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What is Depression & How to seek help?

What is Depression & How to seek help?

Depression has been portrayed extensively in pop culture and media, from R.E.M.’s hit song “Everybody Hurts”, to the television series “13 Reasons Why”. The phrase “I’m so depressed” is thrown around casually when someone has had a bad day or when they can’t get their favourite brand of ice-cream. But what is depression, really? How does it affect us, and can it be treated?

If someone was recently fired or lost a loved one, it would be natural to feel grief at such events. However, grief is not depression. Depression is classified as a mood disorder that causes unusually low moods for an extended period of time and may impair one’s ability to function at work and at home. Grief or other stressful situations may sometimes trigger depression, but unlike grief, there is often no discernible cause for the hopelessness and despair a depressed individual feels. Depression affects everyone differently, and factors such as one’s family background, environment, or physical state can impact their chances of developing depression, and how severely it impacts them.

Depression has a variety of symptoms that can vary in intensity, including;

  • Low mood;
  • Loss of interest in typically pleasurable activities;
  • Sudden weight loss, or gain;
  • Changes in appetite;
  • Sleeping too much, or too little;
  • Restlessness or being slowed down;
  • Lethargy;
  • Feelings of worthlessness, or excessive guilt;
  • Inability to concentrate;
  • Recurrent thoughts of death or suicide.

Individuals who display five or more of these symptoms over a period of at least two consecutive weeks may be diagnosed with depression.

There are several different types of depression, with the most common being Major Depressive Disorder (MDD). According to a study conducted by the Institute of Mental Health (IMH), 1 in 16 people in Singapore have experienced MDD in their lifetime. Major depressive episodes last about eight months and have a 70% chance of recurring within five years, though this varies with each individual.

There is also Persistent Depressive Disorder (PDD), also known as dysthymia. This type of depression can last for several years, with symptoms receding for no more than two months at a time. PDD is much harder to spot, as the symptoms are often not as severe as MDD. Due to the length in which PDD affects individuals, friends and family may eventually brush it off as part of their personality. Others may think that they are just naturally “gloomy”, or “introverted” and “withdrawn”. Some individuals may also experience major depressive episodes while in the midst of PDD. This is known as double depression.

If any of the above sounds like they might apply to you or someone you know, you may be wondering “what can I do?”. The first step would be to speak to a mental health professional, who can properly assess the situation and make a diagnosis if necessary. They can then recommend a form of treatment. However, there is no “one size fits all” treatment. It may take many tries to find one that works for you. To help find that, here are some proven methods of treatment.

Medication

Antidepressants prescribed by psychiatrists help to stabilise one’s mood by adjusting specific parts of their brain chemistry. SSRIs are the most commonly prescribed class of antidepressants and help to boost the effects of serotonin in the brain. Antidepressants take time to produce full effects so don’t be discouraged if you don’t experience any effects immediately. However, if the antidepressants do not work after an extended period of time, or produce unpleasant side effects, speak to your psychiatrist about changing medications. When taking antidepressants, be sure to adhere to the prescribed dosage in order to see the best results. There is a common misconception that if someone feels better after taking antidepressants for a while, they can stop taking it immediately. This is not the case, and can instead cause their mood to suddenly crash back down again. If you are feeling better after taking antidepressants, speak to your psychiatrists, and together you can work out a plan to reduce the dosage of antidepressants.

Therapy

While medication can help to reduce symptoms of depression and improve one’s mood, they may not cure depression. Speaking to a counsellor or therapist can help to uncover underlying issues that are causing distress. The therapist can then focus on addressing these issues and equipping you with appropriate techniques to cope. Contrary to what is depicted on television, therapy does not involve lying on a couch and talking about your childhood. It is important that you feel comfortable with your therapist and develop a relationship with them where you are able to share openly about your struggles. One of the most commonly used forms of therapy is Cognitive Behavioural Therapy (CBT), which takes a goal-oriented approach to tackle negative behaviours or emotions.

Other forms of treatment

Aside from talk therapy, some individuals may find it helpful to find new ways of expressing the emotions that they are struggling with. This could be done through art therapy or psychodrama. Psychodrama allows individuals to explore different roles in a safe space using actions as well as words. For those worried about the side effects of taking medication, there is Transcranial Magnetic Stimulation (TMS). TMS Therapy is a non-invasive treatment that uses strong magnetic pulses, similar to those in an MRI, to stimulate areas of the brain that are underactive in depression.

Unfortunately, even with the wide variety of treatments available, the majority of people suffering from depression do not actually seek professional help. In many cases, this is due to the stigma associated with mental illness and the fear of what others may say. People with depression are often told “just stop being sad”, or “you should be happy, you have so many things to be thankful for”. So they hide it. They struggle each and every day and they hope that they’ll just get better on their own. But that makes the process so much harder. Support from friends and family is crucial in the recovery process.

