Ellie Pike:
Depression doesn't always look like rotting in bed all day or doom-scrolling on a phone while life passes by. For high achievers, it can hide behind packed schedules, polished accomplishments, and relentless drive. In today's episode, Therapist Jenny Jacobsen helps us pull back the curtain on how depression shows up in people who appear to have it all together. And the small compassionate steps that lead to real healing. You are listening to Mental Note Podcast. I'm Ellie Pike.
Jenny Jacobsen:
I'm Jenny Jacobsen. I'm a therapist in Denver, Colorado. And I like to work with all sorts of people, but I end up particularly seeing people that are just feeling stuck in life, struggling to find a path forward. Maybe they're repeating patterns over and over that aren't working for them and really helping them get to the bottom of what's going on and how they can feel better and show up better in their life. I'm a certified EMDR therapist. I also am trained in IFS, Internal Family Systems. And with most of my clients, I ended up integrating those two models.
Ellie Pike:
Thank you so much for being on the show today. And it's interesting when I think about making episodes about depression, I always think about how to make it not feel depressing, for lack of other words. I recently listened to another podcast of yours and I was like, "Oh, I should ask her to be interviewed." Because I think a lot of times talking about depression can feel really tricky because we all have an image of depression that can sometimes look like lying in bed all day or that there's no point in living or that somebody feels so suicidal. And in reality, that's not always the case. And depression is a little tricky and can undermine how we behave in a general day, especially for high achievers. So I brought you on the show because I know that you're really adept at working with high achievers and with depression, and I was just curious your take on the topic and wanted to just start there.
Jenny Jacobsen:
So it has turned out that in my practice I end up seeing a lot of people that are what they would call high achieving, and that can look a lot of different ways. But a lot of times that looks like high achieving in their jobs or sometimes it can just also be just really driven individuals that consider themselves a little bit more Type A. And so in that population, you're right, what we tend to think of depression, we think of lying in bed all day, can't move type of symptoms. But in people that are more driven and that more Type A personality, sometimes depression is much more of an internal experience than what you're seeing on the outside. Because a lot of times on the outside, it's working for them because they're so driven. But internally, they are struggling to relax. They don't feel like themselves. They're pushing themselves too hard, they're ignoring their feelings, they're isolating themselves, they're detaching. Maybe there's some engagement in kind of more numbing behaviors. Scrolling on the phone, or substances, or whatever can take away from that high level of stress. And really it ultimately leads to burnout and pretty significant depressive symptoms if they're not treated
Ellie Pike:
Well, and I think one thing you didn't mention that I might add is what the internal voice is where someone might be saying, "Yeah, I did that, but I should have done this too." And being really tough on ourselves. And I say ourselves, because I think I can relate with somebody like this. I'm a doer. Everyone would say that from the outside, I look like I've got it together. I'm a high achiever. I don't really let too many balls drop, but internally I do notice that I'm losing energy. Or I might just be like, "Am I burned out or am I actually bored? What's actually happening here?" And it might not look the same that it might look for somebody else who has very expressive, I guess, you could say, depressive symptoms. So do you ever notice a difference between burnout versus boredom, especially with high achievers?
Jenny Jacobsen:
Yeah. I think that boredom tends to be more about just a lack of interest or engagement, feeling like there's not a lot that's really keeping your interest right now, or sometimes it's feeling like you're maybe a little bit purposeless. You've lost your meaning a little bit in life. Whereas burnout can really be more about that shutdown response. There is emotional depletion, exhaustion, overwhelm. Oftentimes it can be associated with the word can't. I just feel like I can't, I can't get off the couch after the end of the day, or I can't go out and see my friends, or I can't make that phone call to my mom I know I need to make because I just don't have it in me. And that tends to be that red flag that, gosh, I'm burning out here because I'm putting all my energy towards being able to achieve my goals, but there's nothing left for me or for my loved ones.
Ellie Pike:
That's really interesting. Because then I think about depression versus feeling disconnected or maybe they're not different. So I'm kind of interested in what you see with folks that are feeling disconnected. Does that mean that they're depressed or how could that be related to depression?
