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Exciting stuff this week guys! Today is another regular Q&A session with some awesome questions about school anxiety, how to disclose mental illness to a partner, and ending therapy. A couple quick announcements:

1. The Hardcore Self Help: F**k Anxiety audiobook has been updated! The quality is SO much better with this one, so if you’ve already listened to it, be sure to download it again. Like listening to books rather than reading them? You can get a trial of Audible and then get my book, for FREE! Head over to Amazon to find out more.
2. I decided to change up the sales page and free previews of my course, Kick Anxiety’s Ass, coming August first! Sign up today to get $150 OFF the final sale price!

Okay, and now for the podcast!

I’m 20 years old and in college for neuroscience. This past year I suffered from mental health issues after a concussion. I haven’t had depressive symptoms for a few weeks now and my panic attacks have vastly decrease in number thanks to therapy and medication.

I recently started a serious romantic relationship, however, and don’t know how to talk to him about my mental health. Most of my close friends know about my struggles but many of them still don’t understand what depression and anxiety feel like and it has strained or broken our relationships. I don’t want this to happen again. So how do I explain depression/anxiety better to those who have not experienced it and in a way that does not alienate them? Also I know my depression and anxiety will affect a romantic relationship differently than a friendship so how do I address those issues as well, especially before they arise?

First off, just want to acknowledge that emotional issues are very common after a concussion. Depression and mood regulation difficulty can be directly caused by the injury and you can also have post traumatic symptoms from the event that causes the concussion. Now to address your question of how to talk about mental health issues in a new relationship.

First thing is that there is no specific timeline for this. It is an aspect of you that may or may not choose to disclose to someone and that’s your right. Of course you don’t want to be bringing it up the night before your wedding or something like that, but it also doesn’t have to be in the first week of dating, unless you want it to be.

I think there definitely CAN be some advantages to talking about your mental health struggles early on. It can provide you with a solid platform of empathy and understanding to work from and build. It will also help you understand if the relationship is not going to work within the context of your particular type of mental health issues.

It’s not the sort of thing that will be perfectly understood in one conversation. You would discuss it periodically over time and ideally fine-tune both of your behaviors to set yourselves up for success. It can be difficult to break it down in super clear terms because depression and anxiety for you might not even present in the same way every day. You have some general symptoms that are problematic and then you have your own flavor of how those symptoms interact with your personality and lifestyle.

You only need to start the process and then over time, your partner will learn and be better able to recognize the effects of your mental heath issues. Don’t forget that you are assuming that they don’t already understand and don’t have their own mental health issues that they are worried about telling you.

I actually have a letter that I wrote in my book, Hardcore Self Help: F**k Depression that is meant to help people explain what depression is like to people that don’t get it. You can find it on the blog here.

If you are super worried about broaching the topic in the first place, it might be a good time to do some cognitive exercises. An ABC thought log would be good here. Try to understand what the beliefs or assumptions are that are making you feel so nervous about the potential of disclosing your mental health issues. Then you can challenge those assumptions and beliefs and try to see if there is any evidence that does not support them.

I know that often there is a fear that someone will not be accepting or understanding and you don’t want to ruin things, but the obvious answer to that is that it’s better than the alternative of sinking a lot of time, effort, and possibly money into this relationship and then finding out that it’s not going to work later on down the line.

The last thing that I would say is that when you think about how to bring the topic up, think about how you would do it if depression wasn’t the issue, but instead it was some sort of physical health issue. Like if you had a prosthetic leg or an autoimmune disease that you didn’t want them to be surprised by. That might help you wrap your head around the fact that this is just another normal difference that people have and there’s nothing wrong with talking about it.

I’m a dental student who struggles with anxiety every time I have something big coming up or I have to study for long periods of time (which is technically daily). It stresses me out and I have a sinking gut feeling. Driving towards my campus is also awful. As soon as I’m near, I get the worst stomach pain ever. It’s terrible because this is new to me. I had never had these kinds of issues with school. I think I need new tools and ideas on how to work this out. I was wondering if you could do a podcast directed at students in demanding fields who feel anxious at the thought studying or going to school, specially if they have experienced failing before. I love what I’m studying, but with a new school year coming up soon, I’m afraid I won’t be able to put myself in a place and mindset good enough to excel.

It sounds like you are having some strong physiological symptoms of anxiety. There are some very common symptoms that tend to happen such as tightness in your chest, racing heart rate, trembling, sweating, and upset stomach and/or diarrhea. It’s definitely no fun to deal with, but you’re not alone in the experience.

