Get Help When You Need It: Depression Is Not a Moral Failure

By Douglas Newton, LMFT

Over the past several years, stigma around seeking help for depression, anxiety and other mental health issues has decreased.  And yet.  Partly because of the way depression leads many to self-criticize, many often think that depression is a stain, a black mark against their character, something wrong with them.  

It is time to disentangle depression from this idea of moral failure.  It is time to stop imagining that depression is synonymous with a person’s character.  


What are the general symptoms of depression?

If you experience depression, you have symptoms that occur with that experience.  These can include sadness, stress, anxiety, sleep issues, negative self-talk, low motivation, feelings of hopelessness and failure to take pleasure in everyday activities, or anhedonia.  For severe depression, self-harm and suicidal thoughts can also occur.  

These symptoms help clinicians like me understand your experience.  No one chooses to experience depression.  And confusion around where it comes from can lead to self-criticism, self-blame, shame and isolation.  These factors can make depression worse, and shut someone down emotionally, which can exacerbate depression.

Thankfully there are many approaches to help people who experience depression find relief.  


What will people think of me if they know I am depressed?  What are some stigmas of depression?

Many public figures, most recently Senator John Fetterman, have decided to disclose that they are dealing with depression.  According to this article in the New York Times (gift article that doesn’t require subscription), “Social scientists say there is demonstrable evidence that the public is growing more accepting of people with depression.”  Relatedly, more people recognize the usefulness of seeking help when they experience anxiety, depression or other issues.  


What if depression is just who I am? 

When you are experiencing depression, it can feel like your entire experience.  It can eclipse your sense of self, or even come to feel like your identity.  Disentangling your self-concept from depression is one fundamental step in therapy to help recognize depression as mental illness rather than identity.  Therapy helps you distinguish between depression and your identity.


You are not alone

Millions of people experience depression, with onset resulting from a wide range of interrelated factors.  People from all walks of life experience depression and many of them find a fresh approach to their lives through therapy.  While your experience with depression is unique to you, the symptoms are not, and there are many ways to help.  

It takes courage and humility to recognize you need help and then make the call. Therapy is private, confidential, informed and professional, creating a safe place to address and treat your depression 


SF Stress therapists have deep experience treating depression

Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are among the effective, evidence-based treatments therapists use.  Research shows that therapy helps people diminish the severity and frequency of their symptoms related to depression.  

Getting help to treat your depression is an act of self respect.  It is a decision to take care of yourself, and an assertion that you matter.  For many people with depression, seeking help can be undermined by depression itself.  Making that call can help.  


Further Reading:

National Institutes of Mental Health on Depression

American Psychiatric Association on Depression

World Health Organization on Depression


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Breathe Your Way Through Stress and Anxiety

What is the simplest, most effective way to address stress?  What can you do to slow your heart and feel more centered when things are challenging?  Deep breathing, and Square Breathing in particular, can help you recover, find your center and lower the impact of stress and anxiety.  


You take your lungs wherever you go

Because we are always breathing, bringing attention to this fundamental process can seem simple, even simplistic.  Fortunately, square breathing is one of the easiest and most effective stress reduction techniques we have.  

What’s the easiest way to lower your heart rate?

Just arrived at work and need to reset your focus?  Get centered with 5 rounds of square breathing.  Feeling a little socially anxious at the wedding reception?  Take a moment to step outside and do some breathing, then hit the dance floor.  Need a moment to decompress from work before attending to your home life?  Take a moment to yourself to re-establish your focus before you walk in the door.  

How do you breathe to relieve stress?

Sit down if a seat is available, and keep your back straight, while also relaxing your shoulders.  Relax your abdominal muscles to allow your lungs to expand into your diaphragm.  Inhale for 4 to 5 seconds, while counting.  Choose a number of seconds that fills your lungs to a deep breath without pushing too hard against that natural limit.  Hold your breath for that same count.  Exhale for the same amount of time.  Then stay at the bottom of your exhalation for 4 or 5 seconds, whichever feels right to you, before you repeat the cycle.  


Benefits of Deep Breathing 

Deep breathing calms down the Fight, Flight or Freeze response. A slow exhalation engages the parasympathetic nervous system, which is involved in relaxation.  It turns down your brain’s alarm center. This leads to a reduction in cortisol, the stress hormone.  Your shoulders tend to drop.  You can feel yourself correct your posture a little and expand your chest cavity to accommodate a deeper breath.  The awareness from breathing can make you feel more restful, calm and aware.  According to psychologist and author Rick Hanson, focusing on the breath can be profoundly centering.  

