August 2020 - Promises Healthcare
ENQUIRY
Burnout and How to Heal from It

Burnout and How to Heal from It

It is an undeniable reality that life, in general, is busy. With long work hours and bills to pay, there are so many things going on that we must and are expected to do. With the increase in pressures and demands in daily life, it is very common for people to feel exhausted and burnt out.

Burnout is a state of exhaustion caused by chronic stress. According to the World Health Organisation, it is classified as “chronic workplace stress that has not been successfully managed”. It is characterised by 3 dimensions: Feeling exhausted or devoid of energy, being mentally detached from your job and being less efficient in work. Employee burnout in Singapore is among the highest worldwide, where work is a vital cause of high-stress levels, and where almost one in eight employees cannot cope with their stress. There are many potential causes of chronic stress in the workplace, such as having too many responsibilities, having a negative view of yourself and the world, or a perceived lack of control over your life and work. All of these factors could cause one to burn out easily.

Let us recognise the signs that indicate a burnout. Physical signs include exhaustion, change in sleep habits or diets, frequent illness and headaches; Emotional signs include lack of motivation or enjoyment towards life events and feeling negative emotions such as anger, anxiety or depression; Behavioural signs include adverse coping mechanisms such as overconsumption of alcohol, withdrawal from responsibilities, taking out your frustration on others and reduced work performance. If you are currently experiencing these symptoms, then it is very possible that you may be burning out from work.

Now, you may ask, if busyness in work is inevitable, then how do we overcome this seemingly unmanageable stress? Below are 4 tips that could help you manage stress and prevent burnout:

  1. Turn to other people

It is extremely beneficial to have a social circle or support network, such that there are people that you can rely on for support, encouragement and a listening ear. Friends or family members can recognise maladaptive patterns in your behaviour, identify your burnout signs, and offer you constructive feedback or advice. Through doing that, you can work towards overcoming burnouts. Likewise, if your loved one is going through a burnout, engage her in a conversation and let her open up about what she is going through, while staying patient and understanding. Confiding in and spending time with loved ones would serve to reduce stress and strengthen your relationship with them as well.

If it is possible, try befriending your colleagues. With a similar job scope, your colleagues can better understand your stress at work and everyone can draw support and motivation from one another. Additionally, good relationships with your colleagues enable you to work faster and better while reducing your work’s monotony. Thus, a more positive work environment keeps you energised and productive, countering the effects of burnout.

 

  1. Live a healthy lifestyle

Healthy lifestyle habits such as sleeping, exercising and healthy eating can have a huge impact on your mood and energy, helping to reduce stress and prevent burnouts. Exhaustion or a lack of rest often worsens burnout through causing you to think irrationally, and can take a toll on your energy and emotional balance. Thus, getting a good night’s sleep energises you and improves your mental state, ultimately improving your productivity at work.

What you consume can greatly impact neural circuits in your body that control emotion, mood and motivation. As such, eat food that can elevate your energy and mood such as fruits, vegetables and food that is rich in whole grains; and reduce consumption of food with lots of caffeine, sugar, chemical preservatives and hormones.

Exercising also enables stress relief. While engaging in exercise, you can focus on your body rather than your thoughts, and how your body feels as you move (feeling the sensation of the wind against your cheek can be strangely calming!). However short or simple, any form of rhythmic exercise is beneficial as it can increase your energy while simultaneously relaxing your mind and body. Ultimately, a healthy lifestyle does wonders to your wellbeing.

 

  1. Find ways to relax and unplug from work

We often burnout due to lack of time for ourselves. Thus, give yourself a chance to slow down, rest and heal. Set time aside for activities that are not work-related and do activities that make you happy and relaxed. This includes your personal hobbies, interests or a passion project such as photography, baking or exercising. Doing these activities can make you feel rejuvenated and accomplished, and helps you rediscover joy and meaning in your life outside of work.

