There is no going Back to ‘Normal’

The end of cancer treatment is often commemorated with the ringing of a bell. This is meant to signify the end of a difficult chapter and life is expected to go back to ‘normal’. However, this is not the reality for many cancer survivors.

The Psychological Aftermath

As a psychologist, who is also a cancer survivor, I’ve come to learn that the emotional impact of cancer often persists long after the physical treatment has ended. In many cases, cancer is both a medical and an emotional crisis. It’s not unusual for a newly diagnosed patient to enter survival mode and perhaps remain in this state throughout the treatment. Life starts to centre around appointments, scans, blood tests, hospital, treatment decisions, side-effects and logistical challenges. The focus is on getting through it. It’s mostly when treatment ends that a survivor has the space to process everything that has happened. Because a cancer diagnosis can shake one’s sense of control and predictability, anxiety, depression and post-traumatic stress are common.

One of the greatest anxieties experienced by cancer survivors is the fear of recurrence. Any pain, bodily change or upcoming scan can trigger intense anxiety. Some become increasingly hypervigilant by continuously scanning for treats, which can be exhausting. The term ‘scanxiety’ was coined to describe the anxiety that arises in the lead up to medical tests, scans or follow-up appointments.

Grief amidst the Gratitude

Surviving does not mean living. There is often support present when one is undergoing active treatment, but there is little recognition for the emotional distress that accompanies remission. Cancer survivors often experience deep grief over ‘living losses’. One may be deeply grateful for having survived, yet still grieve things such as changes in the body, loss of fertility, lost opportunities, career setbacks, altered relationships and loss of hope for the future.

Disconnection

Many survivors also feel disconnected from others. While others may assume that a survivor’s life is back to normal, the reality is often that their lives are permanently changed. Priorities and perspectives undoubtedly shift during such a life-changing experience. Survivors begin to think differently about what is important, about their relationships, careers and what they invest their time and energy in. This can create disconnection from loved ones, as priorities and interests may no longer be aligned.

The Path to Emotional Healing

• Acknowledge and feel your feelings. While there is often pressure to think positive, it is appropriate to experience difficult emotions during a life-changing experience. Emotional suppression can increase distress.
• Practice self compassion. Cancer may force one to improve patience. Give yourself grace and do the best you can, given your capacity.
• Social support can improve emotional wellbeing, but this requires knowing what kind of support if helpful for you and who to seek it from.
• Focus on what you can control. While there is a lot not in control, focusing on what one can control can bring peace and calm.
• Seek professional support if necessary.

Supporting a Loved One who is a Survivor

• Instead of offering positive words that may not land, rather hold space for them to feel and share authentically.
• Listen to understand, instead of sharing unsolicited advice or platitudes.
• Show empathic curiosity so you can understand how their life has changed and discuss different ways to socialise that may support where they are emotionally.

Millions of people worldwide are using AI chatbots as their psychologists. While AI has made knowledge and resources more easily accessible, they need to be used with caution where mental health is concerned.

Pros of using AI for Therapy:

• While you may need to wait for an appointment with a psychologist (or much longer in the public sector), AI is constantly available and accessible.
• The cost of therapy can be a barrier for many, so using AI makes it a very accessible option.
• Even though this is slowly improving, the stigma attached to mental illness and seeking therapy still exists. This can also explain why many prefer the anonymity of opening up to a bot instead of an actual psychologist.

Using AI as a therapist is not without its risks:

• AI cannot make a diagnosis. A diagnosis is a helpful guide in informing evidence-based treatment.
• AI misses non-verbal cues that are crucial in assessment and therapy. This includes body language, eye contact, tone of voice and silence.
• AI is not equipped to assess risk, nor do they have protocols for those who may be suicidal or severely distressed. There have been multiple law suits, where AI chatbots were believed to contribute to mental health crises and suicides of young people.
• AI chatbots can contribute to delusions and isolation amongst adults.
• AI is designed to keep you coming back, and therefore is agreeable and validating. This means that you will not be called out or challenged when your behaviour may be keeping your stuck in dysfunctional patterns.
• While psychologists are bound by ethics, the information that you share with AI is not confidential. 

