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Both depression and anxiety affect people’s relationships with friends. In addition to a deep and prolonged sadness, depression includes a loss of interest or pleasure in activities the person usually enjoys, as well as feelings of fatigue and a loss of motivation. This cluster of symptoms can mean that a person experiencing depression withdraws from their usual activities and friendships which usually bring them joy.

People experiencing anxiety can find being in public or around groups of people triggers anxious thinking and the physical symptoms of anxiety (e.g. heart racing, shaking, difficulty breathing). This is a frightening experience which, understandably, the person wants to avoid.

In both cases, depression and anxiety causes people to withdraw from relationships with family and friends. Unfortunately, these symptoms can set up a cycle for people. Friends may initially try to stay in contact with the person, but will understandably stop contacting them, particularly if they are not aware the person is experiencing mental health difficulties.  It then becomes harder for the person to re-establish the friendships and activities which would be so beneficial.

Here are some ideas for helping friends who are struggling with mental health.

What you would do if your friend had some sort of physical illness or injury?

As a starting point, think about what you would do if your friend had a broken leg. Would you send a card to tell them you were thinking about them? Offer to help walk the dog? Or pick the kids up from school? Show up at their place with a home-cooked meal? In many ways mental illness is similar to other health conditions and people benefit and appreciate the same sorts of support.

Encourage your friend to remain connected to activities and relationships.

Encouraging your friend to remain connected to activities and relationships can be key, although it will feel really, really, hard for them. Think about the things you usually do with your friend, things that the two of you typically enjoy. Get in touch and suggest you do those things together. Your friend may not be able to do all the things they are usually able to do and so you may need to adjust everyone’s expectations. So, for example, if together you have loved tramping through a spectacular bit of the country, suggest a short walk somewhere close by. If you usually go to a gig or some other performance together, dial it back by suggesting listening or watching something at home.

Try to avoid alcohol and other substance use.

If what you do together usually involves the consumption of alcohol and other substances, try a suggestion which doesn’t encourage this. Alcohol and drugs can play a significant role in maintaining depression, anxiety and other mental health problems and so is best avoided when people are unwell.

Exercise and having contact with the outdoors has a range of benefits for both mental and physical health.

The benefits of exercise for both mental and physical health are well known. So, if you can incorporate some gentle exercise with your friend, you’ll be helping in a couple of different ways. Likewise, we are beginning to understand the benefits of being outdoors and having contact with nature for mood and anxiety. This offers another option for spending time with your friend.

Not all conversations need to be “deep and meaningfuls”.

Not all conversations with your friend need to be “deep and meaningfuls”. Some people with depression and anxiety can experience massive amounts of over-thinking, worry and rumination, where painful thoughts turn over and over in the person’s mind, leaving them feeling stuck, overwhelmed and out of control. Sometimes people with depression and anxiety will start voicing these painful thoughts aloud and it possible that friends and family get drawn into “co-ruminating” with them. You will know when this happens because you will begin to feel hopeless, sad or fearful as well. As much as possible, try not to get drawn into these cyclical conversations. Instead, try to focus your friend on some shared interest or activity. Sometimes, an analysis of last weekend’s Super Rugby game or your latest Netflix obsession is just the ticket to interrupt the painful thoughts in your friend’s head and get them focused on something else.

Show that you are listening to your friend by paraphrasing or summarising what you friend is saying. Demonstrate empathy and try to validate your friend’s difficulties and emotions.

There are some key communication skills you can use when talking to friends about mental health difficulties. Make sure you are really listening to what your friend has to say, as well as saying your piece. Show that you are listening by paraphrasing or summarising what they have said back to them. Paraphrasing also leads you naturally into demonstrating empathy for your friend and validating their feelings and difficulties. It could look something like this:

It sounds like you are having rough time at work, the project is not going well, and you don’t think your manager is listening to you. I can see how that would be very frustrating.

Or

It sounds like you are spending lots of time in your head worrying about what’s going to happen next. It makes sense that you feel overwhelmed and out of control. 

Showing empathy and validating your friends situation and feelings are powerful tools in helping them to open-up about what is happening for them. Your friend will feel that they have been listened to, perhaps the first time, and may be encouraged to say more. Empathy and validation are also necessary steps before you can begin a conversation about seeking help and beginning to make changes.  

Good self-care is very important when supporting others.

