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Dear Caregiver, You are not alone in this Circuit Breaker: Anger Management Tips

Dear Caregiver, You are not alone in this Circuit Breaker: Anger Management Tips

by Sharmini Winslow, Psychodramatist / Therapist

 

Anger is a response most of us have when we feel our territory is being threatened. This is a primitive reaction from our days as cavemen (and cavewomen) when a wild animal was nearby! This reaction has not quite been removed by modern civilisation.  When something threatens our security, the brain responds to it with a fight or flight reaction.  The body releases adrenaline which causes changes in the body.  The heart pumps faster, breathing gets faster, blood gets diverted to the legs and arms so we can run or fight back. The blood flow to the reasoning part of the brain is lessened so that thinking becomes difficult. Nowadays there are no saber tooth tigers coming out to attack us which require us to fight or flee.  However the body’s response to a threat remains the same and, unless we find ways to discharge the energy or change our perceptions, the fight response will persist. 

 

Powerless!! That’s the situation most people find themselves in at the moment during this Covid-19 Pandemic Circuit Breaker.  From the home maker, who has to see her family all day long to the child who wants to have his friends over; teenagers who are restricted in their activities with peers to husbands who have to adjust to being at home with no break! Cabin fever is setting in and many are not coping well.  Add to that mix an addiction that is running rampant in the household and you have a powder keg ready to blow!!! 

 

What can family members do at this time to stay sane and not get embroiled in another power struggle or argument with the addict in the house.  Anger that luxury during normal times is just magnified as all of us are forced to Stay Home. A simple request turns into a huge event; an innocent comment gets misinterpreted; and even demonstrations of concern become fuel for accusations of being manipulative or controlling. What to do??

 

Most family members of addicts or dysfunctional families (most of us can attest to being in this category),  have resorted for a while now to manage, manoeuvre, save or guilt trip.  This comes from a place of love and fear. However having time apart has always been a great diffuser of tension.  Now faced with a Stay Home situation things can get stressful. Once free to go out, meet friends, go to the gym and pursue our life goals, we find ourselves having to don a mask and stay six feet away from each other, with frequent temperature checks thrown in!  Yes we know it’s for our own good but just how do we go about removing that sense of irritation or frustration?? What’s wrong with me?  I never used to get SO upset?? Being stuck at home we ‘step on the toes’ of others or they inadvertently step on ours. 

 

So here are some possible ways to cope…..

 

1. Walk away and discharge the energy

Going for a walk, or a run and getting away from the source or trigger for our anger is one option.  Moving away and giving vent to the energy is what we need to do.  Digging in the garden, washing dishes, scrubbing the bathroom tiles or polishing the furniture is a great outlet for this energy. Shredding newspaper is another excellent technique.  After which you could turn the strips into Papier Mache pulp and create an art project.  One woman wrote that she would pull out weeds and imagine she was pulling out her husband’s hair! This is called Detaching.

 

2. Practice Deep Breathing and Self soothing

This taking in of deep breaths, helps bring more oxygen into the body and to the brain.  Especially important is the frontal cortex where our reasoning happens. Improved brain function helps restore some calmer thinking. Follow this up with doing something good for yourself such as listening to some music you like, dancing, playing a game on your phone, doing a craft or even having a nap. Seld care is important when you have to deal with a loved one suffering from an addiction.  We often say, “Put on your own oxygen mask before you attend to others.”

 

3. How Important Is It? 

Ask yourself this question.  After walking away and breathing for a bit, consider how the event figures in the larger scheme of things. Does this event require action right now or can it wait? Do I need to say what’s on my mind right now or can I pause and say it later.  Often I ask myself these questions- Does it need to be said? Does it need to be said by me? Does it need to be said by me now?? By the time ive asked myself these questions, my good sense would have returned and I can leave it for another time.

 

4. Respond not react

After calming down, consider a way to communicate which is kind and thoughtful. Say what you mean, mean what you say, but don’t say it mean. I’ve heard this said by someone- “Try to say it in ten words or less!”  Haha! Most of us have communication patterns that escalate tension! So, try this for a change.

