Category Archives: Anxiety Disorder

Frequent hardship makes a society more resilient

Anxiety Disorder, In the News, Issues & Debates

Do you think it’s applicable to individuals too?

I just read this on the New York Times, I guess it’s not surprising that frequent hardship like famine, war etc makes a society more resilient. Just like ecosystems that go through frequent disturbances become the most resilient too.

But think about people around you, do you think some individuals who survive frequent hardship become the strongest to bounce back, compare with those who have had a smooth life?

What are the other deciding factors?

I’m looking at this as a school counsellor. I work with kids who come from very privileged background, whose, should they fail all their high school final exams, parents could probably open a university in a big city just for them. But I also work with kids who come from very underprivileged backgrounds, who are here on scholarships. They are all in the same school. Often people question why the world is so unfair. One could look at their classmate every day and have all sort of “how if” in their mind.

Which of these groups might be more resilient in face of hardship? (Obviously there are probably many other factors that play a part here)

I’m also looking at this as a parent (a very new one). How do you think we could raise kids who are more resilient? Who can bounce back after falls? Kids who are confident and resilient?

Documentary: Take your pills: Xanax (2022)

Anxiety Disorder, Issues & Debates, Review - books movies series, Treatment Approaches
Watch Take Your Pills: Xanax | Netflix Official Site
Netflix Documentary: Take your pills: Xanax

Xanax, an anti-anxiety that I’m very familiar with from the 7 year working in a psychiatric clinic. I was excited to see this title showing up in the list of recommended shows as I was trying to find something to watch over the weekend, after waking up really late from watching the World Cup (Qatar 2022).

It consists of most things I already know, and many things that I’ve explained to many laypersons over the years, I definitely recommend this to everyone who experiences anxiety, who knows someone who’s taking anti-anxiety to watch this (essentially everyone), and think about it… Unfortunately it’s not the most “interesting” documentary with a twisting story-line, but it’s important to learn how we are often fed certain drugs (and nicely called medicine) when there are many things else we can do to cope with it, might be harder and sometimes more costly, but without any side effects, dependence, tolerance and withdrawal symptoms.

My stance is clear, I don’t mean to not take any pills for anxiety, because sometimes the anxiety can be so strong that it’s almost impossible for anyone to deal with, leave alone function, so this is when pills like Xanax can play a role, but when you’re feeling better, definitely do not just believe that you can just keep popping the pill into your mouth the next time when it happens, instead, learn about anxiety, your triggers, how you can cope with it the next time it happens, and practise those coping techniques. It takes a while, but you can ultimately depend on yourself and nothing else…

Feel free to read about my older writings on medication.

生态&气候变化焦虑

Anxiety Disorder, Clinical Case Studies

几年前，我从马克那里听说，英国大学的一位同事专长治疗“生态焦虑症”患者，那至少有 3 或 4 年前了。当时我有点惊讶，然后我只是耸了耸肩，没有继续深思。 （注意：我不会对很多事情耸肩……）

我有两个选择不生育的家庭成员，因为他们两认为孩子们会在这个星球上受苦，这又是几年前的事了，是的，他们今天仍然没有孩子。每当我想到要孩子时，我个人也会考虑多年以后这地球是否还适宜居住等方面的问题。

就在 12 或 13 年前，我有一个德国朋友会因为其包装方式，不在 Tesco 购买 Kinder Bueno 巧克力威化棒，用上太多塑料了！即使她喜欢 Kinder Bueno，但她也只会买一块 100 克简单包装的巧克力。

从那时开始，我渐渐发现自己对塑料非常敏感，尤其任何一次性丢弃的东西。当我来到新加坡生活时，我遇到了困难。作为一个自豪的马来西亚雪兰莪州人，我们的杂货店和购物商场在 5 年或更早以前就停止提供塑料袋，保丽龙（聚苯乙烯）也被禁止使用，我在日常生活中几乎看不到它们。但是塑料袋和聚苯乙烯在新加坡随处可见（没有记错的话，一个新加坡人平均每年制造四十几吨的垃圾）。

快进一年在这里生活，我开始比较少去意识到气候和环境相关问题。当我看到灾难相关的新闻时，尤其是极端天气的新闻时（森林野火、旱灾、水灾等），我仍然会想它，但后来我有意识地分散了自己的注意力。也许我在逃避。我不确定如果我更深入地思考它，我是否也会变得非常焦虑。