Depression is a disease that can happen to anyone. It could happen to the quiet kid that sits in the corner. Or to your best friend who’s always been bubbly and lively, and now seems like someone else that you can barely recognise. But just like other diseases, it is possible to recover from depression with the right support from friends, family, and therapists. So be kind to one another, love one another, and when things get tough, be there for one another.


Photo by Paola Chaaya on Unsplash

Bipolar Disorder: You Too Can Walk In Recovery

Bipolar Disorder: You Too Can Walk In Recovery

With the recent revelation of American rapper, Kanye West, being diagnosed with Bipolar Disorder, the condition has been brought into the spotlight. The term ‘Bipolar’ (meaning “two poles”) signifies the polar opposites of emotional highs and lows. As the name suggests, Bipolar Disorder is characterised by episodic, extreme mood swings in which the individual experiences intense mania and severe depression. Formerly known as ‘Manic-depressive Illness’, the disorder is a fairly common, yet serious mental health condition. 

 

For individuals struggling with the disorder, manic episodes can last days to weeks and are often associated with hyperactivity, an irritable mood, rapid thoughts, increased recklessness, or an exaggerated sense of self-esteem and power. On the other hand, a depressive episode can last weeks to months. In this phase, individuals may experience increased restlessness, a loss of interest in activities (including those that they usually enjoy), poor concentration or disrupted sleep patterns. In more severe cases, these people may also possess suicidal thoughts and behaviours. 

 

In order to help us better understand the condition, we interviewed Deborah Seah, a peer support specialist at Psaltcare.  

Deborah Seah

Deborah started experiencing extreme mood swings in her early primary school years. Having known that her paternal family had a history of mental illness, she identified that her condition was most likely to be genetic. However, she had chosen to suffer in silence until 2 decades later, when she sought psychiatric help for postnatal depression and work-related burnout. At that point, she was diagnosed with Bipolar Disorder as well as Generalised Anxiety Disorder. For Deborah, the disorder reigned control over her life – straining her relationships with her loved ones. Before her diagnosis, others could not understand why she was being so unpredictable, and her erratic behaviour had unfortunately caused numerous misunderstandings.

 

“It was very challenging to manage my mood swings at the tender age of 8,” she shared. “When I was experiencing my highs, I would talk very fast, have tremendous amounts of energy, get very excited, or become easily irritable and agitated. On the other hand, when I was experiencing my lows, I would feel very sad and experience low energy levels. I could cry for hours or days over trivial matters and be even suicidal at times. The experience of dealing with bipolar disorder consisted of feelings of helplessness, hopelessness and loneliness as I could not predict or control my emotions and energy.” Deborah’s experience with bipolar disorder led her to face an identity crisis – being confused over her contrasting “personalities”, and not knowing which was the real her. 

 

Just like any other mental condition, there are bound to be misconceptions of the Bipolar Disorder, especially if people don’t open up and address it. One such misconception is that individuals struggling with Bipolar Disorder are incapable of managing their mood swings. However, Deborah takes this as an opportunity to debunk such a sentiment: “After a certain point in time, I’ve arrived at a higher level of self-awareness towards my early warning signs, and it has enabled me to gain self-mastery over my condition. When my mood or energy level starts to dip, I’m aware of what could effectively help me to increase my mood and energy. When my mood or energy level is overly high, I know that I need to be extra mindful of not going into overdrive.”

 

While on the road to recovery, Deborah made a commendable effort in helping herself cope with the disorder. This included reading up on the condition proactively to ensure that she could better achieve self-mastery. Of course, finding a silver lining and staying positive is essential over the course of recovery. Keeping up with articles on others’ success stories and breakthroughs helped her to stay hopeful and confident that recovery is not impossible. 

 

Being highly motivated to make headway towards recovery, Deborah knew that she needed to make changes to her lifestyle. For starters, Deborah:

 

  1. ensures that she keeps to a good sleep routine and to have sufficient rest
  2. adopts a healthy lifestyle by having a balanced diet and staying active through exercise
  3. stays in a conducive environment for recovery where all potential triggers are removed as much as possible.

 

She also notes that her Christian faith has played an essential part. Daily prayer and spiritual devotion helped her to calm her mind and provided her with the much-needed inner peace. However, Deborah stresses that one should not brush aside the idea of peer support or psychiatric intervention. The active use of medications coupled with peer support contributed to the turning point in her recovery, and restored any lost hope when the future was seemingly bleak. Connecting to like-minded peers can help one explore new coping strategies and stay on a personal wellness plan.  

