topic Ask Dr Kim | Archived live chats in Treatments, health professionals and therapies

Ask Dr Kim | Archived live chats

Chris_B — Thu, 30 Jun 2016 23:24:15 GMT

Good afternoon everyone, Dr Kim is here and we're ready to start.

Welcome Kim, our first question is below:

I am a 23 year old female with contamination-focused OCD. Do you have any advice about how I could deal with anxiety over my boyfriend's health? He is the only person I kiss and share drinks with, which means that if he does get sick, I will be likely to get infected. I really love and care about him, so the anxiety is not just about fear of contracting germs and illness, but also wanting him to be healthy and well.

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Dr_Kim — Fri, 08 Jul 2016 04:04:40 GMT

Good afternoon everybody.

OCD is a form of anxiety that is very sneaky at times. The key to tackling it is accessing the healthy, non OCD part of our brains that want us to be more peaceful and logical and not be a slave to the unhelpful thoughts and actions. If your OCD feels it can’t “hook you in” by its usual means, it may try another method to get you started on the roundabout of worry . So it sounds like your OCD which you acknowledge usually takes the form of worrying about you being contaminated, is trying to start up another pattern of obsessional thoughts about not only your health , but now your boyfriends. Use your “healthy” brain to be mindful and aware of this sneaky new tactic and see if you can feel more powerful against the “OCD” part of your brain that is trying to keep you locked up in unhelpful thoughts. Go back to what has worked in the past for you around thought-challenging, thought-ignoring, or accessing the parts of your brain that allow you to distract yourself.

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Chris_B — Fri, 08 Jul 2016 04:05:37 GMT

Thanks Kim. Next question:

Dr Kim my anxiety precedes my depression. Some days I feel too overwhelmed to leave the house. Should I force myself somehow to get out or should I accept my anxiety & stay at home?

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Dr_Kim — Fri, 08 Jul 2016 04:06:56 GMT

I often find that depression and anxiety end up together , meaning many people get depressed if they have anxiety for long enough and many people get anxious after having depression for some time. You are alluding to an important aspect of fighting these difficult mental health problems - keeping going and taking small steps every day . I think it is really great to try and do something every day that challenges your depressed or anxious parts so that your healthy brain can be reassured that it is still there ! So even getting up , getting dressed and going for a walk can make us feel like we are being a bit healthy , a bit normal and not only a victim of the depressed or anxious parts of us. So my advice is to keep trying to get out, but if you can’t , please be kind to yourself and try again the next day giving that “healthy” brain another chance to show the “anxious” brain that its still there and wants to try and keep moving forward!!!

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Chris_B — Fri, 08 Jul 2016 04:08:07 GMT

Thanks! Next question:

Hi Dr Kim what options are there when someone is described as "treatment resistant? For example a person could be severely depressed but Drs offer no medical alternatives. If you have treatment resistant depression what is the point of remaining on medication?

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Dr_Kim — Fri, 08 Jul 2016 04:11:38 GMT

“Treatment resistant" is a term that can mean lots of things so I can’t be sure that it means the same thing to you as it does to your Health professionals. I wonder if they might mean that your medications are not having the sorts of effects that you hoped they might have? I think in this situation one might have to think of pulling out all stops and really working hard at the non medication aspects of getting better to see if they improve the medication response. I’m talking about things like increasing cognitive therapy, support groups or intensive outpatient programmes and then the lifestyle factors like diet, exercise and sleep hygiene and mindfulness meditation. I know it sounds like a lot of hard work and energy for someone who is depressed, but you sound like you really want to get better and want and need to support to do it.

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Chris_B — Fri, 08 Jul 2016 04:12:26 GMT

Thanks Kim. On a bit of a similar theme:

Dear Dr Kim what to do when I've tried everything suggested to overcome depression but it remains?

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Dr_Kim — Fri, 08 Jul 2016 04:15:19 GMT

I would be interested to know what you mean by "everything suggested", as I feel that treatment for depression comes under 3 main headings: (1) medications, (2) cognitive therapy and (3) lifestyle options. If you have tried all three together, and you still feel that you are unable to achieve the results that you would have hoped for, my suggestion is to not give up. Have a break, and try again. Depression for some people can be a chronic illness, but at times people can get differing responses for reasons we don't fully understand. So persist, and try again - you may, surprisingly, get a response in a few months time to the same things you are trying now.

Don't forget social supports too, having a team around you to keep you going is such an important part of the journey. Don't give up.

