Category Archives: Treatment Approaches

Can you control your thoughts and feelings?

Many of the self-help books out there teach people how to change their thoughts, physical sensations, feelings etc in order to feel better (including traditional CBT which targets automatic negative thoughts), if you’re one of those who have tried many of these techniques, how workable do you think they are? Do you think you really have so much control over your thoughts and feelings?

Try these:

(1) Try to recall something happened in the past week, anything — a dinner you had, a movie you went, a talk etc. [continue when you’ve got one] Now try to remove it completely from your memory, get rid of it so you will never think about it again in your life… Can you do it?

(2) Now, do not think about chocolate. As you read this, do not think about how a chocolate tastes, smells; do not think about its colour and texture; do not imagine how it feels when it melts in your mouth and how it feels when your tongue and teeth contact with it. Is it possible? Try again with honey maybe?

(3) Think about past experiences, whether when you have to give a public talks and feel very nervous; when a loved ones passes away and you feel really depressed; when your results doesn’t come out as good as expected and you feel disappointed etc etc. You hope you aren’t that nervous, depressed, disappointed, you try to get rid of these negative emotions as how they’re labelled, was the attempt successful? Did trying to control your emotions make it even stronger, ironically? So you’re more nervous trying not to be nervous?

So why ACT (Acceptance and Commitment Therapy)? Because in ACT, we understand in life negative emotions, thoughts, experience, sensations are all just as likely to happen as the positive ones, they are all part of our life, they are what make our lives meaningful, educational and contented. So in ACT, people learn to accept them, to live with them, instead of struggling with them, challenging them, changing them, getting rid of them.

Tips for Succeeding in Your OCD Treatment

Adapted from Fred Penzel, PhD “25 Tips for Succeeding in Your OCD Treatment” (to make it more suitable and applicable to Asian culture)

  1. Always expect the unexpected. You can have an obsessive thought at any time or any place. Don’t be surprised when old or even new ones occur. Be prepared to use your therapy tools at any time, and in any place. Also, if new thoughts appear, be sure to tell your therapist so you can keep them informed.
  2. Be willing to accept risk. Risk is an integral part of life, and as such it cannot be completely gotten rid of. Remember that not recovering is the biggest risk of all.
  3. Never seek reassurance from yourself or others. Instead, tell yourself the worst will happen, is happening, or has already happened. Reassurance will cancel out the effects of any therapy homework you use it on and prevent you from improving. Reassurance-seeking is a compulsion, no matter how you may try to justify it.
  4. Never analyze, question, or argue with obsessional thoughts. The questions they raise are not real questions, and there are no real answers to them.
  5. Try to not be a black-and-white, all-or-nothing thinker — don’t tell yourself that one slip up means you are now a total failure. The good news is that you are in this for the long haul, and you always get another chance. It is normal to make mistakes when learning new skills, especially in therapy. It happens to everyone now and then. Accept it. Even if you have a big setback, don’t let it throw you. Remember the saying, “A lapse is not a relapse.” This means that you never really go back to square one. To do that, you would have to forget everything you have learned up to that point, and that really isn’t possible. Also remember the sayings, “Never confuse a single defeat with a final defeat,” (F. Scott Fitzgerald).
  6. Remember that dealing with your symptoms is your responsibility alone. Don’t involve others in your therapy homework (unless your therapist tells you to) or expect them to push you or motivate you. They won’t always be there when you need them, but YOU are always there for YOU.
  7. Don’t get too impatient with your progress, or compare yourself to someone else. Everyone goes at their own pace. Instead, try to simply focus on carrying out each day’s therapy homework, one day at a time.
  8. When you have a choice, always go toward the anxiety, never away from it. The only way to overcome a fear is to face it. You can’t run away from your own thoughts, so you really have no choice but to face them. If you want to recover, you will have to do this.
  9. When faced with two possible choices of what to confront, choose the more difficult of the two whenever possible.
  10. If your therapist gives you an assignment you don’t feel ready to do, you can speak up and tell them so. As half of the therapist–patient team, you should be able to have a say in your own therapy. The goal is for the homework to produce some anxiety for you to get used to tolerating — not to overwhelm you with it and cause you a setback. On the other hand, don’t be afraid to stretch yourself a bit whenever you can.
  11. Don’t wait for the “perfect moment” to start your therapy homework assignments. Procrastination is a feature of many people’s OCD, so start your therapy homework assignments the day you get them. The perfect moment is whenever you begin doing them. When starting the homework immediately isn’t applicable or possible, at least plan an exact date and time to start it.
  12. Don’t be side-tracked by perfectionism. Perfectionism can be another feature of OCD. You may find your OCD telling you that if you don’t do your homework perfectly, you won’t recover. If you do find yourself obsessing about having to do your homework perfectly, you risk turning it into another compulsion. Watch out for having to do your homework according to the same rigid rules each time you do it. Also, don’t do your homework so excessively that it takes up your whole day. Remember that you still have a life to live.
  13. Don’t forget to go back to the old homework assignments you have done and materials you’ve read before. Don’t assume that you know them all and will not forget them.
  14. Give your homework your full attention, focus on what you are doing, and let yourself feel the anxiety. Try to not let yourself tune out when doing certain assignments, so that you don’t have to feel the anxiety. People sometimes let the homework become routine and do it in a very automatic way as a kind of avoidance. Also, don’t do homework while carrying out other distracting activities. You are building tolerance to what you fear, and for that to happen you have to be in the moment with it.
  15. When faced with a challenging assignment or an unexpected challenging situation, try to look at it as a positive. View it as another opportunity to get better instead of saying, “Oh, no. Why do I have to do this?” Instead tell yourself, “This will be good for me — another chance to practice and get stronger.”
  16. Try to not rush through your therapy homework so that you don’t have to feel as much anxiety. Take your time, and see if you can view it in terms of all the good it will do you. Getting it over with as quickly as possible is not the goal — raising a moderate level of anxiety and staying with it is the goal.
  17. If your homework doesn’t really give you any anxiety, tell your therapist about it. If your exposure homework doesn’t cause at least some anxiety, it isn’t going to help you that much. On the other hand, try doing all new assignments for at least a week before deciding that they don’t make you anxious. Some assignments can cause reactions later on, and it may take doing them a few times before the anxiety occurs.
  18. It is sometimes possible for OCD to try to make you doubtful about your homework. It may tell you that you are not in the right treatment, that your assignments cannot possibly make you better, or that you really don’t understand what you are doing and won’t be able to make it work. Remember that OCD was known as the Doubting Disease, and it will try to cast doubt on anything that is important to you. Don’t try to argue, analyze or question it, just continue what you have to do and over time you’ll find the answers.
  19. Never forget that you have OCD. This means that you will not always be able to trust your own reactions or the things you think and feel, especially if they seem to be telling you very negative and extreme things. If you are unsure if something is really a symptom, treat it as a symptom. Better to do a bit more exposure than not enough.
  20. Remember that in OCD, the problem is not the anxiety — the problem is the compulsions. If you think the anxiety is the problem, you will only do more compulsions to get rid of it (which will only create more anxiety). If you recognize that the compulsions are the problem, stop doing them, and stay with the fearful situation, then the anxiety will eventually go away as you build up tolerance.
  21. Always take a moment to be proud of your own efforts and recognize your successes. It’s a good way to help keep up your motivation. Look back at earlier assignments that are no longer challenging if you believe you aren’t making progress.
  22. Overall, never forget that OCD is very paradoxical and rarely makes much sense. The things that you thought would make you better only make you worse, and the things you thought would make you worse are the very things that will make you better.

