MENTAL ILLNESS MYTHS: UNPACKING MENTAL HEALTH STIGMA

“You don’t have depression,” someone may say. “You’re just sad.”

A comment like that not only minimizes what a person is experiencing, but it displays a basic lack of understanding of that individual’s emotional state. “Depression is not something a person can will away,” according to the National Alliance on Mental Illness (NAMI). “People often have the misconception that a person can just ‘cheer up’ or ‘shake it off.’ It is not just ‘the blues,’ but a serious medical condition that affects the biological functioning of our bodies.”

Failing to see the gravity of depression is one of many mental illness myths that contribute to mental health stigma, or the prejudicial attitudes and discriminating behaviors toward individuals with mental health problems. Other attempts at trivializing or downplaying mental illnesses are common. For instance, a lot of people believe that obsessive-compulsive disorder (OCD) is tantamount to being overly concerned with cleanliness and perfectionism. Such a belief and attitude undermine the types of OCD symptoms that people have, along with their seriousness.

A closer look at mental health myths can shed light on the misconceptions people have. It’s a critical step in understanding and battling mental health stigma.

CORRECTING PERVASIVE MENTAL HEALTH MYTHS

A lot of mental health stigma can be traced to misunderstandings surrounding mental health. Here are a few mental health myths identified by the NAMI.

“MENTAL HEALTH CONDITIONS ARE UNCOMMON.”

Roughly one in five Americans experiences mental illness at some point in life, according to the NAMI. Yet, that statement may considerably underestimate the prevalence of mental health conditions.

About 80 percent of the population will have a diagnosable mental illness over time, according to a study published in the Journal of Abnormal Psychology. Why is that figure so much greater than what the NAMI provided? In an essay for Scientific American, researchers from the study explained that large national surveys rely on participants’ memories, which leads to underestimations. Additionally, up to a third of individuals contacted in those studies fail to enroll; that those “non-responders” tend to have poorer mental health.

Instead of relying on that methodology, researchers in the Journal of Abnormal Psychology study followed a generation of New Zealanders from birth to midlife. Regular, in-depth screenings took place every few years, and only 17 percent of study members failed to develop a mental health disorder, at least briefly, by middle age. The study’s methodology and findings are not unique. They have been corroborated by similar cohorts in New Zealand, Switzerland and the United States.

“Put another way, the study shows that you are more likely to experience a bout of mental illness than you are to acquire diabetes, heart disease or any kind of cancer whatsoever.”

– Authors of study published in the Journal of Abnormal Psychology

“MENTAL ILLNESS IS CAUSED BY PERSONAL WEAKNESS.”

Mental illness is not due to some type of weakness. It’s not someone’s fault.

Causes of mental illness include environmental and biological factors. Compare that with what causes heart disease, diabetes or any other chronic illness share — environmental components as well as biological components, according to former director of the National Institute of Mental Health, Thomas Insel. “The only difference here is that the organ of interest is the brain instead of the heart or pancreas,” he added. “But the same basic principles apply.”

Consider, for instance, the effects of stress on the body. Chronic stress is an environmental factor that increases the risk of heart attack, headaches and diabetes. In mental illness, chronic stress is again an environmental factor. A stressful job or traumatic event can make someone more susceptible to a mental health issue. In both cases, stress as an environmental factor combines with biological factors (such as genetics) to potentially cause diabetes or an anxiety disorder, for instance.

“YOU DON’T NEED THERAPY. YOU CAN’T GET BETTER FROM A MENTAL ILLNESS.”

There are plenty of mental health myths surrounding treatment. Some say that therapy isn’t helpful and that the affected person should just take a pill or tough it out. Others combine that notion, or believe separately, the idea that a person simply can’t get better from a mental illness.

Therapy can be a helpful way for individuals to explore thoughts, feelings and behaviors involved with a mental health issue. In many cases, it’s combined with medication. “Psychotherapy paired with medication is the most effective way to promote recovery,” according to the nonprofit organization Mental Health America. A treatment plan can include some combination of therapy, medication, education programs, peer support and more.

The end result is that people can get better from a mental illness. “Innovations in medicine and therapy have made recovery a reality for people living with a mental health issue, even chronic conditions,” according to the NAMI. “While all symptoms may not be alleviated easily or at all, with the right recovery plan, people can live the productive and healthy lives they’ve always imagined.”

CONFRONTING MENTAL HEALTH STIGMA

It’s easy to see how mental health myths lead to stigma. People’s beliefs and attitudes toward mental illness shape how they interact with people impacted by those issues, according to the Centers for Disease Control and Prevention (CDC). It also affects how people with emotional difficulties and potential mental health issues respond. When people’s beliefs are rooted in popular misconceptions and the resulting attitudes are expressed negatively, mental health stigma emerges.

NEGATIVE IMPACTS OF MENTAL HEALTH STIGMA

The primary aspect of mental health stigma is the negative beliefs and attitudes toward people with mental illness. That’s the social side of mental health stigma. Another aspect is perceived stigma or self-stigma, which takes place when a person with mental illness internalizes his or her perceptions of discrimination. As a result, there are two overarching consequences of mental health stigma.

