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Using Cognitive Behaviour Therapy (CBT) to Combat Depression 

Using Cognitive Behaviour Therapy (CBT) to Combat Depression 

 

Photo credit: The Depression Project
https://www.facebook.com/RealDepressionProject/

 

Depression! It’s a common term for many things. “I feel depressed!”, “This is so depressing.”
The medical definition of depression, however, takes a more definitive approach than just the typical expression of exasperation. If you display five or more of the above symptoms over a period of two weeks or if the symptoms cause clinically significant distress or impairment to normal functioning, there is a chance that you may be diagnosed with depression.

Is it that serious?

A study was done by IMH in partnership with MOH and NTU to find out about Singapore’s mental health. In Singapore, one in 16 people may have depression at some point in their lives. That is just one of the most common mental disorders in Singapore! The percentage of lifetime prevalence of depression has seen a steady increase from 12% in 2010 to 13.9% in 2016. What’s scary is that 3 out of 4 (78.4%) people with mental disorders are not seeking help!

To find out more about depression you can read our recent article: What Is Depression & How to seek help?

So, what is CBT, and how does that help with depression? Glad you asked! Cognitive Behavioral Therapy, otherwise known as CBT, is considered the “gold standard” treatment for depression. It is a combination of cognitive and behavioral therapy that targets our limiting or unhelpful thoughts and behaviors which most of the time can be untrue to reality.

What is CBT

Photo credit: https://med.uth.edu/psychiatry/2019/11/27/what-is-cbt/

Normally the therapy takes 8-12 sessions where the patient and therapist work together to identify problem thoughts and behaviors. With that as a reference, the therapist will equip the patient with tools and techniques to change the way they think, feel or behave in the situation. The basis of this model is the assumption that a person’s thoughts, feelings, and behaviors are deeply connected. Thus, by actively taking part in changing the way we think or behave (which is honestly easier than changing our emotions), we can affect how we perceive certain situations that might have given us a hard time. Also, “homework” between these therapy sessions is useful to help practice the skills acquired during therapy.

That sounds complex and great but the big question is, does this work well for depression?

Well, over the last few decades there have been a plethora of studies to assess just how efficient CBT is. These studies have shown that CBT is not only effective but also produces solid results as a treatment not only for depression but also other mental illnesses!
One study that has shown just how effective CBT would be is a study done by Hollon et al (2005). The study found that patients who underwent and withdrew from CBT were less likely to relapse than those who underwent and withdrew from medications. In another six studies, CBT combined with medications added a 61 lower relapse/ recurrence rate (Vittengl et al, 2009, in Otto, 2013).

To conclude, CBT is efficient and definitely better than not doing anything about our mental health. If you do want to seek help or learn more about CBT therapy, feel free to contact us.


Photo credit: https://adaa.org/finding-help/treatment/therapy 

References:

https://www.todayonline.com/singapore/more-people-singapore-have-experienced-mental-disorder-their-lifetime-study-finds (Accessed 08/12/2020)

https://www.mentalhealthacademy.co.uk/catalogue/courses/using-cbt-with-depression (Accessed 07/12/2020)

Managing Anxiety And Depression During Festivities (especially during the COVID season)

Managing Anxiety And Depression During Festivities (especially during the COVID season)

Written by Jane Low, Senior Psychologist

Christmas is a time of giving, peace and joy. It is also a time to celebrate traditions where family and friends gather, feasting on Christmas goodies and exchanging presents. There are scents, sights and sounds that are familiar to Christmas time where individuals can form a strong attachment with. Therefore, such festivities may likely trigger strong memories and feelings within some of us. The feelings of loss, people being away from us, losing contact with others are examples of bittersweet memories that one can have during festivities like Christmas. 

A past memory can also trigger different memories and they can become potentially difficult to process. Some may experience sadness when remembering a lost loved one, while others may feel anxious to attend social gatherings.

Living in a pandemic, things have slowed down considerably, and feelings of loneliness have intensified because of a lack of stimulation in our environments as well as physical interactions with others. In sum, we have been inside our own cocoons. A quieter Christmas this year may also mean a heightened sense of loneliness, anxiety and depression. Here are some ways to cope with some of these unpleasant feelings you may experience during this festive season. 

Legitimising those feelings

Recognise and acknowledge that you may experience some unpleasant feelings such as anxiety and sadness this Christmas. Take the time and show some kindness to yourself. Take your time to feel some of these things that are missing in your life. You can write those thoughts and feelings down in a journal or confide in a trustworthy family member or a close friend. If you find it difficult to cope with these feelings and feel overwhelmed, please make an appointment and talk to a health professional (e.g. psychologist or counsellor) about what you are going through.

