Articles Archives - Promises Healthcare
ENQUIRY
COVID-19 AND ADDICTION – RECOVERY USING ONLINE THERAPY

COVID-19 AND ADDICTION – RECOVERY USING ONLINE THERAPY

Author : Andrew da Roza

COVID-19 has posed a challenge to everyone, and those more physically vulnerable in our community clearly need our care and attention. 

There are also people whose mental vulnerability deserves equal care.

Mental illnesses such as depression, anxiety, and addictions are exacerbated by a pandemic crisis in multiple ways. 

Collective family and community fears are (in themselves) contagious; and the constant bombardment of medical and financial bad news, can leave those with mental illnesses lost in a cascade of negative rumination and catastrophising. 

The mentally ill and people with addictions commonly have compromised immune systems, and suffer stress or substance, tobacco and alcohol abuse related diseases – leaving them wide open to severe pneumonia with acute respiratory distress symptoms – and other complications from COVID-19. 

Isolation, separation and loneliness – caused by working at home and social distancing – are perhaps the worst contributors to: low mood; agitation; irrational fears; moments of panic; self-disgust; resentment; anger; and even rage.

People whose ability to pause, use reason and find practical solutions can be severely compromised. They may find themselves bereft of the motivation, and ability to engage in even the simplest tasks of self-care. 

Added to this, listlessness, boredom and frustration can lead to despair. Then self-harm and suicidal thoughts may arise, take hold, and even overwhelm them.

Those in recovery or active addiction may also turn to their compulsive and impulsive behaviours of choice, to sooth and find momentary respite from the moods and thoughts that have hijacked their mind. Triggers, urges and cravings may become relentless and unbearable. 

The solution may begin with finding a way out of isolation. 

Starting the journey out of this darkness can start with talking to people who can demonstrate unconditional positive regard, show kindness and compassion, and help reframe the situation. Such people can assist those suffering to put a name to and validate their emotions. 

In short – therapy can help!

In times of COVID-19, working with a therapist via teleconsultation can be effective using ZOOM, Skype, WhatsApp video and FaceTime. 

Although the calming and soothing sensation of the physical presence of a therapist is absent, for those in isolation – distraught with shame and despair – Internet enabled therapy can prove a lifeline.   

Isolation can be further broken, using similar Internet methods, by attendance in recovery groups such as Alcoholics Anonymous, Narcotics Anonymous and Sex and Love Addicts Anonymous – all of whom now hold Zoom meetings in Singapore. 

These Zoom opportunities in Singapore are supplemented by Zoom, Skype and telephone conference meetings in Hong Kong and Australia (in Singapore’s time zone) and in the U.K. and the US (during our mornings and evenings).             

Having broken the isolation, the second step therapists can provide is guidance and motivation towards self-care. This would include tapering or abstinence from the addictive substances or behaviour. A well thought through relapse intervention and prevention plan, specifically tailored to a person’s triggers, will also assist.

Triggers may be particular places, situations, people, objects or moods. 

The acronym “HALT” is often used by those in recovery; which stands for the triggers of being: Hungry; Angry; Lonely; or Tired.

When these triggers arise, people are encouraged to 

  • HALT their behaviour; 
  • breathe deeply, with long outward breaths;
  • think through consequences;
  • think about alternatives;
  • consult with others; and
  • use healthy tools to self-soothe.      

Daily mindfulness, meditation, exercise, sleep hygiene, healthy eating and following a medication regime are important aspects of self-care – and for some suffering mental illness – these actions – and time – may be all they need to find their footing again.

Luckily, the Internet gives a vast array of possible self-care options, including things to distract us, soothe us and improve us. 

Everything is available from: calming sounds and music; guided meditations; games; home exercise, yoga and tai chi; self-exploration and improvement videos; video chats with loved ones; to healthy food delivery options. They can all be had with a few keystrokes. 

Today we live at a time when suffering from mental illness and addictions is commonplace. But we also live at a time when the solutions are literally at our fingertips – if we only reach out for them. 