Jenny Jacobsen:
Yeah, I tend to see disconnection as a stepping stone on the road to depression, where when we start to notice that we're disconnected, it's kind of an early sign that if we don't make some shifts in our life and reconnect, then we're going to end up in a more depressed space. Because where disconnection can be more of a symptom, depression is a little more encompassing, it really impacts all the areas of our life.
Ellie Pike:
In my mind, a lot of the examples of disconnection are really after burnout. If I'm feeling so burned out, I'm not going to call someone or can't take that next step. Then it leads to disconnection, which eventually if I feel disconnected for long enough, I might feel depressed, or isolated, or alone and hopeless. So I can kind of see it as a stair step in my mind.
Jenny Jacobsen:
I agree with you. I do think that it can be a stair step or a red flag along the way that's saying, am I on a path in life that I want to be on? Is this the direction I want to be heading? Am I feeling congruent in all parts of my life and are all parts of my life feeling good to me? Or is there a part of my life that looks good from the outside, but internally I feel like I've lost myself? And I think that's where that disconnection comes into play.
Ellie Pike:
Well, and you might actually be answering the next question I was planning to talk to you about, which is what's essentially happening on the inside. What is that harsh inner voice saying or potentially saying? So if our listeners were listening and they can relate with this idea of being a high achiever, what are some things that they might need to look out for with their own internal selves?
Jenny Jacobsen:
I'll say some early symptoms I start to notice are physical symptoms. And that starts to indicate some of that nervous system dysregulation, but it can be things like poor sleep is a really big one, tummy troubles because your nervous system isn't in that rest and digest place. Headaches, chronic pain that feels unexplainable. Those are some of those physical components. I also notice just an increase in that inner critic, sometimes a little increase in that imposter syndrome telling you you're not good enough, you need to try harder. Starting to slip into more black and white, all or nothing thinking that there is no try, there's only success and the bar keeps moving. And our brain gets a little sticky in those places where we can get stuck in those feedback loops.
Ellie Pike:
Do you notice perfectionism playing a role in that inner voice?
Jenny Jacobsen:
Oh, definitely. I think perfectionism can be really tied to that inner critic that comes up that tells us we can't take our foot off the gas. And sometimes that part even believes bad things will happen if we take our foot off the gas, that that's something that's for other people, but it's not for us.
Ellie Pike:
It's almost like I'm this, I'm an exception to the rule and it's not necessarily rational, but it feels like the only truth. And I think that that's how mental health is, or mental illness is really tricky, likes to trick us into believing that something is true when it might not be. And it seems to me like perfectionism too is so highly tied to anxiety. And for many of us, anxiety is what helps us function. If I didn't have anxiety, it would never be somewhere on time or I would never get an A on a test because if I wasn't anxious about it, I probably would never study.
That ties in with depression of like, "Well, what is my inner voice about how I actually did perform? Was it enough? Was it not enough? Do I have shame around how I am or who I am?" So I see that all correlating with itself. And it's really intricate, it's really complicated, and very different for everyone. So I don't expect you to be a scientist here, but I am wondering if you're aware of any studies regarding the correlation between depression and anxiety since they do feel so hand-in-hand.
Jenny Jacobsen:
Yeah. So studies show that there's about a 50% comorbidity between depression and anxiety. So often they go together. And they do share a lot of underlying biological factors in terms of brain chemicals and imbalances like serotonin and dopamine, which regulate our mood. But I'll tell you anecdotally, in my practice, I tend to see depression and anxiety being two sides of the same coin and oftentimes ways that we're trying to regulate. So if anxiety is up regulation or activation, then depression is that down regulation or deactivation. And a lot of people who experienced anxiety, say you go to a party and you're feeling really nervous and socially anxious. And then at a certain point in the event, you shut down. And you want to go to the bathroom and hide, and then you go home and you're really tired. That's that kind of activation and deactivation both at play in that scenario. And a lot of us experience both of those types of symptoms on a day-to-day basis.
