We caught up with clinical psychologist Dr. Monica Vermani, who previously discussed how parents can help stop bullying and World Mental Health Day.

Here, she further discusses treating trauma, managing stress, dealing with feelings of burnout, setting boundaries in a relationship and dealing with depression.

Hi Monica, please introduce yourself and your role. 

“Hi! I’m Dr. Monica Vermani. I am a Toronto-based clinical psychologist, specialising in treating trauma, stress, mood and anxiety disorders. I am also an author, mental health advocate, public speaker, and frequent expert commentator on TV, radio, podcasts, print, and on social media platforms. I’m the founder of Start Living Corporate Wellness and my most recent book, A Deeper Wellness, Conquering Stress, Mood, Anxiety, and Traumas, was published in March of 2022.” 

Dr. Monica Vermani author of A Deeper Wellness, Conquering Stress, Mood, Anxiety, and Traumas

What do you tell patients who are feeling stretched too thin? How can they deal with feelings of burnout and stress?

“I tell my patients every day: Give from your overflow, not from your well. We all have limited resources of time and energy. We need to first make sure that our life tasks and responsibilities are covered… when we can do that and we have surplus time and energy, we can, if we wish, choose to give these resources to others. But all too often, we give into the needs of others, at the expense of our time, energy, and ultimately, our health.

“Stress is when our activity level surpasses our energy level! We have just four sources of energy: 

1. The food we eat
2. Our sleep (by which I mean quality sleep)
3. Our breath (deep, healthy, relaxed breathing, where we properly oxygenate our blood)
4. A calm state of mind

“These energy sources — when we take care of them — when we eat well, when we get regular, quality sleep, when we remember to breathe deeply, and when we lead a life of balance and engage in activities that bring us joy each day, that nourish our spirit and connect us with ourselves and leads to a calm state of mind — this is what keeps us productive, happy, and whole. 

“We need to learn to build healthy boundaries around these precious resources of our time and energy and to care for these sources of energy. We wouldn’t expect our car to run on empty… and we should not expect this of ourselves. We need to learn to say no at times and place limits around our time and energy.”

How can patients set boundaries in a relationship and recognise when that relationship is no longer healthy?

“We sometimes fall into unhealthy patterns in relationships with friends, family members, colleagues, or our partners. We may have patterns of behaviours, like people pleasing, that lead to unhealthy, and unbalanced relationships, where we do not feel respected, or valued, relationships where there is little or no reciprocity. This is not to say that all relationships are merely transactional! But healthy relationships involve mutual support, respect, and consideration.

“When we are feeling taken for granted or taken advantage of, it’s a sign that we need to learn to set healthy boundaries for ourselves … to communicate these boundaries, and reinforce them. Saying no to a request when you want to say no doesn’t make you mean, thoughtless or uncaring. Remember — good relationships are not merely transactional; they are built on a foundation of authenticity and mutual respect. Learning to say no enables you to express your true feelings in the moment, maintain healthy boundaries, and put your needs where they belong — at the top of your list. A healthy relationship will roll with these changes, and shift and grow; an unhealthy one will not.”

How can patients understand their feelings of anxiety? What breathing and meditation strategies could help?

“Anxiety is about self-doubt. It is the body’s response to a real or perceived stressor. Anxiety involves both cognitive thoughts and physiological (physical) symptoms, causing both to intensify and trigger emotional distress. Over time, anxiety sets in and increases more rapidly, with a worsening intensity of symptoms. People experience mental turmoil when they perceive that they are losing control, and are unable to cope in situations where they may be unaware of what is contributing to feelings of loss of control. 

“When you are anxious, your body enters a fight/flight/freeze state, to manage a perceived real or imagined threat. Your body does this in many ways, including increasing your heart rate, breathing rate, and blood pressure. These changes trigger the release of adrenaline and noradrenaline — the body’s reaction to a perceived threat (real or imagined). This sudden rise of many physiological symptoms at once can feel frightening, and create a sense of loss of control. 

“If you are anxious, you should: 

• Pause and reflect:  It is important to pause, reflect and ground ourselves in situations, breathe deeply and remind ourselves that we are capable of bringing in elements of control, even in challenging situations
• Take charge of your thoughts: When we are anxious we are focussing on negative thoughts. But we can take control of our thoughts, and reframe and replace negative thoughts with more adaptive, positive, ones. We can tell ourselves that we are in control and capable of handling any situation and managing our stress
• Focus on Deep breathing: When we are stressed, we take short, shallow breaths. Breathing deeply is an effective way to reduce anxiety. It slows the heart rate and can reduce anxiety. It also grounds us to the point where it can stop a panic or anxiety attack in its tracks. There are many different types of breathing exercises (it is easy to find many resources online), here is a simple and effective breathing exercise: Put one hand on your belly. Take a slow, deep breath through your nose. This breath should be deep enough to push the hand on your belly forward. Hold this breath to the count of five. Exhale to the count of five. Pause to the count of five, and repeat several times. This deep breathing and focus on the breath will create a sense of calmness
• Consider developing a meditation practice: Meditation allows us to ground ourselves by connecting to one or more of our senses, and takes us out of a state of imagining worst-case scenarios. Being present, or in the moment can be achieved by focussing on one thing with complete presence. Meditation and other relaxation exercises like journaling, counting, and visualising can be effective in calming the brain and slowing anxious thoughts and a racing mind.”

How can patients help those in their life who are experiencing depression, stress, and anxiety before it becomes too overwhelming?

“When it comes to dealing with depression and anxiety, recognising and understanding symptoms, and knowing how to effectively support those close to us who are struggling, are critical. Symptoms of depression and anxiety can range from mild to severe. Severe levels of anxiety and depression can limit, hinder and impede functioning and propel those who suffer into a downward spiral. In order to support people close to us who may be struggling, it is important to understand what depression and anxiety are, how they show up, and how you can support someone close to you who is struggling and suffering. 

“People in the throes of serious depression or anxiety are overwhelmed, and unable to recognise their symptoms as troubling and problematic. They are unable to see the negative impact of their troubling symptoms in their lives, and they are unable to understand and appreciate the effect their symptoms are having on their family, friends, and co-workers. It is important for those with daily contact with someone struggling with depression or anxiety to understand that the sufferer does not intend to hurt and harm others, but that they are unable to see beyond their pain and suffering. 

“When we recognise and understand troubling symptoms in someone close to us, we have a responsibility to that person to let them know that we are concerned. We can approach them with respect and talk about the changes that we see, and share insights into what they may be going through. We can offer them our companionship, support, and company, and assist them in finding professional help. It is important to remember that while supporting someone who is struggling with depression or anxiety, it is critical that we care for ourselves, and do not assist others at the expense of our own mental or physical health.

“People struggling with depression or anxiety can feel hopeless, and lost, and feel that they are in an uncontrollable downward spiral. They often are immobilised by their condition and unable to help themselves. It is important for those close to someone who is suffering from depression or anxiety to get involved. We can reach out, talk to them privately in a caring manner, and offer support. Reaching out to someone who is struggling can make a world of difference for that person, it can open the door to positive change, through intervention, treatment, and healing.”