Category Archives: Obsession & Compulsion

接受不确定性

Anxiety Disorder, Obsession & Compulsion, Treatment Approaches

生活中很多人不太能接受“不确定性”（uncertainty），比如担心孩子老公的安全、担心今晚可能睡不着、担心明天工作报告的表现、担心家人的健康状况等。而这是理所当然的，“不确定性”带来许多不舒服、焦虑，甚至恐惧的感觉。可是，很多人用担心与忧虑来应付不确定性，感觉上担心的事的不确定性在你担心后就变得比较能够预测、比较可以确定，这往往导致你继续担心与忧虑。

但是事实上，你的担心与忧虑，真的能使事情更确定更能预测吗？

挑战对不确定性的接受程度

  • 生活所有事都能肯定确定吗？有可能吗？
  • 对“确定性”的需要其实有多重要呢？有什么好处与坏处？
  • 你是否常常因为事情的不确定性而总是预测坏事会发生？这样合理吗？坏事以外的事发生的可能性不大吗？
  • 你所预测的事，发生的机率有多高呢？如果发生的机率很低，这样一直担心下去对你好吗？生活会快乐吗？
  • 你能尝试接受“不确定性”吗？能怎样做到船到桥头自然直的态度呢？
  • 问问你周围的人，他们怎么接受“不确定性”呢？


接受与警觉


当你无法忍受“不确定性”时，你都把专注力放在“未来”。现在就要学习如
何活在当下，对当下警觉注意，并接受这个“不确定性” －三个步骤：

  1. 警觉：清楚自己目前的思维与感受。用呼吸的步伐来让自己感受当下。当你总是想要确定性时，它给你带来了什么感受或问题？
  2. 放手：放弃这个对确定性的需要，告诉自己“这不过是个需要确定性的想法，我可以放手让它走”
  3. 不批判性：让想法在脑海里走过，不要批判它，或尝试改变它。然后把注意力放回当下，体验现在，注意你周围的声音，身体的感觉，或你的呼吸，或专注于你现在需要做的事。


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.)

Support Group is running now!

Anxiety Disorder, Depression, Obsession & Compulsion, Schizophrenia & Psychotic Disorder, ,

UPDATE 13/2/2020:

Hi all, it’s unfortunate that due to current situation (Covid-19), the support groups are not running, however, please do fill in the google form to register your interest: https://goo.gl/forms/PaFNW2LBfOkOOeUv1

You will be contacted once they are running again. Thank you.

Yes, since my post written in 2017, I’ve finally managed to organise the first meet-up for Support Group for Anxiety and related problems. It went really well and we were all very pleased to meet each other and made this happened together, despite our levels of anxiety! We will continue to meet monthly and welcome new members.

Meet-ups for Depression and other problems will follow soon…

If you’re interested, please fill in the google form here:

https://goo.gl/forms/PaFNW2LBfOkOOeUv1

A few criteria to fulfill:

  • You’ve been assessed or diagnosed with the problem you specified by a mental health professional (be it a psychiatrist or psychologist or GP or…).
  • You’re attending and participating in this willingly, not being forced by others.
  • You are able to arrange your own transport and pay for your expenses.
  • You are able to pay a small fees for administrative/materials purpose.
  • You demonstrate the ability to treat others non-judgmentally and with respect, and maintain confidentiality.
  • In between our monthly meet-ups, we stay connected in Whatsapp group, however, you will only be able to join the group after first showing up in the meet-up.

To read more about it, please check out my previous post:

Support Groups in KL/Klang

寻求安全行为

Anxiety Disorder, Obsession & Compulsion, Treatment Approaches

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.

Safety Seeking Behaviour

Anxiety Disorder, Obsession & Compulsion, Treatment Approaches

(This is my 200th post!! Well done, Hui Bee!! It’s been 4 years writing here.)

There is a tribe who believe that to make the sun rise, they have to build a bonfire each night and dance around it till dawn. Because of this belief, the tribe spends most of their time collecting wood and preparing for the night (Wells, 1997). They are exhausted. This ritual has taken over their lives, but they can’t stop this as they are obliged to make sure the sun rise again for the world the next morning.

A safety seeking behaviour is something a person does to stop a feared catastrophe from happening. But safety behaviours actually make the fear stronger especially in long-term by preventing the person from discovering that the disaster is not going to happen anyway. Overcoming anxiety involves having the confidence to tolerate that anxiety whilst dropping these behaviours.

Some clinical cases

Little Alan believes that if he plays badminton, he will not sleep at night. So he has completely stopped playing badminton that he used to enjoy.

Ms Stephy has panic attacks and agoraphobia, so she shops online, and avoids shopping malls and crowded places at all cost. Now she barely gets too panic, but her life is so limited.

Mr Patrick has social anxiety. He avoids social interactions and social situations whenever possible. Even when he speaks to others, he avoids eye contacts and keeps the conversation minimal. People find him uninteresting, aloof and weird.

So, back to the tribe sunrise ceremony. How would they discover that whether or not the ritual really makes the sun rises?

How would Little Alan know whether playing badminton really lead to insomnia?

How would Ms Stephy know whether the crowds lead to her panic attacks? How can she live a more fulfilling life?

How would Mr Patrick knows whether avoiding social interaction and eye contact help with his problems?

(You might notice that they all pay huge cost in long-term in order to ease their anxiety in short term. “Short term gain, long term pain”)

It seems that this is part of us human, when we do things like “touch wood” or knocking the door before entering the hotel room. For many with OCD and anxiety disorders, it is highly important to identify their safety seeking behaviour, and do some psychoeducation around it to make them willing to drop them, or test dropping them (behavioural experiment).

More importantly, there are also times when we therapists teach them certain coping skills (e.g. abdominal breathing), and it ends up being used as safety seeking behaviour “as long as I focus on my breathing, I will not get panic attack and faint here in the mall.” So, the intention (beliefs) behind these behaviours is important. Why do you do this? Is it as a way to cope (coping strategies), so that you can continue shopping, or is it as a way to avoid a disaster you think might happen (safety seeking)?

Has OCD started as an Evolutionary Advantage?

Issues & Debates, Obsession & Compulsion

It is kind of obvious that it is?

Checking is good, double-checking is good, tidying up is good, washing is good, trying to be perfect is good, counting is good, being attentive is good, thinking thoroughly is good, requiring precision is good, getting reassurance is good … …

From the evoluntionary perspective, are people who are attentive, careful, clean, thoughtful (etc) more likely to survive? Obviously, yes? It’s very much needed in ancient societies, as survival skills.

How if these careful people get married and have children? Do they produce even more “careful” children? And then next generation, and next, and next…

And it’s not just the genes from both lines of the “careful” ancestors, but also the upbringing environments provided by these attentive parents, they certainly continue to reinforce such behaviour… We were taught many of these acts as children, by our parents, older siblings and teachers in the school, weren’t we?

Then as the behaviour continues to be reinforced and developed and advanced… there you go, OCD? (This is just a hypothesis)

It’s just my random thought… But we are surely seeing more and more OCD clients in our clinic these days. Not just that, it’s got harder and harder to treat as well (the illness has got more stubborn and sticky).

Imagine that this theory is somewhat 70% true (another 30% of factors that’s beyond the knowledge of this psychologist in the modern days), OCD is going to get stronger and stronger, right? It can become a real big (detrimental) issue, especially in Asian culture…

What can we do? How do you bring up a child that strive to be better and better, but not aiming to be 100% certain for everything s/he does?