How to use AI safely:

• Journal prompts
• Mood tracking
• Habit tracking
• Grounding exercises
• Sleep hygiene
• Mindfulness exercises
• Psychoeducation
• Use between therapy sessions with your psychologist’s guidance

See a psychologist/psychiatrist for:

• Assessment and diagnosis
• Processing trauma
• Crisis management
• Complex relationship issues

It is well known that connection is essential to mental wellbeing. Strong social bonds serve as a protection factor and are linked to lower rates of mental illness. Because AI is designed to keep us engaged, dependence on AI can isolate one from social support systems. This over-reliance can stunt interpersonal skills.

Therapy is not a one-size-fits-all approach to mental health. Psychologists consider several facets of one’s life before tailoring treatment to their unique needs. AI, on the other hand gives generalised advice and does not ask the deep-rooted questions that a human may ask.

AI is however here to stay. By understanding the advantages and shortcomings, we can use AI with caution to maximise our mental health knowledge and wellbeing – but just not in isolation.

Perfectionism is defined as – the need to be or appear perfect, or to achieve perfection. It’s not the same as striving to do your best, nor is it about healthy achievement and growth.

For many South Africans, juggling work, financial stress, family responsibilities and expectations (self-imposed and from others), adding perfectionism into the mix can lead to increased anxiety, self-doubt and exhaustion. Research has linked perfectionism to mental health problems.

Some of the common signs of perfectionism:

• Procrastinating because you fear not doing something perfectly
• Not finishing tasks and/ or spending too much time on simple tasks
• Being overly critical of yourself (or others/ situations)
• Feeling like nothing you do is ever good enough
• Comparing yourself constantly to others
• Being frequently disappointed that things don’t go as planned

A perfectionist doesn’t believe that what they do is worthwhile unless it is perfect – instead of being proud of their progress, or acknowledging how hard they’ve worked, or how much they’ve learnt through the process, they are likely to compare themselves constantly with others or to obsess about achieving a flawless result or constantly doing better, and improving themselves, others, or their environment.

Having high standards, persevering in the face of difficulties, being conscientious, organised, and goal driven, doesn’t make you a perfectionist. You may just be someone who strives to do your best, and who likes to meet expectations, but you don’t get upset if you can’t always meet your goals, and you are not defined by them.

Perfectionists don’t allow any room for being human, errors are unforgiveable, and they will beat themselves up for the tiniest mistake or flaw or lack, which can rob them of any joy or satisfaction from the things that they do well.

Perfectionists are often afraid that if they stop aiming for perfection, they will become lazy, not achieve anything, and end up destitute; or that it somehow makes them “bad” people.

Causes of perfectionism are complex but include fear of other’s disapproval or judgement; shame and feelings of insecurity, inadequacy or unworthiness; and having parents’ (or other authority figures’) who were perfectionists themselves or had overly high expectations. The media also bombards us with carefully engineered images of success, beauty and perfection that amplify feelings of being inadequate, especially for perfectionists.

Here are some helpful ways to manage perfectionism:

1. Set realistic expectations for yourself and others
2. Celebrate your progress – every small step counts even if it’s not perfect
3. Avoid comparing yourself to others
4. Challenge your inner critic when it becomes harsh or unrealistic
5. Acknowledge that our imperfections are part of what make us human
6. Allow yourself to do some things imperfectly – focus on the learning and growth rather than flawless outcomes
7. Reach out for support if perfectionism is affecting your life negatively – get a coach, a therapist, or chat to a trusted friend or family member
8. Treat yourself with compassion and kindness

Self-Compassion researcher Dr Kristin Neff encourages us to treat ourselves with the same kindness we would give to a friend, and to recognise our common humanity, the fact that there are others who experience the same struggles and challenges that we do.

Ultimately, perfectionism can steal our joy, creativity and peace of mind. Mental wellbeing comes from allowing ourselves to be fully human – imperfect, learning and growing, and enough – just as we are!

How do we find Inner Peace whatever the external circumstances?

A common phrase that we hear from participants in our programs, and from clients that we work with in the coaching space is, “I want to feel happy, peaceful, and content”. Many people feel that if external circumstances were different, they would be able to access the peace and contentment they are striving for.