Reflecting on your values

Connecting with your values can help you to achieve some meaning and purpose in life. Think about what makes your life worthwhile and the values that matter most to you. Some questions to ponder: how do we want to be as a person, what do we want to stand for, and how do we want to connect to the environment around us. For some, feeling positive emotions and being optimistic are important, while for others, engaging in enjoyable and pleasurable activities (e.g. playing the guitar) are meaningful to them. Other individuals may also focus on social relationships with others and some may derive their sense of satisfaction by celebrating their personal accomplishments. When you navigate through life with your values, you will not only experience great inner strength and joy, but you will also have a meaning and purpose which will help you to tide through life’s challenges. 

Maintaining a healthy lifestyle

Looking after yourself physically also helps you to look after yourself mentally which will benefit your overall wellbeing. A good night’s sleep and keeping a balanced diet are both equally important. Having at least eight hours of sleep every night and consuming a diet filled with fruits and vegetables can be helpful for your body. Additionally, exercising at least thirty minutes a day also helps to keep your mind active, leading to a healthier body. Do also, keep yourself hydrated with plenty of water. All these help maintain a healthy lifestyle. 

In closing, try not to dwell on things that have not worked out. As we live in unprecedented times, things can easily interrupt our daily routines. Focus on smaller and more manageable tasks and when you do achieve them, remember to celebrate your small victories! Here is an anonymous quote that I saw at a doctor’s clinic waiting area: “Life is too short to wake up with regrets – so love the people who treat you right, forget about those who don’t believe everything happens for a reason. If you get a chance, take it. If it changes your life, let it. Nobody said life would be easy. They just promised it would most likely be worth it.”

 


Harris, R (2008). The happiness trap: How to stop struggling and start living. Boston, United States of America: Trumpeter.

Mok, Y.M. (2018, December 26). Commentary: The festive season brings loneliness, sorrow and anxiety for some. Channel News Asia, Retrieved from: https://www.channelnewsasia.com/news/commentary/christmas-festive-season-depression-ocd-lonely-sad-grief-stress-11059260?fbclid=IwAR2DisPAYSAB3aB2-K1HIyfWywQfGZNQHVsHsyY-TKSRG-f1h75J14G8k2s

Pascha, M. (2020). The PERMA model: Your scientific theory of happiness. Retrieved from: https://positivepsychology.com/perma-model/?fbclid=IwAR1B_Zuan1aYIkFIowe6aEUIrqnNyjwfVv0x4Hp5GFXOCRYJ4a1ecMF3a-M

Photo by Andy Holmes on Unsplash
Understanding Childhood Emotional Neglect 

Understanding Childhood Emotional Neglect 

As a child, how did adults around you react whenever you expressed your feelings? Did you grow up receiving that subtle message to wall up your emotions so they don’t get the better of you, or become anyone else’s burden? Childhood Emotional Neglect (CEN) is a topic often overlooked, and many fail to realise that it can eventually manifest into mood disorders or anxiety disorders if not dealt with appropriately. 

Childhood Emotional Neglect occurs when our caretakers or parental figures fail to respond to our affectional needs suitably during critical stages in our development. An individual who grows up experiencing emotional neglect may experience a pattern of having his or her emotions being disregarded, invalidated or downplayed by others. While many of us may wonder, “What kind of parent doesn’t pay attention to a child’s emotional needs?” In reality, some parents may not actually realise that they have been shutting their child(ren) out emotionally. In Asian societies in particular, some parents are commonly labelled as “authoritarian” or “tiger parents”. These people may in fact perceive themselves to be giving the absolute best to their child, enforcing strict discipline and ensuring that their offsprings are well-equipped with the best skills to succeed in life. However, young children and teenagers may instead be overwhelmed by such demands, and feel as if their feelings were never considered or understood. Whilst we mentioned its prevalence in Asian societies, it is key to note that it is not merely limited to these children – many worldwide experience it too, making it an exceptionally important subject. With emotional neglect being a common feature in the childhood of many, it can become an undesirable shadow that follows us throughout our lives – eventually leading to undermined happiness and the lack of an authentic sense of self.  

Delving into the matter at hand, Childhood Emotional Neglect (CEN) can come in two forms – active and passive CEN. Active CEN is when parents or caregivers actively act in a way that dismisses or denies the child’s emotions. For instance, a boy is sent to his room for crying over the death of his pet fish, and his parents complain of having an overly-dramatic son. When the child is being denied of his sadness and is receiving the message that his behaviour is unreasonable, this forces the child to grow up hiding his feelings, and at times struggling with fear and shame of his own emotions. On the other hand, passive CEN occurs when parents show a lack of care or validation regarding the child’s emotional needs. When parents fail to notice when the child is angry, upset, hurt or anxious, this gives off a subliminal message to the child that his feelings are irrelevant or not worthy of note. In any case, both forms of CEN are clearly detrimental towards one’s mental health. 