Is hypnosis for me?

Is hypnosis/hypnotherapy for me?

Try these!

Exercise 1 – Postural Suggestion:

  1. Stretch both of your arms in front of you at shoulder level, palms facing up. With eyes closed, imagine a pile of books being stacked on your right palm.
  2. Imagine a couple more books, and then a couple more books being stacked on top of those books on your right palm. Feel the strain in your arm as it gets heavier and heavier, heavier and heavier.
  3. Now imagine a huge balloon filled with helium has been tied to your left wrist and is tugging it up into the air ….higher and higher ….higher and higher.
  4. Open your eyes and notice where your arms are relative to each other.

Exercise 2 – Postural Sway:

  1. Stand up with your eyes closed and imagine holding a big heavy suitcase in your left hand.
  2. Imagine bigger and bigger suitcases weighting down your left side, pulling you over.
  3. After 2 or 3 minutes, open your eyes and notice any changes in your posture.

Make sure you read the instructions clearly, then only you close your eyes and try them.

Most people who try these two exercises notice that their bodies/arms move at least a little in response to these suggestions (Exercise 1 works particularly well for me). If you don’t notice any movement, practice the exercises a few more times. If you still don’t notice even the slightest amount of movement, hypnosis may not be for you!

Also, some contraindications of hypnosis include people who are disorientated due to organic brain syndrome or psychosis, people who are severely mentally retarded, and people who are paranoid or hypervigilant. So these people shouldn’t be performing self-hypnosis or being hypnotised.

Mindfulness and Acceptance tasks

Following my previous post Thought Challenging or Thought Accepting, here is a few tasks that may help to explore on how to “accept” your thought without causing too much emotional distress.

Task 1

Pick a word that may cause slight distress in you (e.g. “cockroach”, “snake”, “work”, “boss”, “kids”, “boyfriend”, “presentation” etc). Now repeat this particular word as quick as you can (while still making sure that the word is pronounced clearly) for 30 seconds.

This tasks doesn’t make you feel better about “presentation” itself, but after repeating the word for so many times, you probably can no longer take the word so literally – it loses its meaning. Same goes to negative thought (e.g. “I’m a failure”, “everyone hates me”). If those thoughts pop up in your mind, try to see them only as some words, accept them as they are, but not to relate yourself to them, as if it’s just some unrelated persons saying it to you.

Task 2

Sit down in an undisturbed place, close your eyes and imagine a tiger (or a dog if you find it difficult to picture a tiger in your mind). Let the tiger does whatever it wants to do there in your mind, not to control what it does or doesn’t. If the tiger stays quietly, let it be; if it moves around, let it be, too. Do this for about 5 minutes.

