An important part of treating our mental health is understanding how our behaviors and experiences contribute to worse mental health symptoms.
For example, if you have a fear of spiders, and you purposefully avoid situations that might cause you to see spiders, your fear of spiders gets worse. This is the psychology of avoidance, which we mentioned in a past article. Or, if you have panic attacks, the way you breathe when you have panic disorder can actually trigger future panic attacks.
Our brains are complicated structures that work in equally complicated, often cyclical ways.
We also see this with depression, and one of the most common ways that this manifests is with the relationship between depression and sleep. Depression can cause sleeping issues and, to make matters worse, sleeping issues can cause depression. Understanding this relationship can help you make better decisions in order to help address your depression and also understand why you may feel the way you feel.
How Depression Causes Sleep Issues and Disturbances
Depression itself causes issues with sleep, both quality and frequency. Depression can cause both insomnia (inability to sleep) and hypersomnia (excessive sleep). Some of the scientific findings that relate to depression’s affect on sleep include:
Depression reduces REM sleep and affects how the body goes in and out of sleep stages.
Depression dysregulates melatonin, which his the hormone that regulates sleep/wake cycles.
Depression increases the likelihood of waking up in short bursts during sleep.
Depression reduces deep sleep time.
Depressed people tend to take longer to fall asleep at night.
These are all findings that implicate depression as a cause for possible sleep related problems.
How Sleep Issues Can Contribute to Depression
So, we know that depression can cause sleep issues. But where challenges arise is that science has shown that sleep issues can cause depression. Examples of these findings include:
Sleep deprivation studies have shown that even one night of poor sleep can cause depression-related symptoms, or exacerbate symptoms in those that already have depression.
Sleep disturbances cause abnormalities in regions of the brain that are linked to mood regulation and negative bias, increasing the frequency of negative thinking.
Sleep quality issues can alter the portions of the brain that are responsible for good decision making and stress coping.
Numerous studies have linked poor sleep, chronic insomnia, and a host of sleep issues with the development and maintenance of depression, although exactly how they are linked is not always clear. Nevertheless, it is clear that sleep issues can both cause depression and increase depression related symptoms.
Breaking the Poor Sleep/Depression Cycle
Sleep is not the only cause of depression, nor is depression the only cause of poor sleep. But the cyclical nature of the two – where poor sleep leads to depression and depression leads to poor sleep – is still very important for those with depression to recognize and understand, as they can help explain symptoms and experiences, and also help improve decision making about when to rest.
This is one of many examples of the ways that our mental health is more complicated than many of us believe. It is also why, by treating depression, we can improve our sleep quality which may also improve or depression. If you feel like you’ve been down or sad, reach out to a therapist and start receiving the support you need to improve your mental health.
Human beings are social animals. Research quite literally shows that we need interaction with other human beings in order to survive. Our life, our health, and our happiness are all directly connected to our ability to communicate and socialize with others.
Still, many of us also struggle with social anxieties. While not everyone may have social anxiety that qualifies as a mental health diagnosis, we can still have fears, anxiousness, and shyness in social situations.
Motivation for Feeling Social Anxiety and Fear
Social phobia can have many different causes and symptoms, and has been linked to issues like trauma, bullying, and other past experiences. One of the most common symptoms of social anxiety is a fear of being judged, and a fear of making a mistake in a way that hurts their social standing.
In psychotherapy treatments for social anxiety, like CBT, one way that we try to help address social phobia is to reframe the way you see and approach different situations. The fear of being judged is a perfect example of this. We often feel like, when we stumble within a conversation, that the person on the other end is making fun of us or thinking about how much we made a mistake.
But, when you leave a conversation, how much time do you spend thinking about all the mistakes *someone else* made? How much time do you spend thinking about and judging other people for their fumbles?
Most likely, you don’t think about other people’s mistakes at all.
The truth is that most people do not spend time thinking about you. Most people do not spend much time thinking about anyone but themselves. We all live very busy lives with our own stresses and distractions. We have our own family to worry about. We have dozens of conversations throughout the day. Most people simply do not have the time and energy to spend thinking about every little mistake you made.
And that’s a good thing.
Part of our social anxieties come from feeling like other people care about us enough to talk about us and think about us all throughout the day. But other people are not thinking about us at all. Even in situations where we do truly and objectively do or say something embarrassing, most people have too much going on in their lives and their own needs/desires to focus on anyone but themselves.
Other People Care About You – But Not That Way
Other people do care about you. They care that you’re happy. They care that you have your needs met. They care if you tell them that you got a new job and they care if you tell them you lost a family member.
But very few people have the time or energy to care about small conversational mistakes or inappropriate verbal responses. They don’t care about your facial tics or your bad jokes. There’s very little that any person can do that can cause someone else to focus and think about them all throughout the day.
So the next time that you find yourself worried about being judged, remember how little energy other people have to spend thinking about your mistakes. We all have our own stresses to worry about.
