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Managing Grief

Managing Grief

There isn’t consensus in the scientific community about whether Kubler-Ross’ five stages of grief is rooted in empiricism. Although much vaunted in popular culture, if you’ve experienced grief and resolved it in your own way, you’ll know that grief is an organic process that is by no means neat or orderly. It’s deeply unique to each individual, and this article is designed to hopefully help you through whatever loss you have experienced in the recent past.

The five stages of grief, which Kubler-Ross first postulated that terminally ill patients experience are: Denial, Anger, Bargaining, Depression and Acceptance. Denial in this context encapsulates a perfectly normal response to a tragedy, and is exactly what you would imagine – it’s simply a refusal to believe that “this bad thing is happening to me”. After reality sets in, and the sobering realisation that the tragedy has occurred is impossible to ignore, Kubler-Ross observed that people often display frustration, which culminates in Anger. Once that Anger has dissipated, people often move on to Bargaining, which is the hope that they can somehow extricate themselves from their dire straits and obtain the balm of a different circumstance. Notwithstanding the success of the earlier bargain, Depression follows, which is self-explanatory. The final stage of Acceptance is the sanguine realisation that nothing will change their situation.

If you are currently going through your own grief and taken a step back to evaluate how you are processing it, you might have noticed some incongruencies between the model and your experience. That’s perfectly natural because there has been some criticism levelled at the Kubler-Ross model in that there is confusion over description and prescription. This means you shouldn’t take it as a rule, no, or feel inadequate or “bad” that you aren’t “properly” grieving. We hope that what follows in this article will provide you with some breathing room to let your grief take its own course, and helps you handle a tragedy with the right tools.

Grief is a loss. It’s your prerogative to define what grief is to you, and even something as banal as losing a cherished item from your childhood can precipitate feelings of loss. So, you shouldn’t wall up these feelings behind what society has proscribed as appropriate. We’re talking about you here, not anyone else. It bears repeating that your grief is unique because of a multitude of factors, for those of you who don’t want to accept that it is your right to give yourself the breadth to grieve – your upbringing, your culture, your faith, your parents, the list is endless. So give pause and slip into your own rhythm of grieving.

To help ensure that you do not slip into the common fallacies that can disrupt your grieving process, we’re going to list some of the pitfalls that ensnare people and prevent therapeutic processing of grief. 

1) If you don’t show an outward display of grief such as crying, you aren’t “sad”

Just like the shortcomings of Kubler-Ross’ model, while crying is seen as a “socially acceptable” way of demonstrating sadness, it isn’t applicable to everyone. You may have been brought up to avoid tears at all costs, perhaps due to tough parenting or some childhood trauma, or you may not wish to “affect” others with your grief. No matter the reason, you should know that physiological responses to grief vary widely depending on your circumstances. Shock, numbness, anger, even hysterical laughter – just about anything is permissible in the initial, very private stages of your grief. 

2) If you don’t “get over it” within an “acceptable timeframe”, you aren’t good enough

Although your family members or people in your community may react to and resolve their grief earlier than you, you need to know that it is by no means healthy to affect the fragility of such a process by introducing the pressures of comparison. Some people simply have better coping-skills than others or are more inured to unhealthy thought processes that hold them back from the therapeutic management of their grief.

3) You feel like you need to “protect” loved ones from your grief, so you turn inwards

We keep emphasizing that grief is individual to everyone – this should tell you that there is no circumscription to how you handle it. Even though it might feel selfish to display your feelings openly because you think less emotionally able loved ones shouldn’t have to deal with your pain, remember that there is nothing shameful about the old adage, “Shared joy is double, shared sorrow is halved”. 

There are some simple coping mechanisms that you can use to help yourself through the process. Although the low mood is a given after the heartache of a tragedy or loss, and you might not feel willing or able to pick yourself up and carry on, remind yourself of the wisdom of eating and sleeping right. Drugs and drink might seem the most accessible ways to insulate yourself from poor mood, but these indulgences, in the long run, are hindrances to sustaining your mental well-being.

If you feel like the person you have lost needs to be remembered, you can do so in the solitude of creative expression, or you can choose to gather loved ones to laugh about cherished memories. If there’s one scenario where laughter in the face of loss is wholly acceptable – here it is! Whether communal or solitary, there are many ways you can raise someone up in loving memory – honouring them and helping yourselves. 