  • The general public fears, rejects, avoids and discriminates against people with mental illnesses. According to the CDC, the result is unequal access to resources that all people need to function, like educational opportunities, employment, a supportive community and access to quality healthcare. Those disadvantages can lead to further negative outcomes, socially and psychologically.
  • The person with a mental health issue experiences perceived, enacted or anticipated avoidance or social exclusion. Perceived stigma can lead to people struggling with shame and encountering poorer treatment outcomes, according to Psychiatric Services.

Issues stemming from mental health stigma are complex and widespread. For instance, a minority of people impacted by mental health conditions seek treatment. Not only are factors like embarrassment preventing people from getting help for a mental health disorder, but they undermines efforts that can help the onset of mental illness. Stigma can prevent someone from receiving early treatment for symptoms that may worsen over time.

“Only about 20% of adults with a diagnosable mental disorder or with a self-reported mental health condition saw a mental health provider in the previous year.”

– Centers for Disease Control and Prevention

When people with mental health problems don’t receive the support they need, further issues can develop. Individuals and their families can have difficulties obtaining decent, affordable housing and living successfully in the community. Some people may turn to unhealthy actions to help them cope with distress, the CDC noted. Behaviors like smoking and excessive alcohol use can increase the risk of chronic disease and worsen overall health.

BATTLING MENTAL HEALTH STIGMA

Responding to mental health stigma is a complex topic that must be considered at several levels of society. Healthcare and mental health professionals may pave the way for changing how people see mental health topics, but preventing stigma also takes place in schools, workplaces and practically every environment.

The NAMI’s StigmaFree campaign offers three simple steps that everyone can take to help eliminate mental health stigma.

  1. Educate yourself and others. Facts about mental health can reject stigmatizing stereotypes. There are several mental illness myths that distort a proper understanding of mental health. Learning the truth about mental health can enable you and those around you to develop a better awareness of various issues and conditions.
  2. See the person, not the condition. People with mental health conditions are not defined by a diagnosis. They are unique, and each has a different story, path and journey that’s much more indicative of who they are than their condition.
  3. Take action. Support legislation and policies that can improve lives.

You can take action by exploring several careers that support individuals and communities in managing mental health. By earning your behavioral health degree online, you can dedicate your work to battling mental health stigma, educating people about mental illness topics and making a difference in people’s life. Potential careers include community health specialist, health services manager, mental health technician and residential treatment specialist. You’ll also be prepared to apply for graduate studies in psychology and counseling.

Mental health crisis could cost the world $16 trillion by 2030

Mental health disorders are on the rise in every country in the world and could cost the global economy up to $16 trillion between 2010 and 2030 if a collective failure to respond is not addressed, according to an expert report on Tuesday.Patients rest during a morning break at the playground, inside a hospital specializing in mental health care in Zhejiang province, November 5, 2013.

The “Lancet Commission” report by 28 global specialists in psychiatry, public health and neuroscience, as well as mental health patients and advocacy groups, said the growing crisis could cause lasting harm to people, communities and economies worldwide.

While some of the costs will be the direct costs of healthcare and medicines or other therapies, most are indirect – in the form of loss of productivity, and spending on social welfare, education and law and order, the report’s co-lead author Vikram Patel said.

The wide-ranging report did not give the breakdown of the potential $16 trillion economic impact it estimated by 2030.

“The situation is extremely bleak,” Patel, a professor at Harvard Medical School in the United States, told reporters.

He said the burden of mental illness had risen “dramatically” worldwide in the past 25 years, partly due to societies ageing and more children surviving into adolescence, yet “no country is investing enough” to tackle the problem.

“No other health condition in humankind has been neglected as much as mental health has,” Patel said.

The World Health Organization (WHO) estimates that around 300 million people worldwide have depression and 50 million have dementia. Schizophrenia is estimated to affect 23 million people, and bipolar disorder around 60 million.

The Lancet report found that in many countries, people with common mental disorders such as depression, anxiety and schizophrenia routinely suffer gross human rights violations – including shackling, torture and imprisonment.

Richard Horton, editor-in-chief of the medical journal the Lancet, which commissioned the report, said it highlighted the “shameful and shocking treatment of people with mental ill health around the world”.

It called for a human rights-based approach to ensure that people with mental health conditions are not denied fundamental human rights, including access to employment, education and other core life experiences.

It also recommended a wholesale shift to community-based care for mental health patients, with psychosocial treatments such as talking therapies being offered not just by medical professionals but also by community health workers, peers, teachers and the clergy.

The report was published ahead of a first global ministerial mental health summit in London this week.

Obsessive-compulsive disorder

Symptoms and Signs

Obsessions are unwanted, intrusive thoughts, urges, or images, the presence of which usually cause marked distress or anxiety. The dominant theme of the obsessive thoughts may be harm, risk to self or others, danger, contamination, doubt, loss, or aggression. For example, patients may obsess about becoming contaminated with dirt or germs unless they wash their hands for ≥ 2 h a day. The obsessions are not pleasurable. Thus, patients try to ignore and/or suppress the thoughts, urges, or images. Or they try to neutralize them by performing a compulsion.