Major depression and bipolar disorder – two of the most common types of depression – can often be lifelong and ongoing without help. While both are treatable, both typically result in thoughts and behaviors that feed into a cycle of depression that keeps the symptoms constant or, in some cases, making them worse. Psychotherapy and related support are often required to overcome these conditions. Postpartum depression is a bit different. While it is unfortunately true that some women do experience ongoing symptoms of postpartum depression (PPD) if it is left untreated, many others overcome PPD almost spontaneously – weeks or months down the road, when the transition to parenthood has settled, hormones have balanced, and both partners have been able to figure out their co-parenting roles. It is because PPD can go away on its own (even though that is not a guarantee) that many women do not seek treatment. But the problem is that, even in situations where PPD has faded away, the effects and experience of that post-partum depression can be long-lasting.
Ways that Post-partum Depression is Traumatic
PPD is, in many ways, traumatic. Most people expect having a baby to be this joyful, exhilarating event. But a large percentage of women end up experiencing at minimum a mild form of post-partum depression (known as the “baby blues”) and many others experience more profound and heavy emotions with symptoms such as emptiness, loneliness, sadness, and depressed mood.
Those negative emotions can have many long-term consequences, even after the PPD has gone away. Many women experience:
Fear over having another child. There are many women that experience anxiety over having PPD again, and some women that will avoid future pregnancies specifically because they do not want to experience postpartum depression.
Guilt and shame over not fully appreciating the baby’s first few months. PPD can make it difficult for new mothers to bond with their baby. After the PPD goes away, many women feel guilt about the experience and feel sadness that they did not fully enjoy those days.
Reliving the experience. Many women remember vividly what it was like to live with PPD. They may have flashbacks or extreme levels of empathy for other moms. They may also still have issues with their partner that resulted from their PPD experiences.
These are only a few of the ways that postpartum depression is traumatic for the moms that experience it. Many women that have postpartum depression struggle with the effects of it long after the PPD has gone away.
Trauma Needs Support
Not everyone will overcome postpartum depression on their own. But even those that do can still live with the effects of having it long after the postpartum depression has gone away. Those emotions benefit from ongoing support by counselors and therapists that understand how to work with both PPD, trauma, anxiety, and more.
Postpartum depression may be common. But we have therapies now that can help address not only the PPD itself, but the months and years after. Seeking help is beneficial for anyone that feels they are struggling, and no one should feel like they need to “wait it out” alone.
All of us have this tendency to focus on the negative. Living in this busy world, we often find that our thoughts are on worries, the things we need to do, where we made mistakes, and on and on. It’s one of the reasons why positive affirmations are considered a part of many depression treatments. By telling ourselves every day things like “I deserve to be happy,” we can restructure our minds to believe it.
Affirmations can seem silly to those that have not done them before, but the research into them – although limited – is largely positive. It’s a key component of cognitive restructuring. We, as therapists, often have people with anxiety and depression repeat these affirmations to themselves every day to essentially rewire their minds so that they learn to see the world in a more positive and hopeful way.
Starting Affirmations Early – Before They Are Needed
What some researchers are doing is looking to see if components of psychological treatments, like affirmations, can help not only treat different mental health conditions, but actually prevent them. To study this, researchers looked at one of the most at-risk populations for depression: college age women.
They had half of the group learn behavioral interventions that included positive affirmations, while another group acted as the control. They then followed up with his group at various intervals over the next 18 months. The group of college-aged women that utilized treatment tools like affirmations had lower depression scores and higher self-esteem across the board when compared to women in the control group, indicating that treatments like positive affirmations were powerful enough to potentially prevent depression and depression-like symptoms.
Are Affirmations Preventative?
Research into affirmations is limited. Even in the above study, affirmations were given with a variety of other behavioral interventions, so it’s unclear if affirmations alone would have had much benefit. Similarly, usually when performing a research study, it is better for the control group to have some type of inert treatment to compare it to. Since the control group had no treatment at all, it’s difficult to say if the existence of any treatment would have provided similar results, no matter what it would be.
But there is plenty of research to suggest that affirmations can actually be quite powerful, especially with our tendency to think negatively. Those that are looking to give themselves a positive mental health boost in their lives should consider seeing if daily affirmations can provide them with some help in boosting their confidence, happiness, and self-esteem.
In today’s world, there is often a societal focus on the effect of menopause on women’s mental health. But what is not often talked about is perimenopause, and the effects of perimenopause on mental health.
Menopause – the end of a woman’s natural fertile period – is typically between the ages of 45 and 55. It is marked by often drastic changes in hormonal levels that, at least during the transition period, affect how a woman feels both physically and emotionally.
But perimenopause begins much earlier. Perimenopause is when the body begins to have hormonal shifts related to menopause but are still often many years away from menopausal onset. Some women experience perimenopause as young as their late 30s, and most women will experience it by the age of 40 to 44.
During this stage, women are still able to have children and still having periods, but their bodies are experiencing hormonal shifts and changes behind the scenes as it prepares for menopause later in life.
Perimenopause Effects on Mental Health
Because perimenopause begins at a younger age – sometimes as much as 12+ years before menopause begins – many women have no idea that they’re experiencing it, and many doctors do not talk to women about their changing bodies. Perimenopause remains an often silent part of the culture.