 

“Upon knowing my diagnosis, my family took the initiative to purchase books on Bipolar Disorder to understand my condition better,” Deborah recounted. “My family gave me space when I needed it and continually held hope for me even when I gave up on myself. They didn’t pressurise me to make quick progress on my recovery but assured me that they genuinely only wanted me to be happy and that is all that mattered to them. I was deeply touched by their love and concern for me and felt motivated to work hard on my recovery because I realised that they would always be affected whenever I’m suffering.” Through her experience, Deborah holds a strong belief that the hope and support from her loved ones had an immeasurable, significant impact on her, and encourages those who are also supporting their loved ones with mental conditions to stay hopeful. 

 

As of today, Deborah has made promising progress and is well on her way towards achieving mental wellness. After consistently attending a Recovery and Wellness Sustenance (RWS) Workshop at IMH, Deborah graduated with a certificate of participation. Recognising that she benefited much from the workshop, she returned as a Mentor to co-train the subsequent class of peers. In addition, Deborah also completed a module conducted by the National Council of Social Services (NCSS) and was involved in the facilitation for the 3rd and current 5th batch of Peer Support Specialist (PSS) training. She said, “It gave me confidence and reinforced my own recovery as I pay it forward and encourage my peers in their recovery journey. Moreover, it has equipped me with effective coping skills to deal with my mental health condition and it brought my recovery to a higher level.”

 

To end off, Deborah hopes to pass on an important message to the readers: “To me, there is no shame to be on psychiatric medication or seeking psychiatric help. Just like how people with diabetic conditions need to be on insulin while some people who are asthmatic need to be on Ventolin, people with psychiatric conditions need to take psychiatric medication too. Resilience in Recovery requires these 3 things: Courage – to embrace the past, Gratitude – for the gifts of the present, and Hope – to make the most of the future. I believe that everyone can recover from a mental health challenge, as long as he or she does not give up hope because I am the Evidence of Recovery myself! Everyone recovers at their own pace, just like every flower blooms in its season – let us hold the hope for our loved ones and for those who are battling mental health challenges by cheering them on and being their source of support to believe that recovery is indeed possible.”

 


References:

https://www.healthhub.sg/a-z/diseases-and-conditions/49/topics_bipolar_disorder (Accessed 01/08/2020)

https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml (Accessed 01/08/2020)

Photo by Samuel Clara on Unsplash

The Online Environment (Internet) and Suicide

The Online Environment (Internet) and Suicide

Thanks to the Internet, a global communications network, thousands of host servers worldwide are connected, making instantaneous and interactive sharing of information effortless and uncomplicated. But is the ease of access to information necessarily a good thing? There is increasing evidence that the Internet and social media may influence suicide-related behaviour, and hence the freedom of information may do more harm than good. 

 

The Internet and social media have become fundamental in the way many people communicate and share opinions, ideas, and knowledge – alongside a multitude of information on the topic of suicide that is readily available. Social media coverage of celebrity suicide, which is unfortunately on the rise in current times, increases the risk for prosuicide behaviour of vulnerable individuals. One concern is the contagion effect where people are triggered to act as a result of learning of the death or self-harm of others that they identify with or admire. The glamorising of such stories can normalise suicide and present it as acceptable and unproblematic, leading to a rise in imitational suicides. The Internet also provides a source of information for people to obtain how-to descriptions of suicide and lethal ways of killing themselves.

 

But that’s not all there is to it. As we dig deeper, we find that the Internet also allows for cyberbullying, the formation of suicide pacts, and even suicide challenges including the infamous ‘Blue Whale Challenge’ – the Internet’s deadliest suicide game. Youths, in particular, are the ones most vulnerable and susceptible to caving into such pitholes – the very generation that is possibly the most in touch with the Internet. Suicide is the shortcut that a large proportion of people with mental health conditions (e.g. depression) succumb to if they aren’t able to cope well – yet, it isn’t an issue that we address much. To look out for one another, we should try to understand how these pro-suiciders think and act, to help them through their difficulties as fast and as much as possible. 

 

There are mainly two categories of suicidal internet users – “Lower Severity Use” and “Higher Severity Use”. These categorial names refer to the extent to which these individuals use the Internet to find out about the act of self-harm or suicide. People that fall under the “Lower Severity Use” category are usually just conducting “pessimistic browsing” – a stage in which they are still uncertain about suicide, but are distressed enough to want to know more. They mostly navigate through the web haphazardly, trying to find stories or others to whom they can relate. They enter broad search terms, and randomly click on whatever appears at the top of their newsfeed. In summary, these people are still struggling to make sense of their feelings. However, a critical distinction between this group of individuals and the other is that people under “Lower Severity Use” actually flit between prosuicide content and online sources of help. Their uncertainty regarding suicide enables them to be more open to rethinking their actions, be it joining online peer support forums or attaining self-help resources. Perhaps the broad search terms they enter on Google could have also played a part in uncovering various methods of treatment.

