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What is Obsessive-Compulsive Disorder and When Do You Need Treatment?

What is Obsessive-Compulsive Disorder and When Do You Need Treatment?

Written by: Fred Chin, Psychologist

 

What is Obsessive-compulsive Disorder?

Think of the following scenario: you have friends over at your place and you serve them drinks. Before they can place their cups on your beautiful coffee table, you exclaim and dart out coasters underneath the ice-cold glasses before the first drop of dew can drip on that expensive rosewood. Your lightning-fast reflexes have intercepted what would have been a disaster. Your friends are startled at first, then they laugh and tease you. They say you have OCD – obsessive-compulsive disorder.

This, or a similar instance, may have happened at some point in our lives before. We tidy up a mess in the presence of others, or when our belongings are organised ever so neatly, and we end up joking about OCD.

But in truth, OCD is far from such behaviours that could be written off so light-heartedly.

A person with OCD will have compulsions – they feel the need to perform certain repeated behaviours to reduce emotional distress or to prevent undesirable consequences. These compulsions are so intense that they cannot carry out other daily routines without acting on them. Some common ones include:

  • Excessive washing or cleaning – They fear contamination and clean or wash themselves or their surroundings many times within a day.
  • Checking – They repeatedly check things associated with danger, such as ensuring the stove is turned off or the door is locked. They are obsessed with preventing a house fire or someone breaking in.
  • Hoarding or saving things – They fear that something bad will happen if they throw anything away, so they compulsively keep or hoard things, usually old newspapers or scraps of papers which they do not actually need or use.
  • Repeating actions – They repetitively engage in the same action many times, such as turning on and off a light switch or shaking their head a numerous number of times, up 20 to 30 times.
  • Counting and arranging – They are obsessed with order and symmetry, and have superstitions about certain numbers, colours, or arrangements, and seek to put things in a particular pattern, insisting to themselves that the layout must be symmetrical.

When Does OCD Become Chronic and What Should You Do If That Happens?

OCD is a chronic disorder, so it is an illness that one will have to deal with for the rest of his or her life. It is difficult to tell when the disorder becomes chronic, as it presents the individual with long-lasting waxing and waning symptoms. Although most with OCD are usually diagnosed by about age 19, it typically has an earlier age of onset in boys than in girls, but onset after age 35 does occur.

A cognitive model of OCD suggests that obsessions happen when we perceive aspects of our normal thoughts as threatening to ourselves or to others, and we feel responsible to prevent this threat from happening. These misperceptions often develop as a result of early childhood experiences. For example, a child may experience living in a dirty and dusty environment, while being subjected to some form of trauma at the same time. He associates a lack of hygiene with suffering from the trauma. At a later stage in life, he may start to feel threatened upon seeing the unhygienic behaviours of someone he lives with, be it his parents, romantic partner, or flatmates. This leads to the reinforcement of the association and to the development of his beliefs that suffering is inevitable when unhygienic conditions are present, giving him compulsions to improve these unsanitary conditions through washing and cleaning. 

If one is affected by OCD to the extent that he or she is unable to hold down a job and to manage household responsibilities, then there is a need for clinical treatment as the symptoms have become severe. Like in the above-mentioned example, recurrent and persistent thoughts of dirt will give the individual compulsions to neutralise these thoughts, resulting in repetitive washing, and checking behaviours. This causes distress and significantly affects one’s functioning.

When OCD has become a chronic illness, through a formulation of intervention strategies, the psychologist should extrapolate the client’s pattern of behaviour and expect a positive prognosis for functional improvement.

 

How Can OCD Be Treated?

A person diagnosed with OCD may seek treatment through a treatment plan that consists of cognitive strategies. These cognitive strategies involve consciously implementing sets of mental processes in order to control thought processes and content. Through these cognitive strategies, we can examine and restrict the thoughts and interpretations responsible for maintaining OCD symptoms. This is conducted in the initial stages of therapy.

