Category Archives: Treatment Approaches

Support Groups in KL / Klang

I’ve been asked about support groups quite a few times and been thinking how I can start this. It’s definitely something very common in western countries, I’m not sure how it will work here in Malaysia. Now I’m proposing the idea here, and for anyone who reads this and is interested in any of the support groups, please get in touch, let me know what you think and how we can start this and get it going!

Support groups for:

  1. Depression or mood related problems
  2. OCD (Obsessive Compulsive Disorder)
  3. Anxiety or stress related problems
  4. Schizophrenia and psychotic related disorders
  5. Carers (immediate family etc)

What is it? How does it go? What do we do?

  1. Meet monthly or every fortnightly for an hour or so
  2. Getting to know people who share the same or similar problems
  3. Casual discussion following a theme that we set (led by me)
  4. Sharing, supporting and learning among/from each other

Languages:

  1. English
  2. Mandarin / Cantonese

Venues:

  1. Klinik Pakar Au Yong, Jln Pudu, KL
  2. Manipal Hospitals Klang
  3. Some cafes in Klang Valley?

Requirements:

  1. Patient’s willingness! (is not forced by others to join us; willingly attend, participate, share and listen to others)
  2. At least 3 to form a group
  3. To treat others with respect and maintain confidentiality
  4. To share the cost of a small administrations/materials/venue fees (if any)

These are just some ideas for now, if you have some ideas or are interested, please do leave your contacts (email or contact numbers) below or get in touch by emailing hello@huibee.com or calling/whatsapp 017-2757813

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。

Muscle Relaxation

Core principles of muscle relaxation:

  • Non-doing: you can’t do muscle relaxation. It is a ceasing of doing. A ceasing of effort.
  • There is always a deeper level of relaxation (people underestimate how much they can relax)

Here is a recording of muscle relaxation skills training:

Muscle Relaxation Recording (English) 

It starts around 6 seconds later. Basically you will be asked to tense various muscle groups in turn, then relax them as deeply as possible.

In general only a few practice of this would be sufficient to develop awareness of muscle tension during the day, then you can just use the cue words (in the recording) to relax any muscle group during exhalation any time of the day, anywhere once you notice the tension. This means that you will not need this guided audio in the long run.

Neutral Pure-O

Most people know that Exposure Response Prevention (ERP) is the main intervention used for Obsessive Compulsive Disorder (OCD). So the rationale is pretty simple here, say we have a patient who is afraid of contamination (obsession) and wash his hands excessively (compulsion), we do some preparation work and can then start the ERP by exposing him to dirt without letting him to wash his hands (response prevention). This is normally done on a very gradual manner (with the patient’s consent and enough preparation work beforehand, so it is definitely not forcefully done to him). And of course in reality the OCD cases are barely as straightforward and simple as this, but this is the general principle.

With pure obsession, i.e. those without any compulsive behaviour, it’s all in their minds, things can get a bit harder, but still, it’s possible. Some commonly seen pure-O are (1) relationship obsessions (discussed in my blog else where as “morbid jealousy” which might or might not be the same condition), (2) sexual obsessions, (3) religious obsessions, (4) violent obsessions, (5) neutral obsessions.

So let’s take a recently seen man as an example here. It started once when he drove past a church, and somehow a sexual related thought popped out in his mind, he couldn’t bear himself having such “dirty” thought in a holy place, and since then, whenever he goes passed any holy places, he will suppress his mind from coming out with any “dirty thoughts”. And as we all know that our minds don’t work this way, the more you try to push some thoughts away, the more they bounce back and pop up.

ERP is possible for such pure-O cases. After the initial preparation work including psychoeducation and relaxation training, they are exposed to those thoughts that they have been avoiding, in those places (based on the items in the hierarchy). So it works similarly for all different types of pure obsessions, be it relationship, violent, religious or sexual (in certain cases where direct exposure is not possible, it will have to be done in imagination, and by watching videos etc).

However, how about neutral obsessions? What the patient has could be some really simple, random thoughts, which might be inconsistent, but they might be spending hours and hours thinking about these random stuff. Like a young man I saw couple months ago, who reacts to any thought his mind comes up with, e.g. “why does the universe work this way?”, “how do my ears listen and my brain comprehend what others say?” etc. I couldn’t really carry out typical ERP to him, since those are really random topics and they can be completely different every time. So I needed him to start thought defusion exercises, mindfulness meditation (then he dropped out…). I believe this is the best way for neutral pure-O, though I understand how difficult it’s to increase their motivation to keep practicing until they see the effects (did have patients in the past who were surprised by how quiet their minds can be after such exercises – and this is just a bonus, as it’s not the intention or purpose of such practices).