 

Another great tool is the acronym – T.H.I.N.K.  Before I speak I need to THINK. 

Is what I’m saying Thoughtful, Honest, Intelligent, Necessary or Kind. If not take a piece of Masking tape and place it nearby.  This helps as a reminder to keep my mouth shut.  

 

When all else fails, go talk to someone you trust and let it out. A friend in need is a friend indeed.  Or seek one of many support groups or counsellors to help you cope. Whatever the case, we are all in this together! So don’t suffer alone. There are many helplines and people available to support you such as the ones listed below. 

 

    

Auteurs, thespians, and emotions. Except it’s all truly heartfelt. Psychodrama!

Auteurs, thespians, and emotions. Except it’s all truly heartfelt. Psychodrama!

Written by an anonymous contributor

I am a self-confessed introvert. And I’m also an addict.

I was recently cajoled into attending a Psychodrama session. I’d heard things about it – years earlier, my then significant other lauded the raw emotional exploration her sessions afforded her. I encouraged her, it was good for her. Personally though, I found the idea of a group session’s ability to evoke genuine emotion alien. It was the antithesis of who I was.

I had never enjoyed group sessions. I hated them. The introvert in me screamed (silently) in indignation at being forced into a room with my peers, lorded over by therapists who would extol the heaven-sent power of vulnerability, hanging it over the heads of us sullen detainees. They would espouse connectedness with others, openness. To me, these were just unattainable states of being that I could never actualise. The years wore on, and I plodded along, entwined with my precious, thorny, addictions. Prison, pricey rehabs abroad. I took care to never bring my real self along to the banal group therapies – I merely presented them with an alter-ego. Faking it to get along. Or “faking it to make it”, in the parlance of addicts like myself who would say or do anything to achieve a discharge.

I was living an entirely unremarkable life, losing friends and embarrassing myself.

Then, I experienced a seismic shift in circumstances. To represent it as merely ‘mandated’ would be to deny gravity to what had happened. I had run afoul of the law again, and paid my penance with a 9 month long “drug rehab”. I got out, and three months later I was a year clean. Still, I wasn’t happy. I had done no soul searching, nor had I even begun to scratch the surface of my addiction, always lurking in the shadows. Of course, a large part of my reticence towards accepting sincere nudges in the direction of help could be attributed to personal and moral failings. But why was I the person that I was? That’s when I decided to attend a psychodrama workshop at the urgings of my boss, a sweet girl whose genuine concern had initially confounded me. Why did I acquiesce? To understand myself, I guess. So, I went in with an open mind.

Psychodrama is about exploring internal conflicts, by acting out emotions and interpersonal interactions. I wasn’t inclined to be the center of attention just yet, so I left other enthusiastic participants to play the protagonists. The director, a bubbly personality whose sharp wit was tempered by insightful, genuine empathy, herded a roomful of clueless attendees with a deft hand, schooling us in psychodrama’s basic concepts. I made myself small in the corner and watched as our director doubled volunteers, acting out scenes from their lives, giving voice to their unconscious. Revelatory perspicacity was the order of these moments. I watched as they were mirrored, experiencing themselves from the outside, drawing from a nonjudgmental pool of collective consciousness. I watched as roles reversed – mothers became their daughters, and wives their husbands. All of them seemed edified, comforted, even. Misty eyes and rivulet strewn faces, sighing into closures when none previously seemed possible. There was a woman pained by a frightful trauma, her repressed malefaction she seemed so sure she had committed driving her to seek expiation from whom had ceased to be able to give her any. From the outside looking in, I was sure her wound was self-inflicted – we all knew this, but one’s own guilt is deeply personal, often insidious. As her situation percolated in my mind, so did my own guilt. I hadn’t wept when I learned of my father’s and sister’s departures, I hadn’t wept at their funerals, I hadn’t wept at their memorials. I hadn’t needed to, because I had my addiction. Now, without the pernicious warmth of substances, these losses became some therapeutic cynosure of a starting point. I had begun to understand myself, through others. The cynic in me finally realised why, across addiction recovery literature, syllabuses are almost invariably characterised by the motif of benefits accrued by group therapy. I think it owes something to the collective experience of humanity, that no matter your guilt or your shame, there are people out there who have lived congruent experiences. It may seem cloying and mawkish for me to say that no-one is truly alone, but it’s true.

