Mental Health Foundations & Toolkit

I've written about my struggles with mental health a few times, and I've posted on Threads about how my anxiety and panic disorder has been way more manageable the last few months. From those posts, I've had a few conversations with folks about what I've done to overcome and manage my disorders. I figured it was time that I wrote something that grouped the foundations of my recovery and the bag of tools I use to continue to stay balanced.

There are some caveats to my story that I'm going to start off with because I think it's important that we speak to our unique circumstances when talking about mental health and what's worked. My journey won't be exactly the same as yours but hopefully these foundations and tools can be a part of your journey, too.

If you don't care for the background or caveats, you can skip to the Foundations section and continue from there.

Caveats and background

I won't fully rehash what's been written before, but I do think it's important to highlight some major turning points in my recovery that add some necessary colour to my current state of being.

1. Time

I was diagnosed with Generalized Anxiety Disorder (GAD) when I was 4–5 years old. Dealing with anxiety isn't new for me. I've had 2 major depressive episodes in my life, January 2021 marking the start of my 3rd major depressive episode. This latest episode is also when I developed my panic disorder, which has been a new thing for me to navigate.

Each major episode has always gotten better by doing one thing: waiting. It sucks to hear, because when you're in it, it fucking sucks to live through. The light at the end of the tunnel seems so very distant, but it's always come. And one thing I've learned—which may or may not be comforting—is that the amount of time spent in the tunnel is almost always correlated to the amount of time it takes to get out. 1 year in? 1 year to get out.

If that isn't comforting for your to hear, just know that there is so much that you can do to make the time it takes to reach the end better for yourself. Hopefully the following foundations might help.

2. Medications

I was reluctant to takes meds for about a year after I developed a panic disorder. I didn't like the idea of being reliant on them, and the possible side effects scared whatever little courage I had out of me.

What finally made me break, was after a year of doing everything in my foundations, I still wasn't fully back to baseline. There was still something going on inside of me that I just couldn't for the life of me pinpoint. And man, am I really happy I started taking meds. I don't think I would've figured it out without them. They quieted the remaining background noise and second guessing just enough to figure out what was going on, and send me on the right path to getting it confirmed (see next section).

I mention this because it's important to note that it's very possible the foundations alone may not be enough for you, and you shouldn't feel bad/embarrassed/lesser for taking meds. Medication can be a crucial part of your recovery process—or forever process in some cases—and that the equalization that they bring can give you the space you need to figure out what's actually going on.

3. Celiac disease

I've had gut-related issues for years. For pretty much as long as I can remember, there was always anxiety related to my stomach and food in some way. As I got older, I kind of shrugged it off and just figured that it was part of life. It seemed people had stomach issues and we were just supposed to deal with it. For most of my life, those issues were pretty manageable. Though, over the last ~4 years, it started to evolve and extend beyond just my stomach.

The last two years or so, it got to the point where after almost every meal I would have crazy brain fog, muscle soreness, elevated heart rate, fatigue and extreme bloating. It was getting to the point where the idea of eating was making me anxious. I didn't want to deal with 30 minutes to an hour of wild discomfort. Sometimes leading to a surprise panic attack at the overwhelming sensations in my body. It also felt like, no matter what I did, I just couldn't gain muscle.

The general consensus from my doctor and people that I knew was: "well yeah, you have a panic disorder, you're just anxious and reacting to the fact that your body is digesting. Keep doing therapy, take some meds and try to find ways to calm down."

I had a really hard time accepting that. I had been putting in the work, a lot of work, and it still wasn't changing, and it was only around meal-time. It just didn't make sense anymore.