According to the New York Times’ Alisha Haridasani Gupta, just breathe, “When you slow your breathing down, ‘the parasympathetic system — what we call the ‘rest and digest’ system — hopefully takes over and helps calm you down,’ she said.”  Because stress and anxiety are deeply woven into the physiological stress response, square breathing can be key to resetting your mood, your perspective, and your awareness.  


Further Reading:

Harvard Medical School Relaxation Techniques  

Deep Breathing to Relieve Acute Stress

NHS Breathing Exercises for Stress  

University of Michigan One Minute Strategies to Relieve Stress


If you’re seeking further guidance and support in managing stress and anxiety, SF Stress & Anxiety Center is here to help. Our experienced professionals can provide personalized techniques and coping strategies for long-lasting relief. Schedule a consultation today to take control of your well-being.


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Understanding the Link Between Stress, Anxiety, and Eating Disorders

Eating disorders such as anorexia nervosa, bulimia nervosa, and binge-eating disorder are serious conditions that not only have a profoundly negative effect on physical and mental health, but are also difficult to treat. These problems often start in adolescence and in early adulthood, although they can occur at any age. The disordered eating behaviors that result can affect the body’s ability to get adequate nutrition and cause physical damage, with potentially serious long-term health consequences. While the exact cause of eating disorders is unknown, certain risk factors that can contribute to their development are well understood, including stress and anxiety. Understanding how these factors can trigger, influence, and exacerbate eating disorders is essential for effectively treating them. 


Can Anxiety Cause an Eating Disorder?

Stress and anxiety are a part of life, as much as we might wish otherwise. Sometimes stress can be helpful, such as when it motivates us to get an important project done before a deadline or study harder before a big test. However, when anxiety becomes unmanageable, persistent and overwhelming worry can make it impossible to function on a day-to-day basis or to maintain healthy relationships. While anxiety disorders may occur on their own, they can also occur with other mental illnesses such as depression.

Anxiety disorders are common among those also struggling with an eating disorder. According to statistics from the National Institute of Mental Health, 47.9% of those with anorexia nervosa, 80.6% of those with bulimia nervosa, and 65.1% of those with binge-eating disorder were also diagnosed with some form of anxiety disorder. The most common types of anxiety disorders associated with eating disorders are obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD). Anxiety and eating disorders can interact in complex ways, which makes it essential not to overlook the role the former plays when treating the latter.

It’s easy to see how anxiety or a stressful life change—such as going away to college, family issues, a new job or promotion, or moving—could push someone already at risk into developing an eating disorder. A family history of eating disorders, having been teased or bullied about weight, past trauma, and/or frequent dieting are all factors that are known to increase the risk of an eating disorder, and adding stress to the mix may be the catalyst that provokes problematic eating behaviors. However, the relationship is more complicated than that. 


Understanding the Connection between Anxiety and Eating Disorders

Eating disorders are progressive—they often start intentionally as a way to feel a sense of control. Once a habit forms, though, it is easy to lose control over disordered eating behaviors and exercise habits. People with eating disorders become compelled to continue their destructive behaviors, which tend to worsen over time. In turn, the consequences of those behaviors can amplify the stress and anxiety they were initially meant to help relieve.

For example, someone with anorexia may begin severely restricting their food intake, repeatedly measuring their weight, or undertaking an extreme exercise regimen as a way of trying to cope with anxiety and a distorted body image. They may also develop ritualistic behaviors such as cutting food into tiny bites or weighing everything they eat. However, having to hide these behaviors from concerned family, friends, or colleagues can become a new source of stress and anxiety. In addition, malnutrition can also make anxiety worse.

Anxiety, stress, and bingeing can create a different dynamic that nevertheless serves to amplify the negative feelings that provoke disordered eating. Instead of avoiding food, people with bulimia or binge-eating disorder have episodes in which they consume large amounts of food in a short period of time. Negative emotions like sadness, loneliness, guilt, or hopelessness are often identified as triggers for a binge, which might begin with eating comfort foods to self-soothe but balloon into uncontrolled eating. Because this releases brain chemicals like serotonin, it works in the short term. In bulimia, that binge is followed by a purge (such as vomiting or laxative abuse) in response to the uncomfortable physical and emotional symptoms of the binge. The immediate feeling of relief, for both those with bulimia and people with binge-eating disorder, is quickly replaced by feelings of guilt and shame.

