Category Archives: Treatment Approaches

创造性的解决方案

遇到任何大小问题时,尝试用一下的提问来转换角度和寻求更有创意的解决方案。

1.问题是什么?

2.你过去处理解决类似的问题做过什么?

3.还有什么是你没尝试过的?

4.如果你关心的人面对类似的问题,你会给予什么劝告/建议?

5.想象你敬重或欣赏的人。他们会做什么?

6.你认为你尊敬的人会给你什么劝告/建议?

7.你可以向谁寻求帮助?

8.列出你可以用来应对的其它资源。

9.一个具有创造性的人会作什么?

10.一个明智的人会作什么?

11.一个勇敢的人会作什么?

12.最容易做的是什么?

13.最有效的解决方案是什么?什么是理想的解决方案?

14.总体上,你认为最实际的或最好的解决方案会是什么?

15.最开始的第一步是什么?

记得:处理情绪,有时也是解决事情的方法之一,因为有些事我们无法直接解决,但我们可以学习处理自己的情绪,而不是被动地等待事情过去或陷入痛苦中…

接受不确定性

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。


减肥是终身事业?

照片取自这里

她的减肥事业,从青春期开始。其实从小也胖,但因为长得可爱,所以也不觉得自己的体重或身型有什么问题。直到十五、六岁的时候,发现周围的朋友身材都纤细,穿什么都好看,哪怕长得比她还矮的,拍照看起来也比她“高挑”。就这样,她开始觉得自己胖,下来的几十年,就在各种瘦身、减肥、节食、运动、产品和配套中渡过。

她给我发电邮的时候是她已经过了40岁的生日,从事物理治疗,结了婚,有个儿子。她和先生想要多一个孩子,可是多次流产、人工受孕也一直失败,医生说她必须减肥才能再试,否则就得放弃剩余的冻卵。挣扎了快两年,她看到我的网站和视频,就来联系我了。

她说,因为自己的身型,尤其在生了儿子以后,她已经自卑很久了。周围不再有朋友,因为她完全躲开大家,深怕自己的身材成为大家的笑话。而她的事业也不发展了,“没有物理治疗师可以这么胖的”。每次照镜子的时候,她就觉得自己恶心,渐渐地也不照镜子了。这些社交问题、工作问题、自卑心理等,常常使她陷入低落的情绪,而最能快速使她脱离低落情绪的方式,就是吃… 她常常可以一口气把6、7个包子吃完。尤其在独处时,她更是会不断的吃,可能把一条面包、几包薯片、巧克力等都往嘴里塞,来安抚自己的情绪和自卑感。不用说,撑饱以后,马上的自卑、恶心、嫌弃、罪恶感就会涌现… 然后不断地陷入这样的恶性循环…

第一次跟她见面做评估的过程中发现,她很不自信(敢言,assertive),总是“别人优先”而忽视自己的感受。她没有办法拒绝别人的要求,她的生活充斥着许多她不想做、不愿意做的事,不管在家里还是工作都一样,而每次她无法更敢言地拒绝他人,过后就会躲在车里或家里吃,来安抚自己的情绪。

她希望我可以帮她减肥、可以再次人工受孕,她也希望自己可以开始运动、可以控制饮食而不是被饮食所控制,她也希望自己的健康状况可以改善,尤其因为肥胖而引致的各种问题,她希望自己的自信可以有所提升,更爱自己一些,不再那么自卑,并且能够继续发展她的事业。

我用接纳与承诺疗法(ACT)开始和她治疗,然后才开始用催眠(Hypno-CBT),这个过程中,她变得更自信,更敢言,而这个自信不只是对他人,也包括对她自己,比如当心里想“再吃一个包子吧!明天再减!”,她有能力坚决的对自己说”NO!!”。这个过程中,她发现她原来不只无法对他人说不,她也无法对自己说不,总是太过随波逐流的活着,没有主见,没有目标,没有坚持… 除此之外,咨询开始的一个月后,她的体重每星期稳定持续减少 0.5-1kg,主要因为她不再被食物所控制,而且有能力更经心的感受真正的“饥饿”和经心的享受食物和进食,而不是盲目的“吞”!她还发现当她经心的进食时,其实原来她一点也不爱吃包子,以前却可以一次过吃下至少6-7个。她变得更了解自己的感受和身体的感觉,学会更疼爱自己,做对自己的身心有益的事。三个多月后,她对我说,这个治疗和探索的过程让她发现,其实她根本不想要多一个孩子,她想要专注的把儿子带大,这才是她真正想要的,所以虽然体重减轻了,她或许在两三个月可以再次尝试人工受孕,但她在更了解自己后,有能力做出她自己想要的决定,而先生也支持她。

很多人减肥很希望快速地看到成果,用许多极端的方式去节食或花很多钱去瘦身中心等,但是很多时候一旦停止,体重就快速反弹,甚至比先前还重还胖。我不反对人们断食、节食、运动,但是很多时候,减肥需要的是一个身心的重新调整和治疗,包括从身体,也包括从心理,而不只是只从一个层面下手,效果或许不快,但它会持久,因为就像心理治疗过程中你学到的任何技术,它都会帮助你变成自己的治疗师,继续应用这些技术帮助自己…

How to explain “Law of Attractions” scientifically?

Last night Mark was explaining “goal visualisation” to some of the College’s students in China (with me doing interpretation of course, since he doesn’t speak Mandarin and the students mostly don’t understand English). Then a student asked, “When we tell clients to visualise their goals, isn’t this to do with law of attraction?”

The law of attraction (LOA) is the belief that the universe creates and provides for you that which your thoughts are focused on, so if you think positively, you will attract positive stuff. But it’s very much believed by most scientists that this is a pseudoscience. Yet when you do think about it, it seems to “exist”, so how do we explain it from a scientific perspective?