Additionally, reserve some time to disconnect from technology. In today’s day and age, smartphones cause us to “carry an office in our pocket”, and make us psychologically connected to our work all the time. Hence, it is a good idea to limit your phone time after work, to prevent yourself from checking your emails or calling your office; such that you can spend quality time with yourself and your loved ones. Through these regular breaks, you are given an opportunity to restock your mental energy and engage in self-care, which can increase your happiness and quality of life.

 

  1. Re-evaluate priorities and set boundaries

Lastly, reflect on the cause of your burn out and consider what makes you feel stressed and anxious. Ask yourself, Is my work making me stressed? Exactly what aspects of work are making me stressed? Do I spend enough time for myself? Through this self-reflection, you can find ways to reduce this burnout. A good solution is to set boundaries for yourself and re-evaluate priorities, such as knowing how much time to allocate to work and relaxation (possibly placing more importance on rest and less importance on work) and learning how to say “no” to tasks. Do not stretch yourself beyond what you can handle or commit to. If you struggle with this, remind yourself that saying “no” enables you to say “yes” to tasks that you find more fulfilling. Through re-prioritising your commitments and tasks, you are able to find balance in your life and focus on parts of life that bring you joy, meaning and satisfaction (even beyond your job).

If possible, you can also identify or consider which aspects of your job you enjoy and find the most fulfilling. After doing so, you could ask your supervisor if you can focus on these tasks as they are more aligned with your responsibilities and strengths. Doing this helps you find value and regain a sense of control in your work, giving you a positive outlook and attitude towards your tasks.

 

Healing from a burnout definitely is not easy, and takes lots of time and commitment to overcome, but it is possible. Take the effort and steps necessary to manage your time and reduce stress, and keep to it. It may be difficult to adjust and keep to these new changes, but ultimately, it will prove effective in preventing burnouts and will improve your physical, emotional and mental well-being.


References:

https://www.helpguide.org/articles/stress/burnout-prevention-and-recovery.htm

https://hbr.org/2015/04/how-to-overcome-burnout-and-stay-motivated

https://www.who.int/mental_health/evidence/burn-out/en/

https://www.pacificprime.sg/blog/employee-burnout-in-singapore/

https://www.fairview.org/patient-education/85169

https://www.helpguide.org/articles/sleep/getting-better-sleep.htm

https://www.inc.com/john-rampton/8-ways-to-get-over-job-burnout-without-leaving.html

Building Trust in Relationships

Building Trust in Relationships

Scientists believe we are essentially wired to connect with other people, to socialise and build relationships with others. Indeed, we are all a profoundly social species as our drive to connect with others is embedded in our biology and evolutionary history. But what makes a healthy and meaningful relationship? A healthy, functional relationship usually involves a few characteristics, and trust is undeniably a key one. A relationship can’t last without trust for a number of reasons. We won’t dispute the cliché, “Breaking someone’s trust is like crumpling up a perfect piece of paper. You can smooth it over but it’s never going to be the same again”. 

 

Building trust in relationships doesn’t occur overnight, it happens over time. Trust can be defined as having confidence, faith or hope in someone or something. But in another sense, trust can also mean believing that the other party will act in our best interest. With that said, let’s take a closer look at how we can learn to build mutual trust between ourselves and others in our personal and even work life.  

 

  1. “Say What You Mean And Mean What You Say”

Trust is fundamentally built on integrity, transparency and truthfulness. We trust those that stay true to their words and follow through with their actions. Perhaps it is also our instincts for self-protection, honed evolutionarily over centuries, kicking in. We pick up easily on red-flags and are particularly attentive to the proverbial boy crying wolf. Afterwhich, we learn to adjust our expectations and behaviour, doubting others and trusting them less in order to avoid getting hurt or being let down. Even the smallest of lies, when told frequently over time, will erode the level of trust between individuals. Actions speak louder than words – don’t allow yourself to give empty promises. Learn to keep to your promises and refrain from making commitments you are unable to honour. Be clear of what you have on your plate. In fact, if you are unable to commit to a request or a favour, have the courage to turn others down and explain your situation. Everyone would be worse off if you had promised something but was unable to follow through with it. In addition, avoid saying things that don’t actually represent your feelings. Hiding behind a facade may give others the feeling that you are being manipulative, and that you have an ulterior motive. This will make you appear unreliable and untrustworthy.