Find solace in your old routines. If you’re hurting after the failure to gain acceptance into a school of your choice, it may help to remember all the things you did well before that gave your life meaning and structure. At the worst of times, it helps to fall back on old patterns if only to hang on to some stability.

Lastly, know that there is a difference between clinical depression and the normal response to grief. You should be aware of critical signs or symptoms in both yourself and your loved ones that may indicate depression. For example, if you notice that your loved one isn’t eating or sleeping properly after a long period of time, or is displaying reckless tendencies such as driving dangerously or overindulgence in addictions, it may be time to seek professional help. Although many people can get through grief without the help of a mental health professional, when it all gets too heavy to handle, you may consider seeking grief therapy. Some of our clinicians are specifically trained in grief therapy, such as Joachim Lee or Winifred Ling.

 


Photo by Claudia Wolff on Unsplash

Mental Health Awareness Panel Discussion feat. Dr Rajesh Jacob & S C Anbarasu

Mental Health Awareness Panel Discussion feat. Dr Rajesh Jacob & S C Anbarasu

On May 16th 2020, Dr Rajesh Jacob, Senior Consultant Psychiatrist & S C Anbarasu, Senior Clinical Psychologist, were invited to be a part of a Public Education Talk: ‘Mental Health Awareness Panel Discussion’ by the ‘Migrant Workers Singapore’  group – a migrant workers community platform.

The discussion touched on a wide range of Mental Health conditions that they are concerned over; explained what they are and how one could cope or be a support.

We encourage you to hit the ‘play’ button to view the video.

 

Mental Health Awareness Panel Discussion

So if you feel anxious, depressed, stressed, or even suicidal? What can you do? Too many people suffer in silence and don’t seek help! Come join a conversation about mental health issues! Our experienced panel will consist of mental health professionals from various disciplines, a Senior Consultant Psychiatrist, Senior Clinical Psychologist from Promises Healthcare Clinic, and an Assistant Head of a Family Service Centre! The panel will be moderated by Casework Manager of SG Accident Help Jevon Ng, an advocate for mental health and wellbeing. Our panel members all have a lived experience of mental health and will be answering questions from the audience.audience participation is encouraged. Please click the link below to join the webinar: https://us02web.zoom.us/j/83397902082Date: Saturday, May 16 2020Time: 4:30 pm – 6:30 pmEvent Categories: Raise Awareness Organizer@Migrant workers Singapore Support by SGcare Physiotherapy Clinic

Posted by Migrant Workers Singapore on Saturday, 16 May 2020

An Interview With Dr. Mark Toh – Coping with Video-Conferencing Fatigue 

An Interview With Dr. Mark Toh – Coping with Video-Conferencing Fatigue 

Dr Mark Toh is a Consultant Clinical Psychologist @ Promise Healthcare.

Is there a reason why these virtual meetings are so exhausting? How is video calling different from face-to-face meetings in terms of mental load?

There have been many changes placed on us as a result of the government’s attempts to create social distancing between one another in response to the threat of COVID-19 in Singapore. For the employed, perhaps the most significant change involves having to work at home instead of working out of our regular workplaces away from home. Accordingly, the necessary attempts to communicate at work have now to be moved online since face-to-face meetings at work have been prevented. The result of having to conduct our regular conversations and discussions previously in the workplace to the online format means that facing the laptop to attend to vocational as well as social in one location becomes the common practice instead. There are certain characteristics of this practice which leaves users of video-conferencing fatigued: 

(a) Previously at a regular meeting often at a conference site, the meetings carry a bigger social bearing. At a virtual meeting, this social bearing is reduced to what is visible only on a screen. Instead of the opportunity to scan the room previously which allows our eyes to adjust and therefore cope with eye strain, virtual meetings mean our gaze is now focused only on what is confined within this screen. We have to stare at this screen and then process everything we hear or see often over a protracted period within a certain frame. As a result, there can be visual overload and mental strain.