Thereafter, Exposure Response Prevention (ERP) methods are carried out once a client is able to understand and utilise these cognitive strategies. ERP requires the client to list out their obsessive thoughts, identify the triggers that bring about their compulsions and obsessions and rate their levels of distress on each of these. Starting with a situation that causes mild or moderate distress, the client is exposed to their obsessive thoughts and simultaneously tries to resist, engaging in any identified behaviours that they have been using to neutralise these thoughts. The amount of anxiety is tracked each time the process is repeated. When anxiety levels for this particular situation eventually subside, over several repeated processes, and when they no longer feel significant distress over this situation, the same method is repeated for the next obsessive thought with the next level of distress.

A client who is able to demonstrate strength in coping with the symptoms has a better likelihood for sufficient recovery.

 

OCD is Becoming More Prevalent in Singapore: How has it Been Accepted in Society?

In recent years, OCD has topped the list of mental disorders in Singapore, with the greatest number of people experiencing it in 2018, compared with other mental illnesses.

The disorder has been found to be more prevalent among young adults than those aged 50 and above. In terms of socio-economic status, OCD is more likely to occur amongst those with a monthly household income of less than S$2,000 than those who earn above that amount.

It has also been found that the prevalence of people experiencing OCD at least once in their lifetime is higher in Singapore than in South Korea, Australia and New Zealand.

In addition to becoming more prevalent, people who experience OCD are also becoming increasingly reluctant to seek psychiatric help or counselling, making matters worse. There is some acceptance of the condition as normal and trivial by society, because people who do not understand the disorder well enough misconceive OCD as a quality of being clean and tidy, as being clean and tidy is usually seen as a good thing. This misconstrual by society is dangerous for the undiagnosed, and their condition will further deteriorate if they continue to put off addressing their disorder.

The disorder will get worse if treatment is ignored, and there is a need to realise it in its early stages through observing how one’s life is being disrupted. Awareness about its onset of symptoms is important.

Do seek out a psychiatrist,  psychologist, psychotherapist (therapist) or counsellor to get professional help for a better recovery journey. Early intervention is crucial to prevent escalation of the condition.

 


reference(s)

https://www.todayonline.com/singapore/mental-illness-more-prevalent-among-young-adults-ocd-one-of-top-disorders-spore

Photo by Anton on Unsplash

Chronic Stress Management: Why Am I Feeling Exhausted All The Time?

Chronic Stress Management: Why Am I Feeling Exhausted All The Time?

Are you feeling tired most of the time despite having a good night’s sleep? Are you constantly feeling low energy and unproductive? These are just a few of the typical symptoms pointing towards unhealthy levels of stress. Constantly feeling worn out could be an alarm that your body is sounding – a message that it is overwhelmed and unable to keep up. Undeniably, we often put ourselves in a constant heightened state of alertness, especially in such a fast-paced society. Our sources of stress may differ, from high-pressure jobs to challenging and taxing relationships. Stress affects everybody – even if you may not be physically attending to any particular concern, allowing it to occupy your mind frequently and fretting over it can contribute to chronic stress. Without proper management and control, chronic stress puts pressure on the body and will ultimately wreak havoc on your physical and mental health.  

 

As a natural biological response to demanding circumstances or situations, our body releases hormones such as cortisol, a stress hormone. Alongside adrenaline, cortisol helps to fuel your body’s ‘fight-or-flight’ instinct whenever a crisis surfaces. A stressor may be a long term one, such as the routine stress related to the pressures of school, work, family, and other daily responsibilities, or short-term occurrence brought about by a sudden change, such as losing a job, illness, or facing dangerous situations. In an ideal situation, when an individual faces a trigger, the adrenal glands in the body secrete cortisol and a complex hormonal cascade ensues, preparing the body for the ‘fight-or-flight’ response. Following that, cortisol inhibits the production of insulin in order to increase the uptake and usage of glucose so that more energy is made available to the surrounding muscles. Arteries will also be narrowed, increasing the heart rate and forcing blood to be pumped harder and faster around the body to help you confront the immediate threat. Once the individual resolves and addresses the situation, negative feedback kicks in and hormonal levels will then fall back to the norm. 

