Blog Category: Stress Treatment / PTSD

Expat life and moving around the world places a great deal of stress on children. DR REBECCA GIESS and DR MARK TOH from Promises Healthcare share how parents can help them adapt to new environments and people.

What issues do children deal with when adjusting to expat life?

Rebecca: They suffer mostly from homesickness, and grief from losing friends, extended family and familiar places. In a new country, they find it difficult to fit in and feel a sense of belonging. They have a fear of missing out (FOMO) on life back home.

Mark: They perceive a threat in relocating. Extended family and friends represent the emotional resources the child depended on, and the disruption in daily routine affects their emotional security and stability. This is an important and largely overlooked stressor. How children experience this, and how prepared they are for the change, is based on their relationship with their parents.

What are the red flags?

Rebecca: It can be difficult for children to know how they are feeling or how to express it. They may exhibit anti-social behaviours by breaking the rules or defying expectations. Tune into your child to uncover the underlying emotional triggers, and what they might need emotionally from you.

Mark: For children under the age of eight, there may be more crying, moodiness and irritability, complaining about school, expressing worry, or becoming withdrawn and clingy. There may also be regressions such as thumb-sucking, temper tantrums or toilet accidents, despite being potty-trained.

Children aged seven to 10 may worry about their health or family and express anger and irritability. They may also pin negative labels on themselves. Some of these behaviours may manifest at school more than at home.

Preteens may be more reactive to the demands and stress of the new school, complaining about the different system or classmates. They could become withdrawn, have more incompleted homework, or have declining grades.

How can we help teenagers adjust?

Mark: Teenagers will miss their friends, prom, graduation and sports pursuits – the rites of passage – and they may feel their sense of identity being stripped away. They may display depression, anxiety, irritability, apathy and withdrawal, which increases their sense of isolation.

Those who feel ready to be independent may feel trapped with their family. They blame their feelings on the relocation and start to resent the family for it.

If the teenager is close to completing Grade 12, consider allowing them to graduate before they relocate.

How can parents navigate their child’s emotions?

Rebecca: Create space and guidance for their emotional experiences. Parents can validate and normalise their emotions by saying things like: “It makes sense.” Or: “It’s normal to feel sad or stressed.”

Don’t place any expectations on how your child “should be feeling”. They feel what they feel. Parents can help them label their emotions and work out how best to manage them.

Talk to your child about becoming a “third culture kid” – someone who spends a portion of their developmental years in another country. There are several benefits and challenges worth understanding and planning for.

I recommend parents read Third Culture Kids: The Experience Of Growing Up Among Worlds (Pollock, Van Reken & Pollock 2017).

What is most important to the child?

Mark: Children are looking for safety and security. With younger children especially, this depends on how close they are to their parents. Pay more attention to any work or social activity that might threaten this bond. Parents must remain accessible to the child, meeting regularly, exploring and discovering the country together and having fun in the process.

They should also assess how they themselves are coping, and if they might be unintentionally neglecting their child’s needs.

What can parents do at home?

Mark: Help children to set up their room. They are more likely to embrace their new home when they know that their needs are being met predictably. Parents should be ready to share their personal feelings and discoveries to encourage their children to communicate as well.

Create routines that bring everyone together. Playing games encourages bonding. Team games, where discoveries can be made individually and shared collectively, are particularly useful. In the process, the family learns about each member together.

How can a therapist help?

Rebecca: Therapists are trained to work with children experiencing anxiety and depressive symptoms due to adjustment difficulties. Children are rarely completely open with their parents and may do better in a non-judgmental safe space.

Mark: A therapist looks at both the child and family’s wellbeing. How is each person in the family coping? If there are individual or collective difficulties uncovered, the therapist could help them get unstuck.

About Dr Giess & Dr Toh

Dr Giess has extensive experience in working with teenagers and parents. She also helps adults address severe and chronic mental and physical health issues, and is trained in couples relationship counselling.

Dr Toh treats troubled children and their families and helps them to address their challenges. Helping parents to parent well is also a concern for him. He also works with couples and individual adults, as well as individuals with personality disorders.

Promises Healthcare is at #09-22/23 Novena Medical Center, 10 Sinaran Drive. Contact the team at 6397 7309.

*This article first appeared online on Expat Living Magazine’s website. Anna Murphy, an editor at Expat Living Magazine, wrote this article.

When the ‘circuit-breaker’ measures were put in place, there is no doubt that our lives have been drastically impacted. Even travelling to work or school – what was once considered a part of our daily routine – is no longer the same. Rules and regulations are put in place too, such as the wearing of a mask is now deemed mandatory and not being able to speak onboard public transports. With such increasing obstacles, it is unfair if we do not acknowledge the effort Singaporeans have put in to manage and cope with these disruptions to our daily routines. While we have moved into the phased circuit breaker emergence period, it may be still some time before we can resume our normal lives.

To cope with being house-bound, some of us have chosen to take on a new hobby or to learn a new skill to pass time and keep ourselves engaged. Others have embarked on some self-reflection and have come to realise that they had taken their past freedom for granted. Whichever the case, we are all trying to keep ourselves mentally healthy in different ways, and this in itself is commendable.

However, with the recent announcements of the circuit breaker emergence phases, this may have once again taken a toll on people’s mental health, with their sense of relief that it’s ending being diminished abruptly. In light of this, we need to help each other ride through these challenging times as circuit breaker measures continue on. Here are some simple tips to help you keep yourself sane, and to adjust to the new “norm”.