In Mindfulness, we gently shift our focus from being caught up in what is happening around us to becoming aware of our internal experience (thoughts, emotions and sensations) and explore ways to be with “what is” with balance, calm and wisdom.

Be the Change

Mahatma Gandhi said that “We but mirror the world. All the tendencies present in the outer world are to be found in the world of our body. If we could change ourselves, the tendencies in the world would also change.”

He is advising us to be the change we wish to see in the world. In a world that is increasingly overwhelming, uncertain and stressful, it can be challenging to find peace and contentment. Mindfulness is one way to change our inner world to feel greater contentment and peace, whatever is happening around us.

Notice pleasant/ unpleasant and neutral experiences

One of the skills that we build in Mindfulness practices is the capacity to be with whatever is happening, whether it is pleasant, unpleasant or neutral. The experience of “pleasant” is different for everybody. I may find the experience of eating olives pleasant, and someone else may find it unpleasant. Also, what initially appears to be a pleasant experience, can have unpleasant consequences – for example, driving too fast can result in an accident, although the initial experience may be one of exhilaration; eating an entire chocolate cake may result in feeling ill although at the time it may feel like a sensory delight.

Similarly, what we initially label as “unpleasant” can result in positive consequences. Waking up at 5am to exercise may be unpleasant, but the result of improved health and energy is pleasant.

Experiences that are neither pleasant nor unpleasant – the neutral – are perceived by many people as “boring”, especially in a world where what feels “normal” is usually an extreme of pleasant or unpleasant, so when life is neutral, it can seem flat, boring or feel like something is wrong – when in fact, neutrality is often where steadiness and ease can be found.

By observing your responses to situations, and becoming more aware of your thoughts, emotions and body sensations, and whether you are labelling an experience as pleasant, unpleasant or neutral, you can begin to change how you respond, and in turn learn to find contentment with things as they are.

Try this Shift

Here is an exercise to try when you notice you are being swept up in the negativity of what is happening around you and wishing for things to be different

1. Pause
2. Bring your attention to your thoughts (simply notice without judgement)
3. Take a deep breath
4. Gently ask: “What is within my control right now?” and choose one small thing that you can change inyourself – your thoughts, feelings, or an action you can take.

Stress is inevitable and when faced with an overwhelming situation, it helps to pause and regulate. Here are 10 psychologist approved practical ways to regulate:

1. Literally ground yourself. Find a quiet, comfortable spot on the floor, lie down and allow the heaviness of your weight to sink into the ground. This sense of being anchored reduces overwhelm and prevents rumination. When we are stress, our posture is often affected. Lying on the ground prevents this. You can just close your eyes and focus on your breathing for as long as you need to.
2. Rock gently from side to side or back and forth to self soothe. The rhythmic motion helps calm the nervous system and reduces cortisol levels. This is very helpful for anxiety and panic attacks.
3. Give yourself butterfly hugs by interlocking your thumbs and placing your palms across your chest. Then tap one side at a time like a butterfly motion. This alternate tapping uses bilateral stimulation to calm the amygdala (fear centre of the brain). Because the alternate tapping engages both sides of the brain, you will feel balanced and grounded.
4. Choose a colour and then look for and name ten things around you in that colour. You could even do a colour walk where you take a mindful walk, looking out for objects in your chosen colour. This helps your focus on the present, thus interrupting intrusive or unhelpful thoughts that are fuelling your anxiety.
5. Humming creates vibrations that stimulate your vagus nerve. This moves your body out of fight or flight response to a rest-repair state, thus reducing cortisol.
6. Hold an ice cube in each hand. When you are particularly overwhelmed, the temperature of the ice cube will keep your mind in the present moment, thus preventing irrational thoughts or catastrophising.
7. Pause and notice the sky. Noticing the vastness of the sky (or the sea) can help us gain perspective and make our problems seem less overwhelming. The changing nature of the sky (e.g. moving clouds) can symbolise our ever-changing emotions, which come and go – they do not remain forever.
8. Shake it off. Literally shake parts of your body to release tension and get rid of excess adrenaline. This calms our flight-fight response as it signals that the danger has passed, while releasing endorphins at the same time.
9. Do a brain dump by just writing down every thought and worry that enters your mind. This helps clear mental clutter and interrupts rumination. Find a quiet space, decide on a time limit and then write whatever comes to mind without judgement. It doesn’t matter how jumbled and chaotic it appears. You can then organise these thoughts into some order of priority and decide what you can let go off. Seeing things on paper can make them feel a lor more manageable than when it’s taking space in your head.
10. And my person favourite – blowing bubbles. This not only makes you feel like a child again, but it forces you to slow down your breathing, which in turn activates the parasympathetic nervous system. You can also pair this with diaphragmatic breathing, where you inhale slowly and then exhale to blow a big, controlled bubble. Blowing bubbles helps you remain mindful.

