Category Archives: Anxiety Disorder

面对焦虑

焦虑就像一只老虎,你为了避开它,减少它可能对你造成的伤害,你给了它一块肉,希望它吃了肉可以离开。是的,它可能离开一会儿,可是,猜一猜,给了它那块肉以后,它真的不再回来了吗?可能一两个小时,可能一两天,这回它又饿了,可能更饿了,更强大,要更多更大块的肉。

焦虑也一样,你越是逃避它害怕它,越是为了它作出不必要的牺牲(害怕在社交场合被拒绝,干脆不去参加舞会;担心无法把工作做好,花更多的时间在担心而不是完成工作,甚至最后真的无法完成),它下一次再出现,只会变得更强烈,让你更不舒服、更恐惧、更害怕。

可是如果你选择和焦虑处在一起,它固然让你感到不舒服,但它并不危险,一段时间后,你的焦虑感会开始下降,下次再面临一样的处境,你也不再那么焦虑,即使还是有一定程度的焦虑,你的头脑也能告诉你,基于上次相处的经验,其实这个焦虑感可能让你感到不舒服,但它并不危险,你并不用逃避它。

那不逃避,就是怎么做呢?如何直接面对它呢?如何接受情绪呢?首先告诉自己,这感觉可能让你感到不舒服,但是它不会对你造成伤害。你可以感受一下它处于身体的哪个部分,比如胸口闷闷地,颈项后方有点紧、心跳有点快、或肚子有些不舒服等,识别它们,并容许、允许它们存在于那里,就像一个朋友带了一个你不太喜欢的客人来到你家一起聚餐,但你并不因此把他赶走,或者为了他一个人,不去招待其他客人,你还是允许他的存在,继续享受你的聚餐、继续做你想做的事。对任何情绪,其实都一样,都可以这么做。

Eating & Anxiety

Substances that may raise your anxiety level and foods they are found in:

Caffeine: coffee, tea, chocolate, soda

Refined white sugar: nondiet soda, candy, cookies, cakes, ice cream, other desserts, sugar-coated cereals

Refined white flour: white bread and rolls, hamburger buns, spaghetti and other white pasta, pretzels

Alcohol: beer, wine, hard liquor

Artificial sweeteners: diet soda, most foods labeled “diet,” many sugar-free products, cereals

Substances that may lower your anxiety level and foods they are found in:

Niacin: chicken, turkey, wheat, brown rice, tuna

Thiamin: oats, wheat, pork, tuna, asparagus, sunflower seeds, white rice

Riboflavin: milk, yogurt, pork, avocados, mushrooms

Vitamin B-6: turkey, bananas, mangoes, sunflower seeds, sweet potatoes, tuna, pork

Vitamin B-12: beef, yogurt, tuna, crab, clams

Biotin: eggs, cheese, peanuts, cauliflower

Pantothenic acid: yogurt, avocados, salmon, sunflower seeds, mushrooms

Folic acid: turkey, oranges, peas, avocados, cabbage, broccoli, soybeans

Calcium: milk, yogurt, cheese, broccoli, spinach Magnesium: spinach, almonds, avocados, sunflower seeds, Brazil nuts

Omega-3 fatty acids: tuna, salmon, sardines, walnuts, dark green leafy vegetables, soybeans

Complex carbohydrates: whole-grain breads, whole-grain cereals, whole-grain pasta, brown rice

Everyone’s body is a little different from everyone else’s. This is just a general guide. To be fully aware of everything you are putting into your body, you may have to read the labels on the packages of the foods you eat. To learn more about their chemical makeup, you can also look up individual foods in an encyclopedia or a book on nutrition, or on the Internet. Sometimes people’s favorite foods are those that raise anxiety. It can be hard to give those up completely, but even cutting back on anxiety-raising substances can be helpful.

