dark clouds rolling in

The Cloud of Depression

Unexpectedly the cloud moves in. I feel my mood slowly start to change. I know the storm is lingering. Will it be a strong one this time, or will it quietly pass by with little fanfare?

The storm continues to linger. It hovers over my soul slowly draining my ability to think for myself. Almost without warning the negative thoughts emerge from the darkest depths of my soul.

“I’m unloved.”
“I’m a failure.”
“I’ll never amount to anything.”
“I offer nothing to society.”

As these thoughts bounce around my mind like a ping pong ball, my mood continues to deteriorate. The storm is not passing this time; now it is growing stronger. At first, I am able to fight off some of the negative thoughts and remind myself they are not true. As the storm grows, I lose more and more control over. Feelings of despair and loneliness engulf my soul.

The further into despair I sink the more the outside world seems to fade away. Those talking around me disappear into the background. As I sink, I fall further into my own mind and the more negative thoughts take control. While only a few moments ago I was able to fend off these thoughts, the strength to fight them has waned.

When the storm emerged, I reached out to a friend asking for prayers. A Hail Mary I know but worth the try. This time the prayers don’t seem to be helping. I don’t know who is in control, but I know it’s not me and I don’t believe this could be from God. All I know is this day is only getting worse. The storm has rolled in, and all I can do is hope to hold on long enough to survive.

Before long I start to lose the ability to move. My eyes stare straight ahead at my computer screen. Co-workers walk by thinking I’m intensely working on something, but in reality I can’t see what is in front of me. All I can see are the negative thoughts bouncing around my head.

Every once in awhile I snap out of it for a minute or two. I spend most of those minutes trying to remember what I was doing before I went into my trance. Today, I barely remember what I was trying to get done.

The cycle continues for a few hours until it is time to clock out. I slip out of work a few minutes early hoping to beat the traffic on the way home, knowing that stopping will only trigger another trance. Fortunately today I was able to make it home without any incident.

I stumble through the rest of my evening. My to-do list from earlier is left undone. Maybe I’ll be in a better place tomorrow. I do my best to attend to my kids and to be a good father, even though it takes every last bit of energy out of me. After they go to bed, I pour myself a glass of Scotch and head outside to smoke a cigar hoping some time alone outside will clear my head enough. Some days this helps… today it takes the edge off, but the negative thoughts are still lingering.

After an hour or so, I head back inside and get ready for bed. I reach for my sleeping pills knowing if I don’t take them I will be up all night fighting this storm. As the medicine does its job I slowly see the storm fade into the background, not knowing if it will return in the morning.

With depression not all days are like this. Some days are worse. Some days are better. Most days it takes everything out of me just to appear normal. I have hopes and dreams, but most days I don’t have the energy to pursue them. Today, I outlasted the storm. Who knows what tomorrow will bring?

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When Saying 'I'm OK' Gets to Be Too Much

I find myself heading to the bathroom for much needed silence and privacy. I lock the door behind me and lean against it, as my body hits the floor along with my tears. I massage my chest in the hopes of making the awful pain go away. I tell myself the same thing over and over again.

It’s OK. You’re OK.

All this is happening, and just behind the door in another room, is my special someone — my friend, my mom, dad or any member of my family. Just behind the bathroom door is someone oblivious to the fact that I am frantically pulling myself together to make it seem like I’m OK. Having physical and emotional pain in the process.

Why? Why do I do it?

Maybe it’s because I’ve argued about something repeatedly, and the other party just does not understand me just wanting to stop talking about it. So, I have to make it seem like I’m OK.

Maybe it’s because I don’t want to offend the other person because they know I’m going through a rough time and they’re trying their best. Maybe I’m scared they might take my depression personally, or feel bad about not being able to help me.

Maybe I’ve opened up to someone before, and they didn’t take it seriously so I’ve been scarred ever since.

Maybe it’s because I don’t want to be viewed as a “weak” person for feeling things that to them, I shouldn’t be feeling.

Whatever the reason is, I know I’m not alone.

