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Treat Smokers with Compassion – Why Quit Smoking is so tough

Treat Smokers with Compassion – Why Quit Smoking is so tough

Written by: Andrew da Roza, Addictions Therapist

To non-smokers and those who have an occasional cigarette at a party or outside a bar, it is baffling why smokers just can’t simply quit. What’s the big deal?

If you think this, then the conclusion may be: “well they just don’t want to quit”; or “they are uneducated, and don’t know how much damage they’re doing to themselves and those around them”; “they have no conscience” or “they have no self-control”. 

The problem with these conclusions is that the scientific evidence doesn’t support them. 

70% to 80% of smokers want to quit – and many of them desperately want to quit – and most smokers fail.  

A majority have tried to quit multiple times – and about 40% are still drawn to smoking -even after losing fingers and toes to gangrene, or lungs to cancer and COPD, as a result of smoking. Many suffer heart attacks, mouth, throat and colon cancer, or labour under serious diabetes problems; some even lose their close relationships with their families. 

They wish that if only they could quit, their lives would be so much better – yet they continue to smoke. 

So, there is more to the compulsion to smoking than meets the eye. 

Perhaps kindness and compassion for smokers may be a more rational reaction – than dismissal, frustration, irritation, anger or contempt?    

There are very good reasons why the chemicals in cigarette smoke are so compelling – and it’s to do with our brains and our bodies. It’s not a mystery.  

Although nicotine in the smoke is a comparatively benign substance, and it doesn’t cause the damaging effects of the other harmful substances in the smoke – it is highly addictive. It is the nicotine that causes the addiction – but it is the tar and other substances that cause the damage. 

In addition to nicotine, there is another substance, in smoke, that creates a potentially “pleasant” psychoactive effect.  It is a monoamine oxidase inhibitor – which results in chemicals in the brain staying longer in the space between neurons and firing those neurons.

And the effect the smoker feels? Well, there can be numerous combinations of “positive” effects. 

Those smokers who feel down, moody and unmotivated, may feel a pleasant “lift” or “boost”. Anxious, fearful and nervous smokers, may feel calmer, and more able to think straight. Smokers who are tired, sleepy or lethargic, may be able to focus, concentrate and pull themselves out of their procrastination.  

Smoking helps some people become more energetic, have better reactions times and become more effective or efficient. Smoking enables people who are mentally tired with work or constant rumination, to feel like they are taking a break and “relaxing” from their thoughts. They can just let their minds gently wonder. They may even feel that after their “reverie” with a cigarette, they have managed to solve a problem that they have been grappling with.

Some people use smoking as a bonding experience. Ironically, all the community stigma that surrounds smokers makes some feel like a “band of brothers and sisters”, as they stand outside in smoking areas or in smoking rooms. It enables instant connection and the sense of “belonging”.

In short, the effects of smoking depend on how you are feeling in the moment. 

Insidiously, mental illness and other addictions result in many becoming vulnerable to smoking – either to cope with: their illness; the difficult side effects of their medication; and the social stigma against mental illness addiction that so oppresses and shames them. 

By way of examples, ADHD, schizophrenia, bipolar disorder, anxiety and major depressive disorders, and personality disorders, can all result in life-long suffering – that smoking may appear to “take the edge off”.  

There is now persuasive research that some people are more genetically susceptible to being addicted to cigarette smoke. They may get more of a “buzz” from it, they may be more tolerant to its side effects, the effects may wear off faster, and they may feel the withdrawal effects (when not smoking) more keenly. They may have more trouble starting to quit – and staying quit. 

There are many other vulnerability factors as well: adverse childhood events (which afflicts 2 out of every 3 Singaporeans); traumas; family and peer modelling; rebelliousness, isolation and loneliness, financial distress, problems in relationships and at work; and many more factors, may all conspire to lead smokers to smoke daily. 

Once they smoke enough cigarettes for long enough – the brain changes, it becomes “hijacked” by the smoke.  

Smokers experience brain changes as: 

  • Tolerance – the need for more smoking, more often, to get the same effect;
  • Withdrawals – 45 minutes to two hours after smoking, they may feel the exact opposite of what they felt when they smoked – and therefore need a cigarette to feel “normal”;
  • Impulsiveness – in the moment (of smoking), they forget about the harms of tobacco and their resolves to quit, and habitually light up;
  • Smoking triggers – smoking cues are everywhere – and they trigger the urges and cravings – and once these build up, they become overwhelming;
  • Stress – their stress response slowly but inexorably ratchets upwards, daily – so that even things that used to be experienced as minor, now elicit strong and intolerable emotions. If health, relationships, jobs and self-image are all on the line because of smoking – the stress can be intense. 

Luckily – there is a solution. Smokers now have access to psychotherapy, nicotine replacement therapy, quit smoking medication, and any number of other tools to help them on their quit journey. In other countries, new nicotine delivery technologies like e-cigarettes and heat-not-burn are being improved and refined – and they are much safer than smoking. 

Smokers deserve our respect and compassion in their struggle with cigarettes. And they don’t have to do it alone. So that the help-seeking and quit smoking load can be lightened. 

You can also hear more from Andrew at the 7th Asia-Pacific Behavioural & Addictions Conference (APBAM2020: Forum 1 – “Tobacco Harm Reduction: Myths & Realities).

 


 

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)

 

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

Counsellor, Psychotherapist, Psychologist, Psychiatrist. Which is right for you?

Counsellor, Psychotherapist, Psychologist, Psychiatrist. Which is right for you?

