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Hello, friends! In this episode I answer some great questions relating to depression in relationships, managing anxiety nausea, and also tackle the misconception that a lot of people hold in thinking they aren’t “sick enough” to take part in therapy.

Special Announcement

The month of October marks five years since my wife and I started the Duff the Psych brand! It was on my birthday when Joelle gifted me the Duff the Psych website, which if you know the history of why I started my books, is amazing (if you don’t then please do check out my TEDx talk right here!).  Not only is it five years since we started Duff the Psych, but it is also my Birthday on October 27th and so to celebrate I want to do some special stuff this month! If you’re not yet following me on Facebook, definitely do follow along as I will be announcing freebies, discounts, giveaways and all sorts of really cool stuff across the month of October!

To kick things off, I’m going to be giving a massive discount on my online course, Kick Anxiety’s Ass until October 15th. Typically it’s $300 – I’m going to be giving it to you guys for $100! If you’ve been considering the course it’s definitely a great opportunity to get stuck in. You can find out more about the course on the website, or if you have any questions at all, shoot them over either by email or on Facebook!

So, to take advantage of this incredible offer, head to kickanxietycourse.com and sign up using the offer code “FIVE” at checkout, or just click here, and you can start kicking anxiety’s ass!

Stay tuned for more great things coming soon this month!

Hi! I’ve noticed some unhealthy changes in my behavior recently (two or three months). I don’t want to do therapy – I should be healthy, why wouldn’t I be, and seeing a therapist would be as if I think that I could have some serious problem – which is laughable, especially given how much shit many other people have to live through; actually, I feel some shame about even asking you. My question is – how do I find the root, and where do I begin changing stuff to prevent things from worsening? Or maybe I should just shut up and stop whining? That’s what I think most of the time. Below are some details about what changed. My sleep schedule got destroyed – I can’t get up in the morning, and have trouble going to sleep at night; I’m slacking off at my job (I work remotely), I’m indifferent about activities that I used to enjoy – like playing in a band and board game parties, so I haven’t participated in either for some time; alcohol (I probably consume more than I should) used to make me happy, but now just makes me drunk; I kinda enjoy unhealthy food most of all, but then I feel guilty for eating it. Thank you for reading this, sorry to waste your time.

First off. You are not wasting my time. Your question is valuable and my response might be able to help out other people who are in your situation, but weren’t able to reach out about it.

I think you have a common misunderstanding of therapy. A lot of people feel like they aren’t “sick enough” or suffering enough to take part in therapy. That’s totally not how it works. Therapy is not an exclusive club. You don’t have to be suffering to a certain degree in order to qualify for therapy or to be taken seriously. Almost everyone can benefit from therapy at some point in their lives whether they have a diagnosed mental disorder or not. Therapy is also not an indicator that you have failed in some way. I feel like I’ve said this many times on the podcast, but getting professional help is not a sign that you couldn’t do it yourself. It’s a sign that you are willing to use the tools at your disposal to improve yourself. That’s strong.

So no. I don’t feel like you need to suck it up and stop whining. I’m sure that comes from a sense of personal responsibility that you should just deal with your own shit, but in some ways letting this get the best of you without using the resources at your disposal would be less responsible. Admitting that there is an issue and trying to see what can be done about it is the first step. So good job.

The signs of depression

I know I said that you don’t even have a mental condition to get therapy, but when we are looking at whether something counts as a diagnosable condition, one of the most important factors is how the symptoms are affecting your life. Are they impacting your ability to work or go to school, are they impacting your relationships, are they causing you significant discomfort. You sound depressed. Whether this is a temporary state or a full depressive episode doesn’t fully matter. The things that you described fit – these are the signs of depression:

• depressed mood – feeling down, feeling sad
• diminished interest in activities – lower interest in activities, not feeling pleasure or happiness from things you used to enjoy.
• weight loss or gain, change in appetite
• slowing down of thoughts and physical movements
• fatigue or loss of energy
• feelings of worthlessness or excessive guilt
• diminished ability to think or concentrate
• suicidal ideation – thoughts of hurting yourself.

