Category Archives: Anxiety Disorder

What’s good about Covid-19?

Anxiety Disorder, Depression,

Really, if you have to come up with some positive points about Covid-19, what can you think of?

It’s an exercise I have done with two of my support group members, initially most of them were like.. “Huh? Positive thing about Covid?”, “I can’t think of any”, and after squeezing their brain juices, “Ok, maybe xxx…” reluctantly. But I collected a rather long list in the end, there were more and more coming out:

  • spending more quality time with family
  • spending more time with the self (some people never get the chance to do so)
  • developing some new habits and routine (e.g. work out, cooking their own meals)
  • developing some new interests (e.g. baking, cooking, growing plant, DIY this and that)
  • learning new skills online (e.g. yoga, taekwando, cooking, coding)
  • rediscovering some old passions
  • working from home, saving time on traffic and money on petrol/toll
  • more things go online, becoming more accessible (not just clothes, now you can get fresh seafood and physiotherapy online too)
  • people are more accepting anything online (e.g. psychotherapy, university courses, ballet classes)
  • better problem solving skills facing difficulties, how a lot of people transformed their business and work and career creatively
  • becoming more resilient, more able to cope with stress and challenges
  • spending less on unnecessary items (working from home, no longer need to buy office outfits)
  • started finance planning (due to pay cut, less income generated during this period)
  • better for the earth, animals, plants when humans are all staying home
  • contemplating what humans have done to the mother earth and natural environment
  • contemplating what a tiny virus can lead to and how we should change
  • developing much better hygiene related habits, like washing hands after coming home, wearing masks
  • having more personal space in the public areas! (many people with and without anxiety related issues love this)
  • watching live concert online (being very close without paying for the expensive tickets and worrying about parking, traffic etc)
  • not going home for Chinese New Year celebration, meaning they don’t have to face the relatives and answer their questions (“Why are you still single? Why aren’t you getting married? Why aren’t you having children? Why aren’t you having another baby?” etc) (Happy Chinese New Year, by the way!)

Can you come up with more?

被压抑的创伤事故？

Anxiety Disorder, Issues & Debates, ,

在中国做培训的时候，发现学生蛮常喜欢问关于“创伤” (trauma) 相关的问题。过去几十年，创伤是心理学里一个很“夯”的课题，许多抑郁、焦虑、人格障碍 (personality disorder) 等心理与精神疾病，都会被与创伤事故做联想，并以此角度去谘商与治疗－－这其实没有太大问题（虽然在认知行为的角度，我们更多去关注“维持因素”，而不是问题的起因）。可是随着心理知识通过网络、自助书籍等的普及化，现在连一个7、8岁的孩子，到没有受过高等教育的70、80岁的长者，都会开始说自己“受到了创伤“。换句话说，“创伤”这个词，开始被“滥用”，不适当的应用。这就有些类似好多年前开始，“忧郁”被滥用一样，后来“我有点强迫”也开始被普及化，然后现在，“创伤”也是。

当然对我来说，心理知识，尤其有科学依据的心理学知识的普及化，一点问题也没有，它增加了社会对患有心理相关问题的意识、的关注，并能让人们提前寻求帮助，以及减少偏见和歧视等，这并没有问题。问题在于，传统上，弗洛伊德派系（Freudian) 的理论，相信人们的大脑在经历重大创伤事故时，会启动防御机制(defense mechanism)，比如抑制(repression)，把不合理的信念、痛苦的记忆等，在你无意识、不自觉的情况下隐藏它们，以期完全忘记它们。

而这才是我今天想要关注的主题：这种被压抑、被忘却的创伤，存在吗？

我想不少心理学家都会异口同声说：“当然存在！” 以前的我也是。可是这里，我想提出几个“疑点”，让把它看成理所当然存在的人，稍微的再考虑一下下…

（一）以过去许多经历较为重大事故（如：战争、被性侵强奸、地震、911事件、恐怖袭击、攫夺等）的人过后出现闪回(flashback)、失眠等症状而被诊断为创伤后应激障碍(Post traumatic stress disorder, PTSD)，这些事故其实被更强烈的记住，并不断在脑海里“重播”，所以才会导致情绪激动、焦虑等症状。这似乎显示：经历创伤事故的人，是会更强烈的记得这些事故，而不是忘却它、压抑它？

（二）有些时候，这些创伤事故发生在我们懂事以前。在孩子还未懂事前（4、5岁之前），他很可能根本不以为意，并不知道这是“创伤性的”，或许带来一些不舒服、不自在的感觉，但是后来随着时间的飘逸过去了，多年后长大了，可能因为一些环境或电影情节，再次想起，这时候才了解当时那是什么，但在不懂事的情况下，这能算是“被压抑的创伤”吗？

（三）与（二）相关，婴儿遗忘症(infantile amnesia)，显然也不是“被压抑的创伤记忆”。因为在我们未懂事以前，几乎所有经历都没有被编码 (encode) 进入我们的长期记忆 (long-term memory)，那就没有所谓的无意识压抑了。虽然其实近几年有些研究似乎发现，学语言以前长期记忆的编码方式，与逐渐掌握语言后的编码方式不同，而导致我们在学会语言后，无法“复取”(retrieve)旧有编码的记忆。