Compulsions (often called rituals) are excessive, repetitive, purposeful behaviors that affected people feel they must do to prevent or reduce the anxiety caused by their obsessive thoughts or to neutralize their obsessions. Examples are

  • Washing (eg, handwashing, showering)
  • Checking (eg, that the stove is turned off, that doors are locked)
  • Counting (eg, repeating a behavior a certain number of times)
  • Ordering (eg, arranging tableware or workspace items in a specific pattern)

Most rituals, such as hand washing or checking locks, are observable, but some mental rituals, such as silent repetitive counting or statements muttered under the breath, are not. Typically, the compulsive rituals must be done in a precise way according to rigid rules. The rituals may or may not be connected realistically to the feared event. When connected realistically (eg, showering to avoid being dirty, checking the stove to prevent fire), the compulsions are clearly excessive—eg, showering for hours each day or always checking the stove 30 times before leaving the house. In all cases, the obsessions and/or compulsions must be time-consuming (eg, 1 h/day, often much more) or cause patients significant distress or impairment in functioning; at their extreme, obsessions and compulsions may be incapacitating.

The degree of insight varies. Most people with OCD recognize to some degree that the beliefs underlying their obsessions are not realistic (eg, that they really will not get cancer if they touch an ashtray). However, occasionally, insight is completely lacking (ie, patients are convinced that the beliefs underlying their obsessions are true and that their compulsions are reasonable).

Because people with this disorder may fear embarrassment or stigmatization, they often conceal their obsessions and rituals. Relationships may be disrupted, and performance in school or at work may decline. Depression is a common secondary feature.

Many people with OCD have coexisting psychologic disorders, including

  • Anxiety disorders (76%)
  • A depressive disorder or bipolar disorder (63%; the most common is major depressive disorder [41%])
  • Obsessive-compulsive personality disorder (23 to 32%)

About half of the people with OCD have suicidal thoughts at some point, and up to one fourth attempt suicide. Risk of an attempt is increased if people also have major depressive disorder.

Diagnosis

  • Clinical criteria

Diagnosis of obsessive-compulsive disorder is clinical, based on the presence of obsessions, compulsions, or both. The obsessions or compulsions must be time-consuming (eg, > 1 h/day) or cause clinically significant distress or impairment of functioning.

Treatment

  • Exposure and ritual prevention therapy
  • SSRI or clomipramine

Exposure and ritual prevention therapy is often effective in patients with obsessive-compulsive disorder; its essential element is gradually exposing patients to situations or people that trigger the anxiety-provoking obsessions and rituals while asking them not to perform their rituals. For example, a patient with contamination obsessions and washing compulsions may be asked to touch a toilet seat without washing her hands. This approach allows the anxiety triggered by exposure to diminish through habituation. Improvement often continues for years, especially in patients who master the approach and use it even after formal treatment has ended. However, some patients have incomplete responses (as some also do to drugs).

Cognitive therapy techniques may also be useful in targeting some OCD symptoms.

SSRIs and clomipramine (a tricyclic antidepressant with potent serotonergic effects), are often very effective. Patients often require higher doses than are typically needed for depression and most anxiety disorders. Many experts believe that combining exposure and ritual prevention with drug therapy is best, especially for severe cases.

Key Points

  • Obsessions are intrusive, unwanted thoughts, images, or urges that usually cause marked distress or anxiety.
  • Compulsions are excessive, repetitive rituals that people feel they must do to reduce the anxiety caused by their obsessive thoughts or to neutralize their obsessions.
  • Obsessions and/or compulsions must be time-consuming (eg, > 1 h/day, often much more) or cause patients significant distress or impairment in functioning.
  • Treat by gradually exposing patients to situations that trigger the anxiety-provoking obsessions and rituals while requiring them not to perform their rituals.
  • Giving an SSRI or clomipramine may also help.

Overcoming Depression and Finding Happiness

Remember sadness is always temporary. This, too, shall pass.

Can’t, If, When, and But never did anything.

Trials give you strength, sorrows give understanding and wisdom.

Depression involves sadness, pessimism, a preoccupation with personal problems, and perhaps feeling sorry for one’s self, anguish, crying, and hopelessness. Depressed people often lose interest in many activities and social contacts because of loss of pleasure in and enthusiasm for their usual activities. They may become apathetic or socially withdrawn. Low energy, chronic tiredness, excessive sleeping, and insomnia are common. Other possible symptoms of depression include poor appetite, heavy eating, weight loss or gain, feelings of inadequacy or worthlessness, anxiety, regrets, decreased productivity, poor concentration, or recurrent thoughts of death or suicide. Four out of five cases of severe depression clear up without treatment within six to nine months, but half of the people with severe depression experience it again later.

People often become depressed about marital, romantic, or family problems. For example, one study found an unhappy marriage increased the risk of clinical depression 25 times over untroubled marriages. A personal loss often triggers depression: divorce, separation, loss of a job, the end of a love relationship, physical or mental problems from old age, the death of a loved one, etc. Many stressful events or major changes may also help bring on depression. Going away to college or moving far away from family and friends after getting married may lead to depression. No matter how much you wanted to have a child, the resulting loss of freedom may cause depression. When children grow up and leave home, you may become depressed. Retirement can lead to depression because of loss of work activities to fill the day and loss of friendships with coworkers.

Depression may occur without any loss or great stress to trigger it, however. Personal problems often lead to depression. The chronic use of alcohol or other drugs often leads to mood swings, personal problems, and depression. Using alcohol or other drugs to improve your mood is especially risky because addictive substances often intensify pre-existing mood or personality problems. Even prescribed medications may lead to severe depression.