Albeit not having a test or questionnaire that can help with a diagnosis for CEN, there are certain “symptoms” of CEN that may surface, be it in the later parts of one’s teenage years or adulthood.\

For one, individuals who have experienced CEN may find it difficult to prioritise their wants and needs, even if it’s something that would bring them great joy. It is innate for us to have desires and to just be aware of what we want and need. However, for someone who grows up having his feelings invalidated and cast aside, it could become a natural thing for him to keep his desires to himself. As such, even if opportunities do come along, these people would often fall through the cracks, most probably due to their inability to request for it upfront, or by allowing others to seize it instead. 

CEN also causes one to start projecting any feelings inward, regardless of whether they are negative or positive ones. People who have experienced CEN are particularly predisposed to turning feelings of anger inwards, as they never learnt how to be comfortable with their emotions, nor how to handle them in a healthy manner. It is often said that nothing good comes from bottled-up feelings, and that is absolutely true. 

Having pent-up feelings also mean that these individuals are not likely to seek help or lean into their support systems whenever things get tough, making them feel all the more isolated and vulnerable. Even at times when they are feeling deeply challenged by certain life events, they find themselves trying to cope all on their own, leading to unhealthy stress levels and anxiety. Unsurprisingly, the constant feelings of shame and inability to get in touch with one’s emotions will eventually lead to one losing sight of his or her strengths as well. As a result, poor self-esteem is sometimes a consequence of CEN.

While many individuals, including adults, fail to recognise the impacts of childhood emotional neglect on their lives due to its subtle nature, it is important that they get themselves back on track – to regain true happiness and greater self-esteem. You might have grown up devoid of your own emotions, but you need to recognise that facing them head-on will ultimately help you to cope with life events and for you to regain your sense of self. 

Learn to start getting in touch with and embracing what you feel – both the good and bad. Identifying what you feel in certain situations will be a good step towards helping yourself cope with your environment and daily life. When challenges seem overwhelming, don’t feel afraid or ashamed of reaching out to your friends and family for help either. Even more so, if you ever feel like you’re losing control of your life and are derailing emotionally, seek professional help as soon as possible. While not everyone who grows up with emotional neglect ends up with mood disorders such as depression or anxiety disorders, there are certainly people who do. Don’t deny yourself of your emotions any longer, therapy might just be the solution to helping you learn the vital life-coping skills you never learnt as a child.  

 


References: 

https://www.straitstimes.com/singapore/how-emotional-neglect-during-childhood-affects-ones-mental-health (Accessed 07/10)

https://blogs.psychcentral.com/childhood-neglect/2018/09/the-2-types-of-childhood-emotional-neglect-active-and-passive/  (Accessed 07/10)

Photo by Isai Ramos on Unsplash

 

Burnout and How to Heal from It

Burnout and How to Heal from It

It is an undeniable reality that life, in general, is busy. With long work hours and bills to pay, there are so many things going on that we must and are expected to do. With the increase in pressures and demands in daily life, it is very common for people to feel exhausted and burnt out.

Burnout is a state of exhaustion caused by chronic stress. According to the World Health Organisation, it is classified as “chronic workplace stress that has not been successfully managed”. It is characterised by 3 dimensions: Feeling exhausted or devoid of energy, being mentally detached from your job and being less efficient in work. Employee burnout in Singapore is among the highest worldwide, where work is a vital cause of high-stress levels, and where almost one in eight employees cannot cope with their stress. There are many potential causes of chronic stress in the workplace, such as having too many responsibilities, having a negative view of yourself and the world, or a perceived lack of control over your life and work. All of these factors could cause one to burn out easily.

Let us recognise the signs that indicate a burnout. Physical signs include exhaustion, change in sleep habits or diets, frequent illness and headaches; Emotional signs include lack of motivation or enjoyment towards life events and feeling negative emotions such as anger, anxiety or depression; Behavioural signs include adverse coping mechanisms such as overconsumption of alcohol, withdrawal from responsibilities, taking out your frustration on others and reduced work performance. If you are currently experiencing these symptoms, then it is very possible that you may be burning out from work.