(b) Virtual meetings also require more effort than face-to-face meetings. We have to work harder to process non-verbal cues such as facial expressions, the tone and pitch of the voice, and body language. In contrast to face-to-face encounters, virtual meetings require more effort to assess social and personal meaning because of the context. According to Dr Gianpiero Petriglieri, an associate professor of Organizational Behavior at INSEAD, there is a dissonance that emerges during virtual meetings because during this interaction between participants in this format, “our minds are together when our bodies feel we’re not.” This dissonance or disconnection causes people to have conflicting feelings which add to the fatigue. This makes it difficult for people to relax into the conversation naturally. 

(c) Dr Marissa Shuffler, an associate professor of industrial/organizational psychology also describes the fatigue that can come from being watched because the camera is physically and constantly focused on us. In natural social settings, this does not happen. During virtual meetings, people can feel they are on stage and therefore, they feel the social pressure and are expected to perform. The larger the group, the stronger the pressure.

(d) There is also the stress that comes from delays on phone or conferencing systems or when the screen freezes. Glitches in the application of technology put pressure for the participants to ensure that relevant or significant information is not missed out, or to avoid misunderstanding information from what has been communicated. This becomes harder to slow down to clarify when there is a group meeting out of concern that questions could be seen as interference within a tenuous electronic connection.

(e) Visual overload and fatigue that comes from constant online viewing occur not only if meetings are long or frequent with its inherent stresses. The restriction to home has also placed reliance on engaging other activities online, eg. taking classes, ordering food, maintaining social connections outside the immediate family. If there is a practice of over-reliance on the computer screen to attend to other interests, the physical effort to position ourselves at a prolonged period in front of this screen can also create fatigue.  

(f) The strain that comes from virtual meetings can be accumulative when meetings are arranged close to one another. Since the worker is already confined at home, virtual meetings can easily be scheduled one after another. The meetings can appear to be executed efficiently. But there may not be any mental breaks in between.  

(g) Dr Petriglieri also noted that meeting online creates stress from being reminded that the familiar context has been disrupted by the pandemic. We are all coping within a crisis that has taken the lives of the elderly and the vulnerable in society and endangers our well-being. It is also stressful in the fact that we are used to separating different relationships such as family, friends or colleagues. But now they are all happening within the same space. The self-complexity theory posits that individuals have multiple aspects about themselves –context-dependent social roles, relationships, activities and goals–and we find this healthy. When we find this variety reduced, we become disoriented and become more vulnerable to negative feelings. Over a prolonged period of the self-quarantine, he notes the effect: “We are confined in our own space, in the context of a very anxiety-provoking crisis, and our only space for interaction is a computer window.” 

How do you alleviate the exhaustion that comes with virtual meetings? Are you able to share a few tips or suggestions?  

In light of the stresses and strains of increased virtual meetings as outlined, I would suggest the following:

(a) limit the video calls to only what is necessary; this implies that it is important to take breaks from electronic devices, in general, to avoid over-reliance on them and the subsequent emotional effects from excessive use,

(b) allow for the option to turn off cameras on yourself to be involved and/or face the screen off to one side so that you can concentrate without feeling the pressure to be on camera,

(c) plan breaks in between virtual meetings so that the body and mind have a chance for a break, eg. getting the body to move and stretch increases blood flow and reduce mental fatigue,

(d) if virtual meetings are unavoidable and long, learn to practice the 20-20-20 rule: every 20 minutes, takes 20 seconds to look at something 20 feet away. Remember that the electronic devices are our tools and not our master. 

 

What can bosses or organizers of these meetings do to facilitate these meetings so people don’t leave the meetings feeling exhausted? (While taking into consideration, the time spent on these meetings, or the feelings of the attendees)

It may help to start the meeting by quickly checking in to each other’s well-being. Being ready to acknowledge that the virtual meetings are unusual and that working at home means having to accommodate other family members inconvenienced by the pandemic invites everyone to be mindful about coping collectively with the current disruption. Secondly, consider if virtual meetings are the best way to work. To prevent information overload, would sharing files be more effective? Or the use of the phone to communicate may be a better device in many cases if there is only simple information to share. Thirdly, it may help if the meeting agenda is clearly defined and the end of the meeting is outlined at the start to reduce mental fatigue. Can the meetings be brief knowing that other meetings may be required? If meetings are prolonged, plan for breaks.