For information on teleconsultation for addiction therapy and addiction recovery meetings, contact:  Andrew da Roza at Promises Healthcare by email to [email protected] or by calling the Promises Healthcare clinic at: (+65) 6397 7309 

 

   

 

#WFH : Tips to navigate the emotionally stressful ‘Work from Home’ COVID-19 chapter

#WFH : Tips to navigate the emotionally stressful ‘Work from Home’ COVID-19 chapter

Author : Dr Ivan Lau

The coronavirus is known to be extremely contagious, with its ability to transmit from person to person through tiny respiratory droplets. At work, it is inevitable that we come into close contact with our co-workers, especially if we are working in tight, enclosed workspaces. This unfortunately increases the likelihood of infection for everyone. For the betterment of everyone’s health and safety, many firms have thus implemented a ‘work-from-home’ scheme in an effort to limit the COVID-19 spread through proper social distancing. In fact, the Singapore government has made it mandatory for employers to allow their staff to work from home as far as possible, or else they would risk bearing fines or stop-work orders. 

With such measures implemented, we would have to start relying more on telecommunication methods. Working from home may hence mean that face-to-face social interactions are limited as we are no longer able to meet others physically. Communication between colleagues may also be delayed, since more time is required for information or messages to be sent across. Over time, this may cause us to feel increasingly frustrated and anxious, and unless we know the right methods of keeping ourselves mentally and emotionally healthy, this will be greatly detrimental to our wellbeing. And for this, we will need to identify potential sources of distress in order to counter them effectively.

Unwanted feelings of stress and loneliness can indeed be an issue of concern if an individual works alone at home – after all, humans are social animals. This is especially so if he/she is extroverted in nature, and is highly dependent on social interactions on a day-to-day basis. Coupled with the unprecedented demands of meeting deadlines, these individuals may feel a sense of detachment and isolation if they are unable to socialise with colleagues which they had already bonded closely with. Thankfully, with an increasing number of social platforms such as Zoom or Skype, employees can make the most of them and easily arrange video calls with their colleagues to catch up with one another over lunch. Make sure you reach out to others and seek support as well whenever you are feeling too overwhelmed. 

On the other hand, some of you may face a whole new set of problems. Some individuals may have siblings or other family members working alongside them at home, and it may simply create an unfavourable working environment. Having your family members around you, be it young or old,  could be distracting at times, and employees could be more easily affected by their moods or habits. The stress of having to manage those around you may kick in, thus heightening the level of anxiety and irritation. In order to tackle this, employees must make sure to set clear boundaries between themselves and their family members during working hours at home. This could mean allocating specific rooms for respective family members to work in, and ensuring that they stick to their allocated rooms. In addition, perhaps there could be an agreement made between members of the household, where no one is permitted to enter others’ rooms when the doors are kept closed. This would help to protect the working space of everyone at home, and to minimise any disruptions or distractions. With this, it would undoubtedly be easier to remain focused and productive. However, it is also necessary to designate enough space for yourself to work in. Cramming yourself into a tiny room and working in it for long hours can make you feel claustrophobic and restrained. This will certainly not be beneficial to your mental wellbeing.

Some may question: “I’ve ensured that my family members are aware of my work-from-home schedule. Why do they still keep barging in?” If you are one of these individuals, you may want to consider if you are creating a “work” atmosphere. Are you lying in bed with your laptop, with your PJs on? Or are you sitting upright at your desk, and dressed the part? If you find yourself doing the former, then perhaps it is sending a false signal to other household members that you are available, or that you are working “casually”. Establish a proper routine and follow through with it. Always ensure that you have the right working attitude whenever appropriate, and this will surely help your family members understand. Nonetheless, remember to set strict limits to your working hours as well. Working from home can, understandably, cause the boundaries between work and your personal life to be blurred. Learn to detach for the day once working hours are over to spend time with your family and loved ones. 

We also cannot exclude the possibility of experiencing technical difficulties when communicating with our colleagues through online platforms – this creates a need for better understanding and exercising patience with one another. Expecting an instant reply from your co-workers may be more challenging, due to possible time lags from network servers or devices. Others may also be busy handling other tasks at hand, and settling down amidst the new work arrangements. One way to prevent yourself from getting distressed or anxious is to plan ahead. Try creating a plan of action by listing all the tasks you need to complete. Ensure that you have prioritised your tasks wisely, that deadlines are set clearly, and that you have sufficient time to complete them. Allow for buffer time if you are working on certain assignments with other colleagues, so that any delays will not cause you to overshoot your deadlines. 