 

Unfortunately, this has been proven otherwise for those who fall under the “Higher Severity Use” category. Individuals in this group are much more troubled and perturbed – so much so that they conduct “purposeful researching”, and are no longer as open to receiving online help. These people turn to the Internet to identify, evaluate and choose suicide methods. They research and learn about the effective implementation of each plan, and subsequently acquire the means to carry out the suicide attempt. Part of their research also includes evaluating different factors such as the speed, effectiveness, pain level and technical instructions for them to carry the suicide method. What types of household items can be used for suicide? How much drug constitutes an overdose? What would be the appropriate height to jump to death? Such thoughts fill the heads of these individuals, and the same things are searched up online for them to make a successful suicide attempt. Regrettably, a handful of them also makes use of websites that were never meant to encourage suicide, some of which include professional websites such as WebMD. The published notes on symptoms of overdosage etcetera on such sites could lead some individuals to deduce the amount needed for a successful suicide attempt. This, coupled with the ease of purchasing medications over-the-counter or online, could very well lead to undesirable consequences. 

 

You might wonder, is there a link between the two categories? The answer is yes. Many a time, people start with “pessimistic browsing” before they move on to “purposeful researching”. The decision and will to pursue the act of suicide comes during the transition from former to the latter. The haphazard online navigation, or what was once considered rather “purposeless”, could become addictive. These sensitive and vulnerable individuals could find themselves roped into a cult of negativity, being enticed and increasingly drawn to the provoking and graphic content online. Subconsciously, they will start searching things up more frequently, and their suicidal thoughts and motive escalate. Eventually, they will find themselves under the “Higher Severity Use” category.

 

Above all, we should be concerned with protecting our loved ones. If we sense that a friend or family member is contemplating suicide or is vulnerable to the suicide-promoting influences of the Internet, seek help from a professional i.e. a counsellor, a psychotherapist or psychologist, immediately. As time passes, there is a higher chance that their initial help-seeking thoughts will be displaced. They will start validating their self-harm and suicidal thoughts and will expose themselves to more suicide content. Suicide isn’t okay, and should not be portrayed as an acceptable response to distress or difficulties. Never downplay the seriousness of suicide and delay help. Trust me; You will be doing anyone at-risk a vital service by persuading them to seek professional assistance.

 


 

References:

Dr Lucy Biddle, 2019, Tackling Challenges of the Online Environment and Suicide-related Internet Use, video recording, Mental Health Academy <https://www.mentalhealthacademy.co.uk/dashboard/catalogue/tackling-challenges-of-the-online-environment-and-suicide-related-internet-use>.   (Accessed 16/06/2020)

Photo by Oleg Magni on Unsplash

 

Emotional Self-Regulation: The difference between having a controlling behaviour and having self-mastery

Emotional Self-Regulation: The difference between having a controlling behaviour and having self-mastery

For someone who struggles with emotional self-regulation, what does having a “breakthrough” mean? A “breakthrough” could mean coming to a point of realisation and acceptance of one’s mental state, and taking a step forward to change his/her seemingly challenging behaviour. To achieve this, we’ll need to learn the art of self-mastery in order to transform our emotions, attitude and most importantly, our behaviour. 

Let’s not beat about the bush – the most pivotal factor to attaining self-mastery is for the person in question to understand that he/she needs to take charge of his/her own thoughts, emotions and actions. The model of self-mastery dictates that we should acknowledge and accept that we are the ones who are responsible for changing our own life experiences. It is often said that we are each the author of our own lives, in which we live in whatever we create. At any point in time, we should always be open to learning life skills to deal with whatever life presents us, instead of resisting or reacting against it. We should learn to control what happens to us by exercising creative control over the circumstances that we throw ourselves into. Without the will to take charge and make the relevant changes, this “breakthrough” would, unfortunately, be a tough feat.

There is a difference between control and self-mastery, and it is crucial that we internalise this. Oftentimes, people with mental health conditions tend to display controlling behaviours of themselves or others. To put it succinctly, controlling behaviour arises when we compel others to change their behaviour to cater to our own experiences of life. On the contrary, self-mastery means transforming our own behaviour in order to change our own experiences of life. Practising self-mastery implies that we adapt to what life presents us, instead of quitting or getting emotionally erratic when things become challenging. This involves learning new life skills that we have yet to master in order to carry us through frustrating tough times and eliminate controlling behaviour. Controlling or manipulative behaviour often emerges from within ourselves whenever things don’t go as we expect. We victimise ourselves and push the blame towards others or life in general for what was presented so as to “correct” the situation.  The truth is, when you feel that people aren’t showing you the gratitude or appreciation that you deserve, the fault is not with them. In actual fact, you are exhibiting a need to control – to bring your current life experiences to fit your idealised version of it. For individuals with disruptive emotions and impulses, self-mastery may not come easily to them, as a result of the dysfunction of their self-regulation skills. Yet, this doesn’t mean that it is entirely impossible. 

