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This episode is a straightforward question and answer episode. Not too much preamble in this episode, just straight to the nitty gritty. As always, if you’d like to learn more about me and what I do, check out http://duffthepsych.com/starthere

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Hello Dr. Duff, I have been with my boyfriend for a year now. Unfortunately he had to move to a different country for work and we’ll be apart for 1 year (planning to meet twice within that time). I’ve been suffering from anxiety for a while now but since he left a month ago I’ve been feeling really depressed. I try to keep myself busy but I can’t help but to just feel sad.

But the worst thing of it all is that I find myself jealous of other people that spend time with him or even places. For instance, if he posts something on social media from his “new life” I tend to feel jealous and sad and I feel pain in my chest. We talk a lot about these and he’s very supportive, he says no matter how bad these negative thoughts get he will always try to help me. We are moving in together next year and I don’t want to ruin my awesome relationship. I of course want him to be happy but why do I keep feeling this way? What can I do to stop this? I feel like I’m being selfish and I cant stop. It’s affecting my life in a bad way. Any advice would be really appreciated. Thank you for the good work, you have helped me a lot.

I really feel for your situation. I want to say that what you are feeling is super normal. I’m afraid there isn’t some big mystery about why you feel so bad. You care deeply about someone and you have to be apart from them. And that sucks.

It’s also normal to be jealous about the situation. That doesn’t imply that there’s something wrong with you. It’s something that you are going to have to accept, but you don’t have to like it. He is allowed to live his life over there and succeed, but it can hurt to know that you can’t be enjoying life with him at this time. It can hurt to know he’s having a good time without you. And all of these things can create strong feelings – jealousy, regret, resentment – and that’s ok, but you do have to accept part of it. It’s heartache and I think it’s a universally relatable experience.

You aren’t being selfish, this is just how you feel. Now the selfish part would be telling him that he is not allowed to do certain things because of these feelings. But it doesn’t sound like you’re doing that. So again you can feel mixed about the situation, but still act in a way that is good and appropriate for the relationship.

Communication is key

It’s a good thing that you guys are communicating openly about this. That will help a lot. Sometimes sadness and jealousy are not talked about. If that were the case, he might have a hard time interpreting why you might be acting or talking in a certain way. Rather than assuming it’s because you aren’t happy with him or you want out of the relationship, he may understand that it’s actually the opposite and you yearn to be together again. So that information can help him interpret the way you might act or what you might say. And this is the case for a lot of things in a relationship – if you don’t put things out there and talk about them then the only option left is to make assumptions, which can be really dangerous as a lot of times we misinterpret things and come to the wrong conclusions. So keep up that communication. Try to be clear about how you feel both positively and negatively. You can say that you feel jealous and also be clear that doesn’t mean he has to stop doing what he’s doing. You are both happy for him and sad that you can’t be with him. You’re allowed to feel both. It’s also important to realize that likely the circumstances are to blame…it’s not either of you personally that is causing the emotional turmoil. Nobody is to blame here.

Embrace independence

Now to look at this in a different way, this might be an important developmental step for you. When you are in a relationship where you have no sense of individuality, that can lead to codependence and relying on the other person entirely for your emotional state. Which can be problematic. Being able to operate independently (even if you prefer to be with the other person) can actually strengthen your relationship and provide an even better platform for growth moving forward.

So this might be good practice for you. Think of it like an exposure exercise for anxiety. You are learning how to better tolerate being away from your partner and living your own independent life. That is going to take adjustment and it’s going to take practice. You don’t need to be a pro at it yet. You don’t ever need to become a pro at it. But you will get through it. And you will learn from it.

Also, realize that a year is a long time, but in the longer scope of your potential relationship, it’s hardly a blip on the radar. Soon enough, you’ll be looking back at this time happy that you made it through. Keeping busy as you mentioned is a good strategy. Finding a hobby that you can dive into might be helpful. Changing the frame and focusing on helping other people might be surprisingly effective as well.

Even if you don’t want to, you will probably want to make sure that you are engaging with others socially and spending time with other people that you care about. Being left to your own devices and suffering through this in isolation is not what we want. You don’t always need to be completely busy or always have a social engagement, but you definitely don’t want to be in complete isolation.