Ellie Pike:
Right. And it seems like it's all a spectrum. We can have anxiety and we can have downers, but it doesn't always mean to a clinical degree. So how would you define in your practice when you're seeing folks and they're like, "Okay, yeah, I have the spectrum. Sometimes I'm fine, or sometimes I just feel these feelings." Versus something is clinically indicating that something is wrong neurobiologically or maybe they need more support, whether that's training their brain or actually taking medications and seeing a psychiatrist, et cetera. What is that tipping point, if you will?
Jenny Jacobsen:
Well, I think in terms of therapy, the tipping point doesn't matter as much, because if you're starting to get that niggling feeling that something's not right in your world or internally or externally, then that's a great time to seek help. Whether you meet the diagnostic criteria for depression and anxiety or not. But in terms of when to seek a psychiatrist or other supports outside of therapy, I tend to find if you're engaging in all the things, if you're going to therapy, if you're doing mindfulness. If you're trying to take care of yourself, and getting sleep, and drinking water, and doing all of those things, and you still feel like I cannot get there. I am out at sea and I am paddling as hard as I can and I still cannot see the shore. Then sometimes more pharmaceutical interventions or other types of interventions can just help be a boat to shore. They can help you get there faster, and sometimes that's what we need.
Ellie Pike:
So Jenny, you've done a great job, I think, helping us think through some of that inner critic voice or what might be happening with someone who's a high achiever with depression. What other symptoms might you notice, especially as you're working with individuals and that might be orange flags for you, not necessarily red flags, but something that's noticeable that you might work with your client on?
Jenny Jacobsen:
I think an inability to relax is a big one. When someone feels like they are pushing so hard all the time that they can't come back down. And that's something that I tend to clock. I think when I hear people talking about just a lack of interest in things, and I know you spoke to that boredom piece, but it seems like it goes a little bit more than that. Things have lost their meaning. I'm working so hard at this job or these tasks in my life and I don't even really know why I'm doing them. I don't even really like it, or it's not really doing for me what it used to do for me. I tend to be curious about those feelings. And something else I tend to notice is just kind of a chronic sense of guilt or worthlessness. No matter how hard they're trying, I'm not doing enough, or I'm not doing it right, or there's something within myself I inherently need to prove that I'm not okay as I am. And that's where I really would be curious about some of those core beliefs.
Ellie Pike:
And we'll definitely dive into more of those core beliefs in a minute because I want to know more about what you mean. And I also know how important it is, especially in therapy, to create some of the foundational habits, like sleep helps regulate our mood more than a lot of things. So what are some of those foundational habits that you work on with your clients before you dive into maybe some of the deeper ones or before you might refer to a psychiatrist, for example?
Jenny Jacobsen:
Well, there's the foundational habits that most of us know we should do. If you've ever gotten a handout from a doctor, or watched a TikTok on self-care, and it's all-
Ellie Pike:
I like that those... We're in the same sentence.
Jenny Jacobsen:
Sure, sure, sure.
Ellie Pike:
We're a doctor on TikTok.
Jenny Jacobsen:
That's probably a better combination. But getting adequate sunlight, having exercise, having connection, eating in a way that feels good to your body. Those are some of those foundational things. Drinking enough water-
Ellie Pike:
Sleep.
Jenny Jacobsen:
Sure, sleep, right? It can feel like, sure, sure, I do those things, but sometimes when we really dive into it, actually some of those things are fundamentally broken. I'll hear clients tell me that they sleep and then realize, "Oh, they only sleep five hours, or they actually feel pretty disconnected, or they're not moving their body." Things like that. And so those are good foundational places to start. Another place I really like to start, and that carries throughout my work with clients is self-compassion and building a practice of self-compassion. Kristin Neff is someone who's done a lot of work on self-compassion and has a really great book on self-compassion. But it really is a practice similar to mindfulness. And I think it's something that you can teach and work on and find moments of self-compassion throughout your day when you're struggling, that really starts to change that inner dialogue.
