The financial toll debt takes is obvious: The average American household carries over $15,000 worth of consumer debt and doesn’t have the cash reserves to pay for a $500 emergency. The psychological toll of debt, however, is often overlooked. But a study from Northwestern University found that consumers with higher levels of debt had a 13.2 percent increase in depressive symptoms and an 11.7 percent increase in perceived stress.

In her book Dear Debt, personal finance writer Melanie Lockert chronicles her own experience with this kind of financial anxiety. She offers some useful advice for coping with money-induced stress and depression.

1. FOCUS ON BOOSTING YOUR CONFIDENCE.

After graduating from a prestigious university, Lockert had amassed over $80,000 worth of student debt and she was unable to find work. As her confidence dwindled, she says she learned to create her own opportunities to earn extra cash, even if it wasn’t a standard full-time job. She sold her stuff. She babysat. She passed out flyers in Central Park.

Obviously, the extra cash helped. But more importantly, Lockert says, these gigs gave her the confidence boost she needed to cope with her financial stress. “Realizing that I could create my own work and not just wait for others to give it to me helped boost my confidence,” she tells mental_floss. “During hard times or points of doubt, I just kept repeating ‘I am a money-making machine’ to myself.”

If you’re struggling to find a job or even side gigs while you’re in debt, volunteering might be another useful option. Not only can it lead to paid opportunities [PDF], but it can also help you establish a sense of purpose and confidence at a time when you need it most. Of course, an increase in income will go a long way toward offering relief, but in the meantime, it’s important to look out for your sense of self-worth and well-being.

2. EMBRACE ACCOUNTABILITY.

When your debt load feels overwhelming, it’s easy to give up. The stress takes over, you forget about your goal, your debt increases, the stress multiplies. It’s a vicious cycle that snowballs. This is where accountability partners come in handy. When you feel like giving up, a trusted friend or loved one can gently remind you why your debt payoff goal is important to you. They can also help boost your spirits.

Lockert held herself accountable through her blog, where she wrote letters to debt, chronicling her financial and emotional journey to the black. “I started my blog as a lifeboat during a dark time in my personal and professional life," she says. "The writing gave me a purpose and helped me stay accountable in the debt payoff process.”

3. GET PROFESSIONAL HELP.

There are also professional resources available when you feel helpless against your debt. Credit counseling is designed to educate consumers about debt and then come up with a realistic plan they can stick with in order to stay above water.

While debt plan services typically come with a small fee, agencies accredited by the National Foundation for Credit Counseling (NFCC) begin with a free session that explains the basics of managing your debt and your budget.

In Lockert’s case, she enlisted the help of a low-cost therapist at her university to talk about her anxiety and depression. If you can't afford a private therapist, many church organizations, community centers, or employers also offer low-cost options for mental health services.

4. PRACTICE GRATITUDE.

It sounds hokey, but a little gratitude can put you in the right frame of mind for sticking with your payoff goal. Lockert believes the daily gratitude exercise suggested by her therapist played a crucial role in changing her perspective. “Gratitude can help you get out of debt because it can shift your mindset. At the suggestion of my therapist at the time, I started writing three things I was grateful for each day,” she says.

Those three things could be anything, Lockert explains, from a cup of coffee to a nap to an afternoon walk. She says that embracing gratitude made her realize that, in many ways, she did have a rich life, despite her financial struggles. Her debt didn’t disappear overnight, of course, but the ritual gave her the motivation she needed to keep pursuing her payoff goal.