If you are supporting someone with mental illness, your self-care becomes very important. It is very difficult to be empathic, patient and persistent if you yourself are stressed. Take care of yourself by eating well, getting sufficient sleep and exercise and having time for fun and relaxing activities. Make sure that you share the load of supporting someone with mental illness. See if you can recruit other friends or family members to help.

A family doctor of GP is a good place to start in accessing professional help.  

Remember that there are professionals available to assist. A family doctor or GP is always a good place to start when seeking professional help.

I originally wrote this piece in response to a request from Stuff. If you’d like to read the resulting article here is the link.

Enough as She Is shines a spotlight on the pressures facing adolescent girls and young women today and encourages those young women, their families, friends and communities, to see them as “enough as she is”. Author Rachel Simmons has spent two decades researching and working with young women. In this book she details the stressors placed on them by our society and how these stressors lead to anxiety, depression and feelings of being overwhelmed. As such, this book is part Feminist literature and part self-help. There are particularly interesting and relevant chapters on the role of social media and body image in young women’s lives. These are two issues, one new and the other which has been around for several generations, for which the author offers a unique perspective and challenge. The book is very solidly set in American society (and predominantly upper-middle-class society at that). There are, therefore, several aspects of the book which may not translate to the New Zealand situation. For example, the author talks a lot about the “College Application Industrial Complex” – the name she has given to the process American high school students go through in order to be accepted into an American University. From what I have seen, applying for Universities in New Zealand has not (yet) become this competitive, although there are aspects which young women and their families may recognise.  The book is primarily aimed at parents of young women and the author provides plenty of useful strategies and conversation starters, most of which are grounded in Cognitive Behaviour Therapy and Mindfulness, for parents wanting to assist their daughters. I suspect, however, that anyone struggling with perfectionistic standards and role overload would benefit from reading this book, considering the questions it poses and completing some of the exercises.

Just a thought is a new e-therapy website recently launched in Aotearoa / New Zealand. It provides two six-session cognitive behaviour therapy (CBT) online courses, one for people suffering from depression and another for people experiencing generalised anxiety disorder – that is worry and lots of it. The courses provide lots of information, questions to get you thinking about your specific situation and exercises and skills to use outside of the course. All good standard CBT stuff. And it’s free!! You can self-refer to the website or you could be referred by your GP or mental health practitioner. You set the pace at which you work through the course and have up to three months to complete it, although you can extend this if needed. If you think that you are experiencing either depression or generalised anxiety, Just a thought recommends you visit your GP to check out possible physical causes for these problems. The symptoms of an iron deficiency, for example, can look like a depressive episode and the two can be mistaken for each other. It is always a good idea to check these things out.

The website says that 80% people who complete the course show some improvements. As always, the trick with self-driven exercises is to maintain the motivation to work your way through the whole course. My posts on motivation may provide some tips for this. If you think you could benefit from these courses please check it out.

As we head into the busiest part of the year, I thought some tips on how to say no might be useful, helping you to avoid feeling overwhelmed and instead able to enjoy precious time with family and friends.

Postpone giving an answer

At the very least, you can postpone giving an answer. Don’t say yes immediately. Instead, say you are going to take some time to think about it. You could say:

“Let me check my calendar / diary / to-do list and get back you.”

“I will need some time to think about that.”

Then look at what you’ve got on and make a reasonable decision about whether you can do the requested thing or not. If not, use one of the strategies below.

Postpone the task

If it is something you want to do, but you are not able to now, you can give the person a timeframe which will be realistic for you. You could say:

“That sounds great! But I won’t be able to do that now. I could next week / month / after the holidays.”

Validate

If it is something you definitely don’t want to do, you can soften the no a couple of ways. You can validate and be empathetic for the other person’s situation. You could say:

“I can see why this is very important to you but I’m not able to help out, I’m sorry.”

“I’m sorry to disappoint you but I’m not able to do that.”

Be Gracious

Being gracious and polite is another way to soften a no. You could say:

“Thank-you so much for thinking of me, but I’m not able to do that”

“I really appreciate you asking me, it’s a great opportunity, but I’m not able to help you out.

Be a Broken Record

Sometimes people are particularly persistent and will just keep asking. At these times, don’t be afraid to be a broken record. Simply repeat your no – whichever from above works for you – as many times as you need.

