Category Archives: Treatment Approaches

寻求安全行为

有一个部落相信,为了让太阳升起,部落里的每个人,每晚必须建立一个篝火,并围绕着它跳舞直到天亮。由于这种信念,部落每天花费大量时间收集木材并为夜晚篝火做准备(Wells,1997)。他们筋疲力尽。这种仪式已经占据了他们的生命,但他们无法阻止这一点,因为他们必须为整个世界确保第二天早上太阳再次升起。

寻求安全行为是一个人为了阻止恐惧灾难的事情发生所做的事情。但安全行为实际上使恐惧更加强烈,特别是以长远来说,人们没有机会发现其实灾难无论如何都不会发生。克服焦虑的过程,就包括有信心地放弃这些行为同时容忍焦虑。

一些临床病例

小艾伦认为,如果他打羽毛球,那他当晚就会失眠。所以他完全停止了他曾经最喜爱的羽毛球运动。

林女士患有惊恐发作和广场恐怖症,所以她在网上购物,不惜一切代价避开购物中心和拥挤的地方。现在她几乎没有太恐慌,但她的生活是如此有限,甚至已经许久没有和闺蜜见面聊天吃饭。

郭先生有社交焦虑。他尽可能避免社交互动和社交场合。即使他和别人说话,他也会避免眼神交流并保持简短的谈话。人们发现他无趣,冷漠和怪异。


所以,回到部落日出仪式。部落民族要怎么发现仪式是否真的让太阳升起?

小艾伦要怎么知道打羽毛球是否真的导致失眠?

林女士如何知道人群是否导致她的惊恐发作?她怎么能过更充实的生活?

郭先生如何知道避免社交互动和目光接触是否有助于解决他的问题?

(你可能会注意到,为了缓解他们在短时间内的焦虑,他们都已付出长远的巨大代价。“短期收益,长期痛苦”)


当我们“触摸木头”(touch wood)或在进入酒店房间之前做敲门之类的东西时,这些迷信似乎是我们人类的一部分。对于许多患有强迫症和焦虑症的人来说,识别他们的安全寻求行为非常重要,并且围绕它进行一些心理教育以使他们愿意放弃它们,或者测试放弃它们(行为实验)。

更重要的是,有些时候我们的治疗师会教他们某些应对技巧(例如腹式呼吸),并最终被用作寻求安全的行为 — “只要我专注于我的呼吸,我就不会惊恐发作并且不会在商场里晕倒。”因此,这些行为背后的意图(信念)很重要。你为什么这么做?它是一种应对(应对策略)的方式,以便您可以继续购物,或者你用它来预防您认为可能发生的灾难(安全寻求)?

This is a Chinese translated version of the post Safety Seeking Behaviour.

Stop it!!

A (very short) “counselling session” by the American stand up comedian and actor Bob Newhart. Do watch it!

I came across this video while learning thought stopping techniques. Seriously, sometimes I think this is simply and exactly what some people need.

Notice the thought and stop the thought, accept whatever you are feeling, focus on the present, use your sensation, pay attention to the external environment (as opposed to the internal), and do what you want to do!

Remember, only present exists! Everything else is only in your mind.

Also remember, you can’t stop the thoughts from popping up, but you can decide how you react to them!

Safety Seeking Behaviour

(This is my 200th post!! Well done, Hui Bee!! It’s been 4 years writing here.)

There is a tribe who believe that to make the sun rise, they have to build a bonfire each night and dance around it till dawn. Because of this belief, the tribe spends most of their time collecting wood and preparing for the night (Wells, 1997). They are exhausted. This ritual has taken over their lives, but they can’t stop this as they are obliged to make sure the sun rise again for the world the next morning.

A safety seeking behaviour is something a person does to stop a feared catastrophe from happening. But safety behaviours actually make the fear stronger especially in long-term by preventing the person from discovering that the disaster is not going to happen anyway. Overcoming anxiety involves having the confidence to tolerate that anxiety whilst dropping these behaviours.

Some clinical cases

Little Alan believes that if he plays badminton, he will not sleep at night. So he has completely stopped playing badminton that he used to enjoy.

Ms Stephy has panic attacks and agoraphobia, so she shops online, and avoids shopping malls and crowded places at all cost. Now she barely gets too panic, but her life is so limited.

Mr Patrick has social anxiety. He avoids social interactions and social situations whenever possible. Even when he speaks to others, he avoids eye contacts and keeps the conversation minimal. People find him uninteresting, aloof and weird.


So, back to the tribe sunrise ceremony. How would they discover that whether or not the ritual really makes the sun rises?

How would Little Alan know whether playing badminton really lead to insomnia?