Next, for 5 minutes, try NOT to think about tiger at all. Do not think about tiger. Whenever it pops up in your mind, suppress it, avoid it.

What do you realize? Which part of task 2 is harder? To accept the tiger being there and does whatever it likes, or to suppress the tiger, avoid the tiger?

Task 3

Take a few minutes to practise to complete the following sentence, “Right now I’m aware of …”, and putting different descriptions at the ending each time. For example, “Right now, I’m aware of the brightness of the screen”; “Right now, I’m aware of the sound of the air-conditioner”; “Right now, I’m aware of some numbness on my left foot”; “Right now I’m aware of my thoughts on completing the homework”. Name and describe, avoid making judgement. By using language to describe things, you get to control your attention and get to connect to your field of consciousness, rather than its content, so you’re becoming like an observer to your experience. This task requires more practice!

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Now imagine this: A and B fell over badly in public.

A thinks, “this is so embarrassing, ah, but it’s so funny at the same time”, so he laughs at his own carelessness and let go of it.

B thinks, “this is so embarrassing! Everyone is going to laugh at me and watch me like a clown”, he gets so angry and ashamed.

Most of the time, it’s how we relate ourselves to those incidents, thoughts, feelings etc, it’s really not what that happens. If we choose to calm ourselves down and accept whatever that happens, that come to our minds, and allow ourselves to feel the waves of our emotions, the discomfort will soon no longer be “discomforting”.

When Schizophrenics Don’t Recognize Their Illness

Do you confront them? Do you “make” them realize their illness?

This couple came to consult the psychiatrist few months ago, but they paid only the consultation fees after seeing the doctor for almost an hour, without collecting any medicine.

The patient is their son, who is in his late teens. He’s currently attending a very famous top college in the town. He lives in hostel with two other roommates, only back to parents during term holidays. The son doesn’t think he has any problem.

But sometimes he sits on his own and laugh. He spends a lot of time thinking. His behaviour is purely “weird and strange”, as how his mother termed it. According to his roommates, he sometimes gets disappeared from college and hostel, for couple of nights, then came back and kept to himself, like nothing happened.

There isn’t much the parents can do about him, as he doesn’t live with them, they don’t even have the chance to put medicine for him (see case study 1 & case study 2 for why putting medicine without patient’s knowledge). They did try to confront him, they actually set up on him and made him to a general hospital where he was hospitalized for over 10 days, then put on medication for few months after discharge (he stopped medicine subsequently as it was causing drowsiness and disabling him from studying).

Since then he became more vigilant. The parents know it’s almost impossible to set him up again or force him to see a psychiatrist doctor again.

At some points counsellor from the college contacted the parents, they discussed about his strange behaviours. At one point the roommates even had to put tranquilliser or sleeping pill in his food or drink to make him stay in hostel and rest. Yet academically he was still not doing that bad (afterall he’s one of those top students… though the mother is sometime a bit doubtful whether being such a top student is a good thing for her son).

Few days ago he came back home for term and chinese new year break. The parents thought it was a good opportunity to help their son. However, after one night being home, the son couldn’t stand the confrontation and parents’ lecturing, he ran away from home, and hasn’t been home since. The mother has been trying to get in touch through phone, but when she spoke to him, she really isn’t sure what to say to bring him home.

Perhaps she hopes that the son get well without any medication and treatment? Perhaps she hopes that the college expel him so that he’d be home to get treatment? Perhaps.. she doesn’t know what to hope for.

So… back to my questions – how do we make them realize their illness? Or do we do this at all (let them be? confront them?)?

Leading a Normal Life after Recovery?

Part I:  Teenage Schizophrenia (the same topic person as below)

Few days ago the father rang us. The patient is now in ICU in a general hospital. She attempted suicide taking over 200 tablets of medicine. As she usually wakes up late in the day, so the father wasn’t concerned that she’d been in her room all day. Till that evening when the father was thinking to bring her some food, and found out that she was covered in urine on her bed, and was unconscious.

Over the past few months, she had got so much better with medication, no longer spending all her time pacing in her house, talking to herself or swearing at her younger siblings. Her father was even able to get a tuition teacher for her, and later the patient even requested to go back to schooling. They were looking forward to seeing patient going back to lead some “normal life” just like any other teenagers. The only thing is probably that she’s spending a lot of time looking at her phone (don’t you think this is also a common feature of a “normal” teenager nowadays?!)

Then this happened. She tried to kill herself and is still unconscious. The father could only guess that as the new academic year is starting soon, patient couldn’t manage the stress and intended to avoid it by ending her life. She went to school to collect the text books the day before. The younger sister said the patient asked for a cut blade from her, but she didn’t give it to her.

Quite often we may think that the patient is ready for a normal life once the active symptoms of mental illness is not presented, yet it is very difficult to judge whether or not the patient is ready psychologically, to go back to the society, to face other so-called normal people and function normally just like others.

What can we do about this? What can we do for them? What can family do to get them prepared to go back to the society, if they can ever achieve it?