You don’t have to practice all of these, but choose what works for you and add it to your stress toolkit.

There is a moment I return to often when I think about dissociation not from a textbook, but from a consultation room. A young woman sat across from me and said, quietly, “I was there but I wasn’t there. Like I was watching myself from the outside.” She had just described surviving something terrible, and what she was also describing without knowing the clinical term for it was dissociation.

It is one of the most misunderstood experiences in mental health, partly because it sits at the uncomfortable intersection of the ordinary and the extraordinary. My aim with this article is to demystify it: to explain what dissociation is, why it happens, what it looks like when it becomes a problem, and most importantly that it is treatable.

What Is Dissociation?

Clinically, dissociation refers to a disruption in the integrated functions of consciousness, memory, identity, and perception of the environment (Griffiths et al., 2025; Petrič, 2022). It is best understood not as a single event but as a complex psychological phenomenon situated at the intersection of mind, body, and lived experience. A person may feel disconnected from their thoughts, feelings, memories, or surroundings, and this disconnection can affect their sense of identity and their perception of time.

Importantly, dissociation is not inherently abnormal. Everyone has experienced it in mild forms daydreaming, becoming absorbed in a film, or arriving somewhere without remembering the journey. These moments of drifting attention are ordinary and benign.

The concern arises when dissociation shifts from an occasional, unremarkable experience to a persistent, intrusive one particularly when it is rooted in trauma.

Why Does the Mind Dissociate?

The short answer is: to survive.

When we encounter experiences too overwhelming to process, the mind responds by disconnecting almost like tripping a circuit breaker before the whole system overloads. Clinicians refer to this as peritraumatic dissociation: a protective response that allows a person to function in the immediate moment by compartmentalizing what would otherwise be unbearable.

This is a remarkable feat of psychological self-preservation. The difficulty arises later, when the danger has passed but the brain continues to rely on this same mechanism long after it serves any protective purpose.

Trauma and dissociation are closely linked. Experiences such as abuse, assault, accidents, war, medical emergencies, or childhood neglect can produce a flood of feeling and memory that cannot be processed all at once. Dissociation acts as a kind of psychological anesthetic, temporarily numbing the mind to pain it cannot otherwise bear. Initially protective, it can become a barrier to full engagement with life if it persists beyond the immediate crisis.

In essence: dissociation is how the mind survives when reality feels unbearable. Recognizing this without shame or judgment is where recovery begins.

The Spectrum of Dissociative Experiences

Dissociation does not look the same in everyone. It exists on a wide spectrum, and understanding its range is important.

At the milder end are experiences many people recognize: feeling foggy or detached after a stressful day, a sense of being “on autopilot,” or going through routine tasks without fully registering them.

More pronounced experiences include feeling like an observer of one’s own body, the world appearing blurry or dreamlike as if seen through glass or losing track of time in ways that feel disorienting rather than restful.

At the more severe end, dissociation can crystallize into recognized clinical presentations. The DSM-5 identifies three primary disorders:

Dissociative Amnesia

An inability to recall important autobiographical information, typically of a traumatic nature. The forgetting may be limited to specific aspects of a person’s life or may encompass much of their life history and identity.

Depersonalization/Derealization Disorder

A persistent sense of detachment from one’s own mind, body, or sense of self (depersonalization), or a feeling that the world is unreal, muted, or dreamlike (derealization).

