Is Depression the End Stage of Anxiety?

We often talk about anxiety and depression as separate conditions, but in real life, they so often coexist. Sometimes, I wonder whether what we call “depression” can actually look like late-stage, unresolved anxiety.

When life stops aligning with our values, expectations, or basic emotional needs, stress and anxiety naturally rise. Our nervous system shifts into fight/flight/freeze. If this state becomes chronic, it slowly drains us leading to fatigue, helplessness, hopelessness, and “burnout”. It then can affect multiple domains of our lives.

At a certain point, something else can happen.

When our care factor drops to near zero, the anxiety may ease, but in its place comes a depressed mood, with loss of motivation, meaning and purpose.

Many people we see are right at this junction, oscillating between anxious distress and emotional numbness/depressed mood.

This is why early stress and anxiety management matters so much.

If we can support people early, we don’t just reduce anxiety, we may prevent deeper depression.

Understanding the Purpose of Our Emotions (DBT Framework)

In my counseling work, I often highlight to my patients the 3 main key functions of an emotion based on DBT Dialectical Behavioural Therapy originally developed by Dr Marsha Linehan. 

1. It activates us into action. Without it, there may be less “urge” or compulsion to act. No action may result in no/little outcome or impact and at the same time, action can be helpful or destructive depending on context.

2. It helps us to communicate with others in a more holistic and non verbal kind of way. Nothing needs to be said and communication can still occur.

3. It helps us to communicate with ourselves and guides us to move towards a life that matters to us, our values/conscience, and to the people we care about.

Without it, we may be lost and without meaning and purpose.

The problem is, if we do not know how to process/use our feelings/emotions properly and avoid/suppress it due to discomfort, we may become lost, stuck with unresolved conflict, and not able to live a life truer to self.

Part of therapy is to raise more aware, acknowledge and equip us with better emotional literacy, to improve our emotional wellbeing and our overall physical, psychological and social health.

Close Enough to Care, Steady Enough to Help

When we care for someone who’s struggling whether we’re a doctor, nurse, carer, parent or friend, it’s natural to feel their pain.

But real compassion means being present with someone’s emotions, not absorbed by them.

One of the many important life skills is to cultivate mindfulness/holding space for the feelings and emotions of others especially with the “uncomfortable painful ones”. It can often be very difficult for many of us to do.

Not too fused or “zoomed into” the feelings and emotions of others but not too detached or “zoomed out” either. 

Too fused or “zoomed into” the feelings and emotions of others and we may “catch it”, suffer with them, burn out and get compassion fatigue.

Too detached or “zoomed out” and we may risk losing empathy, connection and miss the subtle emotional signals behind their communications with us. 

Mindfulness with “the feelings of others” is the “sweet spot”. Not too close but not too far either. 

Emotional Literacy — The Language We All Need to Learn

In counseling work, I often explain to patients that feelings and emotions are like a language.

Some people understands very little of it.

Some people understand a bit and say a bit.

Some people can understand a lot but can’t speak it very well.

Some people are very fluent at it through deep understanding and expression.

Some people use this language well with others but not with themselves. 

Part of counseling is to reflect on what level we are at in the “feeling and emotional language”. From there, both acceptance and pivot for change with clarity is important.

If we cannot understand or speak French, and our context requires us to understand or speak French, then we need to consider learning French.

The same goes for the “Feelings and Emotional Language”.

Is It Intuition or Emotion? Learning to Tell the Difference

In counseling, one of the key skills in understanding your feelings is learning the difference between an intuition and an emotion.

They can both feel similar, but they serve different purposes.

So what is an Intuition?

Intuition is like your inner knowing — a calm sense or “gut feeling” that gives you information without needing strong emotion.  It’s often steady, quiet, and reliable.  You might not know why you feel it, but it often turns out to be true or helpful.  Think of it like a fact in your feeling language — it gives clarity. 

What is an Emotion?