Self-mastery means not allowing our past negative experiences to affect our present and future. It is not easy to undo those past experiences, as they are like deep-seated stains on our clothes that cannot be removed. However, we can choose not to wear those clothes again. It is hard to pick up anything new if our hands are full of burdens. Making peace with our past by letting go, forgiving or even forgetting, will give us space for an untarnished and more objective approach to our present and future. Practising self-mastery also includes being mindful of how you interpret an event in a way that reduces the negative thought or completely replacing it with a positive one. This psychological strategy can be understood by looking at a glass and asking yourself whether it is half full or half empty. Instead of focusing on the dark clouds, we should change our interpretative lens to uncover the silver lining. For example, instead of envying your friend’s success, you should see your own failure as a temporary detour and not a dead end. 

Being mindful of our actions and reactions helps us see them for what they are so as to reign in any impulsive controlling, or difficult behaviour. Truth be told, we have all displayed difficult behaviour at times, which as a result, might have caused us to burn a bridge or two. However, the display of fluctuating emotions may be a regular occurrence for some individuals who may not know how to work towards a “breakthrough”. In this case, only if we are mindful of our behaviours can we be less reactive and better able to reframe our perception of our current experience in a less emotional and upsetting manner. With practice, we will slowly become better at creating that space which will then allow us to choose our reactions rather than just reacting out of habit or impulse. Of course, this, in turn, leads to happier and healthier relationships, ultimately improving our mental state of health as well. 

Last, but not least, a crucial step in developing self-mastery is to start with self-honesty and truthfulness. Do some self-reflection. That is, have an honest assessment of your own strengths and weaknesses, as well as owning up to your problems. When you are able to identify your weaknesses, you will be able to direct yourself better to what needs to be worked on and the relevant life skills you’ll need to master in order to find a breakthrough. In contrast, focusing on your strengths will also help boost your self-confidence, and act as a motivation for you to work towards making the change you need (i.e., self-improvement). If it helps, attend a peer support group. Peer support groups are built on shared personal experiences and empathy – it focuses on one’s strengths and helps you work towards your mental health and happiness goals. At the same time, it comforts you that you aren’t on the road to mental resilience and self-mastery alone and that there are many out there like you. Don’t be afraid to reach out for professional help too, for it could very well be the push you need to help you achieve the breakthrough you desire.

 


Photo by Annie Spratt on Unsplash

Tanya Curtis, Control vs Self-Mastery: A Key to Lasting Change for a Person with a Mental Illness, video recording, Mental Health Academy
<https://www.mentalhealthacademy.co.uk/dashboard/catalogue/control-vs-self-mastery-a-key-to-lasting-change-for-a-person-with-a-mental-illness/video> (Accessed 16/06/2020)

 

How to be a Mental Health Supporter to Your Friend

How to be a Mental Health Supporter to Your Friend

“I’m depressed”, “I need help”. How do you react when a friend of yours approaches you, hoping to seek help and comfort? In a society that unfortunately stigmatises mental health issues, many of us are most likely incapable of tackling such situations appropriately. Sadly, people would feel a sense of awkwardness, then attempt to shrug it off by changing the topic. Worse still, some may distance themselves from their troubled peers – being unsure as to how they can help and would rather stay away. To date, mental health issues are considered taboo, and many would prefer to avoid talking about it. 

Unsurprisingly, it has come to light in recent times that mental health is ranked second in a study conducted on concerns among Singaporean youths, amid others such as employment opportunities. At the fundamental level, we’ll need to be more informed on how we can assist those around us to seek help from mental health professionals when things get hard, and how we can better support them to cope with their condition. The reason behind this is that many would favour talking to their friends before all else instead of consulting a counsellor or a therapist. Besides the stigma of having to seek therapy, the trust and bond between friends nudges them to find comfort in their peers, allowing them to express themselves more easily. To a certain extent, we are at the frontline and act as the safety net for our troubled friends, thus exponentially increasing the need for us to be more mindful of how we respond and act. 