Now, you may ask, if busyness in work is inevitable, then how do we overcome this seemingly unmanageable stress? Below are 4 tips that could help you manage stress and prevent burnout:

  1. Turn to other people

It is extremely beneficial to have a social circle or support network, such that there are people that you can rely on for support, encouragement and a listening ear. Friends or family members can recognise maladaptive patterns in your behaviour, identify your burnout signs, and offer you constructive feedback or advice. Through doing that, you can work towards overcoming burnouts. Likewise, if your loved one is going through a burnout, engage her in a conversation and let her open up about what she is going through, while staying patient and understanding. Confiding in and spending time with loved ones would serve to reduce stress and strengthen your relationship with them as well.

If it is possible, try befriending your colleagues. With a similar job scope, your colleagues can better understand your stress at work and everyone can draw support and motivation from one another. Additionally, good relationships with your colleagues enable you to work faster and better while reducing your work’s monotony. Thus, a more positive work environment keeps you energised and productive, countering the effects of burnout.

 

  1. Live a healthy lifestyle

Healthy lifestyle habits such as sleeping, exercising and healthy eating can have a huge impact on your mood and energy, helping to reduce stress and prevent burnouts. Exhaustion or a lack of rest often worsens burnout through causing you to think irrationally, and can take a toll on your energy and emotional balance. Thus, getting a good night’s sleep energises you and improves your mental state, ultimately improving your productivity at work.

What you consume can greatly impact neural circuits in your body that control emotion, mood and motivation. As such, eat food that can elevate your energy and mood such as fruits, vegetables and food that is rich in whole grains; and reduce consumption of food with lots of caffeine, sugar, chemical preservatives and hormones.

Exercising also enables stress relief. While engaging in exercise, you can focus on your body rather than your thoughts, and how your body feels as you move (feeling the sensation of the wind against your cheek can be strangely calming!). However short or simple, any form of rhythmic exercise is beneficial as it can increase your energy while simultaneously relaxing your mind and body. Ultimately, a healthy lifestyle does wonders to your wellbeing.

 

  1. Find ways to relax and unplug from work

We often burnout due to lack of time for ourselves. Thus, give yourself a chance to slow down, rest and heal. Set time aside for activities that are not work-related and do activities that make you happy and relaxed. This includes your personal hobbies, interests or a passion project such as photography, baking or exercising. Doing these activities can make you feel rejuvenated and accomplished, and helps you rediscover joy and meaning in your life outside of work.

Additionally, reserve some time to disconnect from technology. In today’s day and age, smartphones cause us to “carry an office in our pocket”, and make us psychologically connected to our work all the time. Hence, it is a good idea to limit your phone time after work, to prevent yourself from checking your emails or calling your office; such that you can spend quality time with yourself and your loved ones. Through these regular breaks, you are given an opportunity to restock your mental energy and engage in self-care, which can increase your happiness and quality of life.

 

  1. Re-evaluate priorities and set boundaries

Lastly, reflect on the cause of your burn out and consider what makes you feel stressed and anxious. Ask yourself, Is my work making me stressed? Exactly what aspects of work are making me stressed? Do I spend enough time for myself? Through this self-reflection, you can find ways to reduce this burnout. A good solution is to set boundaries for yourself and re-evaluate priorities, such as knowing how much time to allocate to work and relaxation (possibly placing more importance on rest and less importance on work) and learning how to say “no” to tasks. Do not stretch yourself beyond what you can handle or commit to. If you struggle with this, remind yourself that saying “no” enables you to say “yes” to tasks that you find more fulfilling. Through re-prioritising your commitments and tasks, you are able to find balance in your life and focus on parts of life that bring you joy, meaning and satisfaction (even beyond your job).

If possible, you can also identify or consider which aspects of your job you enjoy and find the most fulfilling. After doing so, you could ask your supervisor if you can focus on these tasks as they are more aligned with your responsibilities and strengths. Doing this helps you find value and regain a sense of control in your work, giving you a positive outlook and attitude towards your tasks.

 

Healing from a burnout definitely is not easy, and takes lots of time and commitment to overcome, but it is possible. Take the effort and steps necessary to manage your time and reduce stress, and keep to it. It may be difficult to adjust and keep to these new changes, but ultimately, it will prove effective in preventing burnouts and will improve your physical, emotional and mental well-being.


References:

https://www.helpguide.org/articles/stress/burnout-prevention-and-recovery.htm

https://hbr.org/2015/04/how-to-overcome-burnout-and-stay-motivated

https://www.who.int/mental_health/evidence/burn-out/en/

https://www.pacificprime.sg/blog/employee-burnout-in-singapore/

https://www.fairview.org/patient-education/85169

https://www.helpguide.org/articles/sleep/getting-better-sleep.htm

https://www.inc.com/john-rampton/8-ways-to-get-over-job-burnout-without-leaving.html

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