 

What can attendees/employees do to reduce the number of hours spent on video calls? (for example, what they can say to their bosses, or to keep track of the time so everyone is on track)

There needs to be increased education all around related to this topic of fatigue that comes from increased video-conferencing. It is a condition exacerbated by changes at work because of the pandemic. Employees should know their limits. If they recognize when fatigue sets in from excessive computer use, they should limit themselves from relying on their electronic gadgets throughout the day. Research has already shown that excessive computer use is correlated with depression. With more apps available online, there is an increased potential to become more dependent on electronic devices already. During this pandemic, the pressure to depend on the computer through increased virtual meetings is intensified. It is times like this when the wise among us would learn to separate the benefits of computer use from its downsides.

In light of this knowledge, employees can be more proactive to define the perimeters in which they would like to have virtual meetings conducted. If they recognize when fatigue will set in because of prolonged virtual meetings, they can ask to clarify (or specify) to their managers how long the meetings will take to monitor their mental and physical strain. In cases when prolonged virtual meetings are unavoidable, they can clarify if permission can be given to practice adjustments such as moving around as a way of coping with eye strain or from limited mobility experienced during the meetings, avoid the direct exposure to the camera, mute the calls to focus on listening or take breaks after every hour. At times, a person may have to prepare for any interference from young children who find it hard to ignore the presence of the parent at home.  

 

How do we instil positivity in our working lives, when the line between work and home is so blurred right now?

The pandemic and the subsequent quarantine is experienced as a period of adversity to some people. The emotional distress that comes from being quarantined has been recognized as common during this period. Common symptoms of this distress include fear, sadness, numbness, insomnia, confusion, anger, stress, irritability, post-traumatic stress symptoms, depressive symptoms, low mood, emotional exhaustion and emotional disturbance (eg. paranoia, anxiety). More specifically, people are faced with the disruption to the routines they have set up to cope with their stressors before the imposition of the quarantine. Distress is experienced because of the effect of the disruption on their autonomy, their sense of competence (being in charge of their lives to cope with their lives), their connectedness and their sense of security. It is a test on our resilience and ability to cope.

At the same time, the very challenge of this situation also provides us with the opportunity to develop our resilience. The first step is to understand and remember that these circumstances are temporary and not permanent. Pandemics happen but they are not frequent in history. Secondly, realize that there is a way to cope with the circumstances. As such, coping with this current situation is priority. I would suggest the following:

(a) Establish a routine for yourself (and that of your children). By creating a structure to attend to work and recreation, you start to organize and occupy yourself with addressing your daily needs as well as that of your family.

(b) Be as active as possible to maintain a fitness level physically, mentally and relationally for yourself and with your family. This also helps to battle against boredom. There are exercise videos online which you and your children can participate together to exercise as well as bond together. Also, for a personal project, you can ask yourself, “What will it take for me to become physically and mentally and relationally stronger as a result of this crisis?” Be curious about how to grow your resilience and to nurture the best version of yourself. Or as a parent, create a project to help your child develop resilience in their own lives and ask, “How can I help my children become physically, mentally or relationally stronger as a result of this crisis?”

(c) Deal with boredom by creating projects that self-nurture, eg. start a hobby or clean out your closet. Competing personal tasks provide a sense of purpose and maintain a sense of competency despite the external circumstances. Creating plans daily offer a focus on accomplishing what is important to your well-being.

(d) Communicate more to avoid isolation as well as cope with boredom. This can be an opportunity to nurture relationships if you are in quarantine with family and to strengthen social bonds with them, or with your support group. Remember that kids may be stressed too from this experience. More time together can provide opportunities for increased play to increase bonding. Games are useful means to bring fun into your relationships and to develop socially besides your entertainment. It can also become a reminder that the family is safe and coping together.

(e) Be informed without being overwhelmed to cope with the anxiety that comes from the unknown. The Straits Times newspaper provide a useful daily update so that you can monitor the threat of the virus rather than obtaining information from cable news. There is much information on the virus today locally and globally so be careful not to become obsessed with the topic.