I can’t even count the number of times I had to give myself a pep talk to remind myself it’s going to be OK, because I felt like nobody was going to do it for me. I remember being in a place where I was so alone and lonely, but at the same time, felt that I needed to be independent. I needed to be OK. And I had to do it by myself.

It’s horrible. The nasty ache in my chest when people ask if I’m OK, and I smile and nod. It’s me who is assuring them, and not them assuring me that I’m going to be OK.

Twisted, isn’t it?

We’ve all been there, some more frequent than others. We’ve all faked smiles and said we were OK, when we knew we weren’t. For some of us, we have this programmed into our minds that we must be OK at all times, for various reasons.

Sometimes we get so used to this kind of attitude that when it gets to be too much, it just blows over. We keep in so much pain, anger, sadness and sorrow, that sometimes even the slightest thing could tip us off.

I’m here to tell you it’s OK not to be OK. It’s OK to cry. It’s OK to be sad, angry, confused.

It’s OK to feel.

You are only human and you are allowed to feel.

It’s OK to want to think of yourself first sometimes. It’s OK to want to show people you’re mad, sad or depressed. Just be sure it’s the right person.

Be sad.
Be angry.
Be depressed.

Take all the time in the world to feel whatever it is that you’re feeling. Cry. Scream. Do it for yourself. When you’ve let everything out, you’ll be ready to conquer the world again.

Because I believe things don’t get easier, you just get stronger.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741.

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Unsplash photo via Larm Rmah.

woman behind ivy

The Guilt of Being Depressed

When asked the one word that is synonymous with my depression, “guilt” comes to mind. I feel guilty for having depression; I had a great childhood. No, nothing terrible has happened. I live in a lovely flat, have an incredible boyfriend and great friends. “I should not feel depressed.” This phrase turns over and over in my mind. There are people in the world who really suffer. “Not being able to get out of bed is not suffering,” I tell myself. “Surely, it’s a luxury.”

I’ve had depression for many, many years now. There are times when the clouds seem to clear, when the darkness dissipates and life feels good, but right now the clouds are ever-present, and it is hard to remember those times. However, no one would really know — I should be a spy, I am so good at leading a double life. I can put on a smile, muster up a good conversation (after ignoring a few calls and messages), but the reality is, all those “normal,” happy interactions exhaust me, and for that I feel guilty.

I feel guilty that I want to scream at my boyfriend who is just trying to be understanding. I feel guilty that I cause those closest to me to worry. My parents, my partner, my family and friends, all of them try to support me, to ensure I don’t get too low. How do I tell them it isn’t them and no matter what they do often I just feel low? I feel guilty that their efforts to help sometimes just make it worse.

I feel guilty for canceling plans last-minute. I mean to go, I want to go, but often I just don’t have the strength. I am brilliant at making excuses, but the shame I feel for letting people down is ever-present.

I even feel guilty for feeling guilty. Maybe some other people understand this warped way of thinking. I would tell anyone else with depression to not be so hard on themselves, to acknowledge their efforts. But to me, I just feel guilty.

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How 'Staying Strong' in the Face of Depression Nearly Demolished Me

What does the word “strong” mean to me? I have spent most of my life being “strong,” and it nearly demolished me. Maybe because of the stigma around mental health, people learn to see mental problems as something to be ashamed of, and the “done thing” is to be “strong” and soldier on. What that meant in reality for me was that all my natural emotions were suppressed, hidden away and treated as “bad” things. Control, calmness and coping were my watchwords. I was known, and even admired, for it. I realize now, what I was actually doing was building a wall around my natural emotions, brick by brick.

Until one day, I woke up and knew I couldn’t carry on with things the way they were. That brick wall was going to fall down and bury me if something didn’t change. Those emotions were shouting to get out and they demanded to be heard, in very scary ways. So I took myself to the doctor and received medication and counseling.

Now that last sentence is easy to say, but within it, is a whole lot of horrid. Was it easy to go to a doctor and say, “I’m broken, and I need fixing?” Was it easy to fill out the referral form and post it? Was it easy to call the therapist and arrange that first session? Or talk to people close to me about it? Or take medication? No. No, it wasn’t, it was hell. I hated it. I put off every single part of it for as long as I could.