First of all, start being grateful for your privileges in life. Gratitude will give you a sense of hope amidst these trying times, and that there is light at the end of the tunnel. There are many things to be grateful for, such as the increased connection and bonding with your friends and family. As they say, distance makes the heart grow fonder. Have you found yourself wanting to reach out to others more than ever, be it through the phone or video conferencing platforms? Do you appreciate that you are not just stuck at home, but that you have a home that provides comfort, safety and security? During these times, also be grateful and appreciate that you are in good health. For those of you who are feeling artsy, perhaps you can create a gratitude vision board. Whenever you are feeling down in the dumps, write notes of affirmation or gratitude and decorate your walls. Take a look at them and remind yourself of the little things in life that keep you whole.

Another tip that is often overlooked is to set goals and a fixed routine. For some of us, staying at home is an excuse to idle, especially if you are not working from home or waiting for HBL to start. Contrary to what people think, that there is nothing much to do at home, there are in fact many activities that we can keep ourselves busy with. Make time for indoor exercise routines, do online crossword puzzles, read books, hang out with your friends on online platforms – you name it. Try setting weekly goals and track your progression too, and don’t forget to reward yourself for every milestone achieved. Believe it or not, stimulating your mind can definitely help reduce feelings of helplessness and to deal with cabin fever.

Nonetheless, it is also important that you seek help whenever necessary. Consultations for psychological services are available at Promises during this period of time, with Teleconsultations as an option. You should never hesitate to seek help if things get hard.

Stay home, stay safe, stay happy!

Visions by Promises’ Addictions therapist, Alexis Fosler, gave some great insights and tips for dealing with stress in an interview about “Spring Cleaning Your Mind For Better Well-Being” with ANZA Magazine’s editor.

Restrictions are lifting, the workforce is returning traditional office spaces, travel is go. On the outside many would say we are emerging into a ‘new normal’, but that doesn’t necessarily mean that our minds are at ease. Having a human brain, particularly right now, is stressful.

Much like how the homes we’ve become so bound to in the past few years have grown more cluttered, our minds are filled with chaotic debris and discontent too. Recent research by YouGov found that six in 10 Singapore residents have suffered adverse effects to their mental health due to the pandemic, with those aged 35 – 44 most affected.

“Covid-19 has certainly impacted both our thoughts and our behaviours, and studies have shown that population mental health has declined significantly during this period,” confims Alexis Fosler, psychotherapist at Promises Healthcare. “These same studies indicate that we may have given more time to think about our anxieties and our worries such as employment, health and our lack of social connection. We’ve put less brain power into thinking about others and about our future plans – both of which are associated with better wellbeing.”

Clutter-free environment

While we don’t experience seasonal changes in Singapore, the arrival of spring can serve as a natural point to take stock of our mental wellbeing and reconnect with the things that bring us purpose and joy. We know that positive outcomes are associated with physical decluttering. When we clean the messy spare room, give the kitchen a clear out or tidy the drawer that hasn’t closed properly since 2019, we experience lower levels of stress, greater productivity, better focus, higher self-esteem and increased mental health. Alexis believes that same positive effects can occur when you spring clean your brain.

“We know that our brains like order and are less likely to be distracted and overloaded in a clutter-free environment,” she says. “We live in two states: our external environment and our internal environment. Both can affect our overall wellness, so it’s equally important to live in an internal world that is not overwhelmed with noise and distraction.”

Creating a soothing internal landscape is easier said than done, but Alexis recommends achieving a calmer, clearer mind by “thinking about wellbeing as the house in which you live, which is supported by a number of important pillars”. Here are a few of her simple rules:

• The first pillar to your house of wellbeing is exercise which improves mood and decreases feelings of depression, anxiety and stress. It also produces changes in parts of the brain that regulate stress and anxiety and boosts the production of endorphins, which are known to help produce positive feelings.
• The second pillar is service to others. “The more I think about other people, the less I am concerned with myself, and the more I’m able to focus outwardly, and escape the natural whirlpools and eddies of my own mind,” Alexis says.
• The third pillar is social connection. Research indicates that the number of social connections, and the type, quality and purpose of relationships, can affect brain function. So it seems that better social engagement is good for brain health (like we need another reason to love an ANZA Ladies Night!). There is also evidence that loneliness increases the risk of loss of thinking skills in older people.
• The fourth pillar is learning or education. “At times in my life where I’ve felt stuck, picking up a new skill or a new degree has been a lifesaver – the rigour of studying hones our mental skills and keeps us engaged; it has a wider benefit of opening doors to new skills and relationships,” Alexis confirms.
• The final and perhaps most significant pillar is meditation, something which many studies claim gives rise to mental focus and clarity. “I never really understood what this meant, but meditation completely changed my outlook,” admits Alexis. “Most people think about meditation as the absence of thought, but really, it’s the ability to observe your thoughts, thus allowing yourself to see where your mind takes you, and to press pause on negative thinking. If I’d known the power of meditation, I would have started many years ago!”

Having the ability to observe her thoughts, Alexis says she is much better able to detect negative thought patterns and allow herself to reframe situations she finds herself in. “The ability to monitor or control our thoughts allows for an internal – rather than external – locus of control, which is incredibly important in an era where there are so many things (