Eating & Anxiety

Anxiety Disorder, Basic & General

Substances that may raise your anxiety level and foods they are found in:

Caffeine: coffee, tea, chocolate, soda

Refined white sugar: nondiet soda, candy, cookies, cakes, ice cream, other desserts, sugar-coated cereals

Refined white flour: white bread and rolls, hamburger buns, spaghetti and other white pasta, pretzels

Alcohol: beer, wine, hard liquor

Artificial sweeteners: diet soda, most foods labeled “diet,” many sugar-free products, cereals

Substances that may lower your anxiety level and foods they are found in:

Niacin: chicken, turkey, wheat, brown rice, tuna

Thiamin: oats, wheat, pork, tuna, asparagus, sunflower seeds, white rice

Riboflavin: milk, yogurt, pork, avocados, mushrooms

Vitamin B-6: turkey, bananas, mangoes, sunflower seeds, sweet potatoes, tuna, pork

Vitamin B-12: beef, yogurt, tuna, crab, clams

Biotin: eggs, cheese, peanuts, cauliflower

Pantothenic acid: yogurt, avocados, salmon, sunflower seeds, mushrooms

Folic acid: turkey, oranges, peas, avocados, cabbage, broccoli, soybeans

Calcium: milk, yogurt, cheese, broccoli, spinach Magnesium: spinach, almonds, avocados, sunflower seeds, Brazil nuts

Omega-3 fatty acids: tuna, salmon, sardines, walnuts, dark green leafy vegetables, soybeans

Complex carbohydrates: whole-grain breads, whole-grain cereals, whole-grain pasta, brown rice

Everyone’s body is a little different from everyone else’s. This is just a general guide. To be fully aware of everything you are putting into your body, you may have to read the labels on the packages of the foods you eat. To learn more about their chemical makeup, you can also look up individual foods in an encyclopedia or a book on nutrition, or on the Internet. Sometimes people’s favorite foods are those that raise anxiety. It can be hard to give those up completely, but even cutting back on anxiety-raising substances can be helpful.

接受不确定性

Anxiety Disorder, Obsession & Compulsion, , ,

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，担心睡不着，担心明天工作报告的表现等。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：

  • 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？
  • 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”
  • 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。

 

N.B. 在我看来，除了广泛性焦虑症(generalised anxiety disorder, GAD)，不能接受“不确定性”（就是凡事都要百分百确定，不能冒一点险）也是强迫症(obsessive compulsive disorder, OCD)的一个明显特征，只是除了在脑中担心、不断思考，强迫症患者会对不确定性做出（反复的）行为反应。

新的一年，不妨把这当成今年的目标之一，学习与练习“接受不确定性”，活得灵活自在些！

You don’t have to see the whole staircase, just take the first step.

– Martin Luther King Jr.

How is your Psychological Health?

Basic & General

The above are some statements measuring level of emotional distress. They can serve as a guideline that something might start to go wrong in life.

It is a difficult time for almost everyone, whether it is the economy globally, crime rates in the country, personal financial issues or major life events, or day to day stress from work, family, relationships etc. We might not be able to change all these challenging situations, but we are able to change our perceptions to them, and improve our coping abilities and psychological resilience.

I am a psychologist specialised in Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT). I am also trained in Problem Solving Therapy and Hypnotherapy. I help people to pick up the role of therapist for their own problems.

Feel free to leave a comment below, or contact me via hello@huibee.com or 017-2757813.

Let it go or Chuck it away?

Basic & General, Issues & Debates,

I was looking at some psychotherapy worksheets and came across some exercises on “learning to let go“. Here are some of the exercises:

Exercise 1

On a separate sheet of paper, describe a problem that has been making you feel depressed lately. Write about it in as much detail as you can. Choose one of the methods below to physically let go of what you have written, and then do it. As you destroy your problem, tell yourself, “I am letting go of this. I will not let it depress me anymore.”

  • Rip up your paper into tiny pieces and throw it into the garbage.
  • Put your paper through a shredder.
  • Read what you have written to someone else and then give that person the paper and ask him or her to rip it up in front of you.
  • With permission and in the presence of an adult, burn your paper in a fireplace.
  • Write your problem on bathroom tissue instead of regular paper and flush it down the toilet.

Exercise 2

Sit quietly and comfortably where you will not be disturbed. Close your eyes and picture yourself in vivid detail doing one of the following:
You wrap your problem in a box and seal it very securely with strong tape and rope. Then you attach the box to a very powerful rocket. You take the rocket to an outdoor area where there are no houses, trees, or other obstructions. You light the rocket and stand back. You watch as the rocket blasts off into the sky with great speed and force. You watch it carry your problem quickly and powerfully away from you. You watch until it is completely out of sight, far off beyond the pull of Earth’s gravity, continuing to travel farther into space. As you watch it go, you say to yourself, “I am letting go of this. I will not let it depress me anymore.”

What do you think about these exercises?

According to thefreedictionary.com, to let (something) go has the meaning of

  1. to stop having something
  2. to stop trying to control something
  3. to not take action

Whereas to chuck (something) away has the meaning of

  1. to push or shove something out of the way quickly and roughly
  2. to throw something away
  3. to dispose of something

I think the person designing the exercises of “learning to let go” wasn’t quite able to differentiate between letting go and chucking away. By letting go, you don’t push things away, sometimes the thing that upsets you might even still be there, with you in the same room, but you just let go of the struggle, stopping the control… Because pushing it away, throwing it away involve a lot of control too. And most people do find that the more they try to get rid of something off their mind, the more likely the thing returns (have you tried the “try not to think of a pink elephant” exercise?).

