Ask Dr Kim | Archived live chats

[Chris_B]

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.

[Chris_B]

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?

[Dr_Kim]

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.

[Chris_B]

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.

[Dr_Kim]

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.

[Chris_B]

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?

[Dr_Kim]

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.

[Chris_B]

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..

[Dr_Kim]

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.

[Chris_B]

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?

[Dr_Kim]

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.