Written by Leisa Tanner
As a therapist, we will see many, many patients for many, many reasons. Each person who presents to us comes with a unique history; a story often of pain, confusion, hurt and sadness. Within these stories we often find common threads or similar experiences. Of these threads, undoubtedly the most common are symptoms of depression and anxiety which, if present for an ongoing period of time, can often feel overwhelming and intractable.
What does it feel like to have depression or anxiety?
Over the last twenty years of my counselling career, I have heard many patient’s accounts of what living with these two complex mental health diagnoses is like. Depression with its clinical symptoms of low motivation, low mood, despair and frequent teariness, difficulties with sleeping, eating and facing the day can feel like being stuck in a veritable emotional quicksand. One patient likened his experience of depression to being trapped inside a black box, unable to find the lid and see the light outside. Another reflected upon the feeling of being trapped beneath a heavy blanket of emotional fog which separated him from anything and everyone who might have given him joy.
Anxiety on the other hand can feel like being trapped in a life-threatening situation, every moment, every day. The simple activities of going to work, seeing friends or facing a myriad of everyday experiences can lead to a racing heart beat and elevated sense of impending doom. One patient likened it to living with a pervasive sense of dread, that something was about to go terribly wrong. Her mind was like a relentless security guard, always scanning the environment for potential threat. Its voice was powerfully seductive, encouraging her to retreat from anything that might threaten to overwhelm.
Living with both mental health diagnosis is exhausting. When our daily existence is dominated by either feelings of constant threat or a persistent lack of enjoyment, our mental energies can be drained considerably just by going about the everyday activities of life. Getting out of bed can feel impossible. Calling in sick to work can feel like a much safer option than facing the day. Making ourselves eat well can feel like a lifeless task.
It is at these times that self care, which is important for all of us, becomes vitally important. In my counselling sessions with patients experiencing depression or anxiety, I provide psychoeducation about these conditions. One of the core messages I try to convey is that both Depression and Anxiety need to be managed, and if they are not managed they often end up managing us. If we don’t actively and intentionally make choices which challenge the symptoms of these conditions, what we may find is that over time our initial presentation of symptoms has become a long standing mental health disorder. Enter the need for self-care.
What can I do to feel better?
Self-care with depression or anxiety is fundamentally important to recovery. Whilst the role of medication is often paramount in the treatment journey, so too is developing a mindset which includes taking an active role in nurturing ourselves. Incorporating healthy coping behaviours is a necessary component of lifting mood and managing the very seductive nature of these two disorders.
When I ask patients who present to therapy what they are doing currently to take care of themselves, often I will be met with an answer which both reveals the degree to which their diagnosis is impacting upon their daily existence as well as their readiness to do what needs to be done to shift its intractable grip.
Mary was a 49-year-old woman whom I had the pleasure of working with as she made her steady climb out of a dark pit of depression. We worked closely for six months to explore what had led to the depression and to identify practical and helpful strategies she could use to manage her mood. In our last session, we explored the many changes she had made which had enabled her to loosen the steady grip depression had had upon her following a series of life crisis which had left her feeling flattened. Amidst the many things we discussed that day, a few things she said stayed with me for the significance they revealed of the role of self-care and depression.
‘You need to stay active. You need to be busy. In the early days when my depression was at its worst it was very tempting to avoid everything. I didn’t want to get out of bed or engage with anyone. I just wanted to retreat.’
Whilst she had allowed herself to do that for a period of time, Mary quickly found that Depression’s seduction upon her to disconnect from life was also disconnecting her from anything and anyone which might offer her a mood shift and challenge the pervasive depressing thoughts she was dominated by. The ongoing thoughts and feelings she had that life was pointless, that there was nothing in her life which provided joy and that the future was bleak were very quickly able to embed themselves in Mary’s mind with every day that she spent at home on her own. At its worst, Mary stated that the toughest days were those when she found it hard to get out of bed, slept most of the morning, stayed in her pyjamas each day and ate poorly. During that time, she recalled going days without showering and when she glanced at herself in the mirror being filled with such sadness, looking so uncared for.