生态焦虑，怎样才算是个问题、才需要寻求帮助？

这篇文章是为了认可我们心理学家和治疗师了解这件事的一个时代的开始，因为在过去的两个月里，我看到有两个患者因为生态焦虑相关问题和症状来找我，他们在 Hogg 生态焦虑量表上的得分都偏高。然而，重要的是，我们不应该将正常的担忧或顾虑病态化。目前 DSM-5 中没有特别列出生态焦虑，我也认为它不应该被列其中。当焦虑变得持续性和压倒压迫性，而且开始影响正常运作和日常生活时，那就应该寻求专业的帮助。问题是，当然，如果它以积极的方式影响你（例如，意识到碳足迹和塑料无所不在然后决定停止乘搭飞机或购买塑料包装的巧克力和蔬菜等），那么我们需要考虑的是，这个人过这样的生活时的情绪状态和感知幸福感。我记得我曾经工作过的大学国际办公室女士不坐飞机，她会坐火车去任何她想去的地方，不管它有多远。我会说她喜欢这么做，这样做可以增强她的整体幸福感，她也以此为傲。

不得不说，对一些有环保意识的人来说，生活在一个还没有采取多少适当措施的发达国家是蛮痛苦的。即使是普通老百姓和小企业主所做的也比我所说的政府要做得多很多。

无论如何，这是一段漫长的路。任何一步都是一步。当我得到他们的许可时，我可能会写更多关于我的患者的生态气候焦虑的内容。

Is being a perfectionist good/bad?

Anxiety Disorder, Clinical Case Studies,

She’s only 15, and has been doing great academically in all the subjects all her life. It’s probably not wrong to say that she is one of the top students in her country, that’s also why she received a scholarship to receive better education in a different country.

Now being in one of the top colleges in the world, she is struggling to still be the best. But she doesn’t give up. She sacrifices her sleep just so she can catch up. After all this is a very different education system from the ones she was in.

After 6 months of persistent trying, she still doesn’t see much of any results. She cries. She feels like a zombie. She wants her family to be proud of her. She needs to be the best. She wants to be perfect, in all subjects, in her writing, in her presentation, in every piece of work that she produces. But it’s not happening…

She told me “I never see perfectionism a bad thing. I always thought it’s good. Why is it bad?” She believes she’s where she is today thanks to her perfectionist trait, or she wouldn’t have worked so hard and strived so hard.

But over time she starts to see that this trait is pulling her down, is creating a lot of self-doubts and criticisms in her mind, is affecting her work, is stopping her from functioning properly, is preventing her from enjoying studying that she always loves, is making her depressed and feeling hopeless.

I guess for many of us, we were all once there, weren’t we? I remember how I was like in high school, the lucky thing is I managed, and that’s mainly because I wasn’t studying in the top school in the world. But many students who do very well but come from an underprivileged background struggle when they receive scholarship and get into a top school. It’s hard for them to see that being top in their country might not mean anything once they are here. Some people give up, some people try persistently; some people see some results, some never.

Most people are usually rewarded as a perfectionist, at least initially, like in the first one or two decades of their life. So it’s natural that we see and experience the benefits and sense of achievement being one. But it’s either now, or later in the university, or when we are in the society, that we see how academic results don’t matter, how being a perfectionist alters your worldview and reduces how you could have enjoyed life and things along the way.

For the perfectionists, only the results matter. But life isn’t like that, because the ending of life is always the same, life is about the processes. Still, you can strive to be excellent, strive to become better than yourself yesterday, but not to be flawless…

But, will young students see that?

Eco-Anxiety / Climate Change Anxiety

Anxiety Disorder, Clinical Case Studies

A few years ago, I’ve heard from Mark that a colleague from the college in the UK works with people who suffer from “eco-anxiety”. It’s at least been 3 or 4 years. Back then, I was a little surprised and then I just shrugged. (Note: I don’t shrug at many things…)

I know a family member who wouldn’t have kids because they think the kids are going to suffer on this planet, again this was quite a few years back, yes they still don’t have kids today. I personally consider this aspect too whenever I think about having children.

