industries & Communities Served > Entertainment Industry.

by Allie Dainow, Registered Psychotherapist (Qualifying), in Toronto, ON, Canada

“That Never Happened” — Experiencing Gaslighting

What Is Gaslighting?

Gaslighting is when someone distorts reality, which has the intentional or unintentional effect of causing another person to doubt their own perceptions. It has become such a commonly used term that there are even songs about it. In the Chicks’ (formerly known as the Dixie Chicks) song titled “Gaslighter,” Natalie Maines sings about someone cheating on her and trying to convince her she was imagining it:

You just had to start a fire, had to start a fire
Couldn’t take yourself on a road a little higher
Had to burn it up, had to tear it down
Tried to say I’m crazy
Babe, we know I’m not crazy, that’s you
Gaslighting

The term first originated from the 1944 movie Gaslight (based on a play written in 1938), in which a husband tries to prevent his wife from realizing that he’s a criminal by altering her reality and trying to make her believe she is imagining what’s happening. The title itself specifically comes from a scene where he makes the gaslights in the attic flicker and, when she asks him why they’re flickering, he tells her that she’s hallucinating it.

Gaslighting is a very common behavior that is used in many different situations and relationships to gain power and control. It also occurs at a group level, often with women and other marginalized groups, whose experiences are frequently dismissed, seen as “crazy” and “too emotional,” and judged by double standards (Sweet, 2019).

Understanding Why People Gaslight

Healthy ways of dealing with negative behavior involve acknowledging it, reflecting on why it happened, and trying to learn from it. Gaslighting occurs when the person is aware, either consciously or unconsciously, that their behavior is inappropriate in some way, but they are unable to acknowledge this because they cannot handle the guilt and shame associated with it. It is very commonly used as a narcissistic defense, because narcissists attempt to compensate for a core of shame by presenting themselves to others (and often convincing themselves) that they are perfect. They cannot admit to negative behavior (even if it’s actually quite minor) because it’s too threatening to this image. Narcissists also become immune to this sense of shame by developing a sense of shamelessness, which allows them to engage in unethical and cruel behavior that others wouldn’t.

Strategies Used in Gaslighting

There are several common tactics that gaslighters use to manipulate others. They can have a preferred strategy that they use the majority of the time or cycle through several of them, especially if the first ones they use are not having the desired effect. These tactics include:

• Denial — Claiming that something that happened didn’t happen or that something that didn’t happen did.
• Distraction — Changing topics to something unrelated.
• Deflection —  Blaming the situation on someone other than themselves. There are several different ways they try to deflect, including:
  • Projection — Denying they behaved negatively and accusing someone else of the behavior they engaged in.
  • False equivalencies — Excusing their inappropriate behavior by comparing it to a minor mistake that the other person made and acting as though those actions are of the same severity, e.g., “Yes, I did that, but what you did was just as bad (or worse).”
  • Black and white standards —Emphasizing mistakes the other person made to make them believe they’re at fault. This is effective because the other person will almost always make some mistakes, since no one handles situations perfectly. This is different from false equivalencies because when using false equivalencies, the gaslighter will acknowledge mistakes on their part, but claim that other person’s were worse. With black and white standards, they will deny any wrongdoing on their part.
  • Bringing up past mistakes — Causing the other person to doubt themselves by bringing up previous incidents that are irrelevant to the current one where they did or remembered something incorrectly, e.g. “You know you have a problem remembering things.”
  • Claims of misinterpretations — Saying that they didn’t do anything wrong and the problem is that the other person misinterpreted or misunderstood what they said or did.
• Omitting context — Presenting the other person or their behavior as bad by neglecting to mention the context in which it occurred, which would make it understandable or reasonable.
• Overnormalizing — Insisting that their behavior is fine because “everyone” does it when in actuality most people would not behave this way.
• Comparing to extremes — Downplaying the severity of their actions and framing them as acceptable or even good by bringing up examples of worse behavior that they didn’t do e.g. “What I did wasn’t that bad.”
• Invalidation — Minimizing and trivializing your feelings and the effect that an experience had on someone else, e.g., “You’re oversensitive,” “This isn’t a big deal,” “You shouldn’t feel that way.”
• Non-apologies — Giving apologies that deny any responsibility and put the blame back on someone else, e.g., “I’m sorry you felt that way,” “I’m sorry that you saw it that way.”
• Guilting/shaming — Making it seem as though the other person is doing something wrong or is a bad person for standing up against mistreatment, e.g., “You’re making me feel bad by bringing this up,” “You’re so negative.”

The Experience of Being Gaslit

Gaslighting can feel very disorienting, almost like having whiplash. It often causes us to leave a situation completely confused, wondering what just happened or thinking that something was wrong, but not being able to pinpoint what it was. It can lead to intense rumination where you go back and analyze every detail of a situation to ensure that you’re not imagining it. It’s exhausting to do this and it’s scary to feel like you can’t trust your own perceptions. Once you start to uncover what really happened, it can be extremely upsetting, disturbing, and infuriating. Gaslighting, especially when experienced repeatedly, can cause adverse psychological effects, including chronic self-doubt, shame, isolation, depression, anxiety, impaired relationships, trauma, and physical symptoms related to stress (Christensen & Evans-Murray, 2021, Pietrangelo, 2019).

Responding to Gaslighting

Trying to have a conversation with someone who’s gaslighting you is incredibly difficult and draining. Here are some strategies for how to communicate with them:

• Redirection — If they’re trying to distract you by changing the topic, keep redirecting the conversation back to the situation at hand.
• “I” statements — This is an assertiveness skill where you communicate how their behavior affected you and set a boundary (“I felt ______ when you did ______ so I would like it if you did/didn’t ______”). This is meant to be a non-blaming way of communicating that focuses on your experiences, which can reduce denial and defensiveness from the other person.
• The broken record technique — This is also an assertiveness skill where you can repeat what you’re saying if you think the other person is not hearing you (Larsen & Jordan, 2017). In this case, if the gaslighter is claiming you’re wrong about the facts, you can repeat and assert the facts.
• Collaboration — Try to find common ground by talking to the other person about the shared goal or values you have and how you can go about achieving them. This can shift the conversation’s tone to cooperation, rather than antagonism.
• Walking away — Talking to someone who’s gaslighting can be like talking to a brick wall. No matter what you say or how much evidence you provide, nothing gets through to them, and sometimes it’s just not worth it to keep trying. You can let the person know that you don’t think this conversation is productive and you’re not going to continue it.