You just have to look in the right places.

 

 

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 andrew@promises.com.sg or by calling the Promises Healthcare clinic at: (+65) 6397 7309 

 

   

 

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.  

Dual Diagnosis: Anxiety and Substance Use Disorder

Dual Diagnosis: Anxiety and Substance Use Disorder

Anxiety, stress, and fear are common emotions people experience through the course of everyday life.  Anxiety disorders, on the other hand, go beyond our daily worries and fears. Stress and pressure is subjective to each person – anxiety disorders can induce heavy stress and pressure, and these feelings can become more intense over time. Issues that crop up for anxiety disorder sufferers range from anodyne to hair-raising. For example, some people are terrified of meeting new people and having to interact with strangers, while others suffer panic attacks when memories of past traumas surface. The most common types of anxiety disorders are diagnosed as:

  • Panic Disorder (PD)
  • Generalised Anxiety Disorder (GAD)
  • Social Anxiety Disorder (Social Phobia)
  • Agoraphobia (Perception of certain environments as unsafe, with no easy escape)
  • Obsessive Compulsive Disorder (OCD)
  • Post Traumatic Stress Disorder (PTSD)

Not only are there psychological symptoms, people dealing with anxiety disorders may also experience a litany of physical symptoms such as insomnia; inability to concentrate or relax; heart palpitations; gastroenterological issues; and sexual frustration, among others. When all these problems start impinging on one’s behaviour, mood and thoughts, life can start to feel like a slog through quicksand. A once “normal life” now appears out of reach, and getting there again can feel like a Sisyphean task.

What makes people suffering from an anxiety disorder seek out substances?

It’s important to understand a little more about addiction before dealing with this question. Addiction is indubitably a very uncomfortable disorder, and that’s characterising it mildly. For a “preference” to devolve into full blown addiction, a person must keep making the same conscious decisions every day, day after day, that facilitate  indulgence in his or her vice – in spite of a mounting cornucopia of problems. Maintaining an addiction certainly is tiresome. People suffering from addiction make these choices because their addiction serves them a purpose. Concomitant discomfort is tolerated in light of perceived benefits garnered from substance abuse.

A parsimonious way to think about addiction is to assume that it is a simple cost-benefit analysis. For someone struggling with an anxiety disorder, the allure of a “quick-fix” in the form of a suitable drug or drink is hard to ignore. What may begin as a misguided attempt to ameliorate paralysing fear can eventually develop into a fully-fledged addiction. With this in mind, it is now a lot clearer why substance use disorder (SUD) is a co-occurring psychiatric disorder that is one of the most prevalent among people with an anxiety disorder. The most recent and largest comorbidity study to date (with over 43,000 participants), the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), found that 17.7% of respondents with an addiction problem also had an anxiety disorder.

Ironically, the problem with the “solution” of substance abuse is that the ”solution” hurts more than helps. It can often exacerbate the anxiety disorder – which becomes ensnared in the convoluted mess that is addiction. Thus comes the slippery slope of anxiety, substance use, and elevated tolerance.

Chronic dependence is the likely consequence of this chain of events. For example, a person who suffers from social phobia might employ stimulants or anxiolytics to engender artificial confidence during a social situation. This can feel liberating, exhilarating, even, for someone who has spent a lifetime on the sidelines. The folly in this endeavour lies in the eventual normalising of this ‘chemically induced courage’ – if you turn it into a precondition to interacting with other human beings, you will only succeed in erecting progressively more imposing barriers in a completely self-defeating, tautological situation.

Are there psychotherapies out there that treat anxiety and addiction together?

Diagnosing a mental disorder in a person who also suffers from an addiction is challenging.

It may be hard to determine which came first, the addiction or the anxiety/depression. A clinical history, which is triangulated with loved ones, teachers and others may assist to know which came first. In any case, both the addiction and the disorders have to be treated at the same time. Otherwise, if untreated, the anxiety and depression may lead to the resumption of drug or alcohol use.  Cognitive behavioural therapies (CBT), meditation and mindfulness therapies, experiential therapies and medication can assist to address both compulsive behaviour and anxiety and depressive disorders.