(f) If you find that your distress is becoming more intense, consider support for your mental health. Your mental health is very important for your daily and long-term functioning. Different places may offer telehealth support where you can consult a therapist or mental health professional. Some services are available online and they can be reached through email, phone calls, texts or video calls.

 


Photo by Gabriel Benois on Unsplash

Confinement (Circuit Breaker) Emergence and Mental Health: Be Kind To Yourself

Confinement (Circuit Breaker) Emergence and Mental Health: Be Kind To Yourself

Written by: Andrew da Roza, Psychotherapist, Promises Healthcare

As the COVID-19 confinement continues, you may have a nagging question on your mind – “what have I managed to achieve”?

Tidy, clean desk draws, closets, and glove compartments; a surprising proficiency in a new language; the final 100 pages of War and Peace; an impressive yoga position; a dazzling new magic trick?

Several weeks into the confinement in Singapore and with several weeks to go before we can be physically social with our friends, some of us may be deflated. 

When the confinement/circuit breaker started, we may have vowed to use all the new free time to do things we have never got around to doing. 

Now that time is gradually slipping by – we may think that we still haven’t accomplished our goals.

As a psychotherapist, I listen to many people starting to stress that this opportunity of more time isn’t panning out the way they imagined – and that critical voice in their heads is telling them they are inadequate and unworthy.

Feeling Stuck in Shame 

What I hear is the frustration of “stuckness.”   

Clients tell me: –

  • I must be more productive 
  • I should have achieved more since confinement began
  • I should be able to concentrate more and procrastinate less
  • I must have more enthusiasm, motivation and energy

Note the use of the words “should” and “must”. Our inner critic loves to remind us of all the things we should have done or must do.  

It is important to be compassionate to ourselves and banish these words from our vocabulary – at least for the time being.

We may have overestimated what we could achieve in confinement; and underestimated the power of the inner critic, worry and low mood. These are preventing us from feeling satisfied with what is. 

Perhaps we had the fond notion that confinement would be like a holiday – more rest, more family time, novel and interesting things to do, and relief from work and the other routines in life.

Reality may now be striking home. Anxiety about our jobs, income, and savings; fear about us and our loved ones contracting the virus; worry that food, masks, and other resources may be scarce; boredom at a routine in the cramped confines of home; the resurrection or development of old family dynamics, fraught with irritations, frustrations, disappointment, mistrust and anger. For some, isolation and loneliness may be an even more crushing weight.             

Reframing our Expectations

What will help is kindness – and, in particular, kindness to ourselves. 

Perhaps some of us are high achievers, driven by: concrete stretch goals, targets and objectives; KPIs; reports; numbers; test or exam scores. 

But COVID-19 confinement is not the time to measure yourself in this way. It’s like drinking soup with chopsticks – frustrating.

I recommend that we redefine productivity and measure our day by whether:

  • we have achieved an emotional connection with ourselves and others, 
  • ate healthily, 
  • slept well, 
  • got some exercise, 
  • meditated for a few minutes, 
  • did some yoga or Tai Chi, 
  • walked outside, 
  • read something (other than COVID-19 news or social media content); 
  • did something creative, like photography, videos, painting, made some music, baked something new; and 
  • spent “me time” – just sitting quietly, relaxing and enjoying being in the moment. 

 

This confinement is not a competition – so we do not need to compare ourselves against others. 

We must permit ourselves some numbing out to Netflix and videos – and not beat ourselves up if we eat some chocolate, cookies or chips. 

Let’s also be realistic and recognise that our routines will be different – and that we won’t accomplish the same things in confinement. We will have accomplished things – but they just won’t be the usual things.

Manage your expectations, be gentle with yourself and kind to others – and you will find that there is meaning and purpose to your confinement.   

 


Photo by Paolo Bendandi on Unsplash

I Don’t Know How to Slay My HBL (Home Based Learning) Stress Giant, or Do I?

I Don’t Know How to Slay My HBL (Home Based Learning) Stress Giant, or Do I?

The COVID-19 pandemic has caused many usual activities to be disrupted – apart from most adults having to work from home, the majority of students are also left with no choice but to do home-based learning (HBL). This leaves them cooped up at home with less face-to-face social interaction with their peers and teachers, and most importantly, this may have heightened their stress levels with regards to their academic performances. Considering that some students will most likely have to bear with HBL for quite some time, they will need to ensure that they are keeping themselves mentally healthy. In any case, having to deal with burnout is certainly undesirable, and learning how to handle their stress is crucial.