Recovering from Gaslighting

It is important to give yourself time to identify that you were gaslit and process what happened. You can use mindfulness strategies to detach from your thoughts and reduce the urge to ruminate about it until you’re ready to reflect on it or if the distress from this is interfering with other aspects of your life. These might include meditation or thought diffusion techniques from Acceptance and Commitment Therapy, such as saying to yourself “I’m having the thought that…” before a distressing thought in order to distance yourself from it (Harris, 2006).

In order to process the feelings that arise from being gaslit, we need to identify and validate them. We often invalidate ourselves and say that we shouldn’t feel a certain way or that our reactions don’t make sense, but when we try to understand why we might have reacted that way, we realize it makes sense and stop criticizing ourselves. In the case of gaslighting, it is an extremely unpleasant experience, and it makes sense that you would experience negative emotions in reaction to it. It’s very helpful to practice self-compassion, which involves noticing these difficult thoughts and feelings and being kind to yourself about them. Many people describe self-compassion by saying it’s like speaking to yourself the way you would to a good friend.

Sometimes knowing that you were gaslit can stop you from criticizing yourself, but other times this just makes us feel bad and blame ourselves for being manipulated. Unfortunately, gaslighting is a very common behavior because it’s effective. The very nature of gaslighting makes it so difficult to identify what’s happening because it disorients you and makes you even wonder if you’re being paranoid for questioning the gaslighting behavior. Many of us also want to give others the benefit of the doubt and think that perhaps we did misremember or misinterpret their behavior because it can be so difficult to accept that not only did the initial hurtful behavior happen, but that the gaslighting did as well. It’s important to be self-compassionate about the pain you have experienced from both. Try to remember that the problem isn’t you, it’s the person who did the gaslighting.

References

Christensen, M., & Evans‐Murray, A. (2021, May). Gaslighting in nursing academia: A new or established covert form of bullying? In Nursing Forum.

Harris, R. (2006). Embracing your demons: An overview of acceptance and commitment therapy. Psychotherapy in Australia, 12(4).

Larsen, K. L., & Jordan, S. S. (2017). Assertiveness training. Encyclopedia of Personality and Individual Differences, 1-4.

Pietrangelo, A. (2019, March 29). What are the short and long-term effects of emotional abuse? Healthline. https://www.healthline.com/health/mental-health/effects-of-emotional-abuse

Sweet, P. L. (2019). The sociology of gaslighting. American Sociological Review, 84(5), 851-875.

7 Indicators That You Might Be Experiencing Social Anhedonia

Life comes with ups and downs, joys and sorrows, mourning and celebration. Our emotions can act as a useful indicator of when you might need support. For most people, pleasure, happiness, and joy are tied to many life experiences. What if you could not feel these things? If that’s happening to you, you may be experiencing anhedonia.

What Is Anhedonia?

You may have heard of hedonism, the pursuit of pleasure. Anhedonia is its opposite — the inability to enjoy something. We use the term anhedonia when someone is unable to enjoy the good things in their life.

There are two types of anhedonia. The first is physical anhedonia, which is when someone cannot enjoy physical sensations such as physical touch from another person or the taste of food. The second is social anhedonia, which is when someone cannot enjoy the companionship of other people. Both types of anhedonia can be symptoms of depression, other mental health conditions, and physical health conditions, as well as side effects of certain medications.

How Common Is Social Anhedonia?

Social anhedonia is more common than its physical counterpart. It is not comparable to social anxiety; it’s not introversion or fear, resentment, or negative feelings about social situations. Instead, anhedonia refers to a diminished or missing capacity for enjoyment.

7 Signs of Social Anhedonia

1. Social Withdrawal

Social withdrawal is the avoidance, removal, or isolation of yourself from social activities. This could look like no longer showing up to social gatherings like family dinners or a night out with friends, or even no longer engaging with friends remotely (through texting, social media, etc.).

2. Lack of Relationships

Social anhedonia can make you uninterested in relationships with other people. You may find yourself no longer wanting to pursue and maintain friendships, romantic relationships, and/or family relationships. If interpersonal interaction is not enjoyable to you, you may refrain from engaging in the relationships you have or starting new relationships.

3. Reduced Emotional Response

While most people might smile, hug, and celebrate the news and lives of their loved ones, people with social anhedonia might struggle to do so. Symptoms include a reduction or inability to show and feel emotional responses to social interactions, both verbal and nonverbal.

4. Depression

Both physical and social anhedonia can be rooted in preexisting depression, but this does not apply in all cases. If you’re struggling with some form of depression and find yourself withdrawing or preferring solitude, you might be experiencing social anhedonia. Be sure to mention this symptom to your doctor or mental health provider – it will help them help you.

If you are experiencing an inability to enjoy the good in your life and you aren’t already working with a physician or therapist, consider doing just that. A physician can look at possible physiological causes (like an out-of-whack thyroid, certain vitamin deficiencies, or medication side effects) for your symptoms, and a mental health professional can help you heal whether the causes are physical or not. Reach out to a therapist in your area today!

5. Poor Social Adjustment

When facing a new situation where you must adjust to the social climate, you might struggle to adapt if you’re dealing with social anhedonia. The skills you’ve acquired and are used to using in this type of setting may no longer be working for you. You might feel like you have to “fake it” in social situations where you’re not feeling genuine pleasure.

6. Decreased Overall Positivity

Another indicator of social anhedonia is the inability to be positive. The old you might provide encouragement, offer solutions, or bring optimism to a situation, but social-anhedonia you might not be able to. Instead, you might tend to say nothing or be pessimistic.

7. Monotone or Flat Vocal Expression

Lastly, if you’re feeling no pleasure or joy, you might also use a monotone or flat vocal expression that sounds uninterested or distracted. If this is a trend over time (versus, say, just a couple of days of flat verbal affect due to feeling blue, down, or exhausted), it could indicate social anhedonia.

Conclusion

Social anhedonia is more common than you might think. It’s a major symptom of depression. If you are experiencing any of these indicators or symptoms, consider working with a mental health professional. To learn more about your options, click here.

Struggling with anhedonia or depression? Start your search for a therapist who can walk this road with you and help you heal.

References

Healthline. (2018, September 17). Anhedonia: Symptoms, Treatment, and More. Healthline. https://www.healthline.com/health/depression/anhedonia.