How would Ms Stephy know whether the crowds lead to her panic attacks? How can she live a more fulfilling life?

How would Mr Patrick knows whether avoiding social interaction and eye contact help with his problems?

(You might notice that they all pay huge cost in long-term in order to ease their anxiety in short term. “Short term gain, long term pain”)


It seems that this is part of us human, when we do things like “touch wood” or knocking the door before entering the hotel room. For many with OCD and anxiety disorders, it is highly important to identify their safety seeking behaviour, and do some psychoeducation around it to make them willing to drop them, or test dropping them (behavioural experiment).

More importantly, there are also times when we therapists teach them certain coping skills (e.g. abdominal breathing), and it ends up being used as safety seeking behaviour “as long as I focus on my breathing, I will not get panic attack and faint here in the mall.” So, the intention (beliefs) behind these behaviours is important. Why do you do this? Is it as a way to cope (coping strategies), so that you can continue shopping, or is it as a way to avoid a disaster you think might happen (safety seeking)?

核心自我是不能被评估的…

new doc 2018-07-04 14.26.14-1

 

这是基于 Albert Ellis, 史上第一个创始了认知治疗的心理学家所说的“人们不能评论自我,只能评论行为”所画的。

如果一个人因为做了一些糟糕的事,而把自己或被别人标签为“糟糕的人”,那这个人要怎么改变自己呢?

只有通过只评价行为,不评价个人,只改变行为,而个人就只是存在着的,是无法被合理公平地评价,无法被改变的。

所以从现在开始,不再评价自己,也停止评价别人,更拒绝被别人评价。

核心自我(core self) = 体验式自我 (experiential self) = 觉察性自我 (awareness self)

Simple Breathing Relaxation 简单呼吸放松

Here is a 5-minute recording of tension release breathing, just follow the instruction (breath in – hold your breath & notice the tension – breath out and release the tension). Hold your breath for as long as you are comfortable, and try to exhale slowly and gently. You can do this anytime anywhere, with eyes open or close.

5 mins breathing relaxation - Recording


这是个简单的五分钟紧张释放呼吸录音,只需要跟着指示(吸气 – 屏气并注意肌肉紧绷感 – 呼气)。只要不造成不适,屏气时间尽可能长;而呼气的时候尽可能缓慢轻柔。在任何时候任何地方都可以做,不闭眼也可以。

五分钟呼吸放松 – 录音

河流上的飘叶

正念练习:河流上的飘叶(取自“接受与承诺疗法”Acceptance and Commitment therapy)

这是个闭眼练习。首先阅读说明,当你理解了这个练习的过程后,闭上眼睛开始。 (或者你可以使用这篇文章末尾的录音)

想象一下美丽、缓慢流动的溪流。水流过岩石,然后穿过山谷,周围有些大树。偶尔,风吹来,一片一片的叶子落入溪流中,随着河水漂流。想象一下,你正坐在那条小溪旁边,在天气很好的一天,看着河水的流动与树叶的飘落。

现在开始意识到你的想法(思维)。每当一个想法出现在你的头脑中时,想象把它写(或放)在其中一片叶子上。如果你用文字思考,把它们作为文字,轻轻地放在叶子上。如果头脑出现的是图像或画面,就将它们作为图像放在叶子上。目标是留在溪流旁边,让溪流上的树叶继续流动。不要试图让河流流得更快或更慢;不要试图以任何方式改变叶子上出现的东西。如果树叶消失,或者你的思绪飘到了其他地方,那就停下来、注意这发生了,然后再次回到溪流边,把刚刚的想法放到叶子上,让叶子随着河水流走。

(图像的生动或清晰程度无关紧要,只要有这个概念在就可以了– 觉察自己的想法,一旦发现它们就轻轻地放下)

继续进行至少5分钟。如果你现在已经了解说明,请闭上眼睛开始试试。

(练习后继续阅读)

当河流在流动,你也能注意到想法并轻轻地把想法放下时,这就是认知解离 (Cognitive defusion) 的时候。记得头脑本来就是设计来思考的,所以它总是会不断弹出各种想法,你虽然不能控制这点,但你能选择是否对这些想法作出反应,或者选择轻轻地放下它们。如果你认为“我做得不对”、“这个练习对我不起作用”或“我怎么会没有想法”,留意到它们也是你其中的一些想法,后退一步,把它们也放到落叶上。一些其它特别“粘”的想法(比较难以觉察和解离的想法),包括含强烈情绪的想法、比较性的想法等。

这里有两个中文版本的录音:

“河流上的飘叶”录音I

“河流上的飘叶”录音II

(类似的内容,只是前面的指示稍微不同;5-6秒后指示才开始)

多些练习,有问题的话,不妨在这留言。