‘It gave my destructive thoughts free rein,’ she said. ‘The less I cared for myself the less happy with myself I felt and the more destructive my thinking became…about myself, my appearance, the future.’ Mary then felt less and less like going out and began to avoid connecting with friends and family whom she avoided. In doing so, Mary removed herself from an avenue of support which might have been very helpful in challenging the constant train of negative thinking which had embedded itself in her thinking. Her mood stayed low. There was very little to look forward to each day because each day was filled with an endless monotony of sleeping, staying in her pyjamas at home, having less and less contact with others and complete disconnection from any activity that might provide enjoyment.
A shift for Mary came when she changed the pattern. ‘I forced myself to go out each day, mainly because you told me I had to,’ she said with a laugh. Each day she would go out for thirty minutes. Even if it meant a trip to the grocery store for one item, she made herself go out so that she could shift the routine she was stuck in. Going out, even for such a small period of time, did shift the routine because she had to have a shower to go out. Practicing the simple self-care act of getting showered and dressed helped her feel better. She then began to incorporate gentle exercise into her day.
‘I made myself go for a walk around the block,’ she said. One day she decided to walk around two blocks, and this eventually became a 30 minute walk.
I asked her if she felt better for it and she laughed. ‘Not really,’ she said, ‘but I did find over time if I didn’t go out I felt worse. I wasn’t necessarily happier but going out and having a structure to my day helped stop me sliding so far. It was good.’
Managing anxiety with self-care
In therapy, a critical component of treatment is managing avoidance. Anxiety loves to convince its victims to avoid anything which makes them feel anxious. Initially upon avoiding the perceived threatening or stressful situation, the anxiety lessens. It feels better initially to avoid.
Yet, I will always say in session that avoidance in anxiety is short term gain but long term pain.
Having avoided something that feels intimidating, when faced with the same situation again our mind reminds us that we felt better last time when we avoided it and convinces us to avoid it again. With each avoidance, our anxiety feels worse. This cycle continues each time we engage in avoidance with anxiety and very quickly culminates into a stubborn pattern of avoidance and anxiety. A child with an anxious temperament misses a few days of school and quickly refuses to go ever again. A woman with social anxiety avoids going to the supermarket and from that point on is filled with increasing dread at the thought of leaving the house.
Self-care with anxiety requires that we not succumb to this avoidance and when we do, we catch it and resolve to face that which feels overwhelming again.
This requires commitment. We need initially to commit to feeling the uncomfortable feelings that will come with this gradual exposure. To do so, lessens anxiety’s grip. The road to self-care with anxiety is uncomfortable, but necessary for recovery.
Simple self care to improve mood
Self-care in such instances doesn’t need to be onerous or sophisticated. The simple things are important. I tell my patients that the following are important:
- Go out every day, even for thirty minutes. Even sitting outside in the garden is better than staying inside.
- Gentle exercise at least three times a week for a minimum of fifteen minutes. Even more is better.
- You need to get up each day before 9am.
- Upon waking, shower and get dressed into clean clothes.
- Eat breakfast, even when you don’t feel like it.
- Limit the amount of time you spend in bedrooms.
- Have at least one conversation with someone each day. If a friend or family member is not available, consider going to the local store or library.
- Limit social media.
- If you struggle with anxiety, recognise that avoidance can be very attractive yet actually worsens anxiety. Commit to whatever tasks your therapist has set to break the hold anxiety has upon you.
- Try where possible to have a predictable routine each day.
- Have a goal of something you would like to complete each day. A simple task such as doing a load of washing can lift a flattened mood.
- Go to sleep, preferably before midnight.
This might seem like a long list (and there are probably more that I would add over time) but these simple things are what each of us should be doing every day to take care of ourselves.
A few final thoughts…
As a therapist, I can’t always find the right tools to help someone recover from depression or anxiety. Unfortunately, mental health is an imprecise area of medicine which is not always easy or straightforward to treat. We cannot guarantee recovery. What I do feel I can guarantee however is that a lack of self-care will certainly worsen any mood or anxiety disorder. It enables such disorders to take hold, making the recovery process that much harder.