 

  1. Consistency

Demonstrating consistent behaviour is key to maintaining a trust-based relationship with anyone, whether friends or colleagues. This means constant communications, being clear with your expectations, and being there for others during both good and bad times. How would you feel if a friend of yours is always there when things are going smoothly, but is the first to go off the radar whenever things get rough? Or if she bad-mouths you or reneges on her promises? It goes without saying that we will start trusting these people less over time, having known that they are not likely to support us when we need them most. Regularly showing your loved ones that you are there for them whenever they need support and care will go a long way in building and maintaining a healthier and stronger relationship.

 

  1. Show Respect

Respect is key in any relationship, and it builds trust by illustrating to others that you value them. If it helps, think of respect as the common denominator in any relationship. People come from different backgrounds and are brought up to believe in different viewpoints.  Disagreement or arguments often happen not because we have different opinions, but often because of the way we put our views forward. Often, our trust in and relationship with others are broken because we are being treated with condescension or contempt instead of the respect we all deserve. Likewise, we should always extend basic courtesy to the people around us and respect their right to an opinion.  

 

  1. Watch Your Body language

Did you know that over 50% of communication is non-verbal? Our body language is a form of non-verbal communication. Simple nonverbals that project openness and warmth can include a genuine smile, eye contact, an open body posture and coming down to their level. Moreover, this also ties in with the previous topic of respect. When talking to others, be present in the moment. Sometimes, we focus only on the words we use but neglect what our nonverbals are projecting. All too often, we try to multitask – and sometimes this means that we use our phones while sitting in front of someone else who’s talking. While we are used to multitasking in such a fast-paced era, simple gestures such as taking some time away from our phones and providing our full attention to others when necessary can help us to build mutual trust and respect.

 

  1. Work on Your Emotional Intelligence

Emotional intelligence can play a huge part in building trust, since it can give you greater insight into how others may be feeling about certain situations. This allows you to be better able to show authentic empathy and give them the support they need. Honing your emotional intelligence will take time, but it can be as easy as making an effort to examine how your words and actions will affect others before executing them. When people feel that you genuinely care for and recognise their feelings and needs, they will find themselves trusting you more. Of course, it is best that you follow through on ways to support them apart from active listening in order to strengthen the trust. 

 

As mentioned, trusting relationships aren’t formed overnight. However, trust is integral to any healthy relationship. Without it, the relationship will end up being shaky and deprive you of emotional security. If you ever feel that a relationship between you and a loved one isn’t working out, and that it is barely kept afloat, it might be a good idea to seek the appropriate help and counselling. 

 


References:

https://www.forbes.com/sites/bernhardschroeder/2019/12/23/to-build-a-great-company-you-need-trust-10-ways-to-build-trust-between-employees-or-cofounders/#2038713767c4 (Accessed 26/06/2020)

Photo by Priscilla Du Preez on Unsplash

Overwhelmed At Work?: Demystifying Executive Functioning Deficits

Overwhelmed At Work?: Demystifying Executive Functioning Deficits

Written by Dr B. Malavika, Psychological & Educational Therapist

Have you met <please insert a suitable name> recently? He/She’s the bright, young, dynamic person at our office… I always thought of him/her as the person who’s the life of the party, and he/she genuinely seems to care for his/her colleagues… Aah, yes, the same person who unfortunately missed out a promotion this year… I heard his/her boss say that he/she definitely had the potential,  but it wasn’t showing up in his/her work. He/She would initiate tasks with enthusiasm but would lose interest quickly; turned up late for meetings, or even forgot about them, and frequently misplaced important files as his/her table was often cluttered.

Does this seem familiar? Do you recognise similar signs in yourself or someone else you know? These issues might be due to something known as Executive functioning deficits or disorder (EFD). Though symptoms start in early childhood,  the challenges might have been seen as the individual’s behaviour problems and not as a syndrome. Even as adults, many of those with EFD aren’t aware they have it — they just know that even everyday tasks can be challenging. 