Things Aren’t That Bad: 5 Reasons People Give to Avoid Getting Professional Help

According to the National Alliance on Mental Illness, 1 in 5 adults experience mental illness, but not all of them seek out professional help. In fact, nearly 60% of adults with mental illness do not seek mental health help. With a seemingly endless list of consequences, not getting help for mental illness can result in increased dependency on substances, increased risk of suicide, disruptions in your everyday life, and much more. Even though it is dangerous to avoid getting professional help, many adults still do. Below are five common excuses for avoiding therapy… and reasons to push past them. 

Common Excuses to Avoid Therapy

#1: “Things Aren’t as Bad as They Seem.”

Even if you’re dealing with a myriad of mental health-related issues, it’s very common for you to tell yourself and others that things are really not that bad. This excuse is often used when other individuals in your life point out differences in your behavior or notice you are going through a difficult time. Even though you are showing noticeable changes in your normal self, saying things are not as bad as they seem is an excuse that seeks to diminish those concerns. But this excuse suggests a “tough it out” attitude about mental health issues, which often doesn’t lead you out of those issues, but merely allows them to persist. You don’t have to suffer alone. 

#2: “Therapy Is Too Expensive.”

A common concern and excuse for avoiding professional help is the cost of therapy. Yes, therapy can be expensive, but not always. Depending on several cost factors, insurance may make it more affordable than you realize. Some therapists offer sliding scale rates, meaning that they have room in their practice for clients who need discounted rates. There may also be affordable and accessible mental health services in your area, just waiting to be explored. 

#3: “I Don’t Need Therapy.”

Sometimes we view professional help as a luxury or something that should only be used by people who suffer from seemingly “worse” mental health conditions than whatever we’re dealing with. The truth is, most mental health issues that adults experience are not considered severe at first, but they can become dangerous if left unattended. For example, mild depression or anxiety, left to fester, can grow into major depressive disorder. Seeking professional help can help you get your symptoms under control before they become overwhelming or dangerous. 

It’s important to note as well that constantly living in state of stress, depression, or anxiety can actually do a lot of harm to your everyday life. You don’t have to “hit rock bottom” for your struggle to be worthy of attention and care. You matter, your quality of life matters, and pursuing your own mental health is worthy no matter how things are going.

Keep in mind the ripple effects of learning better coping mechanisms, healthier ways of interacting, a strong self-image, and direction in personal growth over time. Learning to fight better with your partner, replacing your negative self-image with a positive one, or recovering from childhood trauma are treasures that you will take into every day for the rest of your life.

#4: “I Don’t Know Where to Start.”

If you don’t know where to start in seeking professional help, there are two great places to go. If you have an insurance carrier, you should start by calling them. The number of your insurance provider can usually be found on the back of your insurance card. You can learn more about your coverage for services and receive recommendations about covered professional help in your area directly from them. The second option is to look at an online directory of therapists. Here, you can find a list of therapists in your area who are ready to help.

#5: “I’m Too Busy.”

We all know that life can get busy, and it can seem like we do not have time to spare. This can feel especially true when we’re considering something we do not really feel excited about. But making time to get professional help is worth it. With the support of a therapist, you can learn to manage your mental illness, pursue personal growth in a way that frees you to be your best self, and let go of things that just aren’t serving you. There is always time for that. 

It Is Time to Get Professional Help 

No matter your situation, if you’re struggling with your mental health, you should seek professional help. To learn more about a therapist in your area who is ready to help you, click here.

What Is Smiling Depression?

Millions of individuals in the United States are battling depression. Whether genetics, circumstances, or a bit of both are the root cause, depression is a normal part of life for many. While some can say that they sought out help from a support system or professional when they thought they might have depression, it is not that easy for others. In fact, many find themselves pretending that they do not have it. They smile through the pain and force themselves to hide it from those around them. This phenomenon is known by the name “smiling depression.” 

What is Smiling Depression?

While you will not find smiling depression in the DSM, it is still a branch of clinical depression that many find themselves battling. “Smiling depression” refers to someone struggling with Major Depressive Disorder (MDD) who masks their symptoms. It is often referred to with the phrase “hiding behind a smile.” An individual might be dealing with this if they are trying to convince others that they are OK even though they are not.

Signs and Symptoms:

Individuals struggling with smiling depression (also known as High-functioning Major Depressive Disorder) will find themselves dealing with the classic signs of major depressive disorder. This includes feelings of sadness, hopelessness, anger, or irritability. It could also include loss of interest, tiredness, poor sleep patterns, reduced appetite, overeating, anxiety, and much more.

You may be dealing with smiling depression if you are experiencing these symptoms but are still high-functioning – keeping up with certain demands of life like your job and social calendar, which individuals more debilitated by their depression could not. Individuals with high-functioning MDD might also come across a cheerful or positive. They tend to feel the need to hide their depressive symptoms.

Why Do They Hide It?

There are a number of reasons someone with high-functioning MDD might hide their symptoms. Some common reasons are included below. 

Feeling Like a Burden

Many individuals who struggle with depression often feel as though they are a burden to those around them. In order to lessen that feeling, individuals might try to hide their symptoms.

Shame

While a lot of work has been done to break down the stigma of mental illness, it still exists. Some might try to hide their symptoms if they feel embarrassed or shameful about it.

Denial

Accepting that you might need help with your mental health is a huge step for many individuals. Individuals might hide their symptoms if they are in denial that they exist or do not want them to be real instead of reaching out to get help for depression.

Keeping Up Appearances

If someone is used to having a certain role in their life, they might hide their symptoms to keep up appearances. This can be a form of denial or trying to gain control over yourself and your situation.

The Major Risk of Smiling Depression

Those suffering from severe depression can often be at risk of suicide. The symptoms of depression can cause an individual to think about death. Those suffering from smiling depression are often at a higher risk of suicide because they are not getting the help they need. Due to their ability to function at a high-level, fewer people notice what they are experiencing. Those with smiling depression are more likely to commit suicide than those with low-functioning MDD.

Getting Help

If you think you think you may be struggling with high-functioning depressive disorder, it is vital that you seek the attention of a mental health professional. Working with a therapist near you can help you navigate your depression and find the help you need to feel better.

How to Help Others

If you think someone you know is struggling with smiling depression, share your concerns with them. It’s important to open up that discussion so they know they have someone they can trust in their corner. Listen to them and try to connect them with a mental health professional. Use the fact that you’re worried about a friend’s mental health as a springboard for action – move toward them, not away. You noticing that something is wrong and speaking up might be the encouragement they need to seek help.

To learn more about mental health professionals near you, click here.