My personal record for this was during a telephone conversation with another psychologist who wanted me to do a piece of work. My line was “Thank-you so much, I really appreciate the offer, but I’m not able to do that”. I said this 7 times during an 8 minute phone call. There we were, two highly trained professional psychologists, trying to out-psychologise each other. It was hilarious. Sort of.

Please do leave a comment and let me know if you break this record of mine!

In my last post Motivation Pt 2 I talked about clarifying why you want to make a change and reminding yourself of these reasons at the actual moment of making change. Our next step for enhancing your motivation is to set some goals. To be helpful goals need to be:

Specific

Measurable

Actionable

Realistic

Time-limited

We use the acronym SMART to help us remember this.

An example of this type of goal is: to do a 5k run around my block 4 times this week. This specifically sets out what I’m going to do. I can measure it, simply by counting how many times I go for my run. It is all about the action I take – going for a run. With the training and practice I had previously done this became realistic. And it is time limited to the current week.

It is really super-duper important to set yourself realistic goals. If you do not set realistic goals you potentially set yourself up for failure. To go back to my running example, if I’d set the above goal when I first started running I would not / could not have achieved this. This “failure” could have led to a bunch of thoughts such as “I’m hopeless”, “I can’t do it”, “there’s no point”. All of these thoughts would make it more difficult to try again next time, making it more likely I’ll fail to meet my goal again.

By setting realistic goals, which perhaps start small but then build up, you are much more likely to experience “success” in the early phases. This success will lead to more helpful thoughts, like “I can do it!” and “good work!” Therefore you will be more likely to meet your goal again next time. Start from a smaller place and allow yourself to build up from there.

One way to overcome an initial reluctance for a change is to make sure you are crystal clear about the consequences of that change. To that end, it can be useful to do think about the advantages and the disadvantages of the change. It can also be useful to think about these things from both the short-term and the long-term perspectives. You could use the following matrix to assist with this:

Change I want to make:	Advantages of Change	Disadvantages of Change
Short-Term Consequences
Long-Term Consequences

By making this stuff as clear as possible you are providing yourself with all the reasons for the change you can.

Now, the problem is that when it comes to actually engaging in the new behaviour all this logical and reasonable stuff disappears from your mind completely. And it gets challenged or replaced by whiny,  can’t be bothered type of thinking – See my struggle to get out for a run in the morning as detailed in my earlier Motivation Pt 1 post. This is a pretty classic human response.

We humans have evolved to value short-term consequences over longer-term consequences any day. In the ancient environment short-term thinking was king. Our ancient ancestors were scratching out their living on the African Savanna. If they were to come across a bush laden with berries which the birds were already eating, they would scare away the birds, help themselves and eat their fill. “Saving some for later” is actually a dumb move in this environment. The birds, or other people will get there first and our ancestor would miss out, a potentially lethal outcome.  Of course, we now live in a completely different setting one of abundance and relative safety. Parts of our brain, however, still think we’re living in the scarcity of the Savanna. You need to engage the more sophisticated bits of your brain to over-ride your short-term thinking.

So, when it comes to the actual moment of change it will pay to have your matrix on hand so you can read it yourself in this tricky moment. Remind your reasonable self of reasons for the change and then get on and do it.

Our society is very good at telling us what we should do – eat healthy, exercise regularly, sleep, don’t drink too much etc etc. Most of us a pretty clued up on what a healthy lifestyle looks like. Often when I’m working with people my job becomes about helping them find the motivation to do, and keep doing, healthy behaviours. I’d like to share some of my thoughts and expertise in increasing motivation.

Take a moment. Stop and think about the last time you felt really motivated to do something. Notice how it felt in your body. Notice the emotions that went with it. And finally, importantly, notice the things you were telling yourself.

For me, the best-ever example of this was the 18 months I spent trying to get myself to run around the block. I noticed lots of things about how motivation works for me over this time.

On any given morning it would look like this:

6:00:00 am My alarm would go off and I would immediately think: “No!” I then got into a dialogue with myself about whether I was going to go for a run or not:

6:00:01 am “I should!”

6:00:02 am “I can’t be bothered”

6:00:03 am “I said I was going to!”

6:00:04 am “I’m too tired. “

6:00:05 am “It’s my goal to run 4 times this week”!

6:00:06 am “Tomorrow!”

In split seconds my head was full of all the reasons I should and should not go for my run.