One thing I would also add in here is sleep disturbance. But, my goal here is not to diagnose you – that wouldn’t be responsible or realistic, but I want to point out to you that you’re not just being dramatic. The things that you are struggling with are real and valid. They are significant issues that you deserve to pay attention to. Depression can present in many different ways. Sometimes you have the crying, tearful, despondent, hopeless type. Other times, it looks a lot more like low motivation, lack of pleasure, and general sluggishness. Tbe latter often slips under the radar as it isn’t so outwardly obvious.

You said that you don’t want to do therapy. It’s okay if you don’t want to – that is obviously your choice. But I just want to make sure we address that your issues would be a perfect reason to seek out therapy. There are many people that I have worked within my practice that have situations very much like what you are describing here. It’s not laughable to consider that your current difficulties and changes are worth getting help for. The other part that points toward therapy as a potentially good idea is that there are established treatments that have proven to be effective for dealing with the kinds of symptoms that you are describing.

Alternatives to therapy

If you aren’t interested in pursuing therapy, then it might make sense to just start educating yourself more about depression. Find self-help resources that can give you some ideas of things that you can do to get the ball moving again. I have a book on the topic that a lot of people have found really helpful. There are also countless other books, podcast episodes, youtube videos, blog posts etc. that might give you some insight. Even if you are passively taking in this information in the background while you are doing other things, there is a chance that someone will say something in a way that resonates for you and that is all you need to light the spark that will help you pull through this.

If you find that you are in your head a lot and you tend to bring yourself down be thinking negatively about situations or tend to take a lot of things personally, looking into cognitive exercises and coping skills would be best. If you find that it is much more of a full-body sense of depression and it doesn’t really correlate to the thoughts you are having, you may want to look into resources for behavioral activation. Behavioral activation is the process of getting the ball rolling again and getting your brain used to feeling good again. Right now, your brain has sort of gone into low power, low reward mode. The way to combat this is by forcing yourself to do things you used to enjoy and retraining your brain to feel good from those things. Again, I talk about all of this in my book. You might also try the 5-minute rule for motivation where you give a job or activity just 5 minutes of your time, or even give yourself permission to do a shitty job – you can read more about both strategies in episode 151 where I give my top productivity tips.  I also have an entire episode of the podcast (episode 26) about sleep hygiene as well – I won’t go into detail here, but the name of the game is association and consistency.

Overall, I don’t have any particular preference for what action you take next, but I want my response to you here to simply drive the point home that you aren’t just being weak or dramatic. You’re dealing with some real shit and it’s totally reasonable to pay more attention to it. Whatever you do, just take the first step and build from there. If you are able to make some progress on any front, be that learning more about the symptoms you are experiencing, gaining some skills to get you to stay on top of your tasks, or seeing a therapist and diving deep into problem-solving, any progress will help things get easier. Once the ball is rolling in a positive direction, it’s easier to keep it rolling. It’s just this first part that is so hard.

Thank you very much for your question. I hope you’re not feeling too down about the response here – I think that it’s just really hard to admit how much these things suck, we’re kind of trained not to in a lot of cases…so, be honest with yourself that you’re not happy with this and don’t feel ashamed about that because there are a lot of people who are with you in that. Get some help, do what you need to do, and I really wish you all the best.

Hi Dr. Duff, I have suffered with anxiety and depression for around 7 years now, recently however my anxiety has taken a new form. I have never been a great sleeper, but every morning for the past month or two I have been waking up around 2am with the worst feeling of dread and fear, I was vomiting every morning, however I have stopped eating past 4pm to ensure I have nothing in my stomach, this just means that I dry retch every morning. I can tell that my body is in fight or flight mode when I wake up like this, and unfortunately my body’s response is to vomit. It just feels like I’m in a vicious cycle and I can’t get out, belly breathing and the 4,7,8 breathing really help – but I just wondered if you have any tactics to combat the queasiness? Have a great day.

This is such a common issue and so frustrating. Things feel much more out of control when you’re in the middle of sleeping, so I know this can be incredibly unsettling and also roll over into your anxiety the next day. I don’t have this exact issue, but I can certainly empathize with just how hard it is to deal with stuff when you’re unrested.