 

What is EFD?

Executive functions are the set of higher-order mental skills that allow us to analyse, plan, organise,  make suitable decisions, manage time, focus attention and execute the plan. No matter how smart or talented one is, not much will get done well without these key capabilities. The human brain comprises of two systems: the automatic and the executive.  While the automatic system guides 80 to 90% of our activities every single day, the executive system guides the remaining 10 to 20% and requires purposeful, regulatory effort.1

 

What causes EFD? 

 Experts don’t know exactly what causes this and a 2008 study found that differences in these skills are “almost entirely genetic in origin due to differences in brain chemicals” 2

People who have executive functioning deficits might have problems with many of these functions:

  • starting, organizing, planning, or completing tasks on deadline.
  • multitasking
  • listening  or paying attention
  • remembering tasks or details
  • problem-solving
  • time management
  • decision making
  • controlling emotions or impulses
  • prioritizing

But it is important to note that EFD is not associated with low IQ.

Almost everyone has some symptoms similar to EFD at some point in their lives but It isn’t EFD if the difficulties being faced are recent or occurred only occasionally or intermittently in the past. If you’re curious to know if you do have EFD, you could take the test given below. 

https://www.additudemag.com/executive-function-deficit-adhd-symptoms-test-for-adults/

Even if you’re not sure if EFD is indeed the cause of the problems experienced, or, if you do not want to give it a label, you could still use the tips/ strategies given below to enhance your general skills and productivity at work. 

One surprising way found to improve executive function in adults is aerobic exercise. Many research journals have published that regular aerobic exercise in older adults can boost the executive functions that typically deteriorate with age, including the ability to pay focused attention, to switch among tasks, and to hold multiple items in working memory.3

If you think that the feeling of the constant deluge at the office is largely the result of so many things clamouring for attention at once, a tool like Stephen Covey’s Quadrants can be used. Each quadrant (Q) has a different property and is designed to help prioritize tasks and responsibilities. These  are: 

  • Q 1 – Urgent and important
  • Q 2 –  Not urgent but important
  • Q 3 – Urgent but not important
  • Q 4 – Not urgent and not important

Another useful technique is the Pomodoro technique of time management developed by Francesco Cirillo in the late 1980s. It uses a timer to break down work into 25-minute intervals, separated by 5-minute breaks. This method not only helps you remove distractions and enhance focus on your task, but it also factors in time to take a short breather.  

Those who are tech-savvy can find these as smartphone apps. Other technology tools that can help are File-sharing software like Dropbox to keep notes handy,  digital sticky notes or reminders, and password manager software to keep track of passwords. Those who are not  comfortable with technology can compensate for working memory deficits by making information external — using cards, signs, symbols, sticky notes, lists, journals, clocks and timers.4

Other simple  workable strategies are: 

  •  Break large tasks into smaller individual tasks and put them into a linear order or flow chart. This helps provide clarity and allows you to monitor your progress
  • Keep a routine
  • Know yourself and get your best work done according to your own biorhythms
  • Give it a positive twist – make the activity a ‘want to do’ instead of ‘should do’.

Games can help to improve executive function skills. Games like Checkers, Monopoly, and Clue use planning, sustained attention, response inhibition, working memory and metacognition. Games like Zelda and SimCity help with problem-solving and goal-directed persistence. Managing  fantasy sports teams also use executive skills like task initiation and time management while having fun.4

Positive emotions reduce the impact of stressful events on the self and help build resilience. They make us more flexible, allowing us to be more open to options of problem-solving. Studies show that people feel and do their best when they have at least three times as many positive emotions as negative emotions.5 It is, therefore, most important that you periodically reward yourself when you have met the goals you have set.  Equally important is positive self-talk which is a powerful tool for increasing your self-confidence and strengthening your resolve to make these healthy new habits a part of your personal and working life. 

 

 When to seek help?