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Chris_B — Fri, 08 Jul 2016 04:16:19 GMT

Thanks Kim. A really interesting question up next:

Hi Dr Kim. Thankyou for your time. I am well read on Anxiety since my first major attack in 1983. Your opinion on the long term physiological ramifications of anxiety attacks would be greatly appreciated. Kind Regards. Paul

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Dr_Kim — Fri, 08 Jul 2016 04:22:41 GMT

Well, this is a really interesting question. We know that anxiety and stress cause certain hormonal changes to occur in the body. These hormonal changes were put there to allow our bodies to be able to run or fight predators when we were under threat. However, they were never meant to be around for extended periods of time, or very often. In modern times, with long-term chronic or repeated stress, these hormones (such as cortisol or adrenaline) have been associated with other medical problems like high blood pressure or heart problems. There are good mental and physical health reasons to try and strive to reduce anxiety levels in the body. There has been good research to show that reduction of anxiety symptoms through treatments like mindfulness meditation can alleviate the physical symptoms and restore the body to good health, which is why it's good to concentrate on the lifestyle changes like diet, exercise, etc.

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Chris_B — Fri, 08 Jul 2016 04:23:49 GMT

Another question about handling anxiety:

I gave a presentation at uni with a fellow student which went really well. Instead of feeling pleased, I find I'm rehashing small mistakes - a missed cue, getting too far ahead with the slides, something I said in the moment when I missed the cue. It feels like an endless loop of images, with a could have done better caption and bad feelings attached. This sort of thing happens often. I have been struggling with anxiety and depression over the years (have been getting help). How do I handle this better?

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Dr_Kim — Fri, 08 Jul 2016 04:31:29 GMT

This is not an uncommon way that tricky anxiety comes out to mess us about. You said that you have been getting help with anxiety and depression over the years, and I congratulate you for the work you've put in to manage these difficult problems. There's a mindfulness here, in that you know that you should be feeling pleased, but you know that something is getting in the way, namely your anxiety.

It's a form of perfectionism, you've gotten through 95% of your presentation great, but your brain is focusing on maybe 5% or less that could be improved. I suggest that you see this perfectionism as another form that your anxiety is taking to punish you, and that you use your learnt skills to attempt to be kinder to yourself, and aware that these thoughts are just part of the anxious trap that we can fall into.

With all obsession, rumination-type thoughts of any flavour, good techniques to handle them are either accepting, challenging, or distraction. Accepting might be, "I hear you, but I don't care that you're there". Challenging might be, "This thought is ridiculous, this is perfectionism because...". A distraction might be, "I'm going to turn my attention to something else", seeing friends, going to a movie etc.

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Chris_B — Fri, 08 Jul 2016 04:33:01 GMT

A common topic on our forums is how to handle explaining depression and anxiety to family and friends, and our next question is on that subject:

Like all sufferers of mental illness my biggest hurdle is getting any acknowledgement from family and friends that I have a life long disease, and why my medication does not cure me completely. I try to be very open with telling people why I don't always make appointments, why I can't just snap out of it, why I had to retire, why I'm me, but mention mental illness & no one regards you as unwell. They never ask how I am because they are embarrassed to have a conversation about mental health. If you have any solutions as to how to get people to "destigmatise" mental health I would love to know. I'm at the stage like everyone else where I think twice about admitting I have a mental health issue. My mum, also a mental health suffer, said to me when I told her I was going to start counselling..."They tried to make me go but I'm not nuts!" Never have had quite the same relationship with her since.

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Dr_Kim — Fri, 08 Jul 2016 04:43:20 GMT

I really feel for your situation, and it's unfortunately way too common that family, friends and community do not acknowledge the struggle that people go through with mental health. I've had patients say to me that they would have rather had cancer than a mental health issue because it would have been somehow easier for them to explain and get the care and sympathy that they need. People with severe depression feel just as unwell in their minds as people with severe physical health conditions, yet they're not getting the same family and community sympathy.

My suggestion would be, like all of us you need support, acknowledgment and care from a good team of people. You need to find a good group of health professionals, and perhaps a face-to-face peer support group so that you can get like-minded people that do understand around you as a starting point. Good on you for starting with an online peer support group here. This is just one of a number of steps toward getting that team together.

In terms of how to destigmatise... maybe instead of using terms like "anxiety" and "depression", help to educate them by describing the symptoms instead. "I'm having difficulty motivating myself", "...with my concentration", "...with my energy levels", and maybe then people will understand what you're actually struggling with, rather than their understanding of what words like "anxiety" or "depression' mean. Hopefully they can then support you specifically around your symptoms.