As with anorexia, binge-eating (whether it is followed by purging or not) is accompanied by secrecy and anxiety. Those suffering from these disorders tend to hide food, eat alone, and otherwise go to great lengths to hide their binges. Embarrassment over their lack of control over their behaviors may also amplify the negative emotions that are more likely to spark binge episodes. Physical consequences such as gastrointestinal problems or weight gain may become an additional source of stress and anxiety as well. 


Treating Eating Disorders and Anxiety

While someone might not develop an eating disorder from anxiety alone, when an anxiety disorder is also present, it is necessary to treat both conditions simultaneously. Otherwise, symptoms of anxiety can worsen disordered eating or cause discouraging relapses during treatment. Learning how to reduce anxiety and develop healthier coping mechanisms can help break the cycle of self-destructive behavior.

At the SF Stress & Anxiety Center, our therapists specialize in treating anxiety, using evidence-based methods to produce lasting relief. If anxiety has you feeling stuck, overwhelmed, or hopeless, we can help. To keep treatment accessible and convenient, we offer both in-person and online therapy. Schedule your free initial phone consultation with one of our compassionate Care Coordinators to be matched with the right therapist for you.


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How to Help Adult Anxiety

Feeling nervous or anxious at times is normal, especially if you’re going through a stressful period at work or home. However, there’s a vast difference between typical moments of nervousness in response to pressure and an anxiety disorder—intense, persistent, excessive worry and fear that interferes with your ability to function at work, at home, or in social situations. Adult anxiety is far from rare—according to the National Institute of Mental Health, 19.1% of U.S. adults experienced an anxiety disorder in the last year, and 31.1% of adults have experienced an anxiety disorder at some point in their lives. While it’s all too likely that you or someone you care about will be affected, adult anxiety can be effectively treated.

It isn’t fully understood what causes anxiety disorders, although most experts believe that multiple factors play a role. Genetic predisposition, your personality type, traumatic experiences, and prolonged or extreme stress can all interact to bring on anxiety that is difficult to control and out of proportion to the stressors you face. For example, if you’ve felt more anxious since the pandemic, you’re not alone. A recent study shows that one in three adults worldwide was living with an anxiety disorder during the COVID-19 pandemic due to uncertainty, disruptions in daily routines and health concerns for themselves or loved ones. Understanding what adult anxiety can look like and how best to respond can help keep anxiety from limiting the possibilities of your life. 

Signs and Symptoms of Anxiety

People suffering from anxiety disorders may experience a range of physical symptoms, as well as anxious thoughts and behaviors. Possible physical signs include a racing heart or heart palpitations, shortness of breath, nausea, diarrhea, sweating, shakiness, edginess or restlessness, dizziness, lightheadedness, insomnia, and/or becoming fatigued easily. Characteristic thought patterns can include a sense of impending danger or doom, racing thoughts, an inability to concentrate on anything except the present worry, a constant belief that the worst will happen, and persistent worry that is difficult to control. This physical and mental discomfort leads to common anxiety behaviors such as avoiding feared situations and social withdrawal.

People suffering from anxiety may be reluctant to socialize, afraid to talk on the phone, fearful of going out, and scared to interact in even simple ways with other people, such as speaking to a cashier at a store. When these symptoms of adult anxiety persist and/or get worse over time, interfering with your work, your relationships, or ordinary daily activities, you shouldn’t wait to seek help in the hope that they’ll go away on their own. 


Types of Anxiety Disorders

The type of anxiety disorder someone experiences may be differentiated by the situation that triggers their anxiety and their symptoms. Some types are:

  • Generalized anxiety disorder (GAD): Persistent, excessive worrying about everyday issues over a period of months or years, producing a sense of fear or dread that interferes with daily life.
  • Panic disorder: Regular attacks of sudden fear producing intense physical symptoms in the absence of any real danger or apparent cause.
  • Social anxiety: Intense and ongoing fear of being watched or negatively judged by other people. Some sufferers may experience fear or anxiety in all social settings, while others have difficulty only in certain situations, such as eating in front of others or performing or speaking publicly (performance anxiety).
  • Separation anxiety: Extreme fear or distress at being separated or the thought of being separated from a loved one. While some separation anxiety is a normal stage of development for very young children, as an adult disorder it can prevent normal functioning at work or home when the sufferer is away from their spouse, child, or other loved one.