Diagnosis of EFD can be difficult because certain symptoms are similar to those caused by other conditions, such as ADHD, LD, depression, anxiety, mood disorders or OCD. If any of the symptoms listed above continually disrupt your life, talk to a mental health professional. There is a variety of strategies recommended by experts to help strengthen the areas of weakness that EFD creates. Treatment options could be medications and therapy such as occupational or speech therapy, Cognitive behavioural therapy (CBT).

 


References:

1 https://www.additudemag.com/working-memory-powers-executive-function/

2 https://www.understood.org/en/learning-thinking-differences/child-learning-disabilities/executive-functioning-issues/executive-functioning-issues-possible-causes

3https://www.pbs.org/wgbh/nova/article/the-science-of-smart-surprising-way-to-improve-executive-function/

4https://www.additudemag.com/executive-function-treatment/?src=embed_link

5 https://kidshealth.org/en/teens/power-positive.html

https://www.medicalnewstoday.com/articles/325402#summary

https://www.additudemag.com/executive-function-disorder-adhd-explained/?src=test

Photo by You X Ventures on Unsplash

 

 

 

 

Chronic Stress Management: Why Am I Feeling Exhausted All The Time?

Chronic Stress Management: Why Am I Feeling Exhausted All The Time?

Are you feeling tired most of the time despite having a good night’s sleep? Are you constantly feeling low energy and unproductive? These are just a few of the typical symptoms pointing towards unhealthy levels of stress. Constantly feeling worn out could be an alarm that your body is sounding – a message that it is overwhelmed and unable to keep up. Undeniably, we often put ourselves in a constant heightened state of alertness, especially in such a fast-paced society. Our sources of stress may differ, from high-pressure jobs to challenging and taxing relationships. Stress affects everybody – even if you may not be physically attending to any particular concern, allowing it to occupy your mind frequently and fretting over it can contribute to chronic stress. Without proper management and control, chronic stress puts pressure on the body and will ultimately wreak havoc on your physical and mental health.  

 

As a natural biological response to demanding circumstances or situations, our body releases hormones such as cortisol, a stress hormone. Alongside adrenaline, cortisol helps to fuel your body’s ‘fight-or-flight’ instinct whenever a crisis surfaces. A stressor may be a long term one, such as the routine stress related to the pressures of school, work, family, and other daily responsibilities, or short-term occurrence brought about by a sudden change, such as losing a job, illness, or facing dangerous situations. In an ideal situation, when an individual faces a trigger, the adrenal glands in the body secrete cortisol and a complex hormonal cascade ensues, preparing the body for the ‘fight-or-flight’ response. Following that, cortisol inhibits the production of insulin in order to increase the uptake and usage of glucose so that more energy is made available to the surrounding muscles. Arteries will also be narrowed, increasing the heart rate and forcing blood to be pumped harder and faster around the body to help you confront the immediate threat. Once the individual resolves and addresses the situation, negative feedback kicks in and hormonal levels will then fall back to the norm. 

 

With this said, when we are constantly under high levels of stress, our alarm system doesn’t turn off. This means that our body is continually in high-gear and cortisol levels will remain high, to the point where it becomes harmful. Small doses of cortisol are safe, and in fact, is important for your health as it also serves to regulate your metabolism and blood sugar level amidst other key functions. However, in the case of chronic stress, constantly high levels of cortisol take a toll on your body’s resources, leaving you exhausted. Over time, continued strain on your body from stress may contribute to serious health problems. Hence, there is a need for us to tackle the root of the problem and ensure that we manage our stress levels to reduce the risk of negative health effects.

 

You might have been advised to change your lifestyle for the better at least once in your life by a family member or a friend – and we cannot stress this enough. It is essential that you learn to live a healthier lifestyle, which includes stress reduction and learning to manage your hectic schedule. If you continue to live an overly-demanding way of life, it is highly likely that you may succumb to chronic stress or worse, other mental health issues such as anxiety or depression. Moreover, can you imagine how hard your adrenal glands will have to work in order to continue producing sufficient stress hormones? Needless to say, the high cortisol levels will also impact your physical health and lead to other conditions such as digestive problems, high blood pressure or sleep issues. This results in a vicious cycle – with less sleep, the more exhausted you feel. 