Dealing with Depression

While each person has their own unique experience with their mental health-related issues, when you go inside the mind of someone dealing with depression, some commonalities exist across the board. It is important to both identify and understand what depressive episodes can look like for those battling major depressive disorder, what it is like to go inside the mind of someone dealing with depression, and how to give or get help.

Symptoms of a Depressive Episode

Depression does not look any single way when you go inside the mind of someone dealing with depression often experience a wide range of symptoms as they dip in and out of episodes. Some of the most common signs and symptoms of a depressive episode are:

• Feeling Sad or Down
• Difficulty Staying Focused
• Feeling Foggy or Disoriented
• Feeling Anxious
• Irregular Sleep Patterns
• Lack of Interest
• Fatigue
• Irregular Eating Patterns
• Suicidal Thoughts
• Feeling Lost, Hopeless, Directionless

Discover the positive affect that talk therapy can have on your life. Begin therapy today. Start your search here. 

Go Inside the Mind of Someone Dealing with Depression:

The signs and symptoms listed above are some of the most common experiences for someone facing a depressive episode, but the list does not stop there. Someone dealing with depression might encounter variations of these signs that manifest themselves physically and emotionally.

For example, someone dealing with depression, lacking interest in things that used to excite them could manifest itself as no longer engaging in hobbies or talents, but it could also present itself in emotional connections. One could feel disinterested in friends, family, or loved ones that you used to feel a strong emotional connection to. A physical manifestation of this symptom might involve a low sex drive, where one feels disinterested in sex/intimacy toward their partner or overall.

When someone is dealing with depression, one of the most common misconceptions is that the person is riddled with dark thoughts and sadness. While someone managing major depressive disorder can feel this way, the most common symptoms of depression relate to feeling tired, disinterested, overwhelmed, and directionless toward the future. 

What Causes Depression?

Depression is an increasingly complex mental health issue that is not limited to one cause or reason. Many different factors influence one’s tendency or susceptibility toward Major Depressive Disorder. The most common reason associated with depression is that there is a chemical imbalance when you go inside the mind of someone dealing with depression. Meaning, an individual lacks a certain chemical or maybe has too much of one, influencing their mood, thoughts, and experiences.

While this is true to a degree, it is extremely difficult to detail the exact cause of depressive disorders. Each individual is different in terms of what causes their depression as well as their predispositions toward experiencing an episode. So much is still unknown about how the brain functions and what happens when you go inside the mind of someone dealing with depression. What we do know is that certain external and internal influences catalyze one’s chance of experiencing depression. Some of the most common reasons someone might experience depression are genetic predisposition or navigating a major life event like the loss of a loved one.

What Should I Do If I Think I Have Depression or Someone I know Does?

The most important thing to remember if you think you or someone you know could have depression is that it can feel extremely isolating, or that you have to figure everything out by yourself. Depending on the severity, when you go inside the mind of someone dealing with depression, feelings of hopelessness and fear can enforce isolating actions like cutting off communication from friends and family. The truth is, no one should have to go through a depressive episode by themselves.

If you or a loved one could be experiencing a depressive episode, it is important to consult with a mental health professional. With the help of a therapist, you or your loved one can start to work constructively on how to manage symptoms go inside the mind of someone dealing with depression to get it under control.

Discover the positive affect that talk therapy can have on your life. Begin therapy today. Start your search here. 

How to Show Love When You’re Depressed

Learning how to show love when you’re depressed can save your relationships with loved ones. The first step is recognizing that depression looks different on every person, but a common question that comes up is how to show love when you’re depressed. Whether you have been diagnosed or think you might be dealing with depression and have yet to seek help, showing love to those in your life can look different during this season of existence. Learning how to show love when you’re depressed can also vary from person to person. If you or someone you love is trying to manage symptoms of depression, it may be time to consider getting the help of a therapist.

Remain Honest About What You Are Experiencing

A common tendency of someone managing depression is to put walls around certain emotions inside their mind. Unconsciously, depressive episodes can lead someone to unintentionally exclude someone they love from what they are experiencing. Isolating in nature, this mental health issue may cause someone to distance themselves from the people who care about them. Learning how to show love when you’re depressed should involve as much honesty as you feel capable of giving. Remaining honest about what you are experiencing can give the person you love insight and understanding on how to be there for you.

Educate Your Loved Ones

After opening up and being honest with the people you love, you should then educate them on how depression might impact you during this season. By working with a therapist, you can start to put words, descriptions, and reasoning to your depression. With this knowledge, you can learn how to show love when you’re depressed while educating your loved ones on what you’re going through.

Do Your Best to Accept Their Help

When learning how to show love when you’re depressed, try your best to accept help. It can sometimes be frustrating or isolating when your loved ones are offering help, but not in the way you need. If you are unable to describe or put words to what it is that you need from them, do your best to accept the help in the form they are offering it to you. The more people you love that are in your corner, the more help and support you will have as you navigate your depression.

Be Patient with Yourself

When learning how to show love when you’re depressed, you need to spend time loving yourself. While you might not know how to show love to yourself during this time, try and understand that you are doing the best with what you have. Through working with your therapist and accepting the support of your loved ones, you are working toward success and freedom. Being patient with yourself and the pace at which you heal is essential to learning how to show love when you’re depressed.

Get Professional Help

Getting the help of a qualified mental health professional is the key to learning how to show love when you’re depressed. Your therapist can teach you ways to manage and cope with your depression while also getting you connected to the resources you need to conquer it. Rather than trying to help yourself on your own, accept the help of your loved ones and your therapist.

Search for a therapist near you today. 

Over 17 million adults in the United States had at least one major depressive episode in 2017 (National Institute of Mental Health, 2019). Globally, more than 264 million people of all ages experience depression (World Health Organization, 2020).

In the United States, major depressive episodes are more common among adult women (8.7%) than adult men (5.3%). At 13.1%, young adults, aged 18-25, had the highest rate of major depressive episodes (National Institute of Mental Health, 2019).

As our understanding of mental health increases, we are beginning to look at how the environment of our parents and grandparents influences our own health and the health of our offspring. This knowledge is based on new research that investigates the epigenetic processes which regulate how the environment affects the expression of genes that relate to mental health generally and to depression in particular (Sun et al., 2013).

As our understanding of mental health increases, we are beginning to look at how the environment of our parents and grandparents influences our own health and the health of our offspring.