What are some good steps to take if you know that your friend needs help? The most helpful thing you can do if they choose to open up to you is to simply listen. When someone approaches you to tell you their problems, it is extremely important that you lend them a listening ear and to hear them out. This will mean the world to them, for it probably took them quite some time to gather the courage to speak up. Set aside some time to provide an open and non-judgemental space for them to be fully transparent with you. It is vital that any distractions are limited, so that they are assured they have your full attention. Revealing their deepest, private thoughts to someone else is never easy, and when they choose to, it will be greatly beneficial in knowing that the other party truly cares for them. 

With that said, let your friend take the lead in the conversation. Let them take control over what they’re willing to share, and what they’re not willing to. We have to understand that ultimately, they have the right to guard their personal feelings and privacy, and we should never, under any circumstance, force them to reveal matters that they aren’t ready to talk about. Don’t put unnecessary pressure on them and let them talk at their preferred pace. You could very well be the first person that they have been able to open up to, and it is crucial that you do not break the trust and confidence they have in you.

Oftentimes, people may tend to get overly-absorbed in the conversation, and take on the role of a “therapist”. Unknowingly, they may start to second guess or make assumptions as to what is wrong, and subsequently jump into conclusions with a possible diagnosis or solution. However, hold your horses – bear in mind that you are neither a trained therapist nor a psychologist. Don’t label them with what you think is going on. Focus on providing them with a reliable listening ear or a shoulder to cry on instead.  

Providing words of comfort may seem easy enough – but there are pitfalls in which we often walk into unintentionally. “Things will be better tomorrow”, “I felt the same when I…” Such words are rarely made out of malice, but rather because it is easier to fall back on such overused expressions whenever we struggle to find the right words. However, this could backfire, as the underlying tone may come off as dismissive, unhelpful or even judgemental. Instead, validate their feelings and thoughts. Assure them that you will be there whenever they need someone to talk to, and that it is okay for them to feel what they feel. Moreover, avoid making comparisons between their experiences and yours. Every individual’s journey is personal and unique to them – try to make the conversation less about you and give them a space to express themselves freely. 

Focus on how your friend is coping as the conversation carries on, and be alert to any red flags. If it becomes obvious that your friend needs help dealing with emotional issues or a mental health problem,  talk to them about receiving proper treatment from a mental health professional. It may be tough to start such a conversation as a person’s culture, family background and experiences may influence their perception about seeking help, which makes such a topic about therapy an intense and personal one. Initially, you may expect some resistance, as they might feel a sense of shame and failure. Remember to reassure them that receiving therapy is not a sign of weakness, but rather a sensible way to deal with their troubles. If possible, simple gestures like offering to accompany them to their first session can also be comforting, for they will be less likely to feel abandoned. 

Being patient with them is key, even if your friend is rejecting professional help. Your conversation may have started getting them to consider it, even if it doesn’t mean seeking help immediately. Try to see things from your friend’s perspective and just be there to support and encourage them. Doing this will help facilitate on-going deep and meaningful conversations, and can make your friend more receptive to reaching out to you and for professional help in the future when they are ready. 

 


References:

Mental health, job opportunities among issues raised by youths in engagement sessions (Accessed on 13/06/2020)

Photo by Felix Rostig on Unsplash

An Interview with Dr Mark Toh: The Effects of COVID-19 On Dreams

An Interview with Dr Mark Toh: The Effects of COVID-19 On Dreams

 

Amrita Kaur, a journalist from the Straits times interviewed Dr Mark Toh, Consultant Clinical Psychologist about the effects of COVID-19 on dreams. Parts of the following interview was published in the Straits Times on 13 July 2020. 

 

Here’s the interview in full: 

  1. Dr Deirde Barrett, assistant professor of psychology at Harvard Medical’s department of psychiatry, who has studied the dreams of survivors of the Sept 11 attacks, said people tend to have an increase of bizarre, emotional and vivid dreams after crises (such as Covid-19). Can you share your thoughts on why you think this happens?
  2. Some people dream about sanitisers, face masks and toilet paper. Why such particular items? 
  3. What exactly is happening in our subconscious (when we sleep) during periods of stress? How does that manifest in our dreams?
  4. Will such dreams affect the quality of one’s sleep? Why or why not? 


Answers
:
Nearly all trauma survivors experience some type of trouble sleeping such as insomnia. But for anywhere from half to three-quarters of people, it is vivid dreams that make it difficult to sleep soundly. Having flashbacks to traumatic events, also called re-experiencing, is a hallmark symptom of post-traumatic stress syndrome (PTSD). For half of PTSD patients, those flashbacks occur at night while sleeping. Some people have nightmares that are exact replays of the trauma that they experienced, and these are called “replicative nightmares.” Others have nightmares that are related to the trauma indirectly or symbolically. Trauma and stress can disrupt your sleep in many ways. It can set off your body’s fight-or-flight response, and ramp up production of neurotransmitters that keep you awake and vigilant when it is time to sleep. 