If you’ve been pottering around the Promises Healthcare’s ‘Our Team’ page, and are new to the world of mental health in that you’re considering making the leap to seeking help from a mental health professional, it’s our hope that this casual guide to demystifying the titles, designations and dizzying abbreviations that adorn each profile will point you in the right direction.

 

For starters, there’s one thing that each of our mental health professionals have in common. They all possess at minimum a Master’s level certification in their discipline, so you can be assured of all their competencies.

 

Psychiatrists

As we’ve shared in a previous article, a psychiatrist is at their core a medical doctor, which certifies them to prescribe neuropharmacological support – i.e., medication.

But of course, psychiatrists more often than not do indeed possess relevant counselling and psychotherapy certifications, because being well-versed in the craft of patient care in the mental health sector does help them delve deeper into the minds and psyches of their clients, and assist them in skilfully and empathetically overcoming boundaries that some clients may consciously or unconsciously put up that stymie the therapeutic process. 

Prescribing the most effective neuropharmacological support is buttressed by the psychiatrist’s skill in interpersonal communication, both verbal and non-verbal. Psychiatrists often describe themselves as observers, but it goes without saying that navigating these one-on-one interactions requires input from their side of the desk. While you might think that psychiatrists have reached the peak of the career trajectory of a mental health professional, keep in mind that by no means should you think of a psychiatrist as the fount of all mental health knowledge. Think of the ‘helping’ professions encompassed in the form of a large tree, rooted in a common desire to help people in need and supported by a trunk of science and evidence based knowledge , from which grows different branches representing the many ways in which mental health professionals can help someone in need – certain disciplines are applied more rigorously in helping certain conditions or situations. This is why Promises is described on our page as a multidisciplinary team of mental health professionals. Your treatment plan is provided by our team, and under the shade of our tree, you will be prompted to reach for certain branches – but at the end of the day, it is your choice to pick the leaves which seem most lush to you.

Psychologists 

Psychologists differ from psychiatrists in one key authority. They are not medical doctors, and therefore cannot prescribe you medication. You’ll notice that our stable comprises a good number of clinical psychologists – so, what exactly are they, and how can they help you? Clinical psychologists possess doctorate degrees in psychology, and are imbued with the ability to cater to clients who suffer from any number of the discombobulating disarray of mental health conditions which sadly, are still negatively stigmatised in society. Think schizophrenia, bipolar disorder, depression, and their ilk. A clinical psychologist can make a diagnosis for you, if you think you are suffering from a mental health condition. Using the tools in their arsenals which they are trained in, such as psychometric testing, intelligence testing, personality testing, and much more, their diagnoses are firmly rooted in evidence based science. You could then make the logical conclusion that if they deem your condition treatable with medication, they would refer you to a psychiatrist. There’s a lot of symbiosis going on in our clinic!

 

The difference between Counsellors & Psychotherapists 

We’ll deal with counsellors and psychotherapists next, because the two fields are very much intertwined, aligned in some facets, while possessing in granular detail key differences. Counselling and psychotherapy are both broadly concerned with betterment of clients in need, and there is significant overlap in the goals of either mode of therapy. Now, on to the differences, which will help you better distinguish which leaf you’d like to choose. First, there is a temporal difference between the two in both the length of treatment and how far back into your life each mode of therapy delves into in order to solve your current issue.

Counselling, on one hand, tends to favour clients who are more self aware and sensitive to their emotions and thought processes, and need a helping hand in unpacking a recent difficulty or life altering experience that they wish to resolve. This is rather unlike psychotherapy, rooted in a humanistic tradition – some may refer to it as height psychology, a term which gained currency during the time of Abraham Maslow and his espousement of self-actualisation. Psychotherapy, in this sense, takes a long, lingering look at a person’s past, life changing experiences, deep seated traumas and neuroses, or any relevant factors – all to help a client gain mastery of self (self awareness) and challenge them to enact the necessary life changes that lead to self improvement. You might well think of counsellors more as “advisors”, and psychotherapists as the “life guides”. Of course, detract nothing from both disciplines – their practitioners chose their specialities precisely because they fit into their world-views and probably, because they thought that they were good at it!

 

How do you choose?

Of course, given the array of therapeutic modalities and mental health professionals, we understand that choosing the right leaves can be a bewildering experience. That’s why we feel it’s best that you browse the profiles of our therapists, read their biographies and see which of them you feel most comfortable seeing. In the near future, Promises Healthcare intends to refine and streamline your selection process by having a list of issues or conditions that you are having problem(s) with – your input will then guide you to the mental health professional in our team that is best equipped to deal with your issues. For now, take  a deep breath, sit back, read, absorb, think with clarity about what you want to deal with, and pick one to make an appointment with. Choosing the right therapist isn’t a one hit wonder – it takes time and patience, but rest assured that we’ll do our best to help you in that regard. 

 


Featured Photo by Evan Dennis on Unsplash

Intrinsic motivation as a source of vitality?

Intrinsic motivation as a source of vitality?

“Vitality management is provided for organizations that have a vision”. A quote from Pauline van Dorssen, writer of “Vital People in a Vital Organisation”. This is a new successful training (NIP). Positive psychology and the use of vitality are central. The response from Occupational and Organisational Psychologists and Occupational Health Psychologists was exuberant, with all available places booked. In addition, the same question arises from organizations, who often need advice and coaching in the field of vitality.

To know more, here is the original article in Dutch language: Artikel_De Psycholoog_lisa van der Heijden

Written by Lisa van der Heijden, Clinical Psychologist.

If you are interested to know and learn more therapy for children/adolescents, contact Promises Healthcare for more information.