Environmental Impacts of Depression: Past and Present

Mental illness is incredibly complex and is influenced by a host of biological, chemical, and environmental factors. Depression, for example, is much more than low mood, negative thoughts, or a chemical imbalance in the brain. When we look at the biological component of depression, we see just how powerfully environment may determine our vulnerability to developing depression and how these environmental effects occur and accumulate over the generations.

We know childhood abuse and neglect can have lifelong impacts on the health and well-being of the child. But what about looking into the environment of our ancestors? We are beginning to understand how our parents’ and grandparents’ environment impacts our own and our children’s mental health.

Epigenetics, in its simplest meaning, refers to the stable changes in gene expression without modification of the DNA sequence. In the context of depression, these changes are often triggered by severe stress, and they can result in an increased vulnerability in the brain’s limbic regions (Nestler, 2014). The limbic regions of the brain are implicated in depression, as they are involved in emotion regulation, self-preservation, and the desire to procreate (Pandya et al., 2012). These changes in gene expression can be passed down from parents to offspring. However, the exact process of how this happens is still largely mysterious (Kaneshiro et al., 2019).

While the mechanism of transmission is not clear, the results of environmental exposure to risk factors for depression are measurable. We now know that the stress of our parents and grandparents can cause increased vulnerability to depression in ourselves and our children. The vulnerability to depression can be passed down through generations. This is true even though we may not have experienced early abuse, trauma, or neglect.

Change in Both Directions: How Environment Can Nurture

Epigenetic changes can also occur because of positive experiences such as supportive, healthy relationships and learning opportunities. Good physical health also influences gene expression in a positive way. Having access to nutritious food and a healthy lifestyle may also have a protective effect on mental health.

Even in adulthood, our brain continually changes with experience. For example, chronic anxiety resulting from early adverse childhood experiences can be improved by stress-reduction interventions (Hölzel et al., 2010). For adults, living in a healthy environment without prolonged exposure to severe stress can have a real impact on increasing resilience and reducing a person’s vulnerability to developing a mental health issue.

If we provide a healthy, nurturing environment with supportive relationships for our children, we can improve their resilience against developing depression. A healthy diet and exercise are included as part of an optimal environment for children. (According to researchers, a healthy diet, especially for growing infants and children, does not mean a fat-free diet. Fat is essential for neurological development and brain function (Milner & Allison, 1999).)

Therapy Can Improve Resilience

Part of moving toward a healthy lifestyle can include working with a therapist who incorporates cognitive behavioral therapy (CBT). CBT is an individualized process that has been shown to be effective for reducing stress, anxiety, and depression. CBT works on negative and unrealistic thought patterns and unhelpful behaviors. Additionally, therapy is a supportive relationship that allows for the healing of underlying issues that may be causing distress. Therapy and CBT can lead to improvements in mood and reduction in stress that will reduce anxiety and, over time, lead to improvements in brain areas associated with depression.

In summation, our environment, even the environment of our parents and grandparents, has an important impact on our mental health. It is important to understand that when you take care of yourself and your children, you are not only improving your own health—you may also be improving the lives and health of future generations who have not even been born yet.

References:

1. Depression. (2020, January 30). World Health Organization (WHO). Retrieved from https://www.who.int/news-room/fact-sheets/detail/depression
2. Hölzel, B. K., Carmody, J., Evans, K. C., Hoge, E. A., Dusek, J. A., Morgan, L., Pitman, R. K., & Lazar, S. W. (2010). Stress reduction correlates with structural changes in the amygdala. Social Cognitive and Affective Neuroscience, 5(1), 11-17. doi: 10.1093/scan/nsp034
3. Kaneshiro, K. R., Rechtsteiner, A., & Strome, S. (2019, March 20). Sperm-inherited H3K27me3 impacts offspring transcription and development in C. elegans. Nature Communications, 10(1271). Retrieved from https://www.nature.com/articles/s41467-019-09141-w
4. Major depression. (2019). National Institute of Mental Health (NIMH). Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression.shtml
5. Milner, J. A., & Allison, R. G. (1999). The role of dietary fat in child nutrition and development: Summary of an ASNS workshop. The Journal of Nutrition, 129(11), 2094-2105. doi: 10.1093/jn/129.11.2094
6. Nestler, E. J. (2014). Epigenetic mechanisms of depression. JAMA Psychiatry, 71(4), 454-456. doi: 10.1001/jamapsychiatry.2013.4291
7. Pandya, M., Altinay, M., Malone, D. A., & Anand, A. (2012). Where in the brain is depression?. Current Psychiatry Reports, 14(6), 634-642. doi: 10.1007/s11920-012-0322-7
8. Sun, H., Kennedy, P. J., & Nestler, E. J. (2013). Epigenetics of the depressed brain: Role of histone acetylation and methylation. Neuropsychopharmacology, 38(1), 124-137. doi: 10.1038/npp.2012.73

According to a recent Gallup poll, 44% of full-time employees experience occasional burnout, with an additional 23% reporting frequent or constant burnout. A person’s desire to work hard, be productive, and succeed at work may come into conflict with their need for time with family and desire for a fuller life that isn’t just defined by work.

Most workers say work is more demanding today than it was a generation ago. Research consistently shows Americans face higher burnout rates than people living in other nations. This suggests burnout is widespread cultural problem, not just an individual struggle.

Burnout Basics

The World Health Organization now recognizes burnout syndrome as a clinical syndrome. Because burnout is closely related to working conditions, however, burnout may not get better until a person changes jobs or their workload becomes more manageable. While therapy can help a person identify burnout and work toward solutions, their distress may continue until their working environment improves.

A Gallup study looking at employee burnout identified five factors that best predicted burnout:

• Unfair treatment at work
• A workload that feels unmanageable
• Poor communication and low support from a manager
• Inadequate clarity about one’s job role or tasks
• Time pressure and unreasonable deadlines

People experiencing job burnout may worry the problem is their inability to handle the workload or to fit in at work. The evidence suggests otherwise. Employer and management practices are a major predictor of job burnout. But sometimes, what feels like burnout is actually something else.

Depression vs. Burnout

Distinguishing depression from burnout can be difficult, because both cause emotional exhaustion, low motivation, and anhedonia (difficulty finding pleasure). Moreover, burnout is a risk factor for depression. So it’s possible to be both depressed and burnt out.

Some factors that may distinguish one from the other include:

• Burnout is closely linked to work. So a person may feel better after a vacation or during less stressful times at work.
• While burnout can affect motivation to do most tasks, a person is more likely to feel unmotivated at work. Depression affects motivation even to do tasks a person enjoys.
• The negative emotions of burnout center around a person’s job. A person may feel cynical or frustrated at work, less effective in their role, or frequently feel angry about work.
• Burnout symptoms tend to get worse during times of high work stress.

