Category Archives: Treatment Approaches

What Acceptance is and is not?

I generally try to avoid using the word “acceptance” in my everyday clinical work. I found that people can become resistant when I say “accept it”, normally when I follow it with “allow it to be, let it be, without struggling”, they immediately get it, or at least become more “accepting” to the idea of acceptance.

Acceptance is not wanting or liking. You accept how things are going for you, doesn’t mean you like or want things that way. I accept that my cat has to be put down due to lymphoma, doesn’t mean I like or want him to be put down. I accept the sadness that comes with the loss, doesn’t mean I like or want to be sad.

Acceptance is also not tolerating. They are very different, do you want people to accept you, or tolerate you?

Acceptance is more about allowing things to be that way, accommodating it without struggling (so much) with it. Normally it applies to things that you can’t change directly (external events  which you have no control on, e.g. your cat has lymphoma; but also includes your internal thoughts and emotions, which you can’t simply chuck away like a piece of paper, e.g. sadness, fear, anxiety, thought of “I’m not good enough”).

How to ground yourself during an emotional storm?

Here are some short Dropping Anchor recordings, suitable to be used when you’re feeling intense emotions and wanting to ground yourself to the here and now, and make the most of the situation you are in. (Ideally you’d have done more extensive version of it with me in sessions. )

Dropping Anchor recording 3.5mins

Dropping Anchor recording 2.5mins

Essentially it’s about these steps:

  1. Notice and acknowledge your painful thoughts. What is your mind telling you? (“I notice that my mind is having the thought of I’m not good enough, I’m a failure”)
  2. Notice and acknowledge your feelings and emotions. What are you feeling in your body? (heavy chest? tensed shoulders? headache? numbness? etc)
  3. Come back into your body, straighten your back, put your finger tips together, have a stretch, take a couple of breaths.
  4. Using your senses, connect with the external environment. What can you see? What can you hear? What can you touch/taste/smell?
  5. Action: Now that you’re grounded in this situation, what are you going to do to make the full of this situation?

Please note that it’s not necessary to follow these steps, when I do it I tend to move around. Sometimes you can quickly do this, or even repeat a few times within 30 seconds or so.

It’s important to notice that the pain hasn’t gone away, but despite what the mind is saying and how you’re feeling, you can still notice so many things else going on and take effective actions moving towards a more meaningful and fulfilling life.

中文版:5分钟固定船锚录音

Addiction to Pornography (and masturbation in Muslims)

Disclaimer: I’m writing this post with a lot of compassion (i.e. acknowledging the suffering of certain group of people and hoping to help them to reduce their suffering). In no way I intend to belittle or criticize any person or religion. If you’d like this post to be removed, please be in touch hello@huibee.com

I previously came across a 20 year young man who wrote to me asking about therapy for addiction to pornography. When we first met for an assessment, this is his “addiction” – he watched porn and masturbates for about 1 to 1.5 hours a day, almost every day, other than that he has been functioning pretty normally with his work and sports activities. He doesn’t experience any urges or problems in the day. When I was attempting to validate his experience, saying that many people of his age have much stronger urges and if it isn’t affecting his life, perhaps he shouldn’t see it as an addiction. Then he revealed his guilt as in his religion, masturbation is not allowed, at all. (I’m sorry to have been so insensitive, not knowing that masturbation is prohibited in Islam). He also understands that some of his friends did this when they were younger, not so sure about now.

He never talks to anyone about it, even to his religious mentor or his father. But he has been suffering in pain for few years, trying various ways including throwing all his gadgets away so that he has no access to porn. But normally it came back much stronger when he managed to suppress it for few days. So he fell into this vicious cycle of urge → reacting to the urge → guilt → suppress → stronger urge → reacting → more guilt → trying harder to suppress → even stronger urge……….. I believe it must have been so much pain that he finally made up his mind to seek help from a Chinese therapist. In the beginning, there was some “conflicts” regarding the client’s goal, as he’s looking for “complete termination”, whereas I see it as something natural and normal so a reduction will be more appropriate (yes I subsequently realised my mistake. Therapy is about the client, not about the therapist).