Of course, not every case of anxiety fits neatly into a single category. Anxiety may also occur alongside other mental health disorders, such as depression or substance abuse. While this may complicate a diagnosis, it doesn’t mean that anxiety can’t be treated. 


Adult Anxiety Treatment

It’s common for people to believe they can’t control anxiety or their tendency to have panic attacks and that it’s just a problem they’ll have to learn to live with. In fact, that isn’t the case at all—many people are able to move past the symptoms of anxiety disorders and learn to improve their quality of life. If your attempts to manage anxiety on your own aren’t working, it is possible to get effective help.

One of the first steps should be to consult your primary care physician for a physical evaluation. Sometimes symptoms of anxiety can be related to an underlying health condition or medication you’re taking, so it’s best to rule that out as a possible cause or contributing factor. Properly treating any such medical condition may help alleviate anxiety.

If anxiety doesn’t spring from a physical cause, consulting a mental health professional should be your next move. Psychotherapy helps people with anxiety disorders identify the causes of their worries and fears and develop healthier coping mechanisms and skills to overcome anxiety. Two types of psychotherapy that can be effective for people with anxiety disorders are:

  • Cognitive behavioral therapy (CBT): This type of short-term therapy pairs cognitive and behavioral approaches to recognize our existing patterns of thought and behavior and examine how they can hold us back. Patients then learn how to change those thought patterns and habits. CBT sets specific goals that are meaningful for each patient and teaches them skills to take action to achieve them.
  • Dialectical Behavior Therapy (DBT): DBT is a modified form of CBT developed to help people develop mindfulness, tolerate distress, regulate their emotions, and improve their interpersonal effectiveness. It can include group therapy for behavioral skills as well as individual therapy sessions. DBT validates a patient’s experience while gently challenging them to make positive change.  

Lifestyle changes can also have a positive impact on getting anxiety under control when paired with psychotherapy. Regular exercise, getting adequate sleep, healthy eating, avoiding alcohol or recreational drugs, and cutting back on stimulants like caffeine can all be beneficial. In addition, relaxation techniques such as meditation or breathing exercises can help keep stress at manageable levels. Your therapist can help plan a mix of treatments for anxiety best tailored to your unique situation and needs.


Reclaiming Your Life from Anxiety

When anxiety takes hold, it can gradually take over your life, isolating and limiting you. At the SF Stress & Anxiety Center, our therapists can help you overcome your anxiety and develop psychological resilience so you can thrive in your professional and personal life. We offer both in-person and online therapy sessions to keep treatment accessible. 

To get started, schedule a free introductory phone call with one of our compassionate Care Coordinators to be matched with the right specialist.


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Dating Someone with Anxiety: What You Need to Know

Although everyone experiences anxiety at times, some people suffer from more debilitating or heightened forms that can impact their lives on a daily basis. In turn, this can require more understanding and compassion from their significant other. The truth is, dating someone with anxiety can present additional challenges, stresses, and strains to a relationship. For example, when cohabitating, an anxious partner’s difficulty sleeping can negatively impact the sleep quality of both partners. It may also be necessary to adjust to an anxious partner’s difficulty concentrating, nervousness, or restlessness.

While someone with anxiety might need extra patience, empathy, and support from their partner, that doesn’t mean the relationship is doomed; it just requires a lot more communication, which is crucial as a couple anyway. 

If you’re dating someone with anxiety or an anxiety disorder, but don’t know exactly how to help them, don’t worry. Here are some great tips on dating someone with anxiety, from ways to support your partner to an understanding of how anxiety can affect your relationship.


How to Support Your Partner With Anxiety

Ask them what they need.

Being in a relationship with someone who suffers from anxiety requires more communication on your part. Whenever a partner’s anxiety level is high, it’s important to be mindful of what they may need and ask what they require at the moment. For example, if they want to be held or if touch feels too overstimulating at the moment, you can just ask them what they need.

However, if they cannot articulate what they need in the moment, try a few low-key approaches such as playing some soft music; playing with pets; or focusing on any calming, pleasant physical sensation they need. Use a meditation app with them and offer to meditate with them for a few minutes or do something artistic and creative together. Games that require a lot of concentration and attention can also be helpful since they divert attention from anxiety. Puzzles or simple video games like Tetris or solitaire can be good at distracting them.

Don’t tell them to calm down or relax.