Ways to Overcome Depression

There are many effective ways to overcome depression. Fortunately, we can control our thoughts and feelings much more than most people realize. With enough work and effort, you can change habitual thoughts and feelings. First, however, if you are on any medicines, check with your doctor to see if a medicine may be causing your depression. A surprising number of medicines can do this, including many tranquilizers or sleeping pills, many high blood pressure medicines, hormones such as oral contraceptives, some anti-inflammatory or anti-infection drugs, some ulcer medicines, etc. Changing your prescribed medications may be all you need to eliminate depression.

Predicting Effectiveness of Antidepressants

Some severely depressed people need medicines to control their depression, but most people can conquer depression by following the suggestions in this excerpt. Even those people on prescribed medicines for depression will benefit from the suggestions here. If you feel severely depressed, most psychiatrists will use trial and error to find a drug that will help you. But certain blood and urine tests can detect biological depression, pinpoint which drugs are most likely to be effective, and reduce the risk of depression recurring by determining when the biological imbalance ends. For the fastest, most effective treatment of severe depression, find a psychiatrist who will use the dexamethasone suppression test (DST), the thyrotropin-releasing hormone (TRH) stimulation test, and the MHPG urine test. In both the DST and TRH stimulation test, the psychiatrist administers a hormone and monitors your body’s response with blood tests. Using these tests finds imbalances and predicts the effectiveness of antidepressants. The MHPG urine test helps in choosing among antidepressants. The tricyclic dose-prediction test, involving a test dose of antidepressant and a blood test 24 hours later, predicts therapeutic dose, minimizing dose changes and side effects. When psychiatrists prescribe an antidepressant, they should order one or more blood tests to make sure your blood level of the drug is in the effective therapeutic range.


Develop Interests, Participate in Activites

Perhaps one of the most common reasons for depression is a lack of enough interests and activities. A small number of them tends to become routine and often boring. Interests and activities are very important in mental health, contributing to self-esteem and happiness. They give satisfaction, help make you feel good about yourself, and keep your mind off problems and negative thoughts and emotions. Simply cultivating them can sometimes cure depression, grief, addiction, explosive anger, anxiety, excessive worrying, or guilt, especially if you do the activities whenever you feel the negative emotion. They are also important social skills that give you pleasant and interesting things to talk about, improving your conversation skills and helping in making and keeping friends. Children with many interests and activities are less likely to have behavior problems, including alcohol or drug abuse, teenage pregnancy, violence, and crime later on. Their wide variety of interests keep them busy and out of trouble and naturally build different circles of friends, so they are less likely to be influenced by the wrong kind of friend.

There are three main kinds of helpful interests and activities: pleasurable, constructive, and altruistic. Of course, pleasurable activities give us enjoyment. We may do them just for fun or relaxation. Constructive activities produce or accomplish something and give a sense of pride. Examples include getting things done around the house, working on a project, practicing a skill, or studying a subject that interests you. Altruistic activities help other people. Examples include teaching a friend a craft, helping sick or old people, or volunteer work. Altruistic activities give companionship, gratitude from other people, and a sense of pride. Helping others is one of the best ways to lift yourself spiritually. Helping less fortunate people can also give a healthy sense of perspective. For example, your personal problems may appear trivial after a day volunteering with mental patients or dying cancer patients.

Having only a few interests and activities doesn’t help very much in fighting boredom, depression, or other problems. You can best improve mental health by developing and practicing many of them until you do them well. Truly happy and productive people love life and often enjoy 50 to 100 of them. Strive toward the ideal of the Renaissance man-a well-rounded person with broad social, cultural, and intellectual interests and skills. You may find it difficult to think and come up with new interests and activities. We often forget many we once enjoyed or we were once curious about. Depressed people are especially likely to have forgotten previous interests and activities. Go to the library and ask the librarian for help in finding a list of interests and activities

Of course, depressed people often find it very difficult to motivate themselves and often reject new interests and activities without trying them or after one attempt. But even happy people don’t enjoy interests without first cultivating them. We often don’t enjoy a new activity right away. Instead, it may take time to become accustomed to a new activity and for interest and pleasure to grow. You may need to learn to relax in the new situation or to develop some expertise or skill before you can learn to enjoy it. Don’t reject new activities before giving them a chance. Try any new activity at least several times, with an open mind. Motivate yourself with rewards for engaging in new activities and getting things done. You might decide you must buy your groceries and finish all your laundry before you take a nap. If you smoke cigarettes, you might avoid smoking until you try a new activity or accomplish something. Ask friends and family members to help motivate you, too.

Keep A Positive Attitude

Negative thinking habits play a very important role in depression. Research shows depressed people tend to minimize their accomplishments, talents, and qualities. They tend to see themselves as inferior and incompetent, despite being comparable to other people in qualities and skills. Their thinking habits focus on or exaggerate problems and faults and minimize or fail to see the good things in their lives. They tend to recall negative things more often than positive things, and they tend to minimize, overlook, or forget feelings of pleasure in their lives. They may feel preoccupied with loss or personal problems, perhaps wallowing in thoughts about self-pity, inability to cope, or escaping their problems.