A trained and experienced mental health professional can help you navigate your addiction recovery journey to ensure that you get the best possible outcome within the guidelines of your values and needs. While this article is about substance addiction, you will find that our team of psychiatrists, psychologists and therapists have the expertise and experience to work with a variety of addictions, and mental health issues such as anxiety disorders.

Defeating Shame with Group Therapy for Sex Addiction

Defeating Shame with Group Therapy for Sex Addiction

The Paradox of Getting Started

Attending group therapy for compulsive sexual behaviours (sex addiction) is commonly very difficult.

The fear and shame associated with the compulsion, and the desire to hide and minimise the behaviour subsumes a person’s thoughts. This drowns their motivation to attend. Procrastination or an outright rejection of the benefits of therapy group becomes inevitable.

Ironically, it is the benefits of group therapy that would motivate a person to attend in the first place. But they not be willing to attend unless they get these benefits first.

A chicken and egg conundrum.

 

The Benefits of Group Therapy – Shame Busting

One of the main benefits is group therapy’s ability to “bust” shame and fear.  The same shame and fear that prevented the person from attending.

It is in a group environment of compassion, kindness and lack of judgment, that a person can find the courage to face their reality, and gain hope and purpose in their recovery.

In group, people discover that they are not alone in their secret thoughts, urges and cravings – and that they are not uniquely “broken”. It lifts the impossibly heavy weight of secrecy, lies and half-truths, that people carry – often for years.

They also find out that others – very much like them – have found a way to start a journey to change their behaviour, beliefs and feelings.

 

Sexual Compulsivity is an Issue of Intimacy

At its roots, sexual compulsivity is an issue of intimate relationships. Group therapy is therefore a uniquely effective way to learn how to build healthy relationships.

Having and maintaining personal boundaries and respecting the boundaries of others, is a skill set that can best be learned, and safely experimented with, in a group. Effective communication and emotion management are also learned skills – and a group of peers is the best place to practice them.    

Simply by interacting with someone struggling in similar ways, learning from them – and, in turn, helping them – enables recovery to bloom.

 

Group Therapy and Self Knowledge

One aspect of sexual compulsive behaviour is the struggle with self-knowledge.

A person struggling with compulsivity may common to ask: what motivates my behaviour; why this particular behaviour; why is volition and control so hard; why can’t I learn from my experience; how did I get my calculation of the risks so wrong?

In group therapy, we also ask: what needs is this behaviour really serving; is it really satisfying my longer-term needs; what is the price I am “paying” for dealing with my needs in this way; are there other ways to meet those needs at the “right price”; and what else can I do to meet my needs?

 

The “Mirror” of the Group members

By exploring these questions together in a safe space, a group can feedback their observations of each other’s journeys – and pool their collective wisdom.

Having a “mirror” of four to six people, reflecting back their experiences of who a person is, enables that person to truly see themselves as they are – perhaps for the first time.

 

Group Therapy – the Safe Space Rules

To create a safe space, the group therapy the rules are made clear.

Confidentiality is paramount. Further, members are encouraged to talk about themselves and their perspectives, and not assume or impose things on others.

Advice is offered only if expressly requested. Comments are positive and constructive; and a person’s strengths and skills are celebrated.

 

The Outcomes of Group Therapy

With the dark pall of shame lifted – what other outcomes can be expected from group therapy?

The benefits are many. Self-awareness, self-esteem, honesty, skilful management of relationships, emotions and communications – and greater motivation to stay the recovery course. 

Ultimately, not only does behaviour change, but so do perspectives and desires.

Needs are better understood and met. Purpose and meaning in life return – and having a full life becomes a probability –  not  just something other lucky people have. 

 

If you’re interested to start your CSBD group therapy journey, with a safe, non-judgmental and connected space for peer support and learning, you may want to consider writing in to clinic@promises.com.sg to be a part of our  Sex Therapy And Recovery (S.T.A.R.) program facilitated by Andrew da Roza.