The items sanitizers, face masks or toilet paper may be dreamt about because they represent perceived solutions to address the threat of being harmed by Covid-19. Our psyche (our human mind or soul where we deliberate consciously and unconsciously –judge, think, feel– in relation to our sense of self and our sense of reality) is highly concerned about safety and security and therefore, when a threat is perceived, we consciously and unconsciously move in search for items or avenues that promote and restore our sense of safety. 

There are several theories about the role of dreams in our sleep. In the event of stress, it suggests that our unconscious is working overtime in search for safety or to be settled with what may be traumatic, distressing or are reasons for anxiety. Stress is a disruption to our equilibrium and is communicated as an emotional and physiological alert. Because our psyche does not like to be unsettled or be disturbed, we tend to work consciously and unconsciously to settle what may be threatening or disturbing towards safety.

Yes. Trauma and stress can disrupt your sleep in many ways. It can set off your body’s fight-or-flight response, and ramp up production of neurotransmitters that keep you awake and vigilant when it is time to sleep.

 

  1. Dr Rose Gibson, a research officer at the Sleep/Wake Research Centre at Massey University in New Zealand, said that while some dreams can be confusing or distressing, dreaming is normal and considered helpful in processing our waking situation. Can you comment on this?

Answer:
Dr. Gibson is correct. Dreams are a normal part of our sleep. Dreams have been described as hallucinations (defined by Oxford as “an experience involving the apparent perception of something not present”) during certain stages of sleep. They are strongest during REM (rapid-eye-movement) sleep, one of the four stages of sleep. But dreams are thought to have other functions as well: 

    • Dreams are sometimes engaged in settling what is unsettling or disturbing as already mentioned,
    • Since the psyche is particularly concerned about safety and security in the daytime, dreams can represent an unconscious search to address the threat in overtime when sleep is intended. One of the areas of the brain that is most active during dreaming is the amygdala. The amygdala is the part of the brain associated with the survival instinct and the fight-or-flight response. Because the logical part of the brain is less in play in contrast to the emotional during dreaming. Nightmares may reflect attempts to address our fears or to prepare to deal with anticipated threats in waking life.
    • Dreaming may reflect our muse as it facilitates our creative tendencies. A person can be awakened by great ideas for a movie or song that has been deliberated on during awake hours. The awake period could also involve psychological defenses at play such as denial or suppression that prevent certain ideas from emerging. In dreaming, these filters are not as active so that suppressed ideas or fears often emerge then.
    • Besides sorting through complicated and unresolved events or anticipated fears, dreams are also suspected in aiding the storage of important memories and getting rid of unimportant memories as a part of our need to process information triggered during the awake period. Learning new information and being able to sleep on it facilitates recall of lessons learned.
       

 

  1. Do you think extra sleep, or lack of sleep, might contribute to vivid dreams related to Covid-19?

Answer:
Dreams can also be affected by certain health conditions that result in sleep deprivation. Sleeping issues that cause a lack of sleep, such as insomnia and narcolepsy, can increase one’s risk of experiencing vivid dreams. Changes to your sleep schedule, such as flying overseas (and going to sleep at a different time) or getting less sleep than usual, can also increase this risk. Those who are sleep-deprived can lead to parts of the brain being much more active so when they finally slip into REM sleep they are likely to have more vivid dreams. They are also more likely to recall their dreams too.

 

  1. It seems that people are having better memory of their dreams now (An ongoing study at the Lyon Neuroscience Research Center in France found that “the coronavirus pandemic has caused a 35 per cent increase in dream recall among participants, with respondents reporting 15 per cent more negative dreams than usual). Why are people having a better memory of their dreams?

Answer:
The brain during sleep is involved in information processing where unnecessary information is eliminated and important short-term memories are moved into our long-term memories, and dreams occur during this process. As such, some people may recall dreams with a difference in their ability to memorize things in general. Also, memory is affected by recall. Memories that are repeated as perhaps a sign of preoccupation or paranoia are more accessible. 

 

  1. Have you noticed any of your patients having problems with sleeping specifically related to Covid-19? For example, if they are worried about the number of community cases the next day and this worry keeps them up at night, they fear for their jobs, etc? 

Answer:
Difficulty sleeping because of Covid-19 concerns is not a common complaint among my patients. This may be suggested by them not feeling threatened by the risk of infection, or that they feel they are coping with this threat, or that they are not in jobs or situations that are being threatened by the pandemic. 

 

  1. Have any of your patients experienced any dreams related to coronavirus and such fears? If so, can you share what some of such dreams are? 