There are a few things that you can do to try to cope with this though:

First off, practice and exposure will help. Your body clearly has an association between the location of your school and things that are stressful, threatening, or anxiety provoking. Getting used to being on campus and driving there without avoiding or escaping will help to weaken that. You also might want to focus on doing OTHER things on campus aside from just suffering through classes.

By this, I mean are there fun, enjoyable, or relaxing activities that you can also do on campus. Like could you meet up with friends before class and get a meal or maybe there is a relaxing spot that you can go and meditate or just listen to some relaxing music on your headphones. Basically you want to think about weakening that super strong threat association that you have to the location of campus.

Deep breathing is also a tool that can come in handy here. However it’s important to try to do it the right way. Learning how to calm your body down and initiate something called the relaxation response takes practice. I actually have an entire free lesson from my course Kick Anxiety’s Ass available right now that I really think you could benefit from. Go to the course page, then scroll down and click the link for the free preview and the module is called How to Not Feel Like You’re Dying.

The gist of it is that you want to find a particular exercise that you like and then practice it regularly during times when you are not already stressed so that you can later rely on that breathing exercise as a tool.

Once you’ve trained yourself to use your breath in this way, it can lower your overall physical state of anxiety, which might help to alleviate some of the gross feelings you get when driving. Of course you want to be careful with things like coffee as well, since these can give your anxiety a little kickstart and also be not so gentle on your tummy.

One other thing to look at here is this: is your anxiety totally reasonable and justified? Like do you just have to damn much going on? Obviously a program like that is going to be somewhat intense, but are there ways that you could be managing your time better or are there unnecessary things that you could cut out? Just a thought.

The last tip that I have is to simply give yourself a little time to adjust before going to class. Rather than getting out of the car and going straight to class, maybe make a point to get there early and take a little walk or read for a bit before class starts. That might give your body an opportunity to regulate. And of course, if you think there might be something medical going on here, definitely get checked out by your doctor.

I had a question about when is the right time to stop therapy. I’ve been on a great set of medications for the past couple months (Yay Paxil and Wellbutrin!) and I have made huge strides in therapy as well as my personal development. But I’m curious to see if I’m ready to continue my mental health journey on my own. I’ve already talked to my therapist about how I feel and she agrees that I have a great foundation to continue my own personal development.

A lot of time is spent on how to get started with therapy, but we don’t necessarily talk to much about what it’s like to end. As clinicians we refer to the end of therapy as termination. Sounds sinister, but all it means is that you are no longer regularly working with a particular provider.

It’s a normal part of therapy. In my opinion, therapy should not be indefinite. The goals should be to help you be self-sufficient. Some people fall into a pattern of having a sort of life long therapist that they use as a sounding board and just enjoy spending time with and that’s fine. But ideally in therapy you are doing constructive work and making changes in your life that will lead you to not need therapy anymore.

Take this with a grain of salt, there are many different situations and some issues such as borderline personality disorder or schizophrenia are obviously going to be more chronic and require care over a longer period. But for you, termination sounds like a totally reasonable thing for you to be approaching and I’m glad that you’ve already started to have that conversation with your therapist.

Most of the time, termination does not mean that the door closes forever and you aren’t allowed to contact the therapist anymore. With my clients, I often switch to a less frequent schedule such as every other week or once per month. From there we will have a termination session, which is sometimes like a little graduation. We will review their progress and important takeaways from therapy and look toward the future.

Typically you want to have some plan for after care. Are you continuing to use meds? If so, how often do you want to meet with your psychiatrist? Are there books, groups, etc. that you are planning on using to continue the journey? Are you still allowed to call the therapist up for a one-off session if you feel like you need it down the line? Most therapists will be okay with this and would also be happy to resume regular sessions again in the future if you feel like it’s not working out.

As to what is the “right time” – it’s going to be a little different for everyone. If there is a specific issue that you came in for such as fear of driving that you are now able to do – that would be a good indicator. If your main complaints during your first session have subsided. If you personally feel confident in moving forward without regular therapy. That’s why it’s ideally a conversation with your therapist, so you can define some of those parameters and make sure that you are making an informed decision.

So yeah. I hope you’re super proud of yourself. It’s great that you’re at a place of relative stability and you can even be thinking about termination.

Thanks for listening!

Interested in having Duff answer a question on the podcast? Email Duff at robert@duffthepsych.com and maybe you’ll hear it on a future episode!

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