I'm hopeful that your friends and family may evolve as our community does with their understanding of mental health issues, but if they don't, my hope is with the support and understanding of a good team around you, this is something that you can eventually come to terms with.

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Chris_B — Fri, 08 Jul 2016 04:44:08 GMT

Quite a broad question up next:

I have agoraphobia and don't really have supports in place to assist me. Can you suggest techniques I can try to help myself?

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Dr_Kim — Fri, 08 Jul 2016 04:53:30 GMT

Just to start by checking we're talking about the same thing - agoraphobia is an anxiety induced by leaving a secure home environment, even precipitating full blown panic attacks when leaving the house. It can be pretty challenging to try and treat this on your own.

The first step will be to understand the fight/flight panic symptoms that overcome you as you leave the house, so they don't feel so scary. The next step will be to manage your emotion regulation techniques, an ability to control your breathing and panic symptoms. Doing mindfulness meditation practice at home (the Smiling Mind app can help you with this). Once you feel comfortable that you can manage that, you start to challenge yourself by doing small exercises further and further from the secure base of home, being mindful of the effects on your body and using your breathing control tehcniques to manage the ensuing symptoms induced by the anxiety of being out of the home.

It's tough work, it's challenging, and you often need the support of a good therapist/counsellor to guide you through this process as it can often be two steps forward, one step back with this sort of work. You may need to do some reading on the condition and treatment, and try looking for face to face support groups in your state.

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Chris_B — Fri, 08 Jul 2016 05:05:38 GMT

Last question for today:

Living with chronic suicial thoughts/ intent is so draining. I do see a psychologist and have safety plans in place etc but I am exhausted. I usually just burry myself in work and avoid time to think. I worry that as in the past I will just simply give up and lose everything again and survive to have to start from scratch. I want to find life enjoyable but just can't seem to find enjoyment in anything. I also self harm and that peaks when I am fighting suicidal thoughts.... what else can I do? I eat good food, exercise and push myself to do things I know were enjoyable but nothing helps..

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Dr_Kim — Fri, 08 Jul 2016 05:06:10 GMT

You don't mention whether or not you are on medication. For more severe depression, I often recommend pushing the three aspects of treatment to the maximum - the lifestyle factors, which you seem to be doing (congratulations, as I know it's difficult when you feel so down); the cognitive challenging, which I assume you are doing through your psychologist; but the third one is the medication which I think you would qualify for at this point given your thoughts are still bleak and you have significant anhedonia (this means not enjoying life).

If you're already on medication, you may want to discuss dosage or changing medication as sometimes this will help. I also think you might want to talk to your psychologist to further explore self-protective mechanisms so you can reduce your self-harm at those really difficult times, as it seems like you are losing some control there. Together you can plan more effective ways of managing these thoughts and revisit your safety plan to make sure that it is really making you feel safe.

It sounds like you've been battling for a while and are really tired, but you are clearly someone who is doing a lot of work to get to a healthy place with seeking help, eating well, exercising and continuing to get to work. I feel confident that the rewards will be there for all the work you're putting in. Keep going on your journey - it's not a linear one, it's a curvy one with ups and downs, roundabouts, but in my experience people that keep going will get to the place they need to be in the end.

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Chris_B — Fri, 15 Jul 2016 04:03:46 GMT

Good afternoon everyone, Dr Kim is back here with us for another week. Let's get started with our first question:

Dr Kim one symptom of depression is procrastinating. I can sit & have no motivation yet I get anxious because I want to achieve some goals each day. How do I do this?

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Dr_Kim — Fri, 15 Jul 2016 04:04:57 GMT

Hi everyone!

Procrastination is a common symptom for people with both depression and anxiety . With depression, I think it comes mainly from feeling that everything is an effort and it’s hard to see that one might be able to accomplish anything so why bother trying. With anxiety, it often comes from feelings of not being up to completing a task well enough, so there is a feeling of not wanting to start on a task as it won’t be good or enough or any decision you make might not be the “right” one.

I think it’s important to see "procrastination" as another form of anxious or negative thinking, and treat as one would other forms of negative thinking from that part of our brain ( e.g. catastrophizing ). So, we need to call in the “healthy” part of our brains to notice the negative or anxious thought and then respond to it appropriately. You could say something to yourself like, “Whatever I decide to do right now might not be or feel perfect, but it’s normal to feel that way, and no reason not to take a few steps forward - just see what happens and trust I can cope.”

I hope you set small realistic goals each day, notice the resistance but still try to move forward on them.