Dissociative Identity Disorder (DID)

Formerly referred to as multiple personality disorder, this is the most complex presentation. It involves two or more distinct identity states, each with its own history, traits, and patterns of experience. Contrary to its dramatic portrayal in film and television, DID in clinical reality is far more subtle, and far more rooted in chronic, severe childhood trauma than popular culture suggests.

The Trauma Connection

It is impossible to understand dissociation fully without acknowledging the foundational role of trauma its depth, its duration, and the age at which it occurs.

Research consistently shows that individuals who endure physical or sexual abuse during childhood face a significantly elevated risk of developing DID. Most people diagnosed with dissociative disorders have experienced repeated, overwhelming trauma beginning in early childhood. The American Psychiatric Association reports that approximately 90 percent of individuals diagnosed with DID in the United States, Canada, and Europe have a history of childhood abuse and neglect.

Children who have a high capacity to dissociate may cope with ongoing trauma by generating multiple “not-me” self-states, each serving to distance the child from experiences and feelings that are too painful or frightening to integrate. This is not a character flaw. It is the mind of a child doing exactly what it can with the resources available to it.

Dissociation is also closely associated with anxiety and PTSD. It is a recognized symptom of both acute stress disorder and post-traumatic stress disorder, and it can function as an ongoing avoidance strategy; a way of not mentally returning to experiences that feel too raw to face.

Why It Is So Often Missed

This is something that genuinely frustrates me professionally, and I think it warrants broader attention within the healthcare community.

Severe dissociative disorders are more prevalent than several commonly assessed psychiatric conditions; including bipolar disorder, OCD, and schizophrenia and yet they remain significantly under-recognized and undertreated. People living with dissociative disorders spend an average of five to twelve years actively engaged in treatment before receiving an accurate diagnosis.

There are several reasons for this gap. The symptoms are easily misattributed to depression, anxiety, psychosis, or even neurological conditions. Training in dissociative disorders may face challenges due to the subtlety and complexity of their clinical presentation. Consequently, some professionals may primarily encounter media portrayals of these conditions, which are often sensationalized and inaccurate, failing to represent how they truly present in clinical settings.

There is also the issue of concealment. Dissociation can be hidden, even from the person experiencing it. For those with a trauma history, significant shame is often involved a tendency to minimize, to explain away, to avoid saying the full truth aloud. This makes disclosure genuinely difficult, and it is something clinicians need to actively create space for.

What Treatment Looks Like

There is real, substantive good news here: dissociation responds to treatment.

Psychotherapy is the primary approach, and the goal is integration helping the different elements of identity, memory, and experience come together into a coherent, functional whole. Commonly used modalities include Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). Hypnosis has also shown utility in certain presentations, particularly DID.

For more complex cases, a phased treatment model is considered best practice. This may involve a well-coordinated treatment team comprising therapists, family therapists, and specialists in EMDR (Eye Movement Desensitization and Reprocessing), all working in alignment toward the restoration of integrated functioning.

There are currently no medications that directly target dissociation, though pharmacotherapy can be helpful for co-occurring conditions such as depression or anxiety (APA, 2024). Evidence-based clinical guidelines for both children and adults have been developed by the International Society for the Study of Trauma and Dissociation (ISSTD), and these form a valuable resource for practitioners seeking to deliver effective specialty care.

Treatment for adults typically involves one to three sessions per week over several years. Children and adolescents often show progress more quickly. What is consistent across age groups is this: early, accurate diagnosis changes outcomes significantly reducing the burden on healthcare systems and, more importantly, offering people a meaningful path toward a life no longer dominated by disconnection.

A Note on Grounding

For those navigating dissociation in daily life, grounding techniques can offer real, immediate relief. These are practices that anchor a person to the present moment to the physical reality of where they are, right now.

One of the most accessible is the 5–4–3–2–1 technique: naming five things you can see, four you can physically feel, three you can hear, two you can smell, and one you can taste. By redirecting attention toward sensory input, this technique can interrupt a dissociative episode without requiring clinical training to use.

Grounding is most effective when it is personalized. What works for one person may not work for another, and it is always worth exploring different approaches with a psychologist rather than relying on a single tool.