 

Working on stress reduction can be as easy as doing deep abdominal breathing exercises, and incorporating meditation. Schedule regular times for these and other healthy and relaxing activities. They are simple, cost-effective, and are readily available. In this highly technological age, there are many applications available on your devices to further assist you in such activities as well. On the contrary, if you feel that you aren’t quite the kind to sit down and meditate, you can also opt to do some physical exercise to help boost your mood and improve your health. Organising activities with your friends such as playing a game of badminton or volleyball can help you to keep your mind off things, and at the same time, seek the social support you need when necessary. Of course, exercising alone is perfectly fine too, the main point is that exercising produces endorphins – chemicals in the brain that help alleviate stress by acting as natural painkillers.

 

Watching what you ingest is also equally important. For example, for heavy coffee drinkers, try to cut down on caffeine. Although the threshold for caffeine might differ for every individual if you notice that your excessive caffeine intake is making you jittery or on the edge, consider cutting down on it. Instead, you may want to replace it with other beverages that have a calming effect, such as chamomile, lavender or peppermint tea. Drinking a cup of warm milk before bed can help you get a better night’s sleep too. In addition, you might want to consider eating foods such as avocados, which are known to offer omega-3 fatty acids that can help reduce stress and anxiety. However, we should always remember that everything should be consumed in moderation. 

 

Last but not least, learn to say no, and only commit to responsibilities that you can cope with! Although not all stressors in your life are within your control, some of them are. It is crucial that we manage what we have on our plates, and not bite off more than we can chew. Try to be mindful of what you have accomplished at the end of the day, not what you have been unable to do. Juggling many responsibilities at once can leave you feeling disheartened and overwhelmed, and this increases your stress levels unnecessarily. 

 

Sometimes, despite numerous efforts at self-help, some individuals may still find it hard to cope with their high levels of stress. If you are overwhelmed by stress, ask for help from mental health professionals, as therapy is also a way to help you navigate through and overcome your stress. 

 


References:

https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response (Accessed 01/07/2020)

Photo by Keenan Constance on Unsplash

The link between Anxiety and Alcohol Use; and Implications for Treatment and Early Intervention Especially In Youths

The link between Anxiety and Alcohol Use; and Implications for Treatment and Early Intervention Especially In Youths

Alcohol. A beverage that many people enjoy drinking; be it for socialisation or as an escape from reality. However, it is also a beverage that can harm your health and adversely affect many lives. Indeed, alcohol abuse has become increasingly rampant, where it is one of the leading causes of disease and death, with 5.3% of all global deaths and over 200 diseases and injury conditions resulting from the harmful use of alcohol. Worryingly, it is also a phenomenon that has affected Singapore, with 9.6% of Singaporeans engaging in binge drinking (as of 2016) and an increasing number of Singaporean young adults battling Alcohol Use Disorders (AUD). As such, alcohol abuse has become a growing cause of concern.

There are many reasons why alcohol consumption is increasing. Alcohol consumption has been perpetuated by the media in recent years, with an increase in advertising and marketing of alcohol. For instance, in Australia, people are exposed to about nine alcohol televised advertisements every month. In turn, exposure to such advertisements causes alcohol consumption to be glorified and promoted, where people have unrealistic positive expectations towards alcohol, believing that it boosts one’s mood and invokes cheerfulness and confidence. Additionally, alcohol consumption has also increased due to peer pressure. Be it a work engagement or partying with friends, people often find it hard to say no to alcohol, as that rejection may cause disapproval among colleagues or friends. Thus, many people engage in risky drinking behaviour to socialise and develop their relationships.

However, a more significant reason behind alcohol consumption is feelings of anxiety or having anxiety disorders. People with anxiety disorders have 2 to 3 times the risk of having alcohol use disorders (Smith & Randall, 2012). Many people tend to use alcohol to reduce social anxiety, as they believe that alcohol is an excellent aid to speak up and gain more confidence around others. Similarly, people use alcohol as a form of self-medication to overcome anxiety symptoms and stress, relying on it as a coping mechanism. However, contrary to popular beliefs, alcohol exacerbates rather than alleviates anxiety symptoms. This worsened anxiety makes them drink more and have more alcohol-related problems, which causes further anxiety and stress.