Anxiety vs. Burnout

Burnout can cause immense anxiety, especially when a pile of work accumulates and a person does not feel equipped to tackle it. When anxiety extends beyond work or does not get better when a person’s working conditions change, the culprit might be an anxiety diagnosis such as generalized anxiety or posttraumatic stress (PTSD).

Some signs that the problem might be anxiety and not burnout include:

• The anxiety does not improve when a person’s workload gets more manageable or when they take time away from work.
• The anxiety is not limited to work-related matters.
• A person has a history of anxiety or trauma unrelated to work.
• Anxiety causes problems at work, such as when a person is too anxious to say no to a request from a boss—especially if there’s no reason to believe the boss will react unreasonably.

When Job Burnout Comes with Company

Burnout is more than just frustration with work. It’s a serious affliction that can affect a person’s physical and mental health. Possible physical health effects of burnout include:

• A weaker immune system
• Insomnia and chronic exhaustion
• Heart disease
• Type 2 diabetes
• High blood pressure

These symptoms can compound the stress of job burnout and may even make other mental health symptoms worse. Physical health issues may also make a person less effective at work. Symptoms can force people to take time off, potentially making the stress of a hefty workload even worse.

People experiencing burnout should know there is also significant overlap between mental health diagnoses and job burnout. A person with a mental health condition is more vulnerable to job burnout, and a person with job burnout is more likely to develop a mental health condition.

Mental health interacts with workplace challenges in complex ways. For example, a person with generalized anxiety may struggle to discuss unfair job expectations with their boss. A person with depression may be unable to take pride in workplace accomplishments.

Mental health is complex, with biological, social, psychological, and environmental roots. It rarely has a single cause. The more risk factors a person has for mental health issues, the more likely it is that burnout will lead to a mental health condition.

When to Get Help

It’s not always possible to leave a bad job. That doesn’t mean a person has to struggle with burnout forever though. Self-care strategies such as using the vacation time one has earned, separating one’s identity from work, doing enjoyable hobbies, and getting plenty of rest can protect a person’s mental and physical health.

A therapist can provide a healthy outlet, brainstorm solutions, and offer strategies that may help mitigate burnout. When a person is ready to leave their job, the right therapist can support them during their job search. A therapist can help with common job search challenges, such as impostor syndrome, anxiety, and low self-confidence.

People struggling with depression and anxiety may believe medication is the only option. Yet therapy can also prove invaluable. When a person uses medication, therapy increases its efficacy. And when a person prefers to avoid medication, therapy is a viable alternative that can help a person master new coping skills. Research shows therapy can even change the brain.

When burnout and other mental health issues collide, it’s even more important to get quality mental health care. A therapist can help a person sort through their emotions, develop viable solutions to workplace challenges, and steadily work their way out of the hole of burnout, depression, or anxiety.

GoodTherapy can help you find a therapist who specializes in burnout.

References:

1. Job burnout: How to spot it and take action. (2018, November 21). Retrieved from https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642
2. QD85 burn-out. (n. d.). Retrieved from https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/129180281
3. Schonfield, I. S., Bianchi, R., & Palazzi, S. (2018). What is the difference between depression and burnout? An ongoing debate. Rivista di Psichiatria, 53(4). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30087493
4. Smith, S. B. (n. d.). Americans tend to burn out faster than other countries’ workers—Here’s why. Retrieved from https://www.rd.com/advice/work-career/american-workplace-burn-out
5. Wigert, B., & Agrawal, S. (2018, July 12). Employee burnout, part 1: The 5 main causes. Retrieved from https://www.gallup.com/workplace/237059/employee-burnout-part-main-causes.aspx
6. Wigert, B., & Agrawal, S. (2018, July 16). Employee burnout, part 2: What managers can do. Retrieved from https://www.gallup.com/workplace/237119/employee-burnout-part-2-managers.aspx?g_source=link_wwwv9&g_campaign=item_237059&g_medium=copy
7. Wigert, B., & Agrawal, S. (2018, July 18) Employee burnout, part 3: How organizations can stop burnout. Retrieved from https://www.gallup.com/workplace/237185/employee-burnout-part-organizations-stop-burnout.aspx?g_source=link_wwwv9&g_campaign=item_237059&g_medium=copy
8. Workplace stress. (n. d.). Retrieved from https://www.stress.org/workplace-stress

George felt weighed down as he checked into yet another motel room. This was his ninth business trip in one month. He didn’t used to mind the traveling so much. Sure, it gets tiring, but he was also feeling irritable, disheartened, and down. He loosened his tie and collapsed on the bed.

Lifting his head, he noticed a notepad and pen on the bedside table. He sat there and started scribbling away, writing about everything and anything – whatever came to mind with no analysis or self-censorship. He just let words flow on to the page. After about 20 mins or so, he sat back with a sense of satisfaction. He felt lighter in his body and more clear-headed in his mind.

He decided to repeat this activity the next day before his first meeting. He even spent a few minutes in the end reflecting on some of the things that were going well in his life. As he left his room to go to work, he was pleased to feel the bounce in his step return.

Whether in movement, song, dance, art, music, or words, there is something natural and liberating about self-expression. Not surprisingly, it can be a useful medium for processing challenging moments and accumulated stress. It can also promote self-empowerment and acceptance.

I often invite my clients to try journaling. They usually ask me if there is a specific way to start. As it turns out, researchers have been studying expressive writing for a while now, seeking to determine what format works best for different issues. The following are some of the results.

Unstructured Expressive Writing

The classical writing instruction as a therapeutic practice was introduced by Pennebaker and colleagues in the 1980s. It goes as follows:

1. Write “your very deepest thoughts and feelings about an extremely difficult or emotional event that has affected you and your life…” (Baum & Rude, 2013, p.37).
2. Keep the flow of writing going for 20 minutes nonstop.
3. Don’t worry about spelling or grammar.

Gratitude Writing

Researchers also found keeping a gratitude journal can have a significant positive effect on mental health. It can create a greater sense of optimism and life satisfaction (Froh, Sefick, & Emmons 2008). A simple daily or weekly gratitude journal involves taking a few minutes to bring to mind things you are currently grateful for. Items on the list can be grand or mundane: “I am grateful that my kid is healthy” and “I am grateful for my toothpaste” are both acceptable.