Closing Thoughts

What I hope readers take away from this is a shift in how dissociation is understood. It is not bizarre. It is not manipulative. It is not a sign of weakness or instability. At its origin, it is an act of psychological self-preservation one that deserves the same clinical seriousness we would extend to any other response to severe adversity.

If you or someone close to you experiences persistent feelings of detachment, unexplained memory gaps, or a fragmented sense of self particularly in the context of a trauma history please seek an assessment from a qualified mental health professional. The path back to an integrated sense of self is real and well-travelled. No one should have to walk it alone.

The views expressed in this article are intended for educational purposes and do not constitute clinical advice. Always consult a qualified healthcare professional for individual assessment and treatment.

Sleep is one of the most important pillars of health. Sleep and mental health share a bidirectional relationship, meaning that poor sleep can negatively impact our mental health and that mental health difficulties can contribute to poor sleep quality.

Poor sleep quality can lead to symptoms such as anxiety, irritability, low and concentration difficulties. It reduces our capacity for managing stress. On the other hand, many mental health conditions can interfere with our sleep. Those who experience anxiety may be kept awake at night by racing thoughts, while those with depression may experience insomnia or hypersomnia (excessive sleep). This can lead to a cycle where poor quality sleep worsens mental health symptoms and these symptoms, in turn, interfere with sleep.

I grew up in a time where quotes such as ‘I’ll sleep when I’m dead’ or ‘sleep is for the weak’ were popularised and sacrificing sleep for productivity were glamorised. However, sleep is essential for optimal physical and mental health.

The Relationship Between Sleep, Cognitive and Emotional Symptoms

Emotional regulation: during sleep, our brain processes emotional experiences from the day, helping us to regulate our moods.

Memory and learning: Sleep strengthens neural connections that support memory and learning. Inadequate sleep means that the brain will struggle to retain information acquired during the day.

Stress management: Because sleep helps regulate stress hormones such as cortisol, poor quality sleep can heighten our stress responses and increase feelings of overwhelm.

Decision making and judgement: fatigue can impair our thinking and judgement, increasing the likelihood of poor decisions. It’s believed that driving when sleep deprived can be as harmful as driving under the influence.

Factors that Contribute to Poor Quality Sleep

• Stress and anxiety
• Inconsistent sleep routines or schedule
• Blue light exposure (from screentime can inhibit melatonin production)
• Environmental factors, e.g. noise, excessive light or unsuitable temperature
• Lifestyle factors such as caffeine, alcohol and eating close to bedtime
• Mental health conditions

Practical Tips to Improve Sleep Quality

• Go to bed and wake up at the same time every day (including weekends)
• Create a relaxing bedtime routine, engaging in a wind down activity such as reading or meditation.
• No screens for 1-2 hours before bed, or at lease use blue light filters.
• Make your bedroom comfortable, cool, dark and quiet.
• Limit caffeine intake to the mornings.
• Regular physical activity, but not close to bedtime.
• Relaxation practices such as journaling, mindfulness or breathwork.
• Get natural light in the morning and limited light in the evenings.
• Use your bed for sleeping (not for scrolling or working). Allow your brain to associate the bed with rest.
• Create time during the day to process your emotions and work through your stressors, so they don’t interfere with your sleep.

Improved sleep can result in improved mental health, balance and resilience. Stress may be inevitable in life, but being well-rested means that we can deal better with our challenges.

PMDD is a hormone related mood disorder that affects some females during the luteal phase of their menstrual cycle (1-2 weeks before menstruation). While PMS is more commonly spoken about, PMDD is more intense, more disruptive and can significantly impact on one’s daily functioning, emotional wellbeing, work performance and relationships. PMS is more a descriptive term and not a formal psychiatric diagnosis.

While PMS involves mild to moderate physical and emotional symptoms that are uncomfortable, PMDD involves severe emotional symptoms that can feel overwhelming and disabling. Mood-related symptoms are the hallmark of PMDD, while PMS includes physical symptoms such as bloating, breast tenderness, headaches and fatigue. While physical symptoms may be present in PMDD, they are not the main cause of distress. PMS is thought to reflect typical responses to hormonal changes, while PMDD is associated with an abnormal sensitivity in the brain to normal hormonal fluctuations. So while PMS is more prevalent, PMDD is more severe, yet less common.