Happy people experience failure, disappointment, rejection, negative emotions, pain, and great sorrows, too, just like depressed people. But happy people keep a positive attitude by gracefully accepting sadness and suffering as normal parts of life, while doing what they can about their problems. This also makes them more pleasant to be around and improves their social lives. Part of happiness is a courageous choice of loving life in the face of suffering, a chosen position or view of things.

Expecting dissatisfaction and failure, depressed people often give up easily and thereby bring on failure. Happy people know that every failure is a learning experience that can lead to success if they refuse to give up. Starting a successful business, for example, may take many years of learning what doesn’t work. After causing their own failure by giving up, depressed people often blame their problems on fate, bad luck, other people, circumstances, or their incompetence. They may passively resign themselves to problem situations and let the problems continue. Their pessimistic thinking leads them to reject many enjoyable activities. Sometimes their lack of motivation involves not knowing what to do to improve things or fear of making the needed changes.


Are Your Expectations Realistic?

Reexamine your expectations or priorities in life and, if necessary, adjust them to suit reality better. Depressed people often think they can’t be happy without certain things, such as a lover, a particular lover, material possessions, a much higher income, etc. You can eliminate such problems by changing your negative thinking and learning to accept the situation. Certain situations or troublesome people simply won’t change. When you can do something about a problem, however, you should. For example, you may need to leave an alcoholic spouse or to go to school to prepare for a better job.

Get to Work on Personal Problems

Work on your personal problems, using small steps to make sure you avoid becoming overwhelmed. Work on only one or two simple things at a time, breaking large or complex problems into goals you can easily accomplish. Use rewards, friends, family, and support groups. What negative or stressful situations exist in your life? What can you do about them? Don’t give up and allow your problems to continue. Brainstorm solutions and ask other people for ideas. Some depressed people reject all the possible solutions, finding reasons to eliminate each one as unacceptable, unpleasant, or unworkable. Don’t let negative thought habits interfere with problem solving. Keep an open mind to all possible solutions.

Take a long, hard, honest look at yourself for personal problems, paying particular attention to repeating problems in your life. Do you need more interests and activities to avoid boredom and keep your mind off negative thoughts? If you avoid confrontations and bury your anger at mistreatment from others until you explode, work on assertiveness and expressing your anger in constructive ways. Are some people inconsiderate, unkind, overly critical, or overly hostile toward you? If certain people in your life contribute to your depression by the things they do, you may need to become more assertive with these people, to reduce your contact with them, or even to eliminate them from your life. Do you abuse alcohol or other drugs?

Tackle Your Bad Habits

Change bad habits that keep you depressed. Work on replacing negative thoughts with positive thought alternatives every day. If you tend to blame circumstances or other people for your depression, combat these thoughts of helplessness by reading or by repeating, “I made myself depressed over that. I didn’t have to respond that way.” Use assertiveness skills, good problem-solving skills, or more positive thinking the next time a similar situation arises. If you often assume other people think badly of you, read or repeat “I can’t read other people’s minds.” Humor also helps a great deal in facing life’s problems without drowning in negativity.

If you find it difficult to motivate yourself, stop prejudging and avoiding activities because you believe you wouldn’t enjoy them or wouldn’t be good at them. If you force yourself to start, you will often find that you do get some pleasure from and gain some skill in the activity after all. Don’t let negative thoughts about many activities block your improvement and interfere with your happiness. You probably have negative thoughts about lacking energy, not being in the mood, hating exercise, etc. Replace these each time they occur with more positive, helpful thoughts such as: “I’ll feel more like it once I start,” “Let’s just give it a try. Who knows, maybe I’ll really like it,” or “Why sit here and feel bored? I’ll try …”

Depressed people tend to overlook and discount feelings of pleasure and accomplishment, both in trying new activities and in many other areas of life. Learn to recognize these feelings. Develop these slight feelings and take pride in your activities. Counter negative reactions with positive alternatives such as: “Hey, that wasn’t bad. I enjoyed it some. Maybe if I try it a few more times, I’ll really like it,” and “Not bad on my first try, but I’ll get better with practice. That was kind of fun.” Repeat those activities that give you slight feelings of accomplishment or pleasure. You can develop them into very rewarding activities.

Develop Friendships and Relationships

Good social skills and a good network of friendships ranging from casual to intimate ones help prevent depression after life stresses and speeds recovery from depression. Happy people generally have several very close friends and a number of other friends, some closer than others, with whom they can share different activities and parts of themselves. Do you need to reach out and make more friends?

Marital relationships are often important in depression. An appreciative, complimentary, supportive marital relationship can protect you from depression despite challenging life stresses, and as noted previously, marital problems often lead to depression. Work on increasing the positive behaviors in your marriage. Perhaps your marriage lacks a confiding relationship of sharing feelings and receiving acceptance, understanding, and emotional support from each other? Sharing feelings is much more important than simply sharing facts with your spouse. Ask your spouse to compliment you more and to say many of the things normally taken for granted, to show appreciation for the routine things you do every day. Learn about good marital skills and put them to use in your life.


Research shows depressed people are more likely than other people to interact with their spouses and children in hostile or angry ways. Do you yell, sulk, bring up old resentments from the past, nag, insult or use negative labels, make demands or ultimatums, or criticize with overgeneralizations? Do you alienate other people with communication problems such as avoiding important issues, blaming, or assuming you know what another person thinks? Another communication problem is bringing up too many problem issues without focusing on solutions, one at a time. Of course, everyone does these things at times, but bad habits in these areas increase stress and can destroy intimacy with your loved ones. Learn about and practice good communications skills.