So it can be surprising to women in their mid 30s to mid-40s when they begin to have mental health symptoms they did not have before:
The degree and severity of these symptoms differ from person to person, and lifestyle and experiences still play a role. But if a young woman in her late 30s/early 40s starts to notice that they’re feeling more anxious, or they’re having hot flashes, or they simply do not feel as emotionally healthy as they did before, it is possible that perimenopause may be to blame.
Other Factors to Consider
Now, during this same phase, women may be undergoing changes in their lives that may also have an effect on mental health. Many women have children by about 40 which adds stress to one’s life, and that is an age when there could be stresses with marriage or career that might be affecting a person’s mental health. Similarly, changing bodies can come with their own stresses, as reminders of aging and decreased fertility can affect health and wellness as well.
The Perimenopause Age and Mental Health
It is not always clear if anxiety, depression, or other mental health issues are the result of perimenopause, affected by perimenopause, or developed entirely independently. But what is clear is that it can be a stressful time, and those same mental health issues can affect someone’s ability to feel comfortable and confident within themselves.
Even mental health issues that are caused directly by hormonal changes can be addressed using psychotherapy, which is why it is so important for anyone that feels like they’re struggling to control their emotions, no matter their age, consider working with a trained psychologist or counselor. No mental health issues need to be permanent, and while it is useful to be aware of what perimenopause can do, it is also useful to treat it.
Many people with panic attacks develop a condition known as “agoraphobia,” which is best described as a fear of being out of the home or in places that are unfamiliar. One of the reasons that people with panic disorder may develop agoraphobia is because they start to avoid places where they feel like they might have a panic attack.
For example, if they have a couple of panic attacks while in the mall, they may stop going to malls. If they have it in a restaurant, they may stop going to restaurants. Over time, they become limited to very few places, and some people have a trauma response that makes them not want to leave their house at all.
But the problem is not just that people start to avoid places because they’re afraid they may have panic attacks. The problem is that they are often correct – if they did choose to go to a place that they feared, they would be very likely to have a panic attack. That is because panic attacks are self-fulfilling in a way that is caused by the symptoms of the attacks themselves.
How Panic Attacks Become Self-Fulfilling
Panic attacks are intensely physical anxiety events. When a person suffers from a panic attack, they often have rapid heartbeat, chest pains, light headedness, and a series of physical symptoms that can be so severe, they can be genuinely convinced that something is wrong with their health.
Because panic attacks are such overwhelming physical events, a symptom of persistent panic attacks is known as “self-monitoring.” People with panic attacks tend to pay attention to how their body feels at any given time in order to see if a panic attack is coming. If they start to feel the symptoms of a panic attack, it will often cause distress and anxiety – which then contributes to the attack.
In addition, people with panic disorder also develop what’s known as “hypersensitivity.” That means that they feel things stronger than other people do. While most people might not even notice a small pain or bit of discomfort, a person with panic attacks will not only notice it, but will feel it stronger. Both of these symptoms are also more likely the more anxious a person feels.
That is how panic attacks become self-fulfilling and reinforced. Let’s use the example of library.
Someone with panic attacks is worried they may have a panic attack at the library.
Because they’re worried, they’re a bit more anxious.
That anxiety causes them to experience a very mild sensation somewhere on their body.
Because of their hypersensitivity, the symptom feels worse than it otherwise might.
Because of their self-monitoring, they always notice it immediately.
That causes them to experience strong anxiety, worried a panic attack or worse is coming.
That anxiety triggers a panic attack.
Now their fear of going to the library is reinforced, and they may not go anymore.
This cycle can occur to anyone, even those without agoraphobia. Eventually, many people with untreated panic disorders will start to avoid places because of fears they may have an attack, or they may experience attacks more often because they have become self-fulling when they are out and about.
How Do You Stop the Self-Fulfilling Nature of Panic Attacks?
There are many ways to approach panic attacks and panic disorder, and you and your NYC therapist at Flourish Psychology will work to find the approach that makes the most sense for you. We may deploy treatments like cognitive behavioral therapy (CBT), rational emotive behavior therapy, gestalt therapy, positive psychology, and more.
CBT, specifically, is often used to treat panic disorder, and many of the treatment approaches are specifically about addressing these issues:
Monitoring your body for sensations.
Misinterpreting those sensations.
Many psychologists have identified these issues as some of the main reasons that panic attacks keep recurring. So, your therapist will provide you with actions that you can take to address these issues. Some of them may be uncomfortable – for example, you may have to put yourself “at risk” for a panic attack again as you stop avoiding places that caused them.
Your therapist may even have you mimic some of the same symptoms that you’ve had before that have triggered panic attacks. For example, if you get dizzy with panic attacks, you may be asked to make yourself dizzy so that you can learn how to calm yourself when you experience those sensations.
The approach that we take will be based on your specific situation, but much of addressing panic attacks comes from breaking this self-fulfilling panic attack cycle.