Last but not least, work aside, always remember to take movement breaks! Such breaks act as a form of self-care, allowing you to recuperate and to free yourself of your burdens momentarily. This may sound trivial, but taking a short walk at the neighbourhood park or doing some stretching exercises in your room will surely benefit your mental health in the long run. Doing so will also help you to return to work refocused and to regain productivity. Likewise, get plenty of sleep and don’t stay up too late! Ensure that you are well-rested and rejuvenated before your work day starts. In light of the current situation, we should still remain positive and not let our worries take over us. Let’s all do our part to support each other in this period!   

__

Bibliography

Protect Your Mental Health During Quarantine (Retrieved 02/04/20)

Coronavirus: Firms which fail to implement telecommuting where possible may face fines, stop-work orders (Retrieved 02/04/20)

Self-care for psychologists during the COVID-19 outbreak (Retrieved 02/04/20)

ONLINE SEX ADDICTION AND RECOVERY SUPPORT

ONLINE SEX ADDICTION AND RECOVERY SUPPORT

ZOOM –  A CRUCIAL ADDICTION RECOVERY AID

Author : Andrew da Roza

With COVID-19 forcing many of us to practice social distancing and to work from home; isolation and the constant access to Internet devices makes staying in recovery from compulsive sexual behaviour a very tall order. 

There are many reasons why COVID-19 is interrupting recovery from sex addiction. Restless, irritability, and discontent will inevitably arise for all of us, when our routines are disrupted – but there is more to it than that for people in recovery for addictions.  

Some will experience acute urges and cravings to act out because:

    • isolating at home, away from colleagues and friends leaves a recovering person lonely, and without the support of recovering others;
    • if they are now living 24 hrs a day with traumatised partners and disrupted families, tensions may reach flashpoints;
    •  some may already be very anxious and depressed, and the additional worry about health and contracting the virus may prove too much;
    • some may have suffered financial problems from their acting out, and may be  dismayed by their financial future, given the impact of COVID-19 is having on savings, jobs and salaries; 
    • they may now repeatedly look at electronic devices for work, COVID-19 news and distraction – and those may be the very devices that caused or exacerbated the problems in the first place;
    • unstructured time will inevitably lead to both the distress of ruminating about the consequences of the present, and the triggers of fantasising about past acting out.

When people are struggling with an addiction, their mind can play tricks on them. COVID-19 can present a series of excuses to put their recovery “on hold”. 

One person in recovery said

“I started to tell my wife that I was looking out for the family when I decided not to attend recovery meetings and therapy. She then asked whether there were other things I could do, that didn’t involve meeting others. 

I told her, pretty emphatically: “no, recovery requires the support of others”. 

Then she Googled and found recovery meetings online by Zoom, Skype, and telephone conference. I was stumped.  I realised that my mind was once again leading me astray. 

I checked with my therapist and found that I could do therapy by Zoom, and he also gave me lots of online recovery videos to watch, information to read, and exercises I could do. 

My sponsor and I now do our recovery work using WhatsApp video. 

Calling my recovery friends and supporters was what I was doing before COVID-19 anyway.    

I found that some of my recovery work, like meditation, prayer and daily gratitude lists is solitary work any way, and that I now have plenty of time to do that – if I chose to.” 

Many people had to finally admit that they could either work hard on their list of excuses – or they could work hard on their recovery – but not both.

One of the greatest problems that people find preventing them from finding and staying in recovery from sex addiction is shame. Online connectivity platforms like  Zoom, WhatsApp and other online social platforms can help with that. 

People feel safer engaging online – which is one step removed from physical interactions.  They feel greater comfort being at being home, in a familiar and secure space. They can also control whether and when they are seen or heard, and they can leave a meeting at any time.  

Partners and family of those in recovery may also feel more assured. Their loved ones are not outside the home visiting triggering locations. They are also demonstrating their commitment to staying the recovery course – virus or no virus.  

Partners and the whole family may also have more opportunity to join in healthy recovery activities – daily meditation, exercise, healthy eating, and good sleep hygiene.  

Being at home gives people in recovery a unique opportunity to initiate family activities like games, puzzles, movie watching, making meals, arts and crafts, walks and swims. In recovery, this is called: “making living amends”, to the loved ones who have been hurt.     

So at this isolating and stressful time, consider individual therapy and the STAR group therapy delivered by Zoom – and remain on the recovery path.  