Overall, I just want you to be gentle with yourself. It’s okay that you aren’t feeling awesome. It will get easier with time, but you don’t need to feel great about it. Keep communicating, make sure you are well supported, and treat this as an opportunity to focus on yourself and build your personal resilience.

I suffer from social anxiety and depression, along with GAD. I frequently deal with lack of interest, low motivation, and having no hobbies anymore. I also feel lonely quite often as I’ve been abandoned by any friends I had, and my mother and sister are across the country. There’s not many opportunities to make friends where I live, plus my social anxiety makes that hard. I currently live with my dad but he isn’t enough to help with the loneliness as we both are people that struggle with conversations.

I’m moving to another state in July, where I’ll be living near my mom and sister, and I can have them around as a support system and also to help me get out of the house. I’ll also have many opportunities to meet new people as it’s a large city. I was hoping to get some advice on how to cope with the depression and loneliness until then?

First off, I’m really happy to hear that you are going to have a change in circumstance. That’s not necessarily going to solve the root of all your emotional difficulties, but changing the setting can absolutely make a big difference sometimes. It sounds like you are ready to embrace that too.

Plan, plan, and plan

You’re already doing one great thing, which is that you are actively planning for the next stage. That is a really productive use of your time. Brainstorm, plan, research, and make some hopes and goals for yourself as you prepare for your move. In terms of when you actually get there, Facebook groups are a great place to make friends, connections, and find common activities. If you have a hobby, or are looking for a hobby, look for local Facebook groups for your city, join the group and then keep your eye open for opportunities.

It’s also a great time to work on investing a bit into your own coping skills. With depression and anxiety, there are some common patterns that you probably fall into. Low motivation and lack of pleasure in activities can be a major part of depression. Anxiety makes you avoid things for fear of not being able to handle it. The two together can create a vicious cycle. If you haven’t been in therapy before, now might be a good time. Or at the very least, it might be a good time to pour yourself into some self-help materials.

Practice behavioral activation

While it sucks that you don’t have motivation right now, this is a common symptom of depression and this might be the perfect stage to practice some behavioral activation. Think of it as training for your upcoming move so that you can make the most of it. Behavioral activation is the term that we use for counteracting the low motivation and laziness that comes along with depression. Your brain is basically in a depressive mode where it doesn’t know how to feel pleasure and look forward to things. You need to teach it to do that again.

For instance, you said you don’t have any hobbies anymore, which suggests that you probably had some before and you had things that you used to feel pleasure doing. When you are doing behavioral activation, you are basically forcing yourself to get back to those things that you used to enjoy to practice feeling good again. You may not feel like it and it may not even seem fun while you’re doing it, but you basically need to keep at it systematically over time so that you can wake up those part of your brain that used to make you feel enjoyment. Treat it like a job and make yourself some goals/schedules. The more regimented and consistent you can be, the better.

If you find that you have a lot of negative self-talk and thought patterns that are getting you down, that might be a place to focus your efforts as well. Getting some cognitive behavioral therapy or reading something like my book might give you some insight into your patterns and give you the knowledge you need to interrupt those patterns.

And breath…

On the anxiety side, it might be a good time to start trying out meditation or deep breathing exercises. Start teaching your body what it feels like to engage the relaxation response and chill out your physical anxiety symptoms. This will help you out when you are having trouble engaging in those hobbies and activities because you will be able to tolerate a little more anxiety and push through.

All in all, you only have a couple of months to go. Between packing, moving, and all of the stuff that comes along with that, it probably will go by really quick now. All of the tips that I gave are good for giving you a little boost in the right direction.

I really hope that the move works out well for you. Just remember that no situation is going to be perfect for you and there will be ups and downs. But you have the opportunity to capitalize on this move and make it work in your favor in terms of mental health. Keep the attitude of progress and your personal goals in the back of your mind as you start this next leg of your journey. Ask for help or support when you need it and don’t forget about the resources that are available to you.

Good luck!

I recently had a sibling go through a bout of drug induced psychosis. It lasted several days before some concerned friends contacted a family member who took them to the hospital. It was pretty scary for my whole family and the person who was going through it.

After talking to them, I learned they were hallucinating people, conversations and falling a lot thinking someone would catch them, quit their job, and threw a “birthday party” for themself. They also threw a fit at the hospital because they thought they were being taken to a psych hospital.

The doctors said my sibling could fall back into it and that is really what scares me. I don’t really understand psychosis and was wondering if you could talk about it and about ways to support them.

