Mental Health Questions and Answers with Dr. Katey Nicolai

Mental Health Questions Answered: Depression and Anxiety

Hi I'm Dr. Katey Nicolai and I'm the Director of Clinical Care at Joon Care. Today I wanted to answer common questions I've received from teens about mental health and therapy, and provide some quick tips and recommendations I make to my clients. If you have questions or want to learn more, reach out to me at Joon Care!

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What do you do when you can't find a reason that you're sad and there's no clear solution? (0:19)

It sounds like you may be struggling with symptoms of depression. The first thing that I want to put out there is that mental illness is probably more common than most of us realize. Up to 20% of adults can experience an episode of depression or some other mental illness within a given year according to the World Health Organization

The first thing to know is that you're not alone. 

If you are struggling with feelings of sadness that just won't go away and it’s getting in the way of your day-to-day life, my first recommendation would be to talk to someone about that - whether that someone in your life is a trusted friend or a licensed professional counselor. Counseling can help you find practical day-to-day solutions for coping with those feelings of sadness and depression. 

If you've never tried it before, it is not as intimidating as everyone might fear it to be. For every type of personality out there, there is a counselor to go along with it, so go ahead and try looking for a counselor. Find someone to talk to about that sadness and you may be surprised at how quickly you can find some solutions for it.

How can I help depression caused by seasonal gloomy weather? (1:58)

That's a great question especially for where I live!

Here in the Pacific Northwest, we often have long, dark, gloomy winters. So, when someone comes to talk to me about seasonal depression or seasonal anxiety that’s really anchored to the darkness, my first recommendation is usually to take a look at your day-to-day routine and see if it changes at all when it's winter time, when it's darker out. 

Do you notice that you're going to bed earlier? Sleeping in later? A lot of seasonal depression research is finding it can be linked to circadian rhythms, so making an adjustment to your sleep schedule can help with that. 

Another really good recommendation that I make for almost all my clients who struggle with seasonal depression is to make time every day–usually best first thing in the morning–to try and get some outside time. For some folks that might be as simple as standing next to an open window while you have that first cup of coffee looking up at the sky. Even if it's darker than normal, really let yourself absorb that outside light. It's even better if you can actually step outside for a moment. If you live in a busy place like I do, that can be hard, but sometimes there's a little balcony or front step that you can step onto for a moment.  Bundle up if it's cold, bring your umbrella if it's raining, and try to give yourself at least a couple of minutes of outdoor time. 

Those are some initial tips for coping with seasonal depression and if you find that it's significant enough to be impacting your day-to-day life and work, then I really encourage you to reach out and get some support from a counselor because they can find more personalized tips for you.

What's the best advice for dealing with anxiety and panic when you're in public? (3:55)

Almost all of us might be willing to try some new things to cope with anxiety when we're in the safety of our own home and no one's around to judge us, but sometimes anxiety can be a lot worse when we are at work, at school, or someplace outdoors where it feels like other people are watching us. In fact, that can even be a source of anxiety. There are a couple of quick tips that I have for coping with anxiety in public and these are things that you can do so subtly that no one around you will notice. 

  • Pay Attention to Your Rate of Breathing - It sounds really simple, and maybe if you've had anxiety you've heard people recommend deep breathing to you before, but it's actually an easy skill to practice that can change the physiological mechanisms that have an impact on your anxiety. These mechanisms are elevating your conscious anxiety via signals that your body is sending. Place a hand on your abdomen so that you can feel your rate of breathing and connect to your body a little more deeply. This is something that you can casually do in public even if other people are around.  Pay attention to your rate of breathing - do you notice that it's faster than normal?  Do you notice that your heart rate has increased? Then try for the next couple of minutes to slow down that pace of breathing, to fully inflate your abdomen with air and then exhale deeply. If you're standing in line at the grocery store getting nervous about what's going to happen next, placing your hand on your abdomen and engaging in quiet deep breathing can work to lower that anxiety. 
  • Grounding Exercise - Grounding is a complicated topic that you can talk about more in therapy if you feel like it applies to you, but one quick tip that I can give you is using a “rule of five” grounding technique that I teach to lots of my clients. So if you're sitting somewhere or you're out in public the first thing that I'll have you do is just make contact with your own hand.  Then, start to notice and observe five things in the room around you. As you go down that list of five things, actually touch the fingers on your hand pull yourself back into your own body and re-ground you in the present moment. For example if I'm going to do this grounding activity in the room I’m in right now, I might touch my thumb first and say okay, I notice my kid's toys are piled up in the corner and I'll note the colors to myself. I notice my plant hanging from the wall, it needs a little bit of water. I notice that the refrigerator door is ajar. You can do this audibly or mentally and the movements are so subtle that no one around you is going to notice you engaging in these things. 

Again, if you find these things helpful or want to learn more about them, a good place to start doing that is in therapy. Your therapist can help tailor these tools to make it more useful for you.

When I can't sleep at night from anxiety, what do I do? (7:33)

We've talked a little bit about sleep and the connection to anxiety and circadian rhythms. The first step in getting into a better routine and sleep schedule is to note down what that routine is.  That's the first thing that your counselor or your therapist will help you with when you go to meet with them - they'll have you keep a “sleep log” or a “sleep diary” so that you can make note of what time you are going to bed and how frequently you are getting up. That'll give us more insight into the real nature of the sleep problem that you're struggling with.  

Two little tips though if you are hoping to address your sleep problems right now: The first one is to keep a “worry log” on your bedside table if you feel like it's anxiety and racing thoughts that are preventing you from going to bed at night. You can try writing out a list of all of those worries in that little notebook that you keep next to your bed, and then mentally tell yourself you're going to let those worries go. You've recorded them and they can wait until tomorrow now because you're not going to forget about any of them, and give yourself permission to release those thoughts from your mind so that you have a chance to go to sleep.  Anytime they start to crop back up, you just remind yourself “I wrote them down, I can let it go for tonight.”

Another helpful sleep tip is to get into a pre-bedtime routine that starts to signal to your brain that it's time to wind down and go to sleep. A lot of us are in the habit of scrolling on our phones right before we go to bed at night but the light and the activity that comes along with scrolling, even if it feels relaxing in the moment, actually tells our brains that it's time to wake up and do stuff. So I recommend putting aside your phone at least an hour before bedtime and then winding down to bedtime with some relaxing activities (or even something mundane): brushing your teeth, reading a chapter of a book, laying in bed peacefully for a little while and engaging in deep breathing– these are all great strategies for helping your brain to wind down and go to sleep at night.

Those are all of the questions that I have on the agenda for today of course if you have more questions feel free to reach out to me at Joon Care and I look forward to talking with you guys again!

January 20, 2022
Katey Nicolai, PhD | VP of Clinical Services

Katey Nicolai, PhD | VP of Clinical Services

Katey Nicolai, PhD, is a licensed clinical psychologist who received her PhD in Clinical Psychology from Seattle Pacific University. Dr. Nicolai provides services to adolescents and adults using evidence-based treatment rooted in cognitive-behavioral and psychodynamic therapies, including Dialectical Behavior Therapy, interpersonal therapy, and family systems. Dr. Nicolai has specialized training in treating trauma and PTSD, personality disorders, self-harm and suicidailty, family problems, emotion dysregulation, and mood and anxiety disorders.

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