Even though you might think telling your partner to “relax” is helpful, you might actually be adding to their anxiety. When your partner is suffering from high anxiety, it is most likely that they are already fighting within themselves about how to deal with it, and other people saying this can sound more like a directive than comforting. 

Consider calming activities like meditation or a bath instead. Although it may be hard not to tell your partner what to do, trust that when they need you, they’ll tell you. Don’t take it personally if they need some quiet time or some alone time. Respecting them will improve your relationship.

Learn more about their type of anxiety.

In order to be able to help your partner as effectively as possible, you should learn as much as you can about their type of anxiety. This can include generalized anxiety disorder (GAD), social anxiety, separation anxiety, and/or panic attacks. While you may not be able to know exactly how your partner feels, making an effort to learn will benefit both of you.

In order to do this, you can read articles or books on the topic, follow social media accounts, or ask your partner directly what living with anxiety is like for them. As you become more familiar with their condition, you will be able to support them a lot better.

Don’t dismiss their emotions.

You may not fully comprehend what your partner is going through when it comes to anxiety, but that doesn’t mean their feelings are invalid. Whenever you dismiss someone by saying, “You’re overreacting” or “It’s not a big deal,” you can be gaslighting them, making them believe what they’re experiencing isn’t real.

Nevertheless, you shouldn’t let them run wild with their emotions, as this may cause them to spiral out of control. You do, however, want to create a safe space so your partner can navigate their anxiety-which can be difficult if you ignore or dismiss it. Studies show that we seek partners who see us the way we see ourselves in relationships and that this helps the relationship succeed. In a relationship, we want to feel comfortable to be ourselves instead of pretending to be someone we are not.

Be aware of the subtle signs of anxiety, too.

You might be able to spot some of the most common anxiety signs (for example, excessive worrying, restlessness, difficulty falling asleep and staying asleep) easier, but it’s also important to know about less common ones, so you don’t end up supporting behaviors that hurt your partner the most. For instance, perfectionism is often a sign of an anxiety disorder. This may be when our partner can never relax, never stops trying, or needs constant feedback that things are right. They might be feeling more anxiety than they let on. Those with anxiety might seek frequent assurance that they are doing things’ right’. They might be concealing anxiety if they never seem to get enough reassurance or validation.


How Anxiety Affects Relationships

They might have set ways of doing things.

If your partner has anxiety, they may have certain ways of approaching tasks that feel familiar and safe to them. Perfectionism, rigidity, and the desire to control things that do not need to be controlled are some traits they may exhibit. It’s important to understand that they’re usually harder on themselves than they are on anyone else.

One of the ways you can help is by setting boundaries about their need to control things. Discuss their feelings with them, so they feel understood, but also let them know how it affects you. For instance, if you and your partner disagree about how to clean the house because their standards are much stricter than yours, focus on a “good enough” standard and let them know that anything beyond that is on them. Additionally, if you don’t get enough relaxation time, carve out some for yourself that is non-negotiable.

They may have fears about the relationship.

For example, someone may worry about whether their partner will leave them or whether they are truly loved and cared for by them. In many cases, these concerns are unfounded and contradictory to objective reality.

To help cope with this fear, your partner may choose to become extra close, so much so that you may feel smothered. Ironically, this may lead you to create some separation or breathing room, which only confirms the anxious partner’s fears of abandonment. By understanding this, you can navigate the situation with clarity and have an honest discussion.


How to Set Boundaries

While you may love your partner, it’s completely natural to need to set boundaries with them on certain behaviors; what might be considered a healthy coping mechanism for them might impact you in a negative way. Talk with your partner about the specific behaviors that bother you, listen to their perspective, and encourage them to talk about their experience.

Once you find common ground with your loved one, encourage them to seek help from a therapist and continue to set boundaries when their behavior becomes an issue. Be mindful that setting boundaries doesn’t mean you should insult, dismiss, or criticize your partner. The best thing to do is empathize with them and let them know that there might be ways to improve their situation. Don’t take full responsibility for handling their anxiety yourself; don’t put more effort into it than they’re willing to, or you’ll burn yourself out.

At the end of the day, being in a relationship with someone who has anxiety can be a really nurturing and healthy experience. By being supportive, thoughtful, and empathetic about your partner’s anxiety, you’ll be able to build a foundation that will work for the both of you. If you are experiencing anxiety or dating someone who does and need help coping, contact us today for a free consultation to discuss how we can best support your needs.


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