Thank you for the great question. I’m sorry that your sibling, as well as you, your friends and family members had to go through this. Psychosis can be really scary.

What is psychosis? 

Just to define the terms, psychosis refers to the state of having either delusions or hallucinations or both. It alters your perceptions of reality, causing you to perceive or interpret things differently. Delusions are beliefs that are not rooted in reality, such as having delusions of grandeur or persecution. These are things that appear very real to the person, but are not real to everybody else. Hallucinations are where you have some form of sensory experience, such as hearing or seeing something, which in reality isn’t present. It is these aspects that make up the umbrella term of psychosis.

Psychosis can be the result of a mental disorder like schizophrenia, but in some cases, drugs or medications can induce psychosis. Cocaine and other stimulants that create excessive dopamine are common ones to cause psychosis. But you can also see it in individuals who have adverse medication reactions, are on high doses of Parkinson’s medication, or even people who get bad infections.

It is important to realize one key distinction, which is that drug-induced psychosis is not a psychotic mental condition like schizophrenia. It’s a temporary state linked to the changes caused by the substance. It does not persist for the rest of their life. However, in some cases, the substances can be the trigger for a mental disorder. In schizophrenia there tends to be a genetic vulnerability to the disease, which is combined with some sort of trigger like a trauma, illness, or in this case, a drug bender that kicks off the mental disorder. In these cases, it becomes a long-term issue.

If your sibling successfully detoxes and stays sober and they aren’t showing symptoms of psychosis, they should be all good. But if they continue to have delusions and hallucinations even though they are no longer on substances over time, you may be looking at a more permanent condition. Your sibling’s doctors are going to have to be the ones to track this and make the distinction.

The area where your sibling might “fall back into it”, the doctors likely mean that if they were to abuse drugs again, there is a likelihood of falling back into the psychosis. So treatment and monitoring will be important to make sure they can keep themselves safe.

Coping with psychosis

It can absolutely be really scary and difficult to deal with psychosis from the family member perspective. When someone has delusional beliefs, they are not rooted in reality or logic. So you are not going to be able to use reality or logic to talk them out of it. You have probably found that arguing with them about the reality of the situation is rarely effective. In some circumstances, reality orientation can help, but rarely is that the case and often when you push them it just causes more agitation and makes them more upset. Often it’s a matter of sidestepping the argument about what’s true and trying to cope with the situation at hand.

Rather than push them and make them more agitated there are a few things that you can do. Distraction and redirection are going to be your best friends. Rather than fighting directly against their delusional thoughts or hallucinations, accept that it is truly their experience at that moment even if it doesn’t reflect your reality. Don’t tell them that they are wrong, but you don’t have to say that you agree with them either – work within the delusion.

Usually there is some sort of fear or need underneath that you can address. You can often reassure them that you will take care of the situation and then simply try to distract them or redirect them to some other activity. For instance, if they are concerned that their birthday party has left such as mess (even if there is no party or mess), you can say “Oh don’t even worry about it. I’ll get it taken care of. Let’s just go out and grab something to eat. You don’t need to worry about it”. So you are working within the delusion, using elements to help you move forward, without fully immersing yourself in it.

Continuing forward if there is no more psychosis, simply being supportive and making sure that they have resources in place is one great way for you to help them out. Often drug abuse is secondary to some sort of psychological issue that they are self-medicating for. If you can lead them toward resources to help them with their underlying emotional difficulties, that can help prevent them from relapsing back into the drugs. If you’re looking for treatment programs in the area to refer them to, look for “dual diagnosis” programs. These are designed to help someone who has a co-occurring mental illness and substance abuse problem and really work to help tease the two apart and provide a full, wraparound treatment.

You don’t have to solve the problem

Overall though, it’s important to realize that when someone has psychosis, there may be no perfect right answer. You don’t have to solve the problem or know what to do. Keep your care for the person in the back of your mind and continue learning and educating yourself when issues pop up.

Remember that none of this is on you. You can try to help and offer support, but sometimes these issues are like a force of nature and they may find themselves using again. Having been through it before, it might make it easier to interpret their behavior and not take it personally, but it will always be hard.

I’m glad you care enough to write in and educate yourself. They are lucky to have you in their life. Be gentle with yourself, take care, and whenever you’re in doubt always seek advice if you need to.

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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