Talk to your doctor

Starting with the most obvious answer, just make sure your doctor knows about this. I know that it seems to be corresponding with your anxiety level, but you may also want to make sure you rule out other possible reasons for the nausea and vomiting. One thing that happens with anxiety is that if you have some physical issue, anxiety holds a magnifying glass up to it, makes you react with strong emotions, and then that makes the actual problem worse. So it could be that you have some other physical issue that’s making you feel nauseous, anxiety blows it up and then you start reacting with those strong emotions and start getting that fight or flight that you described and then that actually folds in and makes the problem worse. This makes you freak out a little bit more and next thing you know instead of just feeling ill, you are actually feeling a lot worse than before and end up vomiting and having a near panic attack. So it can be a combination thereof where there is a legitimate physical issue and the anxiety is just compounding it. Or that may not be the case, but it’s important to rule it out.

You may also discuss with your doctor the best strategies for managing the nausea. You don’t just have to deal with it, especially if it’s affecting your ability to live. There are anti-nausea medications like Zofran that you might be able to have on-hand for really bad moments. Or it could be that a mild sedating SSRI medication can help you sustain sleep throughout the night. I would steer clear of sleep medications like Ambien, though. I also suspect that the not eating strategy is probably not a good one to curb the nausea. More likely, you would want to focus on eating lighter meals, avoiding alcohol and high acid foods etc. to see if it makes a difference for you. Again, you might want to chat with your doctor or a dietician about that, but I know for a lot of people nausea can correlate with hunger or changes in blood sugar. In this day and age, you can also talk to your doctor about using CBD products or marijuana to aid in sleep. For my wife, THC and CBD products have had more of a positive impact on helping her sleep and stomach problems than pharmaceuticals. So it’s worth checking it out with your doctor if that’s okay with you, and of course, if it’s legal in your state. In addition, I’m glad to hear that the 4-7-8 breathing is helping out. Remember that the idea for breathing exercises is that you build it as a skill and practice them during periods that you are not already stressed and then you can better rely on them when you are in a tough situation.

Preparing for sleep

Focusing on relaxing and transitioning into sleep might also be helpful. Some people that I’ve worked with have had success in reducing early morning anxiety by journaling before bed. In my mind, the ideal bedtime routine is to set aside an hour. Unplug from the world. No work, no social media, no news etc. Use a journal or notebook to write down whatever is on your mind including worries and problems that still need to be solved. I usually don’t suggest journaling right before bed because that can sometimes get your mind working harder. Instead, put it at the beginning of your hour and then spend the rest of the time focusing on relaxation and letting go of the day. So you could take a hot shower or bath, read a book, color in a coloring book, do some stretching, listen to a guided meditation from headspace or a similar app, or do anything else that helps you chill. Then you go to bed. If you find that you are tossing and turning unable to sleep, leave bed, do something relaxing for a few minutes and then try again.

You can also experiment with some different ways of adjusting your routine. For instance, if this has been very consistent, you might just plan for it. Put some water in the tea kettle and leave it on the stove, have a box of small snacks near the side of your bed with things like crackers, mints, apples, etc, and then plan on waking up at 2am and taking a break from sleep. Rather than getting upset and frustrated, see if you can just get out of bed, have a little snack, put some tea on, and get some cool fresh air for 15 minutes or so. By embracing it rather than fighting it you may find that it’s less agitating for you. Obviously having disrupted sleep like that wouldn’t be the best long-term solution, but it could be that you just sort of need to break the cycle and then things may start to return to normal.

Practice Mindfulness!

And it’s been at least 1 or 2 episodes since I mentioned mindfulness, so I will here. It can also be really helpful to practice mindfulness as a skill. That should allow you to notice the physical sensations of nausea and tension while at the same time letting them exist in the back seat while you continue doing what you need to do. There are many ways to practice mindfulness, but at the most basic level you just pick a simple task like breathing and practice focusing all of your attention on it. When you get distracted by an internal sensation or thought, don’t try to push it away. Instead, notice what the intrusion is (nonjudgmentally) and gently redirect your attention back to the task at hand.