Helping your child feel safe during the COVID-19 pandemic

Helping your child feel safe during the COVID-19 pandemic

Anxiety and the Covid-19 Pandemic – Ways to Help Your Child Cope

Author : S C Anbarasu, Senior Clinical Psychologist

All children have fears. Most simply complain about their worries and move on. However, there are some whose fears get more intense over time instead of naturally fading away.

The World Health Organization (WHO) officially classified the novel coronavirus, also known as COVID-19, as a pandemic on March 11, 2020.   Children’s responses to such stressful events are unique and varied. Children who are privy to information from a variety of sources can be disappointed, confused, angry, or sad. Some children may be irritable or clingy, while some may regress, and demand more attention, or have difficulty with eating, sleep or self-care.

Amidst the COVID-19 outbreak, it is a given that everyday life will change, and will continue to change for most people. Children may have difficulties adjusting to their routines (e.g., schools and child care closures, home confinement and social distancing), which may interfere with their sense of structure, predictability, and security.

To help your child cope with his/her anxiety around the current COVID-19 situation, the following recommendations can be considered:

  1. Validating your child’s feelings is important. 

For example, if someone in the family is unwell,  acknowledging and validating your child’s concerns, in addition to reassuring them that the affected family member has the best available medical care to manage the illness, is helpful. When you talk to your child or teen, it’s also important to use words and examples that are developmentally appropriate for their maturity.

  1. It is important to help your child maintain a sense of structure if they are needed to be away from school.  

Take a break from social media and the news. Use this time to play with your kids and build an even better parent-child relationship. When it’s safe for them to return to school, be patient while helping them return to their routine so that they can gradually readjust to their normal, everyday activities.

  1. Be a source of stability for your children. 

Children are more likely to be intolerant of uncertainties. This means that children tend to view uncertainties as harmful or overwhelming. As such, they may react with fear and avoid preparing for the unknown. It would be helpful if parents focus on the current facts about the situation instead of predicting.  Predicting and guessing can become a problem at times, as this may cause anxiety to escalate. If you don’t have an answer to your child’s questions, don’t feel like you’re obliged to play the all-knowing parent. Say you don’t know but you’ll try to find out. While teens and young adults are old enough to understand the risks that COVID-19 bring, be careful when talking to others when in the presence of preschool kids as they may potentially scare themselves with misguided misinterpretations.

  1. Children learn better from modeling behaviour. 

Demonstrating how to cough or sneeze into a tissue and discarding it properly,   trying to keep your hands from touching your face, and washing your hands regularly can foster good basic hygiene. When you see your kids practicing good hygiene praise them for it.

  1. In stressful times, when children feel helpless, there’s a tendency to blame others.

If they are seen to blame a certain group of people, for example those who have recently travelled, listen to them and address such concerns in your conversation. Importantly, do ensure that you do not reinforce negative stereotypes in your own conversations or behaviours.

  1. Foster a home environment that allows your children to express their feelings. 

In some families, when one child in the family has a severe mental illness, the other children can sometimes feel left out. Parents need to bear in mind that this can be a hard time for all children in the family; hence, it’s important to let all siblings have the latitude to express their feelings and feel like they can retreat to safe spaces in your home environment.

  1. Children are capable of picking up on their parents’ emotional energy.

In dealing with the situation, it’s also important that you acknowledge and manage your own anxieties so as not to amplify your child’s fears. This is even more important for parents of children who are generally anxious or have significant worries about something.

This current situation of COVID-19 is challenging and new to most of us. As there is no template to rely on to approach this crisis, we’re in the dark about how long this situation will last or when we will be able to return to life as we knew it. Nevertheless, parents and others can help children navigate these uncertain moments by equipping them with the right resources and instilling resilience in them.

Breaking the stigma: Teaching kids how to deal with mental health issues

Breaking the stigma: Teaching kids how to deal with mental health issues

By Tan Su-Lynn

Two days ago, I read an article about mental health in schools, and how the school system was falling short of providing mental health support to students. The article began with an anecdote which illustrated how even teachers, who are charged with spreading good values sometimes behave in ways which hinders progressive movements like the destigmatisation of mental health issues in society. Not only did this teacher discount the legitimate need for psychiatric medication that some people have, he also made off-colour remarks about suicide. Given the increased scrutiny the Singaporean education system has come under, and the fact that it has been an exacerbating factor in the suicides of some children and adolescents, his remarks were remarkably insensitive at best.