接受不确定性

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,担心睡不着,担心明天工作报告的表现等。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:

  • 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?
  • 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”
  • 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。

 

N.B. 在我看来,除了广泛性焦虑症(generalised anxiety disorder, GAD),不能接受“不确定性”(就是凡事都要百分百确定,不能冒一点险)也是强迫症(obsessive compulsive disorder, OCD)的一个明显特征,只是除了在脑中担心、不断思考,强迫症患者会对不确定性做出(反复的)行为反应。

新的一年,不妨把这当成今年的目标之一,学习与练习“接受不确定性”,活得灵活自在些!

You don’t have to see the whole staircase, just take the first step.

- Martin Luther King Jr.

Anxiety VS Depression

A brief update:

Hui Bee is away for replenishment from 29th Aug to 3rd Oct. When she is back, she will again be very busy preparing for the Stage II of CBH diploma course in BeiJing. After 3 years of regular updates, huibee.com is likely to be quiet for a couple of months. But she promises that she will definitely be back here. 

焦虑 (Anxiety) 和抑郁 (Depression) 的特点

焦虑和抑郁的不同

焦虑和抑郁的相似处

又是我早年制作的表,分辨焦虑和抑郁的相同和不同之处。这只是简略概括来说,每个人的情况症状都不同,绝对不能作为诊断用途。

Trichotillomania

She started picking hair since standard 5 in primary school, and the problems got worse over the years, especially when she was under pressure. She had seen a few counsellors, also skin specialist, and was given injection on the scalp and prescribed medicine. Finally her parents decided to take her to consult psychiatrist, and within two months she got better with some SSRIs and anti-anxiety drugs. She then stopped taking the medicine. Her hair was growing again.

Few days ago the mother called up, saying her problem is back. When she was sweeping her room, she could see hair all over her bed, pillows and on the floor. The mother asked if we could provide phone counselling to help her (without using medication, as it was causing drowsiness).

This kind of request is not untypical here. Asian people (including myself) tend not to take so much western medicine, and avoid it as much as possible. I can understand that. But the girl’s trichotillomania (hair pulling) problem has a biological components.

Most mental or psychiatric illnesses have a biological component, whether it’s depression, anxiety, OCD, psychosis (obvious!) etc. Sometimes it depends on the type of illness, sometimes on the individual, sometimes it depends on which episode (which means for the same individual, she could have a biological trigger last year but this time it’s a pure psychological triggered episode), sometimes it’s a mix of both. For a person who suffers from very bad OCD, medication can probably reduce his symptoms of 30-50%, but still leaving symptoms that would still interfere with his life, so for this part he would need psychological interventions.

So I explained to the mother that she needs medication, pure counselling may relieve her symptoms to an extend, but not all of it. Because when something is wrong biologically, she would need medication to help her, whereas psychological interventions can help her to reduce her anxiety and stress, and to learn to cope with stress, mood swing, etc.

The best treatment for her would be both medication and psychological interventions, and a good combination is in fact the best and most effective treatment for a lot of people and for many mental illness and psychological problems, unfortunately nowadays this is not the kind of service provided anywhere.


拔毛癖

她从小学五年级开始拔头发,多年来问题一直恶化,特别是面对很大压力的时候。她看过几个辅导师,也见过皮肤专科,并接受头皮注射和处方药。最后,她的父母决定带她去咨询精神科医生,吃了一些SSRIs(抗抑郁)和抗焦虑药,在两个月内情况就好转了。然后她就自行停止服药,头发也慢慢长出来了。

前几天,母亲打了个电话来诊所,说她的问题又回来了。当她帮女儿打扫房间的时候,看见床上,枕头,地板上都有头发。母亲问我们是否可以提供电话咨询辅导服务来帮助她(不使用药物,因为药物使她很疲累)。

这种要求在这里绝对不是非典型的(意即典型!)。亚洲人(包括我)普遍不爱吃西药,能免则免。这点我可以理解。但这女生的拔毛癖不是简单的心理问题,她的起因含有生物因素。

