Dear Maddi: Anxiety and depression

Dear Maddi,

Sometimes I feel like I have a problem but don’t know what it is. I’m always sad and I think I get panic or anxiety attacks. Anything can trigger them like when a friend ignores my messages I start thinking “I always knew this was going to happen. Who is gonna want a friend like me? I wouldn’t want a friend like me.” When those thoughts rush in, I start breathing heavily. I start crying and tears rush out. I start to vibrate and I don’t know how to stop it.

Signed, Broken
[This letter was edited for publishing.]

Dear Broken, it is not uncommon to experience occasional bouts of feeling down and anxious, particularly if you are going through a difficult time but when these feelings persist, re-occur frequently, and interfere with your life, it is time to reach out for help. To discern the nature of your concerns have a look at the following resources on depression, anxiety and panic. It is possible for symptoms of depression and anxiety to co-occur and it can be common for clinical depression to accompany other anxiety disorders like panic disorder, or social anxiety. Symptoms generally improve with psychotherapy, medication or lifestyle changes, such as improving sleeping habits, increasing social support, using stress-reduction techniques or getting regular exercise.

It sounds like you are in a great deal of distress, so much so it literally makes it hard to breathe. When you feel overwhelmed by emotion, or when a panic attack is underway, it can be difficult to reel in your thoughts so first we need to help your body slow down. Anxiety can cause your body to kick into fight or flight mode which releases hormones like adrenaline and cortisol. This release can lead to physical symptoms such shortness of breath and a racing heart. Breathing exercises can help mitigate the fight or flight response and allow your body to relax.

Diaphragmatic breathing allows you to deal directly with the physical symptoms and the situations that make you anxious. In this exercise, you learn to slow your breathing, use your diaphragm and practice a small meditation component.

Place your hands on your stomach, or more accurately your diaphragm muscle. Breathe in normally with a conscious effort to pull the air from your belly, rather than your chest. You should see your stomach expanding when you breathe in and relaxing when you breathe out.
Try to keep your breathing smooth and avoid taking big gulps of air. Do not worry about forcing your breath to slow down right away, this will happen gradually. Simply focus on your breathing as is and follow step one to the best of your efforts.
Lastly, when you breathe in, think “one” to yourself, and as you exhale think of the word “relax.” Continue until you count to “ten” and then go back to “one.” If your mind continues to be bothered with thoughts, notice them, and gradually turn your attention back to your breathing, the numbers, and the words.

Breathing this way might feel a bit uncomfortable at first, but don’t give up. Practice twice a day, about 10 minutes each time. First in relaxing situations, such as a quiet place at home where you won’t be interrupted. Once you become skilled, you can apply it as a coping skill for anxiety.

***It is important to understand that this breathing skill, like many others, is not meant to stop anxiety in its tracks; rather it is intended to help you face feelings of fear and anxiety and the situations in which they arise. Once your breathing feels more under control, you can try self-soothing activities to help your body reset. A hot shower, a run, a cup of tea, a hug from a loved one or a chat with a friend can be helpful. Give your body time to return to a state of calm, since the amount of time necessary varies from person to person.

Once you feel somewhat more settled, you can begin to tackle your internal dialogue with a thought log and some reflective questions. Negative beliefs about yourself contribute to feeling sad, guilty and anxious. They can also lead you to avoid things you enjoy and stop you from having fulfilling relationships. A thought log can increase your awareness of your thoughts, and provide a way to shift your thinking about yourself. There are many examples of thought logs out there, including many useful apps that you can use to work on your thinking, but here is a simple one to get you started.

A. Activating Event: What is the situation I am in?	B. Beliefs: What am I saying to myself (or, how am I putting myself down?)	C. Consequences: How am I feeling?
A friend ignores my message.	I am not a good friend. They don’t like me. Nobody likes people who are sad.  People are not friends with sad people.	Sad Nervous

When you have identified your negative thoughts you can begin to use the following questions to challenge one thought at a time, starting with the most distressing thought first.

• What is the evidence for this thought?
• What is the evidence against this thought?
• Is this thought an opinion or is it based on facts?
• How helpful is it for me to criticize myself in this way?
• What advice would I give to a friend in this situation?

Are there any positives that I am ignoring?

After gathering new information you can follow up with two additional questions that will encourage you to consider a different perspective and new behaviours.

• How else could I view the situation? What other perspectives might there be?
• What would be more helpful behaviour I could carry out?

This practice will help you see yourself in a less harsh, more compassionate way, rather than letting your negative thoughts constantly interfere with how you think about yourself and how you live your life.

I understand it can be hard to do this by yourself, so please do not hesitate to reach out for help. You can consider asking a trusted friend for help, contact Counselling and Clinical Services for an Initial Consultation, or phone one of the many local agencies and private practitioners offering virtual services during the pandemic.

Thank you for your letter Broken, please feel free to reach out again.

Written by Maddalena (Maddi) Genovese, Counselling and Clinical Services Satellite Psychologist for the Faculty of Science.

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