Alcohol abuse also causes anxiety. Drinking alcohol builds a tolerance to de-stressing effects of alcohol. This creates a temporary sense of relaxation but later leads to feelings of depression and anxiety. This is because the prolonged use of alcohol can act as a stressor and activate the body’s stress response system, changing neurotransmitter levels in the brain and causing an increase in stress and anxiety. As such, alcohol can worsen anxiety symptoms.

Therefore, anxiety and alcohol abuse tend to fuel each other in a vicious feed-forward cycle of co-occurring addiction and anxiety, which is difficult to break out from. As such, integrated treatment for both anxiety and alcohol use should be readily available.

Treatment

There have been existing parallel or subsequent attempts to treat both anxiety disorder and AUD (i.e. treatment for anxiety disorders first, followed by AUD). However, studies have found that parallel treatments have caused worse alcohol outcomes compared to just seeking one treatment. This is possible because the cognitive load of receiving two separate treatments may be confusing or overwhelming for people, causing them to feel anxious or turn back to drinking as a coping mechanism. As such, these type of treatments causes a “co-morbidity roundabout”, which is a metaphor of mental health problems resurfacing when attempting to tackle substance disorders (and vice versa), thus failing to break out from the vicious cycle of these co-morbid disorders. Therefore, it is clear that both anxiety disorder and AUD are inter-related issues, and an integrated treatment approach is vital to tackle both disorders.

Stapinski et. al. (2015) carried out an integrated treatment for comorbid social anxiety and AUD, where participants undergo both Cognitive Behavioural Therapy (CBT) and motivational interviewing. Moreover, it involves core components such as building coping skills, developing alternative reinforcers and preventing relapse. This provides participants with useful skills such as enhancing social support networks, correcting misconceptions towards the benefits of drinking, reducing avoidance of social situations and developing healthy coping skills to manage triggers for drinking or anxiety.

This study took place over ten 90-minute sessions, where 117 participants with both social anxiety and AUD took part in this study. 61 of the participants received integrated treatment (both AUD and social anxiety) and 56 of the participants received treatment for AUD only. Results showed that both treatments enabled a great reduction in alcohol use and dependency. However, participants that underwent the integrated treatment were observed to have a greater decrease in social anxiety symptoms and a greater increase in overall quality of life. More importantly, these results remained constant even after a 6-month follow-up. This means that integrated treatment has long term effects on overall functioning and quality of life.

Early Interventions

While the above has proven that integrated treatment is indeed useful in overcoming social anxiety and AUD, the road to recovery is a long and arduous journey, where there are a lot of physical and mental challenges suffered by both the clients and their families. Hence, these issues could be more easily overcome or even avoided if there are early intervention and support to at-risk youths.

Over the years, the number of youths drinking alcohol has increased. According to the Avon Longitudinal Study of Parents and Children (2004), the number of youths that engage in binge drinking increase tremendously between the age of 18 and 21 (from 18% to 35% respectively). Furthermore, 18-year-olds who drank alcohol as a coping mechanism or who had anxiety disorders were 1.8-3.8 times more likely to drink. Both groups had a greater risk of transitioning from low-risk alcohol use at age 18 to high-risk alcohol use at age 21.

There are many motives that may drive youths to drink alcohol. A primary reason is that youths are at a phase where they are transitioning to adulthood. Adulthood brings more stress and anxiety due to changes such as new relationships; along with new responsibilities and challenges such as living in a dormitory and budgeting. Additionally, this phase of life also provides youth with more autonomy and drinking opportunities (e.g. clubbing, drinking games). With these drastic changes in life, youths often drink to enhance positive moods, socialise with others, conform to social groups, or as a coping mechanism to overcome stress or anxiety. This causes harms associated with alcohol to peak in early adulthood, emphasising the importance of early intervention to avoid these detrimental consequences.