Some depressed people long for friendship and love but alienate other people with negativity or with clinging neediness because of lack of enough socializing or interests and activities. Many depressed people make the mistake of hunting for romance to satisfy their unhappiness, poor self-esteem, or other problems. A preoccupation with finding romance is generally frustrating and disappointing. Yearning for a romance to make you happy is looking in the wrong place for happiness. Although finding a mate can help make you happy, your best chance of finding a mate depends on developing a different set of priorities.

Looking for a romance to save you from your loneliness and unhappiness is a rather desperate, needy search that alienates other people. Your personality cannot sparkle with this kind of focus in your life. Instead, focus on enjoying the single life, meeting people, and making friends. Accept you may be single for a long time and get on with your life. You need a wide variety of interests and activities, and you need to enjoy and value your friendships. Having these priorities will make you more pleasant, give you practice in socializing, and increase your chances of finding romance. With interests and activities and a good network of friends and acquaintances, your painful longing will cease.

A common, very painful mistake in dating is to become completely engrossed in a person who shows little true concern for your needs and feelings. Perhaps your partner only wants to see you occasionally or when other relationships end. Perhaps your partner is selfish and repeatedly inconsiderate of your feelings or needs. Staying in any unfulfilling relationship ties up much of your time and deepest emotions. The danger in staying in an unfulfilling relationship is you become accustomed to unhappy situations, making you an easy target for people who will use you. Unfortunately, plenty of people will use you if you let them. Your time and emotional energy are better spent developing interests, activities, ways of meeting people, and a more suitable love relationship. Never settle for less in a relationship-hold out for what you really want.

If, despite an unfulfilling relationship, you sometimes resort to sexual activity to relieve negative emotions such as loneliness, boredom, depression, or anxiety, plan more constructive ways of dealing with these emotions. Keep busy, avoid the problem person, make new friends, find better ways to have fun and to relax, and practice rejecting the person’s advances in behavioral roleplays. If lowered inhibitions due to drinking alcohol or using other drugs play a role in your continuing an unfulfilling relationship, plan ways to avoid this problem or work on your addiction.

Figure Out Why You’re Depressed

If you don’t know why you feel depressed, look for clues by comparing and contrasting your life now with a happier time in your life. The best way to understand your depression is to study it carefully. Use the scale of zero to 100 to rate your depression many times throughout the day, and observe and record all the thoughts, circumstances, and events associated with it. Ideally, you should make your observations and rate your depression hourly. If you think over your day and rate your depression at the end of it, you will tend to rate your moods more negatively because of your negative thought habits. Even if you feel you know your stresses and problems, you can learn from studying your depression in these ways. By frequently rating depression, people generally discover their moods are not always low. Depressed people usually feel better when they keep busy (at work, cooking, visiting, etc.) and worse when idle (weekends, evenings, etc.).

The fastest way to change an emotion is often simply to act the way you want to feel. Act happy, smile regularly, act friendly toward other people, and participate in plenty of interests and activities, including fun things such as dancing. Don’t wait to be in the mood to do these things-you may never feel like it. Depressed people who keep practicing these behaviors find themselves feeling more cheerful. With practice, these behaviors gradually become more comfortable and natural. Other people generally respond in positive ways to these changes, so you receive more pleasure and satisfaction in your life from them. Work on improving nonverbal behaviors that convey depression. Don’t use a slow, quiet, bored, monotonous tone of voice. Show some pitch variation and enthusiasm in it. Use erect posture rather than drooping posture with downcast head and eyes. Use good rates of eye contact with other people and don’t frown.


Balance in Your Life

People need a healthy balance between pleasure and work. A few depressed and overwhelmed people need to quit pushing themselves so hard, relax more, and eliminate some work activities, but most depressed people need more interests and activities. Idle time often leads to negative thinking and depression. Choose more interests and activities, including those you once enjoyed and could resume, and ask yourself which ones you might do if you didn’t feel depressed. As you develop interests, share them with other people.

Many doctors and psychologists recommend regular exercise for depression and note it improves the mood. Exercise invigorates you, giving you more energy. Deep relaxation also helps combat depression and especially helps anxious depressed people. Relaxation helps people find peace within themselves. Learn about different kinds of relaxation techniques and meditation and put them to use in your life.

Journaling Can Be Helpful

Certain kinds of written records help combat depression. Compile a journal or list of joyous experiences you remember. Describe your most special moments, including beautiful nature scenes, especially close moments with loved ones, fun times, a series of events that you particularly enjoyed, or spiritual experiences. Make another list of your positive attributes. Include your talents, qualities, virtues, accomplishments, etc. (Anyone who wants to help a depressed person can make such a list and give it to the person. Sometimes doing this for a depressed friend can make a huge difference.) Make a list of blessings you can be thankful for, too. Compile a collection of inspiring thoughts, quotes, poems, prayers, or affirmations. Affirmations are inspiring statements you write and then repeat throughout the day for self-improvement or emotional well-being. For example: “I will strive to be an example of peace and love for my fellow human beings,” or “Let calmness and serenity fill my heart.” Keep adding new items to these journals or lists as you think of them, rereading them regularly to help keep your mind focused on good, rather than negative, things.