Like I mentioned above, I had been putting off meds, but this was my breaking point. My physical health was going down fast, too. Muscle wasn't staying on. I wasn't eating enough. It was just a bad time. So, I decided to give anti-depressants a shot. Within a few weeks of starting them, I felt an immediate difference in my overall mood. Except, again, around meal-time. It wasn't as bad—no panic attacks—but all the rest stayed. So, I started an elimination diet. I very quickly discovered it was gluten. I've cut it out of my diet now for about 6–7 months, and I feel like a new human. My general anxiety is so much lower, I'm able to put on muscle and I can eat with a hell of a lot more confidence. I can also very easily tell when gluten has been around my food. All the old symptoms come back.

Foundations

1. Sleep

Without sleep, everything falls apart. I can maybe go 3 days maximum without getting 8h30m–9h of sleep before my body and brain start giving up. This hasn't always been the case, but I think the years of getting 6–7 of hours of sleep, and forcing myself into a circadian rhythm that isn't natural to me have caught up to me.

If you're in a position that allows you control over your sleep/wake schedule, do yourself a favour and don't set any alarms for a week. Listen to when your body feels sleepy in the evening, wakes up naturally in the morning, and take note of how long your sleep session lasted. All of those data points become your natural sleep/wake cycle. Listen to that and follow it to the best of your abilities.

2. Therapy

This feels like a no-brainer but having a therapist you trust is one of the best things you can do to better understand yourself and your responses to things. Whether you're dealing with anxiety or not, an impartial third-party who can offer you different lenses with which to view the world or your problems through is indispensable.

3. Meditation

Pop-literature and biggest-podcaster-of-the-period all talk about meditation. It's for good reason. One thing that I think it's really, really important to underscore is that meditation will not be an overnight solution. Meditation is a practice first and foremost. It's like going to the gym for your brain. Consistency and time are super important. At the time of writing this, I am nearing a 1000 day streak of meditation. It's helped me tremendously. I can sit with discomfort a lot better again, I understand my responses to things but it took almost a thousand days to get to that point. The start might be rough, but I think this recipe might help a lot of people get started.

• Week 1: 1 minutes a day, guided (Calm or Headspace)
• Week 2–3: 5 minutes a day, guided (Calm or Headspace)
• Week 3–4: 10 minutes a day, guided (Calm or Headspace)
• Week 4–8: 10–20 minutes a day, guided (Calm, Headspace or Tara Brach's meditations)
• Week 8+: 10–20 minutes a day, un-guided (or guided if you feel your practice slipping)

4. Cardiovascular exercise

There's a ton of research on cardio exercise and anxiety/stress management. I won't go into it, but, I will say that it takes a lot less than you think to be effective. And I don't mean "a lot less" in terms of time spent, I mean in terms of exertion. The amount of exertion/effort required will probably vary from person to person, but I found that listening to common wisdom—HIIT workouts and getting your heart rate high—worked against me. Those types of sessions would put me into a state of panic, not help me.

What I've discovered through trial an error is that for me, getting 10–12k steps a day, with one or two Zone 2 workouts a week, and at least one resistance training day, has been perfect.

I think what's most important is to figure out a form of activity you enjoy doing that's centred around endurance. For me, that's walking on my under-desk treadmill while working. It's enough to warm me up, get the blood flowing and challenge my nervous system. The days that I miss hitting my step goal, I notice a huge difference in my mood, energy and sleep quality.

My current physical health routine:

1. Daily mobility and warmup routine (10–15m)
2. At least 10k steps (mix of errands, around the house and using my under-desk treadmill)
3. At least 2 sessions of Zone 2 cardio a week
4. At least 1 session of resistance/strength training (in my case bouldering) a week

5. Socializing

Working fully remotely and not being very social in nature, being around people other than my partner was something that went undervalued for way too long. Back when I used to work in-office, most of my social needs were met. Those base-line social needs cascaded into so many mental and physical health benefits I didn't realize at the time. Since they've been largely removed, I feel the side-effects of isolation and loneliness a lot more.

