社会焦虑中的典型核心恐惧

社交焦虑是很常见的,严格上来说,每个人或多或少都有一些。而它的关键特征,在于(一)害怕别人负面的批判,和/或(二)害怕被他人拒绝。

以下是一些常见的社交焦虑的核心恐惧:

人们将会看到:
  • 我的紧张不安
  • 注意到我的颤抖
  • 我涨得通红的脸
  • 我卡着说不出话来
  • 我很无聊/我的话让人无法明白
  • 我很难堪和不适
  • 我不知道该说什么/我什么都没说
然后他们会想:
  • 我很弱
  • 我很蠢
  • 我不自信
  • 我无能
  • 我很没用
  • 我不应该做这份工作
  • 我很无聊/无趣
  • 不值得花时间听我说话
  • 我做得不够好

有哪些是你在社交场合常有的顾虑吗?

Everything is Temporary…

That’s a quote from one of the participants in the Anxiety Support Group, during our 4th meeting few months back.

Sad?

Angry?

Disappointed?

In a Crisis?

Challenged?

In fear?

It’s temporary… As long as you do something about it, or stop struggling with it. Sooner or later, it’s going. Bear with it!!

Happy?

Loved?

Contented?

Fulfilled?

It’s temporary too! Everything comes and goes. Meanwhile, enjoy it while you can.

 

Only one thing lasts much much longer than temporary

Plastics!!!!

咨询师评估时最喜欢用的问题

开始面谈时:

  • 今天是什么让你来到这里?
  • 你为什么现在来?
  • 为什么在这个特定时候寻求帮助?
  • 什么使你过来?
  • 你遇到了哪些类型的困难?
  • 你目前是否经历着任何不寻常的压力?

对于问题的评估:

  • 请描述今天使你过来的问题。
  • 将问题分解成想法、情绪和行为是有帮助的:当你体验____________时,你在想什么?感受?做什么?
  • 你对这个问题有多少控制(0-10级)? (10为完全掌控,0为完全没有控制)

目前的运作评估:

  • 你最近的睡眠和胃口怎样?你每晚睡多少小时?你今天吃了什么?在不寻常的日子呢?
  • 请从早上起床开始详细描述典型的一天。
  • 你的收入来源是什么?你有财务问题吗?
  • 你是否定期服药?什么药?什么剂量?
  • 你喝酒或使用毒品吗?哪些、多少?

风险评估和灌输希望:

  • 在糟糕的日子里,你会有时认为不值得活下去了吗?
  • 什么能帮助你度过糟糕的日子?当你想要伤害自己时,是否会想起一些人?
  • 自杀的想法以外,你是否曾自残/伤害自己? (给例子)

评估自我概念和自尊心:

  • 你如何形容自己这个人?
  • 熟知你的人(例如__________)会如何描述你?
  • 你会如何向其他人(例如,之前从未见过你的人,未来的雇主,朋友)形容自己?

评估家庭历史和社会支持:

  • 你是否像你家里的其他人?你家中的其他人是否有相同或类似的问题?
  • 是否有_______________的家族史?
  • 你如何形容你的伴侣?你妈妈?你爸爸?
  • 这世界上,你最亲近谁?如果遇到紧急情况,你会打电话给谁?
  • 你多常和亲近的人聊天或见面?(详情)
  • 你目前拥有哪些支持系统?

评估习惯,物质使用和滥用:

  • 在遇到问题时,你是否奖励自己?它们包括_________吗? (毒品,活动,食品,赌博,赌博,购物)
  • 这么做给你带来什么?
  • 你是否留意到使用酒精或其他药物帮助你应对这个情况或者是否妨碍了你的应对能力?

评估过去改变和治疗的尝试(应对方式):

  • 你过去尝试了哪些干预措施/治疗?
  • 这些干预和治疗对你有什么帮助?
  • 为了应对你的问题,你已经尝试过什么?管用吗? (或对你有效吗?)
  • 你过去是否克服过问题?如何克服?

结束会谈并灌输改变的希望

  • 如果你的生活中没有这个问题,你会做些什么不一样的?
  • 还有什么是我们今天应该谈谈的内容吗?
  • 我们有遗漏了什么吗?
  • 我还需要知道什么来了解你和你的疑虑?
  • 还有什么是我们今天还没有机会谈到,但是是一些可以帮我了解你的重要信息的吗?
  • 有什么要问我的问题吗?
  • 你对治疗过程还有什么想了解的吗?
  • 你希望从这些会谈中获得什么?
  • 你对治疗过程的希望是什么?
  • 你对治疗的希望和目标是什么?
  • 你是否有任何具体的目标?