Quit Rewarding Passive or Dependent Behaviors

When you complain, cry, talk of sad feelings, or discuss problems, your friends and loved ones probably respond with sympathy and tender loving care. Unfortunately, these loving responses reward and help maintain the depressive behaviors. Some friends or family even take over chores for a depressed person who stays in bed or asks for help. Again, this rewards the passive or dependent behavior. Perhaps you reward yourself when you drown in negative thoughts or self-pity. Many depressed people eat, spend money excessively, abuse addictive substances, or have sex without love to feel better. Eliminate these and any other subtle rewards for depressive behavior.

Stop seeking consolation with complaints, sighs, sad looks, and crying. Work to make your social interactions more positive by showing warmth toward other people, taking an interest in them, developing and sharing interests and activities, etc. Ask your friends and loved ones to ignore your depressed behaviors and to cut telephone calls and visits short when you dwell on complaints or drown in self-pity, spending more time with you and showing more warmth and interest when you act in more normal ways. Asking them to do this is very important because close friends and loved ones generally take appropriate behaviors for granted and try to cheer you up with extra warmth and attention when you feel depressed. Tell them to avoid taking pity on you and feeling guilty for not catering to your depression, and ask them not to take over chores and duties you can do for yourself.

Don’t worry about whether you are happy. Develop interests, activities, and friendships, be kind, help other people, strive to be virtuous, accept emotional pain, work on conquering your personal problems, and improve your thinking habits. These things will lead to happiness. Conquering your depression may take months or years, depending on its severity, how long you have had negative thinking habits, your personal problems, and how much effort you put into it.

Signs and Symptoms of Anxiety Disorders

Many people experience anxiety at some point in their lives.

In fact, anxiety is a very normal response to stressful life events like moving, changing jobs or having financial troubles.

However, when symptoms of anxiety become larger than the events that triggered them and begin to interfere with your life, they could be signs of an anxiety disorder.

Anxiety disorders can be debilitating, but they can be managed with proper help from a medical professional. Recognizing the symptoms is the first step.

Here are 11 common symptoms of an anxiety disorder, as well as how to reduce anxiety naturally and when to seek professional help.

1. Excessive Worrying

One of the most common symptoms of an anxiety disorder is excessive worrying.

The worrying associated with anxiety disorders is disproportionate to the events that trigger it and typically occurs in response to normal, everyday situations.

To be considered a sign of generalized anxiety disorder, the worrying must occur on most days for at least six months and be difficult to control .

The worrying must also be severe and intrusive, making it difficult to concentrate and accomplish daily tasks.

People under the age of 65 are at the highest risk of generalized anxiety disorder, especially those who are single, have a lower socioeconomic status and have many life stress.

SUMMARYExcessive worrying about daily matters is a hallmark of generalized anxiety disorder, especially if it is severe enough to interfere with daily life and persists almost daily for at least six months.

2. Feeling Agitated

When someone is feeling anxious, part of their sympathetic nervous system goes into overdrive.

This kicks off a cascade of effects throughout the body, such as a racing pulse, sweaty palms, shaky hands and dry mouth

These symptoms occur because your brain believes you have sensed danger, and it is preparing your body to react to the threat.

Your body shunts blood away from your digestive system and toward your muscles in case you need to run or fight. It also increases your heart rate and heightens your senses

While these effects would be helpful in the case of a true threat, they can be debilitating if the fear is all in your head.

Some research even suggests that people with anxiety disorders are not able to reduce their arousal as quickly as people without anxiety disorders, which means they may feel the effects of anxiety for a longer period of time.

SUMMARYA rapid heartbeat, sweating, shaking and dry mouth are all common symptoms of anxiety. People with anxiety disorders may experience this type of arousal for extended periods of time.

3. Restlessness

Restlessness is another common symptom of anxiety, especially in children and teens.

When someone is experiencing restlessness, they often describe it as feeling “on edge” or having an “uncomfortable urge to move.”

One study in 128 children diagnosed with anxiety disorders found that 74% reported restlessness as one of their main anxiety symptoms

While restlessness does not occur in all people with anxiety, it is one of the red flags doctors frequently look for when making a diagnosis.

If you experience restlessness on the majority of days for more than six months, it may be a sign of an anxiety disorder .

SUMMARYRestlessness alone is not enough to diagnose an anxiety disorder, but it can be one symptom, especially if it occurs frequently.

4. Fatigue

Becoming easily fatigued is another potential symptom of generalized anxiety disorder.

This symptom can be surprising to some, as anxiety is commonly associated with hyperactivity or arousal.

For some, fatigue can follow an anxiety attack, while for others, the fatigue can be chronic.

It’s unclear whether this fatigue is due to other common symptoms of anxiety, such as insomnia or muscle tension, or whether it may be related to the hormonal effects of chronic anxiety .

However, it is important to note that fatigue can also be a sign of depression or other medical conditions, so fatigue alone is not enough to diagnose an anxiety disorder.

SUMMARYFatigue can be a sign of an anxiety disorder if it is accompanied by excessive worrying. However, it can also indicate other medical disorders.

5. Difficulty Concentrating

Many people with anxiety report having difficulty concentrating.