Over the weeks, I began to understand this reluctance to confront things was part of the problem. I couldn’t control strong emotions like that forever — the stress was killing me. But the real issue from this first experience was downright fear of change, fear that all these fine brick defenses of mine would crumble and leave a poor, frightened little thing out in the open for the first time, with nothing to protect her from all the bad stuff. So I dealt with the surface problems on this occasion, because I felt safe doing that.

But there was more to come, unfortunately.

Over the last few years, I’ve developed two nasty illnesses and their associated secondary conditions. I am now disabled, need a wheelchair or scooter to get around and have such severe fatigue and pain that I have to rest most of the time. As the physical illnesses progressed, I fought with everything I had to keep going and keep working. I loved my job and the people I worked with, but it just couldn’t be done. When I finally accepted the medical advice and was signed off, I had lost so much of my life that I didn’t see the point of me any more.

I enjoyed working, I was good at it. I was valued, but I couldn’t do it anymore. I loved walking, going to the gym, dancing madly and gardening, but I couldn’t do any of them. I was housebound and had nothing to occupy my time. Depression hit again, big time. For six months, I couldn’t see a way out of the darkness. The losses were so great they took me over, despite the love and support I had from my husband, family and friends.

But because I had been there before — learned the all-important lesson that help was out there if I asked for it — I knew there was a way out. So, I asked for help. Again, it wasn’t easy, nothing ever is with depression. It took time for me to acknowledge it was back again, and it needed an expert’s help in exactly the same way my diseases did. It was tough as hell dragging myself out to counseling when my body and mind just wanted to stay at home and keep everyone away.

With my therapist’s help, I was able to confront the new and the long buried issues, and have the courage to start letting the bigger and longer buried emotions out. I knew it could be done because I’d done some of it before, if that makes sense. In fact, I have come to realize the very “strength” which had built my brick wall, was in fact, my greatest weakness.

So to answer what is strength to me, it’s realizing what is popularly perceived as “weakness” can actually be the best kind of strength. To ask for help and learn how to cope better during the times when depression bites is strength to me.

This post originally appeared on Bu Bakes.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741.

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Thinkstock photo via BerSonnE.

young woman leaning on bridge with blurred background at night

What My Depression and Mania Look Like

My depression isn’t cute. Depression is five days without a shower or a change of clothes. Depression is eating anything in sight and ordering even more. Depression is skipping classes, ignoring emails, not answering concerned texts and phone calls. It’s feeling alone when you’re the one who isolated yourself. Depression is a raft in the middle of a river with a greasy, sore and exhausted me clinging to it. Depression is not looking in the mirror because I don’t even feel like I exist. Depression is forgetting my birthday or my family’s names or good memories. Depression is leaving my three bedroom apartment when I dropped out of school. It’s finally getting out of bed, because somebody threatened to come check on me, only to step onto a scale I keep close by. Depression is heavy — heavier if you could measure the pounds of fear, agony and regrets I carry around. It’s agreeing to karaoke but I didn’t get to pick the song and they don’t put up the words. It’s embarrassing and feels hopeless. Depression is not catching a boy’s eye in class or on the street or in a bar. Depression is noticing that you don’t get noticed anymore. It’s not cute. It’s disgusting, it’s invisible, it’s hell.

Sometimes, it’s “crazy.” I’m “crazy.” It drowns my bank account in less than 15 hours. I scream and cry and imagine things and hate people I normally love and love people I normally hate. It’s a run-on sentence. Mania is breaking up with a high school boyfriend for no reason, other than he didn’t call me pretty when I was 17 and still wanting to fix it five years later. Mania is signing up for a new school and new classes I’m not capable of completing. It’s taking part in every committee and not ever finishing my jobs. Mania is surfing adoption websites to take care of children when I can’t even take care of myself. Mania is buying a plane ticket in the middle of the night to visit somebody you haven’t spoken to in years. Mania is deciding to move to LA to become a famous comedian. Mania is pacing the apartment at 3:45 a.m., scaring my roommate as she leaves for work. It’s crash diets and fad diets and sick amounts of exercise to lose the weight depression gained. Mania isn’t fun. It’s not a roller coaster. It’s a Tilt-a-Whirl I can’t get off, even after telling the operator I’m going to throw up.