Ellie Pike:
Can you give an example of self-compassion or what that narrative would actually look like in reality?
Jenny Jacobsen:
Yeah. Let's say we make a mistake. We forget to reply to an email that we should have replied to. That inner critic wants to say, "Gosh, I can't believe you did that. That was so stupid. Other people wouldn't have done that. How did you drop that ball? You just need to try harder, be better." It's like that constant feedback loop that tells us just to do more, to try harder, be better. And self-compassion would cut through that noise and say, "Gosh, I made a mistake, that stinks. But also I'm human. Everybody makes mistakes. I've got a lot on my plate right now. There's a lot of other balls that I have in the air, and it makes sense that I would drop one. And gosh, I'm feeling a lot of shame around having forgotten to reply, but I'm just going to own it. I'm human. They're human. They know that I'm not perfect and I'm just going to do the best I can."
Ellie Pike:
Even as you said that, even as a listener, I noticed myself feeling calmer and just more at ease. Whether or not that was permission for me to feel that way or if it was just me experiencing the difference between those two narratives.
Jenny Jacobsen:
Definitely.
Ellie Pike:
And I think that the example you gave is just perfect of self-compassion is in many ways giving us grace to be humans. And we all owe that to ourselves. So Jenny, if depression, anxiety are the ways that our brain processes external circumstances, do you have any thoughts or even tips on ways to shift our internal narrative and the experience that we have with ourselves?
Jenny Jacobsen:
I really feel that curiosity is the starting point because I think that we can't shift anything internally until we start to get curious about it. So first that's just noticing, I'm feeling off, I'm not feeling like myself. I am starting to numb out, disconnect, shut down. My sleep is off. What's going on with me? That's the starting point. And then from there, and some of this can be done by yourself and in other circumstances it's better with the support of a therapist. But I'm a really big fan of parts work. I mentioned Internal Family Systems earlier. It's a therapy model by Dick Schwartz, and he really coined this idea that we all have different parts of ourselves. Parts of us want to go out to dinner on a Friday night, and part of us want to stay inside.
And so, oftentimes, it's not all of us, it's a part of us that feels like we can't let our foot off the brake. And lending that curiosity to the different parts of us and really digging deep with those parts and exploring when did this part develop this belief system that I can't let my foot off the brake? What is it afraid is going to happen if I slow down? And what's this part trying to do for me? Oftentimes those parts of us are protective. What does it think it's protecting me from by working so hard? And oftentimes when we drill down into those questions, we realize that all parts of us are trying to do something positive for us and take care of us, but it's not always working for us.
Ellie Pike:
I like what you said about sometimes that part is trying, essentially serving a purpose. It is trying to protect us, and getting curious allows us to understand where it came from in the first place. I was on a walk with someone the other day and she said, "It's so weird. My dad always hugs me goodbye and says, 'You know, you're still my favorite kid.'" And she's like, "And that screwed me up." And I can imagine. And then also I paused to say, "How, how did that affect you?" And she said, "Well, I think just this feeling of I always need to people please. And this part of me that's like I must do, do, do, and make it look good because that's what gets rewarded." And so, I think about that part in myself that's like, don't let a ball drop. It's like, well, where did that come from? Where did my message of I can't let the foot off the gas? Where did that come from? Where did I get this message internally that I should just keep going?
And it's interesting because it might be really well-intended. I might've just learned that from someone in my life that I admire, but maybe didn't understand what was happening internally. Or maybe we're just different people. Maybe we have different thresholds for what's possible and what my brain can handle versus somebody else's. And so for me, that getting curious piece has been really beneficial just for self-exploration. I don't have to be clinically depressed or clinically anxious in order to ask myself those questions. So what other questions, or what other tactics, or perspectives would you bring for people's internal dialogue?