So here is Mark’s answer.

We are perceiving millions pieces of information in every second, through our eyes, skins, ears, etc all parts of our body. But our brain filters the irrelevant information away just so we are taking in what’s relevant. For example, our eyes can only see a few words each time, but we have the illusion that we can see the whole page, or we thought we can see the whole room, but in fact the eyes can only see a small portion of it, and the rest is made up by the brain, based on information it has. We didn’t actually see it.

When we set up a goal and visualise it, what makes it more likely to come true?

Let’s say now you’ve decided that you want to buy this Kawasaki Ninja motorbike one day when you are able to. And once this becomes your goal, somehow, all in a sudden, you start to notice this motorcycle on the road a lot more than usual. Obviously people don’t just start to ride on it just because it’s now your goal, but what? Your mind now sees it as relevant to you, and starts to allow it to enter your awareness. In other words, you start to notice it more now that it’s your goal, all the while they have been running on the roads.

So when you set a goal and is committed to it, you start to focus on it, your attention is on it, you are motivated to achieve it, you become more open to related information and opportunities, your attitudes also get more active (as opposed to passive), so it seems that “you think positively, you get positive outcome”, but during this process, there are many psychological and biological factors involved.

I remember buying a pair of running shorts from Decathlon or a Snoopy tee from Uniqlo, and in the next two weeks or so, I started to notice quite a few people wearing it. The mind now sees that this is “relevant” to me, while previously this would have been filtered out.

So say now your goal is to look for a job. You would now naturally notice more of the job searching platforms, vacancy advertisements, career advisory services, job centres etc, and thus you would naturally be exposed to more opportunities. So it’s not that thinking about getting a job gets you a job, but your attitudes of becoming more open and your behaviour matter. If you think very positively and do nothing at all all day, does all the positivity still happen out of nowhere?

Likewise let’s say you think that you are an unlucky person, and you’re likely to “see” how unlucky you are and feel miserable about it. Well if you only focus on all the bad things that happen to you and also expect the bad things to happen, it’s difficult to become lucky, right?

Perhaps I can also take this opportunity to recommend John Krumboltz’s “Luck is No Accident”, we can create our own luck, by staying open and curious, not planning much, and expect things to go unexpectedly.

Mindfulness for Beginners (2006)

This is a 2.5 hour audio book that I listened to via the app “Libby”, after learning mindfulness for almost a decade, I saw this book and thought, why not listen from the scientist who has been in this field for so long, and has developed the mindfulness based stress reduction (MBSR), Jon. Kabat-Zinn.

Screenshot of the audio book via the Libby app.

He started with some very basic introduction about mindfulness in the first few chapters, what it’s about, what it’s not about, and how it’s linked with some ancient philosophy and religions. And then there are last few chapters that allow you to experience mindfulness with him, such as:

  • Eating meditation
  • Mindfulness of breathing
  • Mindfulness of the body as a whole
  • Mindfulness of objects: sounds, thoughts, emotions
  • Mindfulness as pure awareness

The last one was quite challenging for me, because I constantly noticed that my mind was wondering where I should focus my attention on, how I embrace the whole experience without focusing on certain something…

It’s very accessible, though I think the voice sometimes is kind of “cracky” and I’d miss what he’s saying when I don’t turn the volume louder (the large part of time I spent listening to this book was when I was having a walk after dinner outside).

I’d recommend it to anyone who’d want to learn and embrace mindfulness into their lifestyles, if you’d prefer reading, there is “Mindfulness for Beginners: Reclaiming the Present Moment and Your Life” (2016), also by Jon. Kabat-Zinn. Feel free to share your experience practicing!

Mind Reading in Mental Illness

During the sessions, I often can’t help wonder, how if she was right and I was wrong. How if the field of psychiatry was wrong to label that as a symptom of psychosis, calling it “delusion”, while in fact our patients were right? How if they could really read minds and it’s not coincident? How if somebody else could really read her mind but the psychiatric consultants were too quick to discard and then label that?

It turned out that I’m not the only person wondering about it and hoping to carry out some experiments with the patients in the psychiatric clinic.

About 44 years ago, Dr Bruce Greyson thought the same. And as agreed by his colleagues in the psychiatric ward, they did this experiment, investigating whether the patients who claimed that they had telepathy ability could really read minds. The senders (those minds being read by the patients) were his psychiatric trainees who volunteered to have their minds read, as they focused on an image during the experiment. After that, the patients were shown the image along with four other pictures, and the experimenter asked if the patient knew which image the sender was looking at earlier.

Unsurprisingly, none of the patient performed above chance expectations. But what was intriguing to me, is what happened later. Before the experiments, they were concerned about the consequences of such experiments, whether they would reinforce or worsen their symptoms and made the delusion worse. But, all the patients were happy to have been given this opportunity to participate, and what’s more:

  • They could trust the hospital staff more because the latter have taken their thoughts and feelings seriously.
  • As they failed to read minds in this experiment, they started to doubt their other irrational thoughts too!
  • They learnt to separate fantasy from reality after that!
  • Patients actually got better.

Obviously as a clinician, if I was too quick to disregard their delusions and beliefs, I would definitely fail to build a good therapeutic rapport, which is one of the most important predictions of therapy outcome. So often it’s a balance between building a mutual trust and strong therapeutic alliance, and challenging some of these so that they get better.

Here I’d like to share this method of experimentation, especially to many family members out there who live with someone suffering from psychosis, to be open and curious, and not too quick to disregard their beliefs, but invite them to try out their beliefs and see what happens!

Read the original paper by Dr Bruce Greyson here: Telepathy in Mental Illness: Deluge or Delusion?