Being social gave me:

1. The energy to be more social
2. A healthier view of people
3. Challenged my way of thinking about problems
4. A greater sense of self-confidence

There are a myriad of reasons why this won't be as broadly applicable as the other categories—which is also why it's last—but I do think that it's worth exploring if you're feeling anxious/depressed/directionless. There's magic in finding your tribe, and greater magic in exploring the beautiful people on this planet. Not everything and everyone is as terrible as the internet can make it seem.

Bag of tools

These are things I reach for when I need extra help. That could mean I'm dealing with a particularly stressful event, a drastic change in my life or if I just need to make sense of something in my life/self.

1. Journaling

I've journaled on and off for 5–6 years. It has a lot of power. Especially when it comes to trying to better understand problems you're dealing with or getting to the root-cause of why you behave certain ways. It doesn't need to be complicated, either.

One of my go-to methods is filling a standard A4 ruled piece of paper first thing in the morning. This was derived from Morning Pages. I just do 1 page since it's often enough to feel clear, but go until you feel like you have nothing left!

It's normal to get caught up thinking you have nothing to say, or don't know where to start. In those instances, I often just start with the first thing that comes to my mind. It often goes in wild directions when you do, and you end up pretty far from where you started, but that's the beauty of it! You're learning how your brain works better.

2. Breath work

There's a lot written (link to articles) about proper breathing and it's affect on anxiety, blood pressure and stress. So, I won't rehash it here. However, learning to breathe with your diaphragm can be a bit difficult. Especially in our constantly-seated society.

One huge unlock for me was listening to Dr. Shirley Sarhmann talk about posture and it's affects on breathing. Prior to this, I always thought breathing from the diaphragm was the only proper breathing mechanic. In this episode on the Tim Ferriss podcast, she mentioned pump-handle and bucket-handle breathing. Ever since I learned about these 3 modes of breathing, I've tried to practice incorporating all three into my breath work. Typically at the start of a meditation session, or sometimes at the end of day in bed.

How I practice using these three modes:

1. Start by breathing from your belly; your chest and sides shouldn't activate yet
2. Once your belly feels full, imagine your chest expanding from the front and back
3. Once your chest feels full, imagine your sides expanding from left to right
4. Repeat 2–4 times

On a particularly tight day, I'll sometimes just start giggling because of the releasing effect it has on my back and shoulders. It's a great way to create space after being hunched over all day breathing improperly.

3. Mobilizations

Mentioned in the cardiovascular section, I do 10–15 minutes of mobilizations and muscular warmup in the morning. This routine changes somewhat frequently, and it's based upon what I feel I need to be working on at the moment.

Without doing these exercises, I'll typically feel stiff and achy the entire day.

If you don't know where to start, I highly recommend the warmup section from the routine on the /r/bodyweightfitness sub-reddit. Tweak from there depending on what your body needs to work on.

4. Supplements

This is highly personal, and I've gone through many, many, many, iterations of my supplement regimen before finding something that works.

Here's what I do right now:

1. AG1 by Athletic Greens—much better than making my own cocktail, has greatly helped my gut-health and general mood
2. Collagen powder—I do this mostly for extra gut-healing, and maybe better tendon strength/recovery for bouldering
3. Creatine to aid in muscle retention/endurance for bouldering

Before starting any supplements, it's worth getting some bloodwork done and talking to your doctor. For years I had, and I quote, the lowest Vitamin D my GP had ever seen. It's good to know where you stand before you start!

Try to enjoy the journey

It's easy to get demoralized when trying to navigate mental and physical problems. There's often the feeling that you'll be stuck a certain way forever, or that things will only get worse. Having gone through quite a few of those periods now, I can unequivocally say that it does get better, even if it takes time, it'll happen.

The journey isn't a straight line. You'll have highs and lows. But if you treat each attempt as an experiment, maybe it'll help take some of the pressure off to "get it right" the first time. Give yourself the space to make tweaks and throw out what doesn't work for you. Know that what works right now might not work forever and that it's ok. You just get to have fun trying to figure yourself out again.