Category Archives: Treatment Approaches

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.

How do I get more clients for my practice?

Here is a list of results brainstormed by a group of 25 students in China. They were trying to find out as many solutions possible to get more clients for their practice (psychotherapy). It is part of the Problem Solving Therapy Exercise (step 2). It is a process of getting as many solutions as possible without assessing how good or practical they are (quantity > quality).

  • Set up personal website
  • Use of social media like facebook, instagram, wechat
  • Share of information online
  • Giving talk in hospital, schools
  • Advertisement
  • Organising workshop
  • Collaborate with government organisation
  • Collaborate with corporates, company
  • Collaborate with schools
  • Collaborate with celebrities
  • Collaborate with hospitals
  • Collaborate with other private practices
  • Collaborate with the community groups or organisations
  • Collaborate with specialist clinics (e.g. post cancer treatment, irritable bowel syndrome, skin problems)
  • Leaflet
  • Business card
  • Summer camp
  • Use of search engines like Google, Bing, Yahoo, Baidu
  • Radio station (share of information, ads)
  • Words of mouth
  • Talk for parents (through schools)
  • Group experiential workshop in the schools
  • Charity events
  • Visiting schools, giving talks to teachers, managements, students, parents
  • Rise your fee per session (to increase your income…)
  • Treating celebrities and make them your spokeperson
  • Running workshop series
  • Set up association
  • Make short videos
  • Personal development, learn more approaches
  • Ads on bus, bus stop
  • Set up good name for your business/practice
  • More flexibility, provide online sessions
  • Raise fund from corporates
  • Be very specialised in certain areas
  • Be interviewed in radio or tv programmes
  • Stage hypnosis or demonstration
  • Target students, teenagers, parents
  • Target women general wellbeing
  • Target insomnia
  • Wellbeing / Healthcare centre
  • Package, e.g. free one session every 5 sessions
  • Pre-wedding package (weight loss, smoking cessation, general confidence)
  • Funerals
  • Target bad habits
  • Target pregnancy (e.g. post-partum anxiety/depression, weight loss, general wellbeing)
  • Therapy during a day-out together

What else can you come up with?

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.