大多心理和精神疾病的起因都有生物成分,无论是抑郁症,焦虑症,强迫症,精神病(显然!)等。有时它取决于疾病的类型,有时针对个人,有时取决于哪次病发(就算是同一个人,她去年发病可能是因为生物因素,但这次却是心理引起的),更多时候是两者混合。对于严重的强迫症病患,药物也许可以减轻他的症状的30-50%,但剩余的症状仍然会干扰他的生活,所以对于这部分,他需要心理治疗。

于是我向她母亲解释她需要来见医生和吃药,单纯辅导或心理治疗可以缓解她部分的症状,但不是全部。因为当头脑里的传输物质出错了,她需要药物来帮助她,而心理治疗可以减轻她的焦虑和压力,并学会应对压力和生活的变动,情绪波动等。

最好的治疗方法是结合药物+心理治疗,其实对于很多人和大部分精神疾病,结合治疗都是最好最有效的方法,可惜在现今这却不是多少地方找得到的服务。

The more you worry about having to take medicine, the more you need to take them

Yes, and that’s all the point I want to make in this post.

Recently I spoke to a woman in her late 50s who has problem sleeping. She has been a patient since 15 years ago, but was never regular with medicination.

She has used all possible means to make herself sleep, taking wine, using chinese herbs, exercise etc. She just doesn’t want to depend on medicines. But she always comes back to see doctor and collect medicine when all other methods fail and she really needs some sleep.

So yes, she came back again last week. And since that visit she has called up the clinic several times. Every time asking about

  • When can I stop taking these medicine?
  • Can I start to reduce them now?
  • Will they harm my body?
  • What are the side effects and possible side effects?
  • What’s going to happen in long-term taking these tablets?

These are just some examples, under one topic/question she can ask in so many different ways and for so many times. (Eh? OCD?!)

At the end everyone couldn’t stand answering her questions repeatedly. So I’ve got the job. I told her that through our experience with many patients with either anxiety-related problems or with insomnia, the more she worries about needing to take medicine, the more she has to take it, it’s always like that. I asked her what has the focus of life becomes now?

All kind of worries about taking medicine.

The medicine is not likely to help her much if she continues to worry this way. So she won’t get well, so she’ll have to continue taking them. So she will continue to worry about taking them… … See the vicious cycle here?

So I asked her back why not continue with medicine, but shift her focus of life in something more meaningful, to how to live more healthily and happily? How about developing new interests, learning yoga, going swimming, forming new social relationships, improving familial relationship etc etc.

When she’s able to shift the focus and live more meaningfully and healthily, she may not even need the medicine without herself realising that.

 


越是担心吃药, 越是需要吃药?

当这过去十几年来一向难入眠的女士, 用尽方法却还是不能好好睡一觉, 她就会回来看医生, 通常每一两年至少来一次. 而这次拿了药回去后, 就开始不断地”电话轰炸”诊所, 问什么时候可以停药? 现在就停可以吗? 停了马上复发吗? 这些药有什么副作用? 对身体有什么害处? 一定要吃这些要吗? 等等等等. 每两到三天就来一通电话.

详细解释许多次后, 她却不见得可以明白. 下次打来, 还是问回这些问题.

所以我告诉她, 经验告诉我们, “越是担心吃药的人, 越是需要吃药, 往往也得吃得越久” 想想这么个担心忧虑法, 你的生活中心全是什么? 生活还剩下些什么?

本来吃药可能很快有效, 但是你这么一直担心, 东想西想, 日想夜想, 人可能反而更不舒服更忧虑, 结果要吃更多药, 然后又更担心忧虑, …恶性循环, 对吗?

何不就相信医生, 继续吃药, 同时好好地, 健康地生活, 培养新的兴趣, 做些运动, 建立社交生活, 改善与家人的关系等等, 在这情况些, 也许不知不觉中已经不需要再依赖药物了.