Those are some ideas for you. I might also encourage you to go to the HCSH facebook group and ask. There aren’t a lot of widely used protocols specifically to combat morning anxiety or nausea – they tend to be more general. Perhaps some people in the group could give you some good ideas of things to try. Be experimental and try some things – if it works it does, and if not then try something else.

Hopefully these tips are helpful and I’m sorry you’re going through this, but hopefully there are a few things here that will make it a little bit easier for you.

This question isn’t in regards to me, but for my friend and her boyfriend. They have been together almost 4 years, with talks of marriage, family etc. Out of the blue this last month he has been acting very distant with her. She finally addressed it with him, and he mentioned that he had been feeling distant from her for a long time, and is not sure if he is in love with her anymore. Of course she is heartbroken but, come to find out after meeting in person and having a long talk together he mentioned to her that he is just dealing with a depression and loneliness unlike anything he has felt before. She wants to help him from spiraling further, but is also hurt at the same time with the uncertainty of their future together. I let her know that I think it would be best if she focused on just being his friend right now, and to give him support and time to figure this out. Is there any specific tips you can recommend to not only help her but, to aid her in helping him. Thanks!

This is definitely a tough situation. Mental health issues like depression can definitely impact the quality of romantic relationships. And if this person is struggling as much as it seems, it might even be hard for him to tell the difference between a lack of happiness or pleasure caused by depression and reduced interest in the romantic relationship. It could be that it’s solely a byproduct of the depression, or it could be that he really wants out of the relationship and the depression is a convenient scapegoat, or it could be a bit of both. I’m not sure that now is the right time to figure out exactly which one it is.

Your friend is allowed to have mixed feelings about this. She’s allowed to care AND hurt. One thing that I would encourage is for your friend to be as open and clear as possible about her feelings. She can say that she cares about him and wants to be with him in the long run and that she feels conflicted about what she should do. She can say that she feels like letting him figure it out on his own could be helpful, but also wants to support him. At the very least, understanding that depression is part of the mix may help your friend not take things as personally. It’s really easy to personalize and assume that we are the reason for someone else’s behavior. In this case, certain depressive symptoms might look a lot like he doesn’t care or is mad at your friend when in reality, things just suck in his head right now and he doesn’t really even know how to make sense of it all.

Staying together romantically or focusing on just being friends are both valid options. I think that some of the decision about what to do needs to be informed by how things were prior to the depression setting in. Were things great and really strong before? If so, that may be an indicator that the depressive symptoms themselves are really getting in the way of his ability to participate in the relationship in the same way. If things were somewhat rocky all the way through, that might be a different story. If they want to stay together, I think it would be important for them to talk about their goals and boundaries for the relationship. Even though things aren’t feeling close and intimate right now, where would they like the relationship to be in the future? And what sort of behaviors are acceptable and not acceptable in the course of the relationship. Depression can cause you to act in a lot of ways that might be difficult to cope with in the context of a relationship, but certain things like name-calling, insulting, or abusive behaviors should still not be tolerated.

I think it’s also important for your friend to not get strung along endlessly while her boyfriend does no work to improve his emotional situation. They could make a deal that she will try to avoid taking things personally and will support him during this period of progress and his side of the bargain is that he needs to be actively pursuing recovery via therapy, medication, or self-help.

Overall, this is something that will require continued communication. There’s no right way to navigate this, but my best advice would be for her to keep her hopes and intentions as the north star in her mind that can guide her behaviors within the relationship.

Sponsor:

This episode of the Hardcore Self Help Podcast is sponsored by MycoMeditations Psilocybin-Assisted Retreats. MycoMeditations provides a legal means of experiencing the transformative and healing properties of the psilocybin mushroom. They provide 7-day retreats in Jamaica that involve guided psilocybin treatments, group processing, massage, accommodations, and authentic Jamaican cuisine. Learn all about MycoMeditations at their website or on episode 171 of the podcast, where I interview their founder.

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