As far as 12 or 13 years ago, I have a German friend who wouldn’t purchase the Kinder Bueno chocolate wafer bar at Tesco due to the wrapping, how each of them is wrapped, and then a pair of them is wrapped in yet another plastic. She would just get the bar of chocolate, all 100g in one wrap, even if she likes the Kinder Bueno.

I find myself being very conscious about plastics, anything that’s single use and disposable. I had my struggle when I came to live in Singapore. As a proud Selangorian, our grocery stores stopped giving out plastic bags 5 or more years ago, polystyrene has also been banned, I hardly see them in my daily life. But plastic bags and polystyrene are here everywhere in Singapore.

Fast forward one year living here, I realised that the climate and environmental related issues have crossed my mind much less than before. When I watch news of disasters, especially due to extreme weather, I still think about it, but then I consciously distract myself. Perhaps I’m denying it. I’m not sure if I will become quite anxious too if I go deeper to contemplate it.

Eco-anxiety. When is it becoming a problem? (Image from coloradu.edu)

But this post is to acknowledge the start of an era for us psychologists and therapists to learn about the matter, because I have seen two clients who came to me due to eco-anxiety in the past two months, both scored relatively high on the Hogg Eco-Anxiety Scale. However, it’s important to note that we shouldn’t be pathologising a normal concern or worry. At the moment eco-anxiety is not listed in the DSM-5, and I don’t think that it should. The reason people should seek help is when the anxiety gets persistent and overwhelming, and that it starts to affect their normal functioning and daily lives. The thing is, of course, if it’s affecting them in a positive way (e.g. being conscious about carbon footprint and plastic uses that the person stops flying on a plane or buying chocolate in a plastic wrap), then we would need to reconsider the person’s emotional state and perceived wellbeing when leading such a life. I remember my university international office lady that I used to work for doesn’t take flights, she would take trains to go anywhere she wants, however far it is. And I’d say she enjoys it, and it enhances her general wellbeing doing so.

However, here is some countries, it’s quite a struggle for the people who are environmentally conscious to live in a first world country who isn’t doing much, yet. Even the people and small business-owners are doing much more than the government I’d say.

Anyway, it’s a long journey. Any step is a step. I might write more about my clients when I have their permission to do so.

接受不确定性

Anxiety Disorder, Obsession & Compulsion, Treatment Approaches

生活中很多人不太能接受“不确定性”（uncertainty），比如担心孩子老公的安全、担心今晚可能睡不着、担心明天工作报告的表现、担心家人的健康状况等。而这是理所当然的，“不确定性”带来许多不舒服、焦虑，甚至恐惧的感觉。可是，很多人用担心与忧虑来应付不确定性，感觉上担心的事的不确定性在你担心后就变得比较能够预测、比较可以确定，这往往导致你继续担心与忧虑。

但是事实上，你的担心与忧虑，真的能使事情更确定更能预测吗？

挑战对不确定性的接受程度

  • 生活所有事都能肯定确定吗？有可能吗？
  • 对“确定性”的需要其实有多重要呢？有什么好处与坏处？
  • 你是否常常因为事情的不确定性而总是预测坏事会发生？这样合理吗？坏事以外的事发生的可能性不大吗？
  • 你所预测的事，发生的机率有多高呢？如果发生的机率很低，这样一直担心下去对你好吗？生活会快乐吗？
  • 你能尝试接受“不确定性”吗？能怎样做到船到桥头自然直的态度呢？
  • 问问你周围的人，他们怎么接受“不确定性”呢？


接受与警觉


当你无法忍受“不确定性”时，你都把专注力放在“未来”。现在就要学习如
何活在当下，对当下警觉注意，并接受这个“不确定性” －三个步骤：

  1. 警觉：清楚自己目前的思维与感受。用呼吸的步伐来让自己感受当下。当你总是想要确定性时，它给你带来了什么感受或问题？
  2. 放手：放弃这个对确定性的需要，告诉自己“这不过是个需要确定性的想法，我可以放手让它走”
  3. 不批判性：让想法在脑海里走过，不要批判它，或尝试改变它。然后把注意力放回当下，体验现在，注意你周围的声音，身体的感觉，或你的呼吸，或专注于你现在需要做的事。