Emotion is a stronger reaction — like anger, fear, excitement, or sadness.  It often comes with a body sensation (heart racing, tense shoulders) and a push to act — to say or do something right away.  Emotions are less steady, more changeable, more subjected to biases, and can shift depending on the situation.  They’re not bad — they give us energy to act — but they may not always be the best guide for clarity and decision making. 

An Easy Analogy:

If intuition is like a fact, then emotion is like an opinion or judgment about that fact.

Facts give us clarity.

Opinions give us motivation — but they can also change quickly.

In the ACT (Acceptance and Commitment Therapy) framework, when we’re fused with emotion, we feel pulled to act right away — we’re caught up in the story or feeling. 

When we defuse, we step back, breathe, and notice the feeling without reacting — we get more space to have more clarity and choose what matters.  This is being mindful with feelings. 

So, when your feeling is steady and calm, that might be intuition.  When your feeling is strong and urgent, that’s more likely an emotion.

So next time you feel something, ask yourself: 

“Is this a calm knowing… or a strong urge?” 

That question alone can help you respond with clarity rather than impulse.

Helping Kids with ADHD/ASD Through the “4 Smarts”

I recently shared a talk with parents of children with ADHD/ASD, drawing on my experience in ACT, CBT, parenting support, and counselling.

Many of these kids have an incredible thinking mind — they shine in Critical Thinking Smart and Practical Smart. Unfortunately, school and home life don’t always nurture these strengths, especially in the earlier years when tasks and subjects may feel irrelevant. This mismatch can lead to disengagement.

Where children with ADHD/ASD often need the most support is in the feeling-based smarts:

1. Social Smart – connecting with others, building collaboration, empathy and harmony.

2. Self Smart – emotional regulation, self-awareness, resilience, self-compassion, and deep self-acceptance.

When these areas aren’t supported, children can feel out of balance, and challenges at school and at home can quickly grow. 

The key?

Helping children integrate all four smarts — so that their strengths are recognised, their challenges are scaffolded, and they are supported to thrive both in learning and in life.

The Hidden Cost of Masking: Supporting Neurodivergent Mental Health

When I work with individuals who are navigating ADHD or Autism Spectrum Disorder (ASD), the term “masking” often comes up in conversation. 

But what exactly is masking, and why does it have such a negative impact on mental health?

To me, masking occurs when someone feels unable to live a life that is true to themselves—because when they try, it simply doesn’t work in their current context. This process can be either conscious or unconscious. Masking carries what I call an “emotional debt,” and over time, excessive masking can lead to “emotional bankruptcy” or burnout.

So, what can we do from a psychotherapy perspective?

We can support our patients by helping them clearly define their values and what truly matters to them. From there, we work together to pursue a life that feels more authentic—while also finding ways to make that life workable within the external world.

Bridging the Gap: How to Align Your Inner World with Outer Demands for ADHD Success

ADHD can often feel like a constant battle between your inner thoughts/feelings and the demands of the outside world. Many people with ADHD may experience a powerful disconnect: their minds zoom in on personal values and internal thoughts, while the external environment demands their attention elsewhere. This mismatch can lead to significant challenges in daily life with adjustment difficulties. 

When your internal values conflict with external expectations, it creates a unique kind of struggle. For instance, you might be deeply passionate about a project but find it hard to focus on tasks that others expect you to prioritize. This disconnect can trigger feelings of anxiety, stress, frustration and low self-esteem, often framed as a "mismatch of focus" rather than a simple focus issue. It can create a lot of misunderstandings from others as well as from self.  

The consequences of this mismatch can be profound. Individuals may experience:

1. Increased Anxiety.  The pressure to conform to external demands can lead to overwhelming feelings of inadequacy and resentment.  I would frame this as secondary anxiety rather than a primary problem.

2. Stress and Burnout.  Constantly switching focus can be exhausting, leading to physical, mental, and social fatigue.  This will ultimately affect our biopsychosocial health i.e. our physical health, psychological health, and our social health.

3. Low Self-Esteem.  Repeated struggles can cause individuals to doubt their abilities and self worth.

Recognizing that this is not merely a focus issue but a deeper alignment problem is crucial for acceptance and personal growth.