（四）许多所谓的创伤事故，多年后在治疗，尤其催眠过程中被“记起”。在美国，这甚至导致家庭关系的破裂、引起诉讼，与家人对薄公堂。可是这里的问题是，记忆的可塑性很强，它不是文档，可以每次打开来看却还保持一样，我们的日常经历、听说的故事、看过的电视电影情节、做的梦、幻想的事情等，都会影响我们的记忆。记忆并不是事件本身，记忆是加入了许多我们的经验、想法、情绪、知识等的事件，可以与原本的事故相差甚远，甚至，毫不相关，完全是虚构的。许多研究已经证实了这件事：我们可以虚构出“事实”，并强烈相信它就是事实。所以，如何“证实”这些被发现的压抑创伤事故的虚实？？

您怎么看呢？

注：我无意淡化遭遇创伤事故的人的痛苦，这篇的内容主要在谈论“被压抑”后“被发掘”的创伤经验。临床上，我还是有在针对大小创伤事故做治疗的。

Getting help at an affordable price

Anxiety Disorder, Depression, Treatment Approaches, ,

I was approached by some students hoping to promote mental health awareness and encourage young people to seek help when they are feeling overwhelmed, burnt out, depressed or anxious for more than a few days. Here are some of my recommendations, the general rule is “affordable” here. Feel free to comment some other services if you are aware of any.

The first point that you can approach is actually any Klinik Kesihatan near you, where you can get a quick assessment, from there, you might get a referral letter or recommendations of what’s next (they do prescribe medication sometimes), all for RM 1 as long as you bring your MyKad with you.

Of course you can also visit your GP, i.e. family doctor, whom you go for when you have cough or cold. They might be able to quickly assess you and refer you to the specialist if needed.

Most major government hospitals offer psychiatric services, some with psychological and counselling services (e.g. UMMC). You will most likely be required to have a referral letter (e.g. from your family doctor or Klinik Kesihatan) before you make an appointment.

You may also approach the Malaysia Mental Health Association (MMHA), some years back they were providing counselling sessions at RM20, I’m not sure if it’s still ongoing now, but do find out more here.

Other than that, you can also check out sols247.org. Few years ago they came to our clinic in KL to promote themselves. They offer individual psychotherapy and counselling at very affordable price, this has been verified by my support group member who used to see his therapist there. You can learn more and book an appointment here.

If what you need is to talk to somebody when you’re feeling hopeless or helpless, you may approach the Befrienders at 03-7627 2929, the call is free when you call from major telcos (Maxis, Digi, Celcom, Telekom, Time, U-Mobile) in Malaysia. You may also email them (sam@befrienders.org.my).

And finally, for women who need help, you can contact the Women’s Aid Organisation (WAO) at 03-7956 3488 (24 hour hotline) or whatsapp 018 988 8058.

Please do comment below if there is any information that’s no longer up to date or if you have other recommendation of affordable service. I’d also welcome any organisation or individual offering such services to comment below so that I can add to the list.

Of course you can also drop me a message at 017-2757813 or hello@huibee.com and I shall try to recommend based on your needs.

Psychological Immune Neglect

Anxiety Disorder, Obsession & Compulsion, Treatment Approaches

Early last week I experienced some flashers and increase of floaters in my left eye, which as I knew, could be signs of retina tear or worse, retina detachment. I got quite worried about the eye, but was quite reluctant to go to the hospital straightaway during this movement control order due to Covid-19. At that time I had stayed home for more than 3 weeks without leaving the front gate.

Just like many of my clients, I googled to understand more about the symptoms, possible causes, treatments, and prognoses. I also started to imagine if I had only my right eye left, how my life was going to be, how long it would take me to adapt. I thought about relearning a lot of skills that require the coordination of both eyes, like touching the finger tips of each hand, driving and playing badminton.

I noticed how my family was worried about me. Normally my parents have the tendency to delay doctor consultation and treatment, and prefer the natural ways of healing, but this time it didn’t happen. At one point, I realised it seems that I was the only one who was still more chilled about it. (I mean of course I know the severity, but at the same time I was observing the symptoms closely and I didn’t wait for more than 3 days till I saw an ophthalmologist).

This reminded me of some books and research I came across long time ago. People often underestimate their emotional resilience and ability to adapt. People without a disability rate the utility or value of life with a particular medical problem significantly lower than those who actually live with the disability. For example, blindness is thought to be much worse by those who have sight compared with those who have lived without sight for years. (refer to Gilbert et al., 1998).

I mean, I had taken some time to imagine what might happen, and even done a little practice pretending it happened. If what I imagined really came true, I have had some time to be prepared for it, and to adapt to that psychologically first. So to me who has been experiencing all this, things seem easier (mind you, it isn’t that easy as I have to sleep sitting for 1-2 months). But for people who only imagine it, it all appeared harder.

This is something I often want to explain to my clients, especially those with generalised anxiety and OCD, those who over-worried about what might happen in the future. Things often seem much harder when you imagine it, and people have the tendency to underestimate the ability of adapt and cope! So I often say, “When it really happens, you will do just fine. Of course it’s not going to be easy, but believe me, You Will Adapt!” (What more, quite often the things they worry won’t happen anyway).

Immune neglect doesn’t just lead to more worries about things that people believe they won’t adapt, but also have big impact on our important decision making, this might include decisions to seek medical testing, get divorced, or file for personal bankruptcy (refer to Hoerger, 2012). Do have a thought about these examples!

So really, believe that you will adapt if unfortunately what you worry about really happens.

(To those who care about my eye: At the time of writing, my left eye is still in the beginning of a recovery process following laser procedure to treat the three retina tears. I’m still seeing a lot of floaters (and blood) in the left vision.)

社会焦虑中的典型核心恐惧

Anxiety Disorder, Basic & General

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？

恐惧&焦虑

Anxiety Disorder, , , ,

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？