 

[注:这些问题是在艾伯特心理学家协会(2004年11月和2005年1月)赞助的两个临床评估研讨会期间根据参与者的反应制定和修改的]

Dobson D & Dobson K(2009).基于证据的认知行为疗法实践。24-5.吉尔福德出版社

恐惧&焦虑

大多数恐惧与焦虑相关的研究人员都认为恐惧和焦虑之间存在差异。 以下是一些关键点:

恐惧:

  • 通常被视为对此时此地的危险的回应。
  • 例如: 狗在我面前,我很害怕!
  • 定位:此时此地
  • 更高的交感神经唤醒,更高水平的战斗或逃跑反应。

焦虑:

  • 通常被视为对预测/预期威胁的回应。
  • 例如。 这里没有狗,但在拐弯处可能有狗!
  • 导向:未来
  • 交感神经唤醒程度较低

当然没有人喜欢感到恐惧或焦虑,我们都不想拥有它们。 然而,恐惧和焦虑都不危险。 他们完全正常,每个人都经历。

想一想:在你的生活中,是否有些时候恐惧和/或焦虑在某些方面帮助到你、拯救了你、 保护你、 激励你?

Female Vs Male Clinicians (Psychologist, Therapist, Psychiatrist, Doctor, Specialist etc)

Note: This is a very different post, it consists of mainly (think-out-loud) personal feelings and opinions, not so professional but I no longer have a personal blog to write this. So please do skip if you’re here for more proper topics and information.

I used to feel quite frustrated as a female therapist, kind of like vulnerable not being able to do home visits as needed. Because of this, I turned down quite some people and felt bad couldn’t help those who are not able to leave home.

Until two days ago, this news of a male psychiatrist “sexually harass his rape victim patient” became viral. (I’m not sure if it’s really viral, as in, if I were not in this field, would I come across this piece of “news”?).

I’m a visiting consultant in the same private hospital with this doctor (no, not the one where the victim consulted him). I don’t know him personally, in fact, I have never met him. But we have referred cases to each other, spoken over the phone for a number of times, and exchanged emails.

After a discussion with my male psychiatric colleagues, we suspect that we know who the victim is, she has consulted each of us before. (Two years ago she found me online, some weeks later I referred her to see one of the psychiatrists, and then not long ago she came to see another one of them).

Yet, I don’t know what happened, and having said so much, I don’t intend to talk about this news. Though I hope the psychiatrist will be found as soon as possible, whether or not he has done it. (It’s fairly unprofessional for those major medias to simply take the information from worldofbuzz and reported it as news as if everything that was said by the victim was 100% true).

No I’m not siding anyone. Not that because he’s my colleague or we are from the same field that I’m siding anyone. But, this incident makes me realised, how vulnerable those clinicians, especially the male ones can be. Because I’m sure 99.99% of the people who read about this news would find the doctor disgusting. (Similar to the politician case, who was accused by his maid of raping).

No I’m saying who’s right or wrong or indicating anything. I’m just saying, it’s important to listen to both sides of the story, if possible, especially before you condemn anyone, or leave strong comments. (Of course, it wouldn’t be possible if the person is missing… Well, then any conclusion can be drawn?)

As of now, I feel lucky, because I’m a female therapist. Of course females do molest and sexually assault others! But at least the stereotype and prejudice are not there to begin with.

I’ve also heard of cases of doctors-to-be or specialists-to-be, during their studies or trainings, were complaint of sexually related wrong-doing (convicted or not I can’t be sure), yet eventually they were still allowed to graduate or to start practicing. I think universities are not there to just educate and train their students to become doctors, it’s also very important to determine, whether or not this person can be a doctor, in that sense. It’s not just about passing the exams academically. HEY med school professors, you are putting the patients out there at risk, if you know and do nothing about it.

So, if I may, I have three hopes here:

For the med schools, your roles are more important than just education and training.

For the law-makers, I think we need sexual offenders register (or sex offender registry in the US) in this country. Not just the child one (which was launched earlier this year, bravo!).

I hope all the doctors and therapists and counsellors out there learn to protect themselves, male or female.

What reinforces Suicidal Behaviour?

Suicidal behaviour doesn’t just mean the attempt or act of killing oneself, but also includes talking about it, thinking about it, threatening others about it, imagining it and even fantasising about it.

Here are some common reinforcers of suicidal behaviour:

  • relief from pain (even just thinking about it can lead to some instant relief from pain)
  • overt avoidance (can stay away from situations that one doesn’t want to be in)
  • diminished responsibility (people expect less from the person)
  • attention
  • forgiveness
  • identification with hero or idol
  • distraction from other issues
  • revenge (I wrote about this before here)
  • prevent abandonment (“if you leave me, I’m going to kill myself”)
  • escape punishment

 

Maybe you want to read about this too: Euthanasia

Please give yourself a second chance. Malaysia suicide hotlines:

The Befrienders
03-7956 8144/ 03-7956 8145
www.befrienders.org.my

Life Line Association Malaysia
03-4265 7995
http://lifeline.org.my/cn/

Agape Counselling Center Malaysia
03-7785 5955 / 03-7781 0800
http://www.agape.org.my