Jenny Jacobsen:
Yeah. Well, Ellie, as you're talking about those parts of yourself, I find myself feeling so curious towards those parts of you and having compassion for them. And I think that's where the self-compassion comes in too. I think if we can have compassion for all of our parts and recognize that they're trying to do something positive for us. Then just like in relationships when we want to feel understood, parts of us just want to feel understood. So maybe we have this part of us that feels like we have to try so hard and we need to take care of everybody else. But if you extend compassion to that part and really try to understand what it's doing, well, it's probably trying to make sure that you never feel disconnected. Your friend being good probably kept her in connection with her dad.
Ellie Pike:
I really appreciate that. And it really highlights the purpose behind the way that we feel, but can also highlight what we value. If I notice that I'm super hardworking, I'm never going to stop. Maybe it means I actually value hard work, or maybe I value what it is that I'm getting out of that. Well, I'm with my coworkers. Maybe I'm actually valuing the connection more than I am the hard work. And so just digging that one layer deeper I think tells us a lot about ourselves. And one thing I noticed when you said that, that feeling or that part of us has a good intention, if you will. And one of the things that, I would say, maybe this is a motto I have for work and the people that I work with. But especially because things can get misconstrued over email and this and that.
One of the things that I always say to me and my team is assume positive intent. It can feel crappy and it can feel harsh at times. And that's the same with our inner voice. So my inner voice can feel really harsh at times, and I can just try to shoo it away, or I could be curious and also assume positive intent. What's it doing for me? What's it trying to tell me? Or how is it trying to protect me? So I love that you're bringing some of the light to that piece, and I think it's really important.
Jenny Jacobsen:
Yeah, I love that. And what's coming to mind for me is there's been so many studies that have been done on the impact of criticism on performance externally. And how when we criticize others, whether that's on a sports team or at a job, all the studies show that performance plummets when we feel criticized instead of encouraged. And the same goes for our internal system because oftentimes we have one part that wants us to do something. And then another part that's critical of that part and that example with the email, that critical part oftentimes believes if I just push myself to be better, to be perfect, to never make a mistake, then I can avoid pain or I can achieve all the things that I want to achieve. But really, criticism just shuts us down, and it's the same process internally as it is externally.
Ellie Pike:
That is really interesting. And now I'm going to bring that one with me as I leave this podcast. I'm like, that is my takeaway. When we think about how the brain works neurologically, one thing that we often say is that our brains are neuroplastic. And that's why we encourage therapy, not just pharmaceuticals or seeing a psychiatrist, but truly we can train our brains to do different things. And I'm curious if you can just share in layman's terms, what is the difference? What happens in our brain when we have this one pathway that's maybe the self-critic or maybe that person that's experiencing depression, et cetera, and then we practice something different? What's actually happening in layman's terms?
Jenny Jacobsen:
Well, what's happening is that you're creating new neural connections. What we know with neuroscience now is that our brains are neuroplastic, and they can heal, and they can change. And so we have these hardwired pathways that a lot of times come from childhood about how we need to show up in the world. But as we start to work on ourselves, and especially I have a bias towards EMDR because I'm an EMDR therapist. But when we can do some rewiring, we can truly rewire how our brain functions in the present regardless of what's happened in our past.
Ellie Pike:
So can I put a visual to this? Because when you describe it, I'm a very visual person and I want to know if this feels accurate. I like to hike, and so oftentimes I'm following these switchbacks to get up a steep mountain so that you don't go straight up. But some people don't like to follow it because it feels like it's the longer road. And then, what I start to notice on my hikes is that people have created their own path where you notice like, "Oh, it's not just the deer that have gone directly through or directly up this hill. It's now people." And it starts to actually create a path, the more people that actually create this new way of going. If you're a hiker, that's not a great thing, but in our brains is that very similar, where you might have this pathway that's been created over time. But to create a new one, the more you tromp through the grass or the whatever you want to call it actually creates a new pathway.