Mental health should never be trivialised, and is most definitely not something that is to be joked about. Behaving like that teacher flies in the face of efforts to bring to light the importance of mental health to the functioning of a healthy society, not to mention the lives of people who do have mental health issues. Last year, nominated Member of Parliament Anthea Ong addressed Parliament¹, musing about how Government had called for greater efforts to combat diabetes, when in fact more people were afflicted with a mental disorder than diabetes. The costs that mental health issues impose on our healthcare system is no laughing matter, and the attitude held by that teacher was indeed regrettable.

Talking about mental health in such flippant and cavalier ways detracts from the ability to talk openly about it. There’s no denying that there is still a stigma around mental health. We, as a society, can help to overcome these barriers by speaking out about the importance of mental health, and by leading by example – we should all strive to speak in an open-minded and accepting fashion about it. It is this very stigma that often prevents people from seeking treatment, or worse yet, even recognising that they are suffering from a mental health condition. We don’t see it happening, because we are often unable to live the lives of others, but the stigma often drives people further into isolation, which has harmful effects on their condition.

In the first place, people who struggle with mental health problems often find it hard to open up about their conditions, or talk about it in ways that other people can understand. It’s with great difficulty that they finally get around to reaching out and asking for help, and unfortunately, even these efforts can be rebuffed if people don’t know how to respond. While it’s true that the onus is on people who have mental health conditions to reach out for help, their personal responsibility should be matched by the wider, shared responsibility we have to each other – to look out for one another, and to pay attention to the signs that someone we know may be suffering from a condition. We need to nurture safe spaces, where the topic of mental health is neither trivialised nor discounted. These safe spaces are essential for sharing, listening, and often are indispensable places for people to offer care in a supportive environment.

Apart from families being the ‘caring nucleus’ of a child’s life, the school environment is an invaluable place from which children derive a solid sense of security that produces strong values. The close ties that children forge with their school teachers and peers help to serve as preventive measures against the seeking out of destructive or maladaptive alternatives. Children are made to feel safe, when they can develop the anchors of strong, meaningful connections to groups as they explore and discover the wider world. It’s in these supportive environments that children learn how to trust others, and learn that seeking help from others isn’t a risky proposition. This is exactly why we need to educate people about the dangers of trivialising mental health, which is especially corrosive when school teachers perpetrate such backward attitudes.

Yet other barriers exist. Sometimes, even if the peers of school children with mental health issues are fully supportive, there simply isn’t enough information on how to get their friend the help that they need. This information vacuum detracts from well-meaning efforts, breeding fear and uncertainty about how to offer support.

It’s my belief that the move by the inclusion of mental health to the refreshed Character and Citizenship Education (CCE) curriculum is a highly commendable one. Teaching about empathy and helping skills is a grassroots move that promises to have far-reaching effects in building a resilient and caring society. Inculcating these positive values in impressionable young minds is definitely a step in the right direction, especially when these soft skills form the bedrock of a more inclusive society in which mental health is less stigmatising. On top of these efforts, in 2022 the Ministry of Education wants to bake this movement of inclusivity into the curriculum – creating a structured “peer support” environment where elected student leaders promote mental well-being is a great platform from which we can springboard discussion about thornier mental health issues.

Parents have also pointed out that that access to the internet does raise legitimate concerns about having children ‘misdiagnosing’ or ‘labelling’ themselves inaccurately – the torrent of information that the internet opens children up to also unfortunately raises the potential of false or misleading information. With this in mind, it becomes imperative for the Singapore education system to create structured guidance for students to learn how to identify and recognise the needs of themselves and others.

Even as a parent yourself, the complexity and range of severity of social-emotional/behavioural needs can be bewildering at times. It’s always okay to reach out for comfort and advice if you feel overwhelmed!

¹. https://www.straitstimes.com/politics/make-mental-health-a-national-priority-like-diabetes

Ask A Child Psychologist: S C Anbarasu on Children’s Mental Health

Ask A Child Psychologist: S C Anbarasu on Children’s Mental Health

Senior Clinical Psychologist and child psychologist S C Anbarasu was featured on Yellow Pages Singapore’s Ask A Doctor series, which decided to engage him to answer some questions about children’s mental health issues because of increasing awareness about the effects of Singapore’s education system on their mental well-being.

He answers questions on how to recognise stress in children, Singapore’s education system, child suicide rates here, recommendations on this pressing issue, and more.

Read the full interview on the YP SG website.