 

With this said, when we are constantly under high levels of stress, our alarm system doesn’t turn off. This means that our body is continually in high-gear and cortisol levels will remain high, to the point where it becomes harmful. Small doses of cortisol are safe, and in fact, is important for your health as it also serves to regulate your metabolism and blood sugar level amidst other key functions. However, in the case of chronic stress, constantly high levels of cortisol take a toll on your body’s resources, leaving you exhausted. Over time, continued strain on your body from stress may contribute to serious health problems. Hence, there is a need for us to tackle the root of the problem and ensure that we manage our stress levels to reduce the risk of negative health effects.

 

You might have been advised to change your lifestyle for the better at least once in your life by a family member or a friend – and we cannot stress this enough. It is essential that you learn to live a healthier lifestyle, which includes stress reduction and learning to manage your hectic schedule. If you continue to live an overly-demanding way of life, it is highly likely that you may succumb to chronic stress or worse, other mental health issues such as anxiety or depression. Moreover, can you imagine how hard your adrenal glands will have to work in order to continue producing sufficient stress hormones? Needless to say, the high cortisol levels will also impact your physical health and lead to other conditions such as digestive problems, high blood pressure or sleep issues. This results in a vicious cycle – with less sleep, the more exhausted you feel. 

 

Working on stress reduction can be as easy as doing deep abdominal breathing exercises, and incorporating meditation. Schedule regular times for these and other healthy and relaxing activities. They are simple, cost-effective, and are readily available. In this highly technological age, there are many applications available on your devices to further assist you in such activities as well. On the contrary, if you feel that you aren’t quite the kind to sit down and meditate, you can also opt to do some physical exercise to help boost your mood and improve your health. Organising activities with your friends such as playing a game of badminton or volleyball can help you to keep your mind off things, and at the same time, seek the social support you need when necessary. Of course, exercising alone is perfectly fine too, the main point is that exercising produces endorphins – chemicals in the brain that help alleviate stress by acting as natural painkillers.

 

Watching what you ingest is also equally important. For example, for heavy coffee drinkers, try to cut down on caffeine. Although the threshold for caffeine might differ for every individual if you notice that your excessive caffeine intake is making you jittery or on the edge, consider cutting down on it. Instead, you may want to replace it with other beverages that have a calming effect, such as chamomile, lavender or peppermint tea. Drinking a cup of warm milk before bed can help you get a better night’s sleep too. In addition, you might want to consider eating foods such as avocados, which are known to offer omega-3 fatty acids that can help reduce stress and anxiety. However, we should always remember that everything should be consumed in moderation. 

 

Last but not least, learn to say no, and only commit to responsibilities that you can cope with! Although not all stressors in your life are within your control, some of them are. It is crucial that we manage what we have on our plates, and not bite off more than we can chew. Try to be mindful of what you have accomplished at the end of the day, not what you have been unable to do. Juggling many responsibilities at once can leave you feeling disheartened and overwhelmed, and this increases your stress levels unnecessarily. 

 

Sometimes, despite numerous efforts at self-help, some individuals may still find it hard to cope with their high levels of stress. If you are overwhelmed by stress, ask for help from mental health professionals, as therapy is also a way to help you navigate through and overcome your stress. 