PMDD requires a diagnosis from an adequately trained professional such as a psychologist, psychiatrist or gynaecologist.

The core emotional symptoms must include one of the following:

• marked mood swings (sudden sadness, tearfulness or emotional sensitivity)
• Persistent irritability or anger
• Feelings of sadness, hopelessness or self-critical thoughts
• Intense anxiety

Added to the core symptoms must be some of the following (five or more in total):

• Anhedonia (decreased interest in usually activities)
• Concentration difficulties or brain fog
• Fatigue
• Appetite changes (overeating or cravings)
• Sleep disturbances (either too much or too little)
• Feeling overwhelmed
• Physical symptoms such as breast tenderness, bloating, joint or muscle pain, headaches or weight changes)

To be diagnosed with PMDD symptoms must be occur during the menstrual cycle, be present in the week before menstruation, improve shortly after menstruation begins and cause significant impairment in work, relationships or daily life. What distinguishes PMDD from other mood or anxiety disorders is the link to one’s menstrual cycle.

Importantly, PMDD us not caused by abnormal hormone levels. Rather, it is a result of increased sensitivity to normal hormone fluctuations. The hormonal shifts affect serotonin, which is the neurotransmitter responsible for mood regulation, emotional stability and impulse control. There is evidence to suggest that PMDD may be genetic.

Because PMDD can interfere with important facets of life such as work, studies and relationships, self help strategies are not sufficient – professional help is recommended. Early intervention can improve quality of life. Treatment may include interventions from a psychologist, psychiatrist (if medication is required) and a gynaecologist.

In addition, there are things one can do to improve their quality of life. These include:

• Tracking symptoms to identify patterns and plan around them
• Planning for lighter loads and extra support during the luteal phase
• Eating balanced meals
• Reducing caffeine, alcohol and refined sugars, at least during the luteal phase
• Reducing high intensity work or workouts during the high-symptom days
• Breathwork, meditation or grounding practices
• Good sleep hygiene
• Communicating needs clearly with loved ones
• Setting realistic expectations for difficult days

Bear in mind that PMDD is not a reflection of weakness. It is a medical diagnosis caused by biological factors. PMDD is highly treatable with the appropriate combination of professional intervention and self care.

An intrusive thought is an unwanted, often distressing thought, that emerges in the mind, almost out of nowhere. Most people experience intrusive thoughts at some time in their lives. However, there are those who experience intrusive thoughts more frequently, which can cause high levels of distress. This is mostly a result of the content of such thoughts.

Common examples of intrusive thoughts are:

• A mother thinking about harming her newborn baby
• Sexual thoughts that are inconsistent with one’s sexual identity
• Thoughts of driving one’s car into pedestrians

It may be reassuring to note that intrusive thoughts are not intentional and are not an indication of one’s values, morals or desires. In fact, most people do not act on such thoughts, nor is there any intention to. The reason that intrusive thoughts are as distressing as they are, is because the content of the thought is very contradictory to the person’s beliefs.

While they are not harmful, intrusive thoughts are no doubt distressing and can consume a lot of a person’s time in trying to make sense of them.

Intrusive thoughts are sometimes (not always) a symptom of a mental health condition, such as obsessive-compulsive disorder or post-traumatic stress disorder. However, they may also be a result of high stress levels, lack of sleep, hormonal changes or heightened anxiety. Intrusive thoughts form the core of obsessive-compulsive disorder, but they are often accompanied by compulsive behaviors aimed at minimizing the anxiety. E.g. someone with intrusive thoughts of a sexual nature, may experience the compulsion to scrub themselves to a point of hard. A person experiencing post-traumatic stress disorder often experience intrusive memories or images related to the traumatic experience. E.g. recurrent images of the scene of a car crash.

The fact that one is distressed by intrusive thoughts is evidence that these thoughts are inconsistent with their beliefs and intentions. The emotional aftermath of an intrusive thought often includes anxiety, guilt, shame or disgust. This can lead to avoidance and social withdrawal.