In other words, let’s say you were holding on to your problems, if you want to let go, you open up your palm, whether or not the problems leave you, it’s not up to you, but at least you stop the struggle of holding on to it. So no, I don’t think the above exercises are helping people to let go, even if they succeed, the upsetting events are likely to bounce back (still, it works for the short terms, sometimes for the long terms). A good way of practicing letting go is being mindful, being in the here and now (you may learn how by reading this book). You may also try leaves on the stream (remember not to chuck your problems into the stream, but just let them go, let them flow down gently).

Religious Experiences and Psychotic Symptoms

Clinical Case Studies, Issues & Debates, Schizophrenia & Psychotic Disorder

I was recently having a conversation in the clinic and a patient back in the time when I was working in North London Forensic Service popped up in my mind. This is a big black man with a diagnosis of schizophrenia, he also assaulted his ex girlfriend and hence was in the inpatient security ward that I worked at.

From day one I met this man, he was in good order and discipline, never exhibited any of the psychotic symptoms, abusive language or aggressive behaviour of any sort, unlike many other patients there. He was also doing an MBA course through the Open University. So most of the staffs in the team believed that he would make his way out soon, to the community, starting a new life. However, his stay was extended. To our surprise, it was due to a note recorded by a nursing staff (what each patient does every day is recorded on every shift). The nurse got along quite well with the patient, on one occasion, the patient shared with the nurse his experience of seeing white light in his room coming from the sky, and an angelic human coming to him and passing him some positive messages.

The patient surely didn’t know this was recorded in the note. However, this was used against to the patient in the court as evidence of him still experiencing psychotic symptoms (both visual hallucination and delusion) and  was not well enough to leave the ward to the community. The patient came to know the details only after the hearing, from his solicitor. He didn’t get to defend himself on his experience, which he later expressed that this was completely a religious experience, which he found amazing and intriguing, and in no way is related to mental illness. He came from a very religious family.

This was at least 4 to 5 years ago. I still remember it because until today I still cannot be sure whether that decision made by the team was correct. I am not a religious person (few years ago I was turned down as a volunteer in an NGO because I told the interviewer that I have no religion!), I can’t truly understand how a very religious person’s experience with god is like. I did complete the Alpha course in the church when I was doing postgraduate in Brighton. I met a lot of very nice persons, some I still keep in touch today. Sometimes I could be quite shocked by their presentations and behaviour during the services, but I respect that it’s their belief, and I learnt from them although I have not experienced it at all.

If it was a so-called normal person experiencing and sharing their religious or cultural experience, we might or might not believe them, but we wouldn’t think they are having hallucinations. How if a religious person with a history of mental illness experienced and shared such encounter? This is like when I worked there, sometimes we had to do night shifts, and many of those African nurses wouldn’t stay on the ward alone no matter what (we shouldn’t anyway, but there are times of emergency etc). They have had so many encounters of “ghosts” and “spirits” and scary stuff, it’s a hospital afterall, it’s easily linked to deaths (and then “ghosts”). But when this was expressed by a patient, even the African nurses would suspect that he was just having hallucination!

I can’t really have any say about these, I have experienced none, spiritual, religious, or thrilling (to be honest I’m happy and keen to experience them). We were told that we should pay attention to cultural influences and backgrounds before we “judge” someone diagnose a patient. It’s true, I now think it was wrong to hold the big man back solely based on that.

CBT & Bipolar Disorder

Bipolar Disorder, Treatment Approaches,

認知行為療法 (CBT) 如何幫助躁鬱症（雙極症, bipolar disorder）？

躁鬱症的治療過程中，藥物扮演非常重要的角色。而加入認知行為療法(CBT)，則可以幫助穩定患者的情緒和保持日常的穩定。

是甚麼導致躁鬱症的高低起伏？根據研究，情緒的起伏，受我們的想法影響。該研究發現極度消極負面的想法或過度積極正面的想法都會影響躁鬱症患者的情緒和行為。而學習和練習CBT就可以緩和這些極端，CBT讓患者學習如何捕捉、挑戰、改變錯誤的或極端的思維，同時識別和改變有問題的行為習慣。

六個針對躁鬱症的CBT技巧

  1. 接受“躁鬱症”這個診斷。首先第一步就是明白和理解這個可以對你的症狀做出解釋的疾病。對很多躁鬱症患者來說，這往往很難接受，所以讓他們學會關於躁鬱症的信號、症狀、起因、病程等是很重要的。這讓患者能去尋求幫助，而且也知道他們其實並不孤單。
  2. 監控情緒。這通常是用工作表或日記來紀錄。目的在於更加能夠覺察情緒的導引和改變。
  3. 進行認知重建。這過程專注于通過學習如何更好的識別想法對情緒扮演的角色、如何識別有問題的想法、和如何改變或糾正它們來改變思維的習慣。（有些時候接受該想法，再與想法產生距離化可能比挑戰和改變想法有幫助－似情況而定）。
  4. 頻密進行問題解決。其中的步驟包括如何識別問題，產生可能的解決方案，選擇適合的方案，嘗試它，和評估其結果。問題解決療法可以應用在生活的任何領域，不管是兩性關係、失業、或卡債等。這所有壓力的根源，如果沒有被好好處理解決，都會帶來復發。
  5. 增強社交技巧。有些躁鬱症的患者缺乏社交技巧，這讓他們覺得自己沒辦法控制生活的其中一些部份。學習自信心訓練等技術能幫助處理與他人的關係。
  6. 穩定日常節奏。給生活建立一個規律的日常活動和節奏，這有助于穩定情緒。

而為了最大化躁鬱症的治療，聽從醫生的指示、完成CBT的家庭作業，和不斷繼續學習關於躁鬱症是很重要的。