In the end we have come into a conclusion of the goals and some tasks. I’m now working with him on self-compassion, and we are using techniques from aversive therapy for the “addiction”. For the past few months it has been going well.

If you’re also a Muslim who’s suffering from similar issues (porn watching & masturbation, compulsive or not), and if you’re willing, please get in touch, I can connect you guys virtually (online, without meeting each other) to support each other to go through this together.

用于精神病患的接纳与承诺疗法 (ACT)

近几年在北京当助教和翻译的时候,常遇见学生问说除了药物以外,还有什么方法可以帮助精神分裂患者,尤其许多患者用药虽然很重,但还是有幻听(auditory hallucination) 和妄想(delusion) 的症状,严重困扰着生活。

其实现在有越来越多的研究表明接受和承诺疗法(ACT)对于精神病患者很有帮助。作为干预,ACT不是特别针对症状减轻,而是强调对精神病症状更灵活的反应,以鼓励价值驱动的行为(就是你的生活由你的生活意义和价值来决定,而不是完全被你的病状所控制)。许多的案例研究显示,用ACT帮助偏执狂 (Paranoia),妄想 (Delusion) 和相关的情绪障碍,虽然症状没有完全缓解,精神病依然存在,但却相当程度的减轻了患者的痛苦,而且生活的功能性和基于价值的活动(Value-based activities) 显著增加。

所以如果你,或者身边的家人或朋友患有精神分裂症,尤其幻听和妄想的症状在用药后依然对生活造成相当的困扰,可以考虑留言或电邮联系,因为只要患者有心改变,6到10次基于 ACT 的心理治疗就可以学习新的应对方式,减轻痛苦,活得更有意义。

Habit Reversal

Do you have some bad habits, like nail-biting, hair-pulling, crossing legs, digging nose, thumb sucking etc?

During the year-end school holiday last year I saw a young boy who’s in primary school. The parents said he had so many habits that he can’t control himself with, including sucking his thumb, enlarging his nostrils, clenching his jaw, etc. Most of them are to do with facial muscles. He’s quite intelligent and performing well academically. However, he was warned and punished many times in class and during assembly due to his bad habits. So the parents decided to take him for professional help. His motivation to change wasn’t high initially, but it soon became clear that working on these bad habits are beneficial to him. Towards the end of the session, I also found that he has bruxism (teeth grinding), just like his mother. And the father thought that it’s in the genes.

We met for four sessions over three weeks, focusing mainly on habit reversal and muscle relaxation. Three months later when I checked with the father again, over 90% of his habits has disappeared, it’s no longer a problem. I’d have started hypnotherapy if he didn’t respond so well.

So, any bad habits, including thumb-sucking, nail-biting, smoking or over eating, and also teeth grinding while one’s sleeping can be target with basic habit reversal techniques plus muscle tension awareness in general. What’s important is actually the motivation, “are you willing to work on your problem?”

ACT Therapists in Malaysia

I came across Acceptance and Commitment Therapy (ACT) in 2011 and fell in love with it almost immediately. Since then I have been practicing it on myself, then subsequently learning it from books, and started to incorporate it into my daily clinical practices.

Now I’ve also completed the course with Russ Harris. I’m wondering if there’s any ACT therapists in Malaysia out there, and if yes, please get in touch (my email: hello@huibee.com, my mobile 017-2757813) and let’s form a Malaysian ACT community together!

 

What’s ACT?

  • It stands for Acceptance and Commitment Therapy, pronounced as “act” (one word)
  • It’s a type of psychotherapy, not a long-term treatment
  • 3rd wave of CBT (Cognitive Behavioural Therapy)
  • It focuses on 6 processes, which can be combined into these:
    1. Being present
    2. Opening up
    3. Doing what matters
  • As of late 2018, there are over 250 RCTs (randomized controlled trials, the gold standard of research) published in peer-reviewed journals, that show the effectiveness of ACT with many disorders, such as depression, anxiety, stress, OCD, chronic pain and psychosis.