Lady Gaga revealed to Yale University that she has been battling anxiety and depression since the seventh grade.

“I invented myself, Lady Gaga — I curated my life to be an expression of my pain. This is how I overcame my depression, by creating somebody that I felt was stronger than me,” the “Shallow” singer disclosed. “But…nothing was able to fix how I was genetically made. I was born this way. No matter how much success you have, no matter how many opportunities, fame, fortune — no matter how many people accept you, to your face, the person that really needs to accept you is you.”

She follows self-care practices to stay mentally healthy, especially during her tours, including meditation, exercise, practicing gratitude and leaning on her friends.