 

Youths dealing with HBL often have many things to stress over – from struggling with technical issues to the lack of discipline over one’s assignments and time management. They may tend to procrastinate more, which is unsurprising considering that they may be studying from the comforts of their bed. For the more studious ones, HBL may pose a challenge since it may be difficult for them to receive immediate feedback and guidance from their teachers. With such factors contributing to their stress levels, these youths may be burnt out even before HBL ends. If you are one of these troubled students struggling with HBL and study stress, here are some tips to help you get through the difficult times and to help you cope better. 

 

Firstly, consider if you are allocating time for exercise in your weekly routine. Are you getting the exercise you need after your online classes? It is a well-known fact that exercising and staying fit can do wonders for your mental acuity, and can help lift your spirits through the release of endorphins, which act as “feel-good hormones”. Setting aside time to keep active will certainly benefit you in more ways than one – both physically and mentally.  In addition to exercise, it is an added bonus if you pay more attention to your diet. Eating more brain foods will help you concentrate and absorb information better, hence translating into greater productivity as well as improved quality of work. 

 

Now that there isn’t a need to attend school physically (at least for some students), there is a high chance that you no longer pack and organise your study materials. Moreover, your study space is most likely cluttered with notes, stationery and various other personal belongings. Take this chance to tidy up your workspace whenever you can – be it once you are done for the day or before you start. Excessive clutter can cause unnecessary stress as well as the loss of productivity, especially if you have to spend additional time looking for your relevant study materials or other lost items. Needless to say, over time, this will have a negative impact on your grades. In order to eliminate such potential causes of stress, try to make a conscious effort to tidy your study area often. Having a minimalistic workspace with only the essential items will definitely reduce distractions and allow you to concentrate better. For those who share a space with other family members, cutting down on excessive clutter will also help to keep familial relationships positive, for they will no longer have to bear with an unorganised environment, possibly resulting in less frustration and conflict. Having said this, start tidying up and you will come to realise that it is worth the effort.  

 

Are you someone who lacks self-discipline? Most students find themselves facing this problem, especially with many more sources of distraction while at home. Some may tend to procrastinate and end up not having sufficient time to complete their tasks. Their poor time management thus leads to heightened stress levels, particularly when deadlines are nearing. The best tip we can offer is to start off with a list of all the tasks you need to complete. Create your own calendar or a to-do list, and work backwards from all your deadlines. Allocate enough buffer time to ensure that you can complete your assignments before the due date. With this, you can prioritise your assignments with more ease, as well as to ensure that you do not leave out any important tasks. You may think that you can remember all of them, but as stress levels increase with poor time management, something is sure to slip your mind. 

 

In Singapore, the education system is very competitive, as most people would know. Many students rely heavily on tuition to give them a head start, or to help them catch up with any content that they were unable to grasp. However, with the pandemic, tuition centres are shut down to minimise the spread of the virus, leaving the students on their own to cope with their studies. As such, these students could be increasingly stressed out, for fear of falling behind on their school work. If you can relate to these individuals, try forming an online support group with your fellow classmates. Conduct group study sessions and help each other out regarding areas for improvement. Brainstorming ideas while teaching others can help you to revise your concepts as well as to gain more insight into particular topics. In a sense, it is killing two birds with one stone. 

 

Last but not least, unhealthy stress levels can cause anxiety issues for some. In such cases, these individuals are advised to seek therapy or the necessary treatment if things get too overwhelming. Speaking to a therapist can help you to get things off your chest. Studies have shown that verbalising your negative feelings can help make them less intense, and can thus help you cope better with your emotions. We hope that you understand that there is no shame in seeking therapy whenever you are feeling too overwhelmed by studies or other forms of stress. Do come to us whenever deemed necessary, and we will be here to help you along the way.

 


References:

  1. Putting Feelings Into Words Produces Therapeutic Effects In The Brain (Accessed on 27/05) 
  2. Photo by Victoria Heath on Unsplash