Stress is something we can never escape from, be it good (eustress) or bad (distress). From the small, tedious daily hassles to long-term occurrences that weigh on your mind, stress can impact us in different ways, and the experience varies for everyone. Just as how different individuals have differing levels of pain tolerance, the same applies for stress.
Stress comes in many forms, but they can be largely categorised under ‘environmental’ (e.g noise), ‘social’ (e.g family demands, friendship conflicts), ‘physiological’ (e.g sleep disturbance) and ‘cognitive’ stressors (e.g low self-esteem, high expectations of oneself). While a certain level of stress may be necessary to provide motivation and encourage positive growth, excessive and unhealthy levels of stress especially in the long-term may cause undesirable mental and physical health consequences:
Disrupted sleep patterns / insomnia
Undue anxiety or fear
Difficulty concentrating / forgetfulness
High blood pressure
Nervous behaviours such as teeth grinding or nail biting
Increased frustration and irritability
A racing mind / constant worrying
Poor eating / digestive upsets
Poor decision-making processes
Increased heart rate / rapid breathing
Sweating / sweaty palms
Sense of helplessness
Restlessness / fatigue
When stress becomes chronic, physical health consequences can definitely worsen, and an individual may also develop depression or anxiety disorders. As such, while there is no one-size-fits-all, this article aims to provide useful tips and suggestions on how you can better manage your stress levels, and to avoid being overwhelmed and giving in to chronic stress.
To guide us along, there are two main types of stress-coping mechanisms – ‘Problem-focused’ and ‘Emotion-focused’ coping. These are possibly the most basic approaches to healthy stress-coping, and aim to reduce or eliminate the causes of stress, apart from merely alleviating its symptoms.
Problem-focused coping is where action is taken to clarify and resolve the stressor directly, and hence addresses the demands of a given situation. An example of this method of coping is when a student who is worried over an upcoming examination copes by attending more review sessions and reading up on her course materials diligently. This serves to reduce her anxiety and increase her confidence to excel in her examination. A problem-focused mechanism is primarily used when one appraises a stressor to be within his capacity to change, and hence makes the appropriate adjustments and alterations to cope with the impending demands. As such, it is also important to learn how to identify the root cause of the direct stressor before responding to it accordingly.
Emotion-focused coping may be a concept that you find familiar. Unlike problem-focused coping, emotion-focused coping involves making efforts to regulate your emotional response to a stressor. This means identifying your feelings, focusing and working through them. According to Folkman and Lazarus (1980), such a mechanism can be extremely helpful especially when you need to work through your emotions before you can think clearly enough to act rationally. Emotion-focused coping can be done in various forms such as:
Venting or talking to a friend / close oneWhenever you feel stressed or overwhelmed, bottling up may not be the best way around. Talking to others about what’s bothering you could bring great relief, and perhaps they could also provide you with the constructive feedback or encouragement that you need. Physical affection, such as hand-holding and hugs can help combat stress too. Just as how others may come to you whenever they need support, don’t be afraid to lean into your social circle and find comfort in your friends. Of course, do also remember to be mindful of your friends’ emotions and needs while you’re busy venting!
Journaling In this digital age, perhaps Journaling may come across as a rather old-fashioned way of coping with your emotions. Many a time, people would rather distract themselves and destress by playing mobile games or browsing through social media as and when they are feeling stressed. Although those can be a possible methods of destressing, the beauty of journaling shines through when you give yourself some time to reflect and balance yourself by creating your very own safe space. Writing in a journal can help you clear your mind by releasing any pent-up feelings, to let go of negative thoughts, as well as to enhance your self-awareness as you write about your progress.
Meditation Practising mindful meditation is an effective strategy to combat stress, for it can help you eliminate the stream of jumbled thoughts that are contributing to your heightened stress levels. Studies have shown that training in mindfulness can potentially increase your awareness of your thoughts, emotions, and maladaptive ways of responding to stress, therefore allowing one to cope with stress in a healthier and more effective way (Bishop et al, 2004, in Shapiro et al, 2005). With guided meditations that can easily be found online, all you need to do is to set aside some time for some mental self-care.
Reframing the situation and finding meaning in it When we are stressed, we often only focus on the bad and how much we dread a particular situation. However, it can be helpful to look on the bright side and to find the benefit and meaning in a stressful event. By doing so, we can make these experiences a little more tolerable, as well as to grow and build resilience as we go along.