On my 14th birthday, I wrote in my journal that it would be my last birthday. I wasn’t trying to be morbid; I just couldn’t picture myself growing up. It’s not that I didn’t want to drive or vote or get married, it’s that I didn’t see it happening for me. That thought eventually worked itself deeper into my subconscious. What’s the point in good grades if I won’t be here for college? Why should I save money if I want ice cream and shoes now if I don’t have to save for my first house? Why fall in love with him, if I’m leaving soon? Depression took a lot from me. It took away the future. I couldn’t let it keep it.

So, I’m here. I can see a future. I can almost imagine getting a real job. For the first time, I see myself growing up. I finally can understand a five-year plan. It took a lot of going through the motions, but I’m here. I learned to drive. I graduated high school. (Still working on the good grades thing). I’ve fallen and failed in love a couple times. That may be the last thing I’m focused on, though. The last date I went on, I told him “I didn’t use to be fat, it’s just the antidepressants,”  so I might need to up my game. Get a little bit healthier before I engage with boys. I read a quote the other day that “you have to want to spend the rest of your life with yourself, first” and I loved that. It’s my focus now. Sometimes, I think about going to my friends’ weddings. Those are the really good days because I think about friends and I realize I have them. I realize that I’m not alone. Plus, I have my dog — he’ll live 15 years and I’ve thought about being sad when he dies. That means I’ll be here 15 years. It’s weird sometimes, to think about being here longer than the next few months. In the middle of the night when I’m all alone thinking about how I haven’t been touched by another human in days, I just tell myself that I’ll high five a co-worker at work. Optimism is weird, but I like it.

I’m still dizzy, I’m still stumbling, I’m still too tired to go on sometimes but I’m here. And sometimes, I’m even OK.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “START” to 741-741.

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What Are the Signs of 'High-Functioning' Depression and Could You Have It?

If I were to ask you to picture and describe a depressed person, what would you envision?

Someone having trouble getting out of bed every day? Someone who’s calling into work sick because they can’t leave the house? Someone who’s isolated from friends and possibly sleeping 10 or 12 hours a day? Someone who can’t stop crying and who’s feeling hopeless?

Or would you envision a popular, college-educated professional living it up in the big city with a great job, a good group of friends and a long list of accolades to her name, but who wakes up each morning with a gripping sense of anxiety and an internalized pressure to continue to be “perfect” and “keep it all together?”

Would you picture a successful Millennial startup employee who you admire for his discipline and drive but who inwardly is devastatingly self-critical and relentlessly demanding on himself and who, after work, copes with his life with a drink or two and several hours of gaming?

And would you picture that smiling, competent, friendly coworker of yours who always seems to be getting All The Things done but who secretly, inwardly feels like she’s a complete failure and fears time is flying by and she’s wasting it every day?

Let’s face it: you’re probably not going to picture these folks. And yet each of them could be a perfect example of someone dealing with what’s come to be known as “high-functioning depression.”

While high-functioning depression doesn’t look like the stereotype of depression most of us hold in our heads, this diagnosis nevertheless carries significant risks if left untreated.

But the uniquely tricky thing about high-functioning depression is that it’s hard to spot precisely because the people dealing with it look, from the outside, like they’re holding it all together.

This can lead to a lack of ability to self-identify (or have those around you identify you) as depressed and, moreover, a possible resistance to seeking treatment because of the stigma surrounding more “typical” depression. And this is a big problem.

So in today’s blog post, I want to explain to you what high-functioning depression really is, walk you through 11 signs of high-functioning depression and how this may show up, explain the unique risks associated with high-functioning depression, and share more about how you or your loved ones can get the help you need if you identify with high-functioning depression.

What is High-Functioning Depression?

In my opinion as a psychotherapist, high-functioning depression is a pop psychology term for what’s clinically known as dysthymia.

Dysthymia, according to the “Diagnostic And Statistical Manual of Mental Disorders 5th Edition” (DSM 5), is a mental health disorder characterized by:

“Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least two years,” and includes the presence of two or more of the following symptoms, “Poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness.”