So what can we do to improve our situation?

1. Cultivate Awareness and Mindfulness.

Begin by recognizing this mismatch without placing blame on yourself or your surroundings. Practice mindfulness techniques, such as meditation or journaling, to hold space for your thoughts/feelings. This awareness is the first step toward change.

2.  Emotional Acceptance.
Allow yourself to feel and accept the tension between your inner and outer worlds. Instead of resisting these feelings, acknowledge and "hold space" for them. This acceptance can provide clarity and renew your energy.  From here, you can pivot for change and personal growth. 

3. Create an Aligned Environment.

Focus on finding or creating contexts that resonate with your inner values but are still workable in the external world.  This might mean adjusting your work to make it more conducive to your needs, seeking out supportive relationships, or changing your daily routines to better align with your inner values/interests. 

4. Set Realistic Goals.
Break tasks into manageable chunks that align with your values/interests. Setting small, achievable goals can help bridge the gap between your internal desires and external demands.

5. Seek Support.
Don’t hesitate to reach out for support, whether through therapy, support groups, or friends who understand your challenges.  Sharing your experiences can provide validation and new perspectives.  You are not alone!

The ultimate goal is to help individuals with ADHD accept, embrace, and fine-tune their inner thinking/values while making it workable in the external world. By learning to align your focus, you can reduce anxiety and improve self-esteem.  There is less friction and the need to "mask".  This journey is not just about managing ADHD; it’s about embracing your unique way of thinking and finding strategies that work for you and your context.  Metaphorically speaking, you are like a "Mac Computer" in a "Microsoft World" or vice versa.

If you found this helpful, please share it with friends or on social media using the hashtags #ADHD #MentalHealth #Mindfulness. Together, we can increase awareness and better emotional literacy around this topic.

ADHD: Why Both Medication and Counseling Matter

When helping our patients who are struggling with ADHD, these are my thoughts around stimulant medications and counseling.

Stimulant medications help patients “zoom into” their thoughts and feelings. This helps them take consistent action that leads to real impact in their lives.

But action alone isn’t enough.

Counseling supports the other side of the process — helping patients “zoom out,” just enough, to get clarity. It can involve defusion, mindfulness and metacognition. It gives people space to understand what really matters to them, what they can control, and what’s workable in their unique context.

It’s not about choosing one or the other. It’s about combining both — in the right balance — depending on the person’s needs and situation.

Because:

 
1. Clarity without action is a problem. You may know what needs to change, but you can’t follow through.
2. Action without clarity is also a problem. You may be doing a lot, but going in the wrong direction or burning out.

A metaphor I often use is this:

Medication gives you the fuel to go somewhere. Counseling helps you figure out where you want to go — or where you need to go.

So in managing ADHD, both medication and counseling are important tools. One sharpens your focus. The other helps you aim that focus at what truly matters.

The best results come when patients are supported to both think clearly and take meaningful action. That’s when things really start to change meaningfully and sustainably.

Feeling Like a Fish Out of Water? 3 Domains to Understand Neurodivergence and Thrive

Understanding Neurodivergence: A “Fish Out of Water” in School and Family Systems

When I screen for neurodivergence—whether it’s ADHD, ASD, or related conditions—I often frame it as a mismatch between an individual and the systems they’re navigating, like school or family, especially in their younger years. It’s a classic “fish out of water” or a “Mac in a Microsoft world” scenario: the environment isn’t wrong, and neither is the individual—it’s the lack of alignment that creates challenges.

I break this mismatch down into three key domains of maladaptation. When someone shows extreme traits in these areas, it can signal neurodivergence, often accompanied by secondary issues like anxiety. Let’s explore these domains and what they mean for understanding and supporting neurodivergent individuals.

Domain 1: Thinking-Biased vs. Feeling-Biased

The first domain looks at how someone processes the world—are they more “thinking-biased” or “feeling-biased”? A thinking-biased individual leans heavily on objective, logical variables, while a feeling-biased person prioritizes emotional, values or relational cues.