Then there are gratitude letters. Researchers compared the difference between psychotherapy on its own, psychotherapy with expressive writing, and psychotherapy with gratitude letters. They discovered the option involving gratitude had the greatest beneficial impact. Here’s the gist of their approach (Wong, Owen, Gabana, Brown, McInnis, Toth, & Gilman (2018)):

1. Choose a specific person to address your gratitude letter to. The purpose is not to send the letter, though you can if you want to.
2. Reflect on and write about what it is you are grateful for in this person.
3. Repeat this exercise over an extended period. You can choose the same person as your addressee or a different person.

Expressive Writing for Depression

In 2013, Baum & Rude incorporated the benefits of mindfulness and self-compassion into the classical expressive writing practice. They discovered “expressive writing plus emotional acceptance” made a better impact on alleviating mild symptoms of depression than the classical approach to expressive writing. Both kinds of expressive writing helped mild depression more than regular writing. However, expressive writing was found not to be helpful for those with severe depression symptoms.

So if your depression symptoms are on the milder side, consider the following tips (Baum & Rude, 2013):

1. Be mindful as you write, taking an observer’s stance. Witness whatever difficult emotions that come out without judging them.
2. Include a paragraph that normalizes distressed responses in the face of difficulty and stops self-blame.

Expressive Writing for PTSD

This year, researchers published findings that expressive writing could help reduce the severity of posttraumatic stress (PTSD) symptoms. Consider the following structure (Sloan & Marx, 2018):

1. Write for 30 minutes every day and commit for at least 5 days.
2. Write from the present moment looking back, as opposed to imagining the trauma as if it were happening now; write while feeling anchored in the here-and-now, present and safe.
3. Go into the details of the events as you remember them, including thoughts and emotions.
4. Be a nonjudgmental observer of the writing.
5. Revisit the same event in your subsequent writing sessions instead of moving on to other incidents.

If you find yourself getting stuck, consider asking yourself some of these questions I adopted from different somatic psychotherapy approaches – including Somatic Experiencing and EMDR – that work with trauma:

1. “What happened next?”
2. “Who was there to help you?”
3. “When did you know you were safe?”

Expressive Writing for Test Anxiety

Studies have found expressive writing helps students with high test anxiety perform better. So if you are a teacher, consider adopting the following activity for your students (Doherty & Wenderoth, 2017; Ramirez & Beilock, 2011):

1. Set aside 10 minutes for writing prior to the exam. (If time does not allow, 5 minutes can also be effective).
2. Let your students know the purpose of this writing activity.
3. Keep the writing anonymous.
4. Let it be an optional activity.
5. Instruct your students to write “as openly as possible” about their thoughts and feelings regarding the exam they are about to take.
6. When they’re done, or when time is up, instruct them to crumple the paper and throw it away.

If you are a student with test anxiety, see if your teacher will give you time to do this before the exam. You can also try it yourself. Find a quiet place near the exam room about 15 minutes before the exam. Use 10 minutes to do the expressive writing exercise and the remaining 5 to get to your exam on time and get settled.

Writing for Sleep Disturbance

In some cases, writing exercises can also help with sleep issues. Spending 5 minutes writing a simple to-do list for tomorrow can help you fall asleep faster. Conversely, writing about tasks you already completed can delay your ability to fall asleep (Scullin, Krueger, Ballard, Pruett, & Bliwise, 2018). So if you want to fall asleep quickly, you can use pre-sleep writing to clarify tomorrow’s activities and de-clutter your head.

Designing Your Own Writing Practice

If you decide to try writing your way to mental health, let yourself be curious and discover what is the best approach for you. If you already have a writing practice, great! If modifying based on the tips above, consider a combined power punch that incorporates a gratitude section into whatever writing practice you have.

If you are thinking of using expressive writing to process a traumatic incident or to manage depression, it might be helpful and even recommended that you do so with the added support of a trained mental health professional.

References:

1. Baum, E. S. & Rude, S. S. (2013). Acceptance-enhanced expressive writing prevents symptoms in participants with low initial depression. Cognitive Therapy and Research, 37(1), 35-42. doi:10.1007/s10608-012-9435-x
2. Doherty, J. H. & Wenderoth, M. P. (2017, August 11). Implementing an expressive writing intervention for test anxiety in a large college course. Journal of Microbiology & Biology Education, 18(2), 39. doi: 1128/jmbe.v18i2.1307
3. Froh, J. J., Sefick, W. J., & Emmons, R. A. (2008). Counting blessings in early adolescents: An experimental study of gratitude and subjective well-being. Journal of School Psychology, 46(2), 213-233. doi:10.1016/j.jsp.2007.03.005
4. Ramirez, G., & Beilock, S. L. (2011). Writing about testing worries boosts exam performance in the classroom. Science, 331(6014), 211-213. doi:1126/science.1199427
5. Rude, S. S. & Haner, M. L. (2018, February 13). Individual differences matter: Commentary on “Effects of expressive writing on depressive symptoms—A meta‐analysis”. Clinical Psychology: Science and Practice, 25(1), e12230. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/cpsp.12230
6. Scullin, M. K., Krueger, M. L., Ballard, H. K., Pruett, N., & Bliwise, D. L. (2018). The effects of bedtime writing on difficulty falling asleep: A polysomnographic study comparing to-do lists and completed activity lists. Journal of Experimental Psychology: General, 147(1), 139-146. doi:1037/xge0000374
7. Sloan, D. M. & Marx, B. P. (2018). Maximizing outcomes associated with expressive writing. Clinical Psychology: Science and Practice, 25(1), e12231. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/cpsp.12231
8. Wong, Y. J., Owen, J., Gabana, N. T., Brown, J. W., McInnis, S., Toth, P., & Gilman, L. (2018). Does gratitude writing improve the mental health of psychotherapy clients? Evidence from a randomized controlled trial. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 28(2), 192-202. doi:10.1080/10503307.2016.1169332

Many people who experience anxiety or depression know the symptoms of each are not always well-defined. For instance, they can overlap. Commonly overlapping symptoms of anxiety and depression include difficulty concentrating, sleep issues, tiredness, and loss of interest in previously enjoyed activities.

It is not always easy to tell which condition is causing symptoms. In many cases, people seem to experience aspects of anxiety and depression. They may not know whether they are dealing with anxiety, depression, or even both. One reason for this confusion is each condition’s ability to mimic the other.

Identifying one main cause of symptoms is not always possible or necessary. But knowing the root causes of your symptoms could help you find the best treatment approach. A deeper understanding of your experience may also help you feel more hopeful about seeking help.