And yet, while these symptoms may look diagnostically similar to the symptoms we think of when we envision major depressive disorder (MDD), individuals dealing with dysthymia may not have the same severe levels of impaired biological and mental functioning that can make major depression easier and more obvious to spot.

In other words, someone struggling with dysthymia may still be able to get up and go to their demanding, prestigious job, be in a romantic relationship, post the believable smiley photos on Instagram, regularly get together with their girlfriends for happy hour and generally handle all the logistical adulting stuff of their life — passing for someone who doesn’t “look depressed.”

But inwardly, this same person may be gripped with a challenging set of symptoms invisible to those of us who love and know them.

Symptoms that may greatly diminish their overall quality of life, their career, their relationships, and bloom into more challenging mental health concerns if left untreated.

11 Real-Life Ways High-Functioning Depression Can Manifest

Above, I provided you with what the DSM-5’s clinically indicative dysthymic symptoms. Now let’s talk, in layman’s terms, about 11 ways that some of these symptoms may manifest in your real life.

1. Difficulty experiencing joy.

With high-functioning depression, the things that used to bring you pleasure — whether this is a cherished yoga class or a monthly ritual of getting together with your girlfriends — these same things don’t bring you joy anymore. They may feel like burdens or events you want to avoid because it feels like more of an effort than a support.

2. Relentless criticality — of self and others.

You may have a relentless and invasive internal narrative that’s critical of yourself, of others and of the world in general. You think you’re a failure, you think your boss is an idiot, your partner’s the most irritating person to have ever lived, and life’s just one big slog. This chronically negative thought pattern may feel like something you just can’t turn off.

3. Constant self-doubt. You may constantly doubt whether or not you’re on the right career path, whether you’re in the right relationship, doubt what you’re doing with your life and if you can even handle being an adult. This pattern of constant self-doubt may be situational or pervasive but it’s something that feels like you just can’t get over.

4. Diminished energy. If it feels like getting through each day is like walking up a mountain with a backpack of rocks, if you feel like you barely have the mental, emotional and physical energy to handle your life anymore, if your overall energy levels are greatly diminished, this could be a sign of high-functioning depression.

5. Irritability or excessive anger. If you find yourself blowing up over small things — your partner says something wrong, your co-worker messed up a project, your kid just broke your favorite coffee mug, if you find yourself exploding in a way that feels disproportionate to the event, if irritability and excessive anger are something you’re wrestling with, this may be a sign.

6. Small things feel like huge things.

Similarly, if you find yourself feeling overwhelmed or greatly stressed by an event that happens that maybe wouldn’t have felt like such a huge deal in the past (a friend cancels weekend plans, the grocery bags break when you’re carrying them in, your darn trackpad stops working because you spilled some coffee on it) and it feels like the End Of The World instead of the annoyance that it is — if you find your stress responses disproportionate to the event itself, this may well be a sign of high-functioning depression.

7. Feelings of guilt and worry over the past and the future.

You worry that you chose the wrong career in college, you question whether you’re in the right grad school program, you worry about paying off all those student loans, you worry your biological clock is running out, you worry that you married the wrong partner, you worry about who’s going to care for your folks when they get older, etc. We all have these worries from time to time, but if feelings of guilt and worry over your past and future feel pervasive and dominant, this may be more than “normal” worry.

8. Relying on your coping strategies more and more.

If you find yourself needing extensive zone-out time after work and on the weekends, turning towards your coping mechanisms more often than not — such as substances or behaviors like using alcohol, drugs, excessive gaming, constant Netflix, etc. — all in an effort to escape your life, this could speak to underlying depression.

9. Generalized sadness.

If you find yourself feeling a generalized sense of sadness you can’t seem to pinpoint the cause of, if you drop your mask and armors of smiling competency when you close your door behind you, if you feel a subtle sense of hopelessness, this could speak to high-functioning depression.