 


References:

https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response (Accessed 01/07/2020)

Photo by Keenan Constance 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)

 

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

Overcoming The Fear of Failure

Overcoming The Fear of Failure

At its most elemental level, people avoid the risk of failure for one simple reason – it hurts. Every single person has experienced failure. If you were to interpret failure by its definition in the dictionary, “the neglect or omission of expected or required action”, wouldn’t you, as a child, have stumbled along the way to achieving those long strident steps you take when strutting along the sidewalk? Yet, nobody feels ashamed of failing to learn to walk as a toddler. Why’s that? You could say that no-one in the right mind would expect that of a human child – we aren’t deer, or gazelles that need to shake off the afterbirth and walk – or risk predation. Our success as a species which put us at the top of the food chain negates that need. Fear is a function of the amygdala, yet failure isn’t. There’s a distinction here that we need to be mindful of. If you’re a parent or have access to YouTube, you’ve probably noticed that there’s an innocence in children that can be quite uplifting to watch, as they try multiple times to succeed at a simple task. They don’t puff their cheeks out and sigh in despair, or bury their heads in their hands. At most, they demonstrate frustration.

Shame is learned behaviour that children integrate into their developing moralities, either from being taught or through observation. Studies done on athletes have shown that perceived parental pressure (or pressure from authority figures) have deleterious effects on how sportspeople experience and interpret failure. Simply put, the fear of failure is a construct of how societies function. For some people, the avoidance of shame that failure brings weighs too heavily on them, and that is the crippling fear of failure. Dr Guy Finch puts this rather more succinctly: “fear of failure is essentially a fear of shame”. How then, do we begin to become more self-aware in the face of these deeply ingrained avoidance mechanisms to start building our best selves?

Evidence-based science suggests that the most efficient way to bring oneself out of the debilitating spiral of negative self-talk – one of the most insidious culprits in perpetuating avoidance based behaviours that stymie growth – is Psychotherapy method, Cognitive Behavioural Therapy (CBT). 

After all, overcoming fear of failure is all about reversing negative thought patterns, and Cognitive Behavioural Therapy (CBT) is designed to help you identify the underlying belief that causes a negative automatic thought (which in turn guides the feelings that come with it).

With the help of a qualified mental health professional, which can be anyone from a trained psychologist, psychotherapist or even psychiatrist, you can be empowered to break the circuit of the pervasive vicious cycle of negativity that prevents the unfettering of fear of failure’s heavy chains.

For instance, think of each deeply held criticism that you can’t let go of as a block in a Jenga game with your friends and the tower represents your thought life as a whole. Even though you’ve suffered through failure after failure, you can’t seem to jettison them from your psyche. Can you imagine a game of Jenga that doesn’t end in peals of laughter? It seems that some re-evaluation is needed to turn the way you handle each soul-sucking gut-punching failure from the darkness of your room. The grip of negativity steadying your trembling hand, an extension of your mind, putting each block up on autopilot because you believe you are not good enough. Instead, we suggest turning the lights on, invite someone you trust into your sanctum of despair, to play the game of Jenga with you. As you ease into their presence, you’ll begin to notice that the tower doesn’t look so intimidating anymore. It’s no longer just a congealed mess of all your shortcomings and toxic thinking, but a simpler thing that can be deconstructed. If each block represents a negative conviction you have about yourself that is too painful to touch, reach for the piece that looks more well-shorn and polished (which represents a perceived positive character trait or accomplishment that you hold dear). Put it back on top of your tower. It is yours, isn’t it? Or perhaps let your confidant handle that splintery block. 

Of course, we all know that Jenga isn’t all laughter and grand gestures. There’s physical tension and the cogitation of making the right choice so the tower doesn’t crumble prematurely. Maybe you aren’t too good at Jenga. That’s fine. But if you start thinking of this special game of Jenga as a collaborative effort instead of a competitive one, you’ll start getting the picture. Who would you like to invite to collaboratively play a game of Jenga?

 

 


  1. Sagar, S and Stoeber, J. Perfectionism, Fear of Failure, and Affective Responses to Success and Failure: The Central Role of Fear of Experiencing Shame and Embarrassment. Journal of Sport and Exercise Psychology, 2009, 31, pp 602-627.
  2. https://www.psychologytoday.com/sg/blog/the-squeaky-wheel/201306/10-signs-you-might-have-fear-failure. Accessed 2/6/2020.
  3. Photo by John Moeses Bauan on Unsplash