If someone’s balance is fairly even—say, 50:50, 40:60, or even 30:70—they’re likely to adapt well to most environments. But when the split becomes extreme, like 90:10 in either direction, adjustment issues can arise. For example, a highly thinking-biased child might struggle to connect emotionally in a family or school setting that values social harmony over logic. This tension can lead to feelings of isolation, frustration, or being misunderstood—a hallmark of the “fish out of water” experience.

Domain 2: Tactical, Operational, or Strategic Orientation

The second domain focuses on how someone approaches tasks and goals: are they tactical, operational, or strategic? In early childhood, schools and parents often emphasize operational skills—getting everyday tasks done, like completing homework or following routines. This operational focus aligns with societal expectations for young kids.

But if a child is wired to be more tactical (focused on immediate, practical actions) or strategic (big-picture, long-term thinking), they might struggle with the operational demands of school and family life. For instance, a strategic thinker might excel at envisioning creative projects but flounder when it comes to the daily grind of assignments. These blind spots can create tension, leading to feelings of inadequacy or conflict with authority figures who prioritize “getting things done.”

Domain 3: Inner-Compass vs. Outer-Compass Orientation

The third domain examines whether someone is guided by an inner compass or an outer compass. An outer-compass orientation means prioritizing what works for others—pleasing teachers, parents, or peers. An inner-compass orientation, on the other hand, is about staying true to one’s own values and thinking, even if it clashes with external expectations.

In early years, schools and families tend to reward outer-compass behavior: following rules, meeting expectations, and fitting in. A child with a strong inner compass—who insists on doing things their own way—might struggle to adapt, leading to friction. They may feel like they’re constantly swimming against the current, unable to meet the external demands placed on them.

When Extremes Collide: The Neurodivergence Connection

When someone is extreme in all three domains—highly thinking-biased, tactically/strategically oriented, and inner-compass driven—the mismatch with traditional systems can be profound. This is where adjustment challenges peak, often manifesting as anxiety, which only complicates the picture further. The “fish out of water” metaphor becomes painfully real: they’re not thriving, but it’s not their fault, nor is it the fault of the environment—it’s the mismatch that’s the issue.

Based on my observations:

• Extreme in all three domains: I’d be highly suspicious of ADHD or ASD, with secondary anxiety due to the intense adjustment struggles.

• Extreme in Domains 1 and 3 (thinking-biased and inner-compass): This often points toward ASD, where logical processing and self-directed behavior dominate, sometimes at the expense of social connection.

• Extreme in Domains 2 and 3 (strategic/tactical and inner-compass), with clear maladaptations: This leans more toward ADHD, with nuances depending on the subtype (e.g., inattentive, hyperactive-impulsive, or combined).

The “Fish Out of Water” Struggle: A Path Forward

For neurodivergent individuals, this mismatch can feel like a constant battle. But understanding the root cause is the first step toward empowerment. It’s not about “fixing” the person or the environment—it’s about finding or creating the right fit.

Here’s the strategy I recommend:

1. Understanding: Recognize how these domains play out in your (or your child’s) life. Awareness is key for both acceptance and to navigating challenges.

2. Self-Acceptance: Embrace your unique wiring.

3. Maintaining Self-Worth: Don’t let societal expectations erode your sense of value. You’re not failing; you’re just in an environment that doesn’t suit your strengths.

4. Seek or Create the Right Environment: Look for spaces—whether at school, work, or in your community—that align with your natural tendencies. This might mean finding supportive social circles, or exploring new settings that feel more congruent and more like “home.”

A Final Thought:

The “fish out of water” experience isn’t a flaw—it’s a signal. By understanding these three domains, we can better support neurodivergent individuals, helping them find environments where they can thrive. Whether it’s advocating for more flexible school systems, fostering self-acceptance, or seeking out spaces that celebrate their unique strengths, the goal is to bridge the gap between the fish and the water. Because when the environment fits, that fish can swim and thrive!