10. Seeking perfection.

This one’s a tough one. In a way our society condones perfectionism — getting good grades, getting into the Ivies, landing that amazing tech job, striving, striving, striving. But perfectionism has a shadow side where striving turns into unrealistic demands of yourself and psychologically beating yourself up when you fall short of the bar you set for yourself. If you find yourself doing this and it’s causing you distress, be curious about whether this a sign of high-functioning depression.

11. Inability to rest and slow down. If you need to clean up, tidy and organize the house after you arrive home from an exhausting day of work before you even consider letting yourself rest, if you find yourself uncomfortable with slowness, stillness and fallow periods of time because of the uncomfortable thoughts and feelings you come into contact with when you do actually slow down, this could be a sign of high-functioning depression.

The Unique Risks To Being Someone With High-Functioning Depression.

Mental health struggles come in all shapes and sizes but, as we undo the stigmatization and globalization of mental health scripted over these past few decades, most of us likely still have an unconscious image in our heads of what a depressed person looks like.

And while this internalized image of someone who can’t get out of bed, who can’t hold down a job, and who has constant suicidal ideations may be one form of depression, it doesn’t mean that someone who sees themselves in the list above or in the clinical descriptor of dysthymia isn’t also dealing with depression.

But these folks may not be willing to see themselves as depressed. And this can be a big problem. Because, in my clinical opinion, there’s a unique set of risks to being someone with high-functioning depression.

First, because you’re still “holding it all together” it may make it harder for both you and others to spot the very real mental and emotional strain you may be under because you pass. You fly under the radar. You and those around you doubt the seriousness of what you may internally wrestle with because, after all, your life still looks pretty great from the outside, right?

Second, as someone who is high-functioning, you may grow up believing that with enough effort and willpower, you can achieve, gain or fix anything that life throws at you. Not so with high-functioning depression.

High-functioning depression isn’t just a bad attitude, and you can’t just “will your way” out of it. High-functioning depression is a biological and psychological disorder that requires adequate and clinically appropriate treatment. Arguably, the more you push and “will yourself out of it” instead of seeking proper support, the worse your symptoms may get.

For example, if left untreated, high-functioning depression, or dysthymia, can potentially bloom into major depression or major depressive episodes where your biological and psychological functioning is more severely impaired.

Or, perhaps in your attempts to deal with your high-functioning depression on your own, comorbid disorders — such as eating disorders or substance use disorders — can develop from your attempts to manage your intolerable feeling states.

Bottom line: Dysthymia, or high-functioning depression, requires adequate clinical treatment as much as the most stereotyped version of major depression does. And the good news is that with proper clinical treatment, dysthymia can be managed.

Treatment and Supports for High-Functioning Depression.

While there is no single reason why someone develops dysthymia or high-functioning depression and while there is not necessarily a way to prevent it, there are several evidence-based effective treatment modalities to help you manage and support yourself if you deal with it: Psychotherapy and/or medication.

In fact, according to a paper from “The Canadian Psychological Association,”

“Psychotherapy is as effective as medication in treating depression and is more effective than medication in preventing relapse. For some patients, the combination of psychotherapy and medication will be more beneficial than either treatment on its own.”

So if you see yourself in this article today, I strongly encourage you to seek out a therapist and/or speak to your doctor or psychiatrist about what treatment options may be available to you.

The reality with high-functioning depression and moving through your days is that it can often feel like you’re attempting to build a castle on a foundation of quicksand. Get the help you need to build a solid, stable foundation for yourself — whatever that takes! — so you can build and craft a life in a more sustainable way. You’re so worth it.

Now I’d love to hear from you in the comments below: Did you see yourself in this article? What’s one piece of advice you would give someone resisting seeking out therapy or talking to their doctor about possibly being depressed because they’re afraid of the stigma, believe therapy doesn’t work or that they can just handle it on their own? Leave a message in the comments below so our community of readers can benefit from your wisdom.

And until next time, take very good care of yourself.

Warmly, Annie

Additional Resources:

1. 5 Important Things to Remember If You’re Experiencing Depression.

2. Four Effective Tools For Managing Anxiety.

3. The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness.

4. DBT Skills Training Handouts and Worksheets, by Marsha Linehan, Ph.D.

Follow this journey on Annie Wright Psychotherapy

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