Do enlighten me if you have better psychological intervention for neutral pure-O. And I hope all the OCD sufferers out there will not give in to the illness!

CBT & Bipolar Disorder

認知行為療法 (CBT) 如何幫助躁鬱症(雙極症, bipolar disorder)?

躁鬱症的治療過程中,藥物扮演非常重要的角色。而加入認知行為療法(CBT),則可以幫助穩定患者的情緒和保持日常的穩定。

是甚麼導致躁鬱症的高低起伏?根據研究,情緒的起伏,受我們的想法影響。該研究發現極度消極負面的想法或過度積極正面的想法都會影響躁鬱症患者的情緒和行為。而學習和練習CBT就可以緩和這些極端,CBT讓患者學習如何捕捉、挑戰、改變錯誤的或極端的思維,同時識別和改變有問題的行為習慣。

六個針對躁鬱症的CBT技巧

  1. 接受“躁鬱症”這個診斷。首先第一步就是明白和理解這個可以對你的症狀做出解釋的疾病。對很多躁鬱症患者來說,這往往很難接受,所以讓他們學會關於躁鬱症的信號、症狀、起因、病程等是很重要的。這讓患者能去尋求幫助,而且也知道他們其實並不孤單。
  2. 監控情緒。這通常是用工作表或日記來紀錄。目的在於更加能夠覺察情緒的導引和改變。
  3. 進行認知重建。這過程專注于通過學習如何更好的識別想法對情緒扮演的角色、如何識別有問題的想法、和如何改變或糾正它們來改變思維的習慣。(有些時候接受該想法,再與想法產生距離化可能比挑戰和改變想法有幫助-似情況而定)。
  4. 頻密進行問題解決。其中的步驟包括如何識別問題,產生可能的解決方案,選擇適合的方案,嘗試它,和評估其結果。問題解決療法可以應用在生活的任何領域,不管是兩性關係、失業、或卡債等。這所有壓力的根源,如果沒有被好好處理解決,都會帶來復發。
  5. 增強社交技巧。有些躁鬱症的患者缺乏社交技巧,這讓他們覺得自己沒辦法控制生活的其中一些部份。學習自信心訓練等技術能幫助處理與他人的關係。
  6. 穩定日常節奏。給生活建立一個規律的日常活動和節奏,這有助于穩定情緒。

而為了最大化躁鬱症的治療,聽從醫生的指示、完成CBT的家庭作業,和不斷繼續學習關於躁鬱症是很重要的。

Non-blind Placebo

Placebo is sometimes called a sugar pill, indicating that it is medically ineffectual, yet a person given such ineffectual treatment will often have an actual improvement in their condition. 

One key thing with the use of placebo, is that it involves deceiving the person receiving it. For example, before many drugs get into the market, they would surely have to be tested against placebo. And people who are being tested, all would think that they are receiving the drug, though some do not know that they are actually taking a placebo, are serving as the “control group”.

So what’s this “non-blind placebo”? In the 1960s, two researchers published an unusual article “Nonblind Placebo Trial: An exploration of neurotic patients.” Non-blind, i.e. the neurotic patients were told that what they were to take are sugar pills, with no active ingredients in it. Fifteen neurotic participants from a psychiatric clinic were selected, and they each read the following script:

“Mr Doe, at the intake conference we discussed your problems and it was decided to consider further the possibility and the need of treatment for you before we make a final recommendation next week. Meanwhile, we have a week between now and our next appointment, and we would like to do something to give you some relief from your symptoms. Many different kinds of tranquilisers and similar pills have been used for condition such as yours, and many of them have helped. Many people with your kind of condition have also been helped by what are sometimes called ‘sugar pills’, and we feel that so-called sugar pill may help you, too. Do you know what a sugar pill is? A sugar pill is a pill with no medicine in it at all. I think this pill will help you as it has helped so many others. Are you willing to try this pill?” (Park & Covi, 1965)

One of the 15 patients refused to take part. Of the remaining 14 patients, 13 showed signs of significant improvement across different measures. The researchers note that the improvement of 41% found here was greater than the improvement found in previous studies of real drugs, using the same measures.

It might sound ludicrous but this is what has been found. (Definitely have to replicate this study when I get the opportunity). What do you think about this research finding?

It’s all about one’s expectation, this is what I think – what you believe and expect is going to happen. You can be given a sugar pill believing that it will do you good and expecting to get better, or you can be given a world most advanced and expensive pill thinking that it is useless and expecting to get worse. So, no matter what kind of treatment you are receiving, be it drug or psychotherapy or hypnotherapy or counselling, have the belief that you will get better, expect that you will get better – these will definitely help! (Self-fulfilling prophecy!)