Answer:
None of my patients have reported dreams related to the coronavirus to me. Those who are more likely to be reactive to the coronavirus are probably those who are vulnerable to anxiety such as those who are obsessive-compulsive in nature.

 

  1. According to National Geographic, Italian researchers found that people stuck in lockdown experienced nightmares that bear similarities with someone going through post-traumatic stress disorder. Can you comment on this? 

Answer:
The hallmark symptoms of PTSD are exposure to a traumatic event; re-experiencing the event or intrusive symptoms (flashbacks); avoidance of people, places, or things that serve as a reminder of the trauma; negative mood and thoughts associated with the trauma; and hyper-vigilance. Trauma is experienced when the perceived threat is overwhelming or life-threatening that leaves a victim feeling numb, helpless, disconnected and having difficulty trusting. Since this article in question is reported by researchers from a particular country (Italian), one has to question the scope of the study. Is the study about the traumatic response to the lockdown found across different countries or is it reported specific to a particular region or town in Italy? It is unclear if the reported trauma is in response to the lockdown itself (which is usually activated as a preventive measure to protect against infection), or that the attempt at lockdown is seen as inadequate because the infection rate is already at such high numbers so that the lockdown is perceived as irrelevant or ineffective. As such, there may be the existence of an extraneous variable to explain how those in lockdown could have experienced this action alone as traumatic. At the same time, once the specific group is defined in the study, the results of the study may be explained by a high and pre-existing inter-dependency on this community to cope together as the norm such that restricting communal support disrupts their coping. Subsequently, imposing personal isolation, which is otherwise highly unusual, is therefore experienced as traumatic. The people in this community feel cut off from a regular method of coping which relies on their dependence on each other.

 

  1. Is there anything people can do to try to control what they dream about? If so, what?

Answer:
This depends on whether they view these dreams as distressing. If trauma is indicated or they could represent disturbing experiences in their past or their present, or difficulties at coping at their anticipated future, I would suggest they seek professional help from those familiar with psychodynamic psychotherapy. Dreams are problematic usually only if they are associated with nightmares or sleep disruption. To sleep better and avoid nightmares or sleep that is not restful, the above factors should be reviewed. In particular: (a) ensure that there is adequate sleep scheduled to avoid sleep deprivation, (b) observe their diet since some studies have found that meals high in sugar, spicy foods, or high in starch, too much alcohol, eating excessively and late are associated with higher reports of nightmares, (c) address reasons for anxiety, (d) address unsettled emotional issues such as trauma or abuse, and (e) develop good sleep hygiene practices. Additional steps can include practising mental relaxation before sleep, recording their anxieties somewhere so that they can resume the next day to avoid rumination of what is worrying when sleep is planned or plan for guidance or support to address the worrying on the next day so they can relax at present.

 

  1. There are some people who have difficulty sleeping due to anxiety about the economy, they worry about losing their jobs and the future. How common can this be, and what can people do to relax their mind before they sleep? Now that people are working from home, some are taking naps in the day. Should this be encouraged? Why or why not? Does this make it harder for them to sleep at night? 

Answer:
For those who tend to have difficulty sleeping because of worries about employment or their future, insomnia is a common occurrence. Some even have chronic insomnia. Various studies worldwide have shown the prevalence of insomnia in 10%–30% of the population, some even as high as 50%–60%. It is common in older adults, females, and people with medical and mental ill health. The consequences of insomnia are significant, such as depression, impaired work performance, work-related/motor vehicle accidents, and overall poor quality of life. The reasons behind insomnia are varied. If the problem of sleep is persistent, they should consult psychiatrists or clinical psychologists. If they are anxious, sleep disruption is a common symptom of poor coping. As such, they should see a mental health professional. But if the question is how to promote good sleep for the average person where the sleeping problem is only recent, consider developing good sleep hygiene practices as a start. The following practices are recommended by the Sleep Foundation:

    • Limit daytime naps to 30 minutes
    • Avoid stimulants such as caffeine and nicotine close to bedtime.
    • Exercise to promote good quality sleep.
    • Steer clear of food that can be disruptive right before sleep.
    • Ensure adequate exposure to natural light. 
    • Establish a regular relaxing bedtime routine. 
    • Make sure that the sleep environment is pleasant.

Since more people are working from home, they should limit their nap time. Their difficulty sleeping at night may be indicative that if they had naps during the day, their nap times may have become excessive. The objectives of those working at home should ensure that they maintain a healthy work-life balance. It is important at this time of disruption and uncertainty over a pandemic that we establish goals to maintain good physical and mental health consistent with building our resilience to cope with the unrelenting demands of living effectively in the present and in the future.


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