An ongoing programme called “Inroads Study” (Stapinsky et. al., 2019) aims to provide early intervention to youths with anxiety disorders and AUD. It seeks to enhance anxiety coping skills and address coping-motivated drinking. Moreover, this programme is specially tailored to make it more relevant and appealing to youths. This includes making the programme available online, which is preferred by youths as it is more convenient, affordable and reduces stigma. Participants can freely access online therapy sessions and modules about tackling challenges often faced by youths. Thus, such interventions can address the interconnections between anxiety and alcohol use, as well as reach out successfully to youths in a relevant and appealing manner.

Prevention programmes are also forms of early intervention that may benefit younger youths (i.e. 13- or 14-year-olds) that have a ‘high-risk’ of developing substance disorders, even if they do not currently have a substance disorder. It is vital to identify early onset of problems faced by youths and nipping them in the bud, providing them with early support and teaching them relevant life skills. This prevents problems faced by youths from developing into more severe adulthood problems such as substance disorders, chronic mental health problems and delinquency.

One such prevention programme was organised by Edalati & Conrod (2019), who first identified at-risk youths through the Substance Use Risk Profile Scale; where those with higher levels of certain personality traits (e.g. sensation seeking and negative thinking) were at higher risk of abusing substances before the onset of use. Afterwards, these youths attended coping skills workshops, CBT and motivational interviewing.  Results showed that the programme proved effective in reducing alcohol use, alcohol-related harms and emotional and behavioural problems (i.e. symptoms of anxiety and depression). This shows the importance of early intervention and prevention programmes.

In conclusion, it is apparent that there are interconnection and the longstanding link between anxiety and alcohol use, where this co-morbidity can cause huge effects on one’s physical and mental wellbeing. Thus, this raises the importance of integrated treatment, allowing both conditions to be resolved at the same time. Furthermore, early intervention is extremely vital to offer support to youths and prevent potential disorders from occurring. More importantly, all this shows that alcohol is not the answer to relieve stress and anxiety, and can only serve to exacerbate rather than resolve our problems. Thus, such action could be done to reduce excessive alcohol use in our society, such that harmful usage and effects of alcohol could be prevented.


 

References:

https://www.mentalhealthacademy.co.uk/dashboard/catalogue/the-link-between-anxiety-and-alcohol-use-implications-for-treatment-and-early-intervention

Smith, J. P., & Randall, C. L. (2012). Anxiety and alcohol use disorders: Comorbidity and treatment considerations. Alcohol Research: Current Reviews, 34(4), 414–431.

Stapinski, L. A., Rapee, R. M., Sannibale, C., Teesson, M., Haber, P. S., & Baillie, A. J. (2015). The clinical and theoretical basis for integrated cognitive behavioral treatment of comorbid social anxiety and alcohol use disorders. Cognitive and Behavioral Practice, 22(4), 504–521.

Golding, J., & ALSPAC Study Team (2004). The Avon Longitudinal Study of Parents and Children (ALSPAC)–study design and collaborative opportunities. Eur J Endocrinol. 151, U119-U123.

Stapinski, L., Prior, K., Newton, N., Deady, M., Kelly, E., Lees, B., Teesson, M., & Baillie, A. (2019). Protocol for the Inroads Study: A Randomized Controlled Trial of an Internet-Delivered, Cognitive Behavioral Therapy-Based Early Intervention to Reduce Anxiety and Hazardous Alcohol Use Among Young People. Journal of Medical Internet Research, 8(4), 1-14.

Edalati, H., & Conrod, P. J. (2019). A Review of Personality-Targeted Interventions for Prevention of Substance Misuse and Related Harm in Community Samples of Adolescents. Frontiers in psychiatry, 9, 770.

https://www.who.int/news-room/fact-sheets/detail/alcohol

https://www.straitstimes.com/singapore/alcohol-abuse-worse-among-younger-people

https://www.drugrehab.com/addiction/alcohol/peer-pressure/

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