Jenny Jacobsen:
Yes. I love that analogy because maybe that critical pathway is one that you've gone down a lot of different times. And so there's a saying what fires together, wires together. And so that has fired enough in your brain that those neural pathways are really strong, and that path is really easy to go down. It's really easy to say, "I made a mistake. I'm stupid or I'm not good enough." And we go there really quickly because that's the path that everyone has walked down on the hiking trail. But as we start to create new neural connections, you're right, it's walking through the path with the tall grass that no one's really walked on. And at first, it's hard to forge a path. Your legs are getting itchy and you're having to kind of tromp through and step harder. But the more you walk down that path, the easier it is and the more natural it feels. And it's the same way in our brains.
Ellie Pike:
I appreciate it because it creates a visual for me that's very approachable, where it's like, "Oh, yeah, okay, that makes sense. It's just practice." But I know for a lot of us, if we are struggling and having that internal challenge of that internal voice or high anxiety, we might overthink the idea of going to therapy. But it might not feel like overthinking, right? Because that's just the way that someone's brain might work. It is just like I'm thinking of all the options, and everything that could go wrong, and why shouldn't go, and why it feels overwhelming, etc. So I'm just wondering if you're speaking to that one person who's listening to this podcast who might feel that way, what would your message be to them?
Jenny Jacobsen:
What first comes up to me is just you can do it. I think that seeking help for yourself in whatever form feels good to you is one of the most loving things that you can do for yourself.
Ellie Pike:
And you deserve that. All of us, we deserve that.
Jenny Jacobsen:
You deserve to heal. You deserve to live your best life.
Ellie Pike:
Thank you so much, Jenny. I'm so glad that you've been on this podcast today. And I do want to ask, is there anything that you want to make sure to leave people with today?
Jenny Jacobsen:
Yeah, something that's coming up for me in this conversation is I'm just thinking about people that maybe feel like, I really cannot take my foot off the gas right now. That is actually what's required of me in life right now, and I can't afford to stop. And to those people, I think I just wanted to extend some compassion and say that maybe your circumstances can't change, but maybe the way you talk to yourself can. Maybe really extending yourself gratitude for how hard you're working in this season can be a way to start to mentally shift or really extending yourself that compassion.
And also something I like to teach my clients is when you really are at capacity, and even just me suggesting those little ways of self-care, getting outside, and exercising, and things like that feel overwhelming. How can you find ways to even just microdose self-care? Can you go on a five-minute walk around the block? Can you send a voice memo to a friend really quick? Or can you just make that tea for yourself before you go put in a couple more hours doing something you need to do? And just finding those little ways to try to take care of yourself so that you're not so burnt out.
Ellie Pike:
I 100% can relate with all of those pieces because I did half of them today, where before every meeting I try to make my tea and just hold it, even though I'm still working and I'm still in a meeting. But using this visual reminder of this is the way I'm taking care of myself right now or right before the podcast, I went outside because I hadn't been outside all day. And I was like, I'm just going to sit in the sun for three minutes, just three, to not be on my phone even for three minutes of self-care. So I appreciate how you broke that down because I think you're right, that many of us feel like, "But this is all I have. I only have three minutes." And in reality, we can use three minutes better than I use three minutes a lot of the time. I could put my phone down more, and I would love to do that. So thank you, I guess, for the encouragement that you just gave me as well.
Jenny Jacobsen:
Yeah.
Ellie Pike:
As Jenny reminds us, you don't have to wait for a diagnosis or a breaking point to ask for help. Compassion, curiosity, and even the smallest acts of self-care can begin to shift the weight of depression. If you're struggling, know that support is out there and that change is possible one step at a time. Thank you for listening to Mental Note Podcast. Our show is brought to you by Pathlight Mood & Anxiety Center and Eating Recovery Center. If you'd like to talk to a trained therapist to see if in-person or virtual treatment is right for you, please call them at (877) 850-7199. If you need a free support group, check out pathlightbh.com/support-groups. And since you're still listening, it must mean you like our show. So can you do us a favor? Leave a glowing review for us on iTunes, Spotify, or wherever you're listening. Also, sign up for our e-newsletter and learn more about the people we interview at Mentalnotepodcast.com. Mental Note is produced and hosted by me, Ellie Pike. Edited by Carey Daniels and directed by Sam Pike. Till next time.