With time and practice I figured out if I got up and put my running gear on, went to the loo, had a drink of water, these thoughts about going or not going were often still present.

I could be out the door, walking down my drive way and walking onto the street and still the thoughts were present.

But by this stage it’s obvious I’m going for run and the thoughts about whether I was going to or not starting to leave me alone.

About 10 – 15 mins into running, I was feeling good, strong. My breathing was steady and controlled (and faster!). I was feeling powerful and in control. AND THEN!!! I THINK

6:21:27 am WHEN ELSE CAN I SQUEEZE IN A RUN THIS WEEK?

My motivation to go for a run appeared about 10 – 15 minutes into running.

There are lots of different definitions of motivation and psychology sees it in quite a precise manner – that motivation is the internal stimulus to a behaviour. But my experiences running around the block is typical of how motivation works for us. There is this urban myth that we need the motivation to do stuff before we do it. The reality is our motivation for a behaviour often shows up once we’re doing it, once we can see the benefits and recognise that the perceived costs aren’t that bad.

Over the next couple of posts I’m going to explore some of the techniques you can use to overcome that initial lack of motivation and get moving to give your motivation a chance to show up.

PS: I did eventually get myself up to a 5 k run around the block in the mornings and it felt fantastic!

Susan Cain was a Wall Street lawyer who found herself in a job that didn’t quite fit. She began a journey to work out why. She argues that ours is a society that highly values extroverts, people who are gregarious, who move quickly and who are sometimes just plain loud. The flip side of this is that people who are closer to the introvert end of the continuum, those who are more inclined to think deeply and prefer, or indeed, need more solitary time, can be overlooked. Worse, these people can be penalised or labelled as anxious for behaviour that is actually just an individual difference. Susan reminds us that the world needs people at the introvert end of the spectrum every bit as much as people at the other end.

My one caveat when reading this book is to note that these personality types sit on the opposite ends of a continuum. The vast majority of us will sit somewhere between the two extremes.  There will be very few “pure” introverts and likewise, very few “pure” extroverts. This is not a black and white concept. In addition, your position on this continuum is somewhat flexible. You will appear more or less introverted depending on the situation you are in. For example, the glass of wine I have in the pub with my workmates on a Friday night is like me getting a dose of extraversion, making me just that little bit louder, talkative and impulsive.

In addition to the book, Susan has recorded a Ted Talk which nicely summarises her work. I recommend this book and the Ted Talk to people who are anxious, hoping that they may recognise that some of what has been labelled “anxiety” is more accurately a preference for some solitude and time to think deeply about the world. This is not pathology, in fact, the world could do with a bit more of it.

This is one of the books I recommend most often. It is a good solid self-help book that can be applied to many difficulties and situations. Russ is an Australian GP turned therapist. His book explores the principles of Acceptance and Commitment Therapy (ACT) and how to use these to assist you to work through whatever issues you may be facing. It talks about the role of thinking in the pain we experience. Equally, it emphasises the importance of living a rich and meaningful life as a means of mitigating pain. This is an easy to read and digest book. Its relatively short chapters allow you to dive in for a bit, think about what you’ve read and do the exercises! Then come back for more when you are ready. Russ has written several other books and his website https://www.actmindfully.com.au contains other helpful resources. This book is a really good place to start.

In my day to day practice I often use mindfulness-based strategies to help people slow down, identify what’s happening for them and unhook from the unhelpful stuff. A common problem we come across is finding time for people to regularly practice these mindfulness techniques. It was with joy and relief that I read in Dan Harris’ book Meditation for Fidgety Skeptics, that when it comes to mindfulness “1 minute counts”. Here, then are my top ten moments when you can squeeze some mindfulness into your busy schedule.

Here are five times you could simply bring your attention to your breath or body:

1. While you’re stopped at a red traffic light.
2. Waiting in line at the café / supermarket etc.
3. For one moment between parking the car and getting out.
4. In the elevator or on the escalator.
5. That moment after you drop the kids at school before continuing on with your day – does anyone else take a deep breath at this point? I certainly do!

Here are five times you could practice being mindful by bringing your full attention to simply what you are doing:

1. Brushing your teeth in the morning and / or at night.
2. Making yourself a hot drink.
3. Making the bed.
4. Washing your hands.
5. Preparing fruit and veges.

All you need to do is pick one of these times and commit to using this time or activity to be mindful. Give it a try and see what happens.