One study including 157 children and teens with generalized anxiety disorder found that more than two-thirds had difficulty concentrating

Another study in 175 adults with the same disorder found that almost 90% reported having difficulty concentrating. The worse their anxiety was, the more trouble they had

Some studies show that anxiety can interrupt working memory, a type of memory responsible for holding short-term information. This may help explain the dramatic decrease in performance people often experience during periods of high anxiety

However, difficulty concentrating can also be a symptom of other medical conditions, such as an attention deficit disorder or depression, so it is not enough evidence to diagnose an anxiety disorder.

SUMMARYDifficulty concentrating can be one sign of an anxiety disorder, and it is a reported symptom in the majority of people diagnosed with generalized anxiety disorder.

6. Irritability

Most people with anxiety disorders also experience excessive irritability.

According to one recent study including over 6,000 adults, more than 90% of those with generalized anxiety disorder reported feeling highly irritable during periods when their anxiety disorder was at its worst.

Compared to self-reported worriers, young and middle-aged adults with generalized anxiety disorder reported more than twice as much irritability in their day-to-day lives .

Given that anxiety is associated with high arousal and excessive worrying, it is not surprising that irritability is a common symptom.

SUMMARYMost people with generalized anxiety disorder report feeling highly irritable, especially when their anxiety is at its peak.

7. Tense Muscles

Having tense muscles on most days of the week is another frequent symptom of anxiety.

While tense muscles may be common, it’s not fully understood why they’re associated with anxiety.

It is possible that muscle tenseness itself increases feelings of anxiety, but it is also possible that anxiety leads to increased muscle tenseness, or that a third factor causes both.

Interestingly, treating muscle tension with muscle relaxation therapy has been shown to reduce worry in people with generalized anxiety disorder. Some studies even show it to be as effective as cognitive behavioral therapy

SUMMARYMuscle tension is strongly linked to anxiety, but the direction of the relationship is not well understood. Treating muscle tension has been shown to help reduce symptoms of worry.

8. Trouble Falling or Staying Asleep

Sleep disturbances are strongly associated with anxiety disorders.

Waking up in the middle of the night and having trouble falling asleep are the two most commonly reported problems

Some research suggests that having insomnia during childhood may even be linked to developing anxiety later in life .

A study following nearly 1,000 children over 20 years found that having insomnia in childhood was linked to a 60% increased risk of developing an anxiety disorder by age 26

While insomnia and anxiety are strongly linked, it is unclear whether insomnia contributes to anxiety, if anxiety contributes to insomnia, or both

What is known is that when the underlying anxiety disorder is treated, insomnia often improves as well

SUMMARYSleep problems are very common in people with anxiety. Treating the anxiety can usually help improve sleep quality as well.

9. Panic Attacks

One type of anxiety disorder called panic disorder is associated with recurring panic attacks.

Panic attacks produce an intense, overwhelming sensation of fear that can be debilitating.

This extreme fear is typically accompanied by rapid heartbeat, sweating, shaking, shortness of breath, chest tightness, nausea and fear of dying or losing control.

Panic attacks can happen in isolation, but if they occur frequently and unexpectedly, they may be a sign of panic disorder.

An estimated 22% of American adults will experience a panic attack at some point in their lives, but only about 3% experience them frequently enough to meet the criteria for panic disorder.

SUMMARYPanic attacks produce extremely intense feelings of fear, accompanied by unpleasant physical symptoms. Recurring panic attacks may be a sign of panic disorder.

10. Avoiding Social Situations

You may be exhibiting signs of social anxiety disorder if you find yourself:

  • Feeling anxious or fearful about upcoming social situations
  • Worried that you may be judged or scrutinized by others
  • Fearful of being embarrassed or humiliated in front of others
  • Avoiding certain social events because of these fears

Social anxiety disorder is very common, affecting roughly 12% of American adults at some point in their lives.

Social anxiety tends to develop early in life. In fact, about 50% of those who have it are diagnosed by age 11, while 80% are diagnosed by age 20 .

People with social anxiety may appear extremely shy and quiet in groups or when meeting new people. While they may not appear distressed on the outside, inside they feel extreme fear and anxiety.

This aloofness can sometimes make people with social anxiety appear snobby or standoffish, but the disorder is associated with low self-esteem, high self-criticism and depression .

SUMMARYFear and avoidance of social situations may be a sign of social anxiety disorder, one of the most commonly diagnosed anxiety disorders.

11. Irrational Fears

Extreme fears about specific things, such as spiders, enclosed spaces or heights, could be a sign of a phobia.

A phobia is defined as extreme anxiety or fear about a specific object or situation. The feeling is severe enough that it interferes with your ability to function normally.

Some common phobias include:

  • Animal phobias: Fear of specific animals or insects
  • Natural environment phobias: Fear of natural events like hurricanes or floods
  • Blood-injection-injury phobias: Fear of blood, injections, needles or injuries
  • Situational phobias: Fear of certain situations like an airplane or elevator ride

Agoraphobia is another phobia that involves fear of at least two of the following:

  • Using public transportation
  • Being in open spaces
  • Being in enclosed spaces
  • Standing in line or being in a crowd
  • Being outside of the home alone

Phobias affect 12.5% of Americans at some point in their lives. They tend to develop in childhood or the teenage years and are more common in women than men