Other Means of Coping with Stress
Last but not least, pay more attention to your diet and nutrition intake. For some of you, caffeine is a must-have on a daily basis, with some people having four to five cups of coffee per day. However, when you combine stress with the artificial boost in stress hormones from caffeine, this creates a significantly compounded effect. While caffeine can be particularly effective in providing you with the short-term energy boost and increased alertness, it can potentially heighten stress levels in the long-term. As such, it is always good to consume it in moderation and to be mindful of your caffeine intake. In addition, you may want to consume foods rich in vitamin B, which can help to reduce stress responses in your body.
As previously mentioned, everyone experiences life events in their own unique way, and a strategy that works for you may not for others. With that said, we hope this article has helped you to understand the various ways to combat stress better, and that you find the strategy best suited for you. However, if you ever find yourself struggling to cope with stressful life events, do reach out to one of our psychotherapists or counsellors for help.
Zimbardo, P. G., Johnson, R. L., & McCann, V. (2017). Psychology: Core Concepts (8th ed.). Pearson. (Accessed 25/11/2020)
Shapiro, S.L., Astin, J.A., Bishop, S.R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: results from a randomised trial. International Journal of Stress Management, 12 (2), 164-176. (Accessed 25/11/2020)
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.
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.
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.
“I forgive you.” while on the surface seems to be an innocuous word and easy to say. But in reality, it’s one of the most difficult words to express in our human language. A few years ago, a middle-aged man angrily dragged his 13-year-old son to our clinic, it turned out that Mr Zhang (pseudonym) had discovered his son hiding in a corner of his room smoking, and slapped the boy hard in a fit of anger. Even after being scolded the boy was recalcitrant and didn’t even feel remorseful. In her efforts to appease the situation at home, his wife suggested bringing the son to see a counsellor.
On that day, I happened to walk past the therapy room. I could only hear the loud arguments between the father & son, and loud sobbings of the mom. Just as I stepped into my office, my office phone rang. It was an urgent call from my colleague, the therapist, who alerted that the situation was getting a bit out of hand, and asked for my assistance in the therapy room. Upon arriving at the scene, I could hear the son’s angry retort, “You’ve never loved me since young, why are you trying to control me now? All you’ve ever done was scolding me. So what if I behave myself? Would you even notice?”
It took more than an hour to calm all parties down. After which, I carefully interviewed both Mr Zhang and his son, and I finally got to the root of why the situation had become so tense between father and son.
It wasn’t the 13-year-old boy who had caused the breakdown in their relationship. The issues stem from painful experiences when Mr Zhang was growing up. Mr Zhang had grown up with an abusive father who was not only alcoholic and chain-smoked, who often vented his anger on his wife and children. As a result, Mr Zhang made a vow from young to never touch alcohol and cigarettes. Unfortunately, his demeanour also became very stern with hardly any smile on his face and had high expectations with his own children. Why did it become like this? It was because he had never forgiven his own father. The deeply buried hurts had made him prone to irritability, and thus he didn’t know how to praise or encourage his own child, and only knew strict discipline as his way of bringing up his child. Moreover, his biggest worry had been over his child coming into contact with alcohol and tobacco.
Mrs Zhang explained, her husband was a good man, but was a man of few words, and was not good in expressing his feelings. She knew that he really cares about the child, but it was a pity that communication was poor between the father and son. As a result of a craving for his father’s love and experiencing scolding and punishment from young, the boy had grown to become more rebellious in recent years.
In fact, Mr Zhang’s father had quit smoking and drinking for many years. However, as a result of the poor relationship between Mr Zhang and his father coupled with a break in communications for more than a decade. Mr Zhang couldn’t come to terms with my conclusion initially. But for the sake of his own son, he finally agreed to receive counselling. After several months, he finally understood the root cause. He asked me, “I’ve finally understood that the root cause of my frustrations was the unresolved anger and hatred towards my own father, but what should I do after so many years?”
Fortunately, one day his mother decided to visit their grandson together with his father. Although he felt embarrassed initially, Mr Zhang struck up his courage, squarely faced his dad and said: “I forgive you.” This simple yet miraculous sentence seemed to untie the knots of anger and hurts between Mr Zhang and his father. From that day onwards, Mr Zhang began to smile more frequently face and he could finally express his love fully to his son.As a result, his son stopped being rebellious. Not only did he stop smoking, but also paid more attention to his studies.
As a psychiatrist, I’m truly happy for this family and admire Mr Zhang’s courage in forgiving his own father. They continued with counselling for some time, and finally mended their father and son relationship that was formerly broken.
Therefore, forgiving others is also giving ourselves a chance to receive complete healing.