So what can you do if you are plagued by intrusive thoughts?

First things first – remind yourself that this is just a thought. A helpful tip is to mentally say ‘the thought that I am thinking is….’ followed by the intrusive though. This helps create psychological distance from the thought and reinforces the fact that a thought is harmless if not acted on.

Trying to suppress intrusive thoughts may actually make them worse. This avoidance gives the thought more power over us as it influences our behaviour. It is more helpful to acknowledge the thought and allow it to pass. This awareness should ideally be paired with a simple grounding exercise – e.g. looking around you and naming  everything that you see. The grounding takes you away from your thoughts and refocuses your mind on the present.

Something that many patients of mine have found beneficial is first acknowledging the thought as an intrusive thought and then humming. Humming interrupts the intrusive thought and counters the anxiety with calmness.

While intrusive thoughts are not always an indication of psychiatric conditions, if they are concerning you and interfering with your quality of life, it is important to see a doctor, psychiatrist or psychologist, who can make a diagnosis and assist with either psychological interventions, medication, or both.

While this is the most wonderful time of year for some, it’s also the most stressful time of year for many. The reality is the mental illness does not take a break during the holidays. In fact, some aspects of the festive season can exacerbate mental health struggles.

The Comparison Trap

Those with mental health struggles may feel worse about their lives, seeing others in a festive mood and posting curated ‘picture-perfect’ moments on social media. Those who are grieving may find it especially difficult when others enjoying time with loved ones. Those who are in conflictual relationships or are undergoing a break-up or divorce can find it difficult seeing other couples happy together. This does not mean that one is unhappy for others, but it can be triggering to be reminded about what one hoped to have for themselves.

Take time to honor your feelings and the weight of the year. Be patient with yourself. Remember that social media is only a highlight reel and nobody’s life is as perfect as it may look from the outside.

Family Conflict

Those with family conflict may find it difficult to spend more time with family, meet family obligations or uphold traditions that no longer feel good for them. Many unresolved family issues can come to a head during the festive season with families spending more time together. Uncomfortable questions about personal issues are also a source of great stress. E.g. someone who is experiencing career uncertainty may dread questions about what they’re doing with their life. Someone who is struggling with infertility may dread being asked when they’re starting a family. Others dread comments about their appearance, relationship status or other personal challenges.

Ser boundaries to that help you feel safe. This may mean deciding to spend limited time (or none at all) in environments that stress you out, rehearsing answers to unwelcome questions, grounding exercises, a grounding person with you or an exit strategy.

Financial Stress

Financial stress has been a huge stressor for many this year with the cost of living crisis. The pressure to spend can add to this already stressful situation, especially if surrounded by those who are not considerate or empathic. Each of us need to be mindful of our individual situations and commitments, so we don’t overcommit ourselves. Set a reasonable budget and be honest about what you are able or unable to do.

Loneliness

Many feel lonely during this time of year. While some feel lonely due to distance from loved ones, grief or unresolved family/relationship issues, others may feel lonely even amid company, because they have disconnected from themselves (to maintain relationships). It helps to know who you can reach out to. Something that many fine find helpful when lonely, is to do something kind for others – perhaps looking for opportunities to volunteer or give back in some way. If you are religious, look out for services or activities where you will be surrounded by like-minded people.

Year End Reflection

As you reflect on the year, remember to celebrate your little wins and understand the obstacles in not achieving other goals. Wins aren’t just material or externally visible – it may be that you’ve grown more resilient, utilised more effective coping skills, become more assertive, etc. Also bear in mind that sometimes despite our best efforts, life happens and we have new challenges that divert our energy. Be kind to yourself.

End the year mindfully

Make time for things that bring you joy. Remember moderation in everything. The festive season is a busy time, so plan ahead, be reasonable about what you commit to and give yourself extra time to get things done. Spend some quiet time reflecting on your priorities for 2026.

Be honest with yourself if you need professional help. If it feels too big of a step, start out by calling a helpline to just chatting to your GP to point you in the right direction.

Wishing you a blessed and peaceful festive season.