Key Differences Between Anxiety and Depression

Anxiety is a constant feeling of worry. It can occur on its own or be triggered by certain events or factors. Physical signs of anxiety often include shortness of breath and tense muscles. People dealing with anxiety sometimes experience panic attacks, heart palpitations, and dizziness.

Depression is prolonged sadness or loss of interest in formerly enjoyable activities. It is characterized by low energy, feelings of low self-worth, and sometimes, suicidal thoughts. [fat_widget_right]

Symptoms that overlap between anxiety and depression often have different origins. For example, anxiety may cause a person to stop doing an activity or withdraw from a social setting. This is often because those things inspire panic. Depression can also cause someone to withdraw in similar ways. In the case of depression, withdrawal may be due to loss of interest in the activity.

Fatigue or loss of energy are other symptoms often linked to depression. But anxiety may also cause a loss of energy, which can stem from a sense of exhaustion. This tiredness is often caused by anxious thought patterns, obsessive thinking, or rumination. In the case of depression, loss of energy may be more likely to occur as a primary symptom.

Both conditions can cause social withdrawal or a change in activity levels. These symptoms can have vastly different causes. Different approaches may be necessary to address these causes.

Signs Anxiety May Be the Cause

If you identify with most of these symptoms, you may be experiencing anxiety:

• Cold, sweaty, numb, or tingling hands or feet
• Shortness of breath
• Heart palpitations
• Racing thoughts
• Dry mouth
• Nausea
• Dizziness

Being diagnosed with a specific anxiety disorder may also mean anxiety is a root cause. For instance, someone who experiences panic attacks or social anxiety may still have symptoms of depression. These may cause someone to withdraw from life, relationships, or social settings. This behavior can trigger feelings of hopelessness and loneliness, which may mimic depression.

Anxiety may also be a more likely cause if:

• You have a family history of anxiety
• You experienced shyness as a child
• You have experienced these symptoms from a young age

People diagnosed with depression may experience feelings of anxiety. The term for this is “anxious distress.” It is characterized by feelings of tension, restlessness, and difficulty focusing. The sense of hopelessness that can come with depression may cause worry about the future. Those who experience depression and anxious distress may be at a higher risk for suicidal thoughts. It is important to seek treatment in these cases.

Signs Depression May Be the Cause

Depression is categorized as major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). One key sign of depression is major depressive episodes. When these occur, symptoms of depression may become severe enough to limit daily functioning. Some other primary signs of depression are:

• Feelings of intense sadness
• Oversleeping
• Fatigue or feelings of being “weighed down”
• Feelings of hopelessness or guilt
• Slowed thought processes
• Thoughts of death or suicide

Some types of depression are easier to identify as such. For example, depression caused by a certain life event may be easy to identify. Postpartum depression, which occurs after childbirth, or seasonal affective disorder (SAD), include symptoms of depression that have distinct triggers.

People who mainly experience anxiety may also be diagnosed with one of these depressive conditions. In these cases, the conditions would be seen as co-occurring, or comorbid. This term is used when two separate conditions are both present.

The experience of swinging to and fro between anxiety and depression can be a frustrating one. It may feel like a negative cycle in which balance is much needed but difficult to attain.

Depression may also be a more likely cause if:

• It runs in your family
• You recently experienced a traumatic loss

If a person is only diagnosed with anxiety, they may still show signs of depression. People with anxiety may expend much of their energy toward worry. These thoughts can leave people with little energy for performing daily tasks or hobbies. When anxiety causes overwhelm or burnout, it may start to look like depression.

The experience of swinging to and fro between anxiety and depression can be a frustrating one. It may feel like a negative cycle in which balance is much needed but difficult to attain.

Do I Have Both Anxiety and Depression?

It can be difficult to tell if you have both anxiety and depression or if symptoms of one just look like the other. In one study, 72% of people with generalized anxiety had a history of depression. Meanwhile, only 48% of people with depression had a history of anxiety. But research indicates comorbid anxiety and depression may be more common than originally thought.

The study also points out that comorbidity can be cumulative. This means a person may experience anxiety and depression at different life stages. Some experts suggest that anxiety at a young age may increase the likelihood of experiencing depression in the future. But depression may also precede anxiety.

When You Are Confused About Your Symptoms

Questions or concerns about depression and anxiety should be directed to a trusted mental health professional. Therapists are often trained to identify the root causes of issues. Discussing your symptoms in therapy may help you discover the source of the issue that prompted you to seek help. Once you and the therapist identify the issue, you can learn how to overcome or manage it.

Talk therapy can be helpful in identifying the cause of certain symptoms. A trained therapist can help unravel your symptoms and see what may be causing them. Whether you experience anxiety, depression, or both, your therapist can help create a plan for addressing those conditions long-term. This may mean more therapy sessions, a support group, psychoeducation, or medication and treatment with a psychiatrist in conjunction with therapy.

Regardless of what next steps you take, it is important to remember that people experience anxiety and depression differently. It’s not always necessary to know every cause of a mental health issue to treat it. But labeling or identifying an issue, especially a root problem, may help reduce feelings of worry or uncertainty in some people. Remember that you are never alone. Any help and guidance for improving your mental health may only be one question to a trusted therapist away.

References:

1. Ankrom, S. (2018, February 15). Depression and anxiety. Retrieved from https://www.verywellmind.com/depression-and-anxiety-2584202
2. Anxiety disorders: Risk factors. (2016). Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#part_145335
3. Davis, J. (n.d.). Is it really depression? Retrieved from https://www.webmd.com/anxiety-panic/features/is-really-depression#1
4. Moffitt, T. E., Harrington, H., Caspi, A., et al. (2007). Depression and generalized anxiety disorder cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Arch Gen Psychiatry, 6(64), 651-660. doi:10.1001/archpsyc.64.6.651
5. Smith, K. (2018, February 13). Anxiety vs. depression: How to tell the difference. Retrieved from https://www.psycom.net/anxiety-depression-difference
6. Stressed or depressed? Know the difference. (n.d.). Mental Health America. Retrieved from http://www.mentalhealthamerica.net/stressed-or-depressed-know-difference
7. Wilcox, M. A., Kent, J., Canuso, C., & Wittenberg, G. (n.d.). The DSM-5 MDD anxious distress specifier: A useful predictor of risk: Suicide, comorbidities, disability, and treatments? Retrieved from https://isctm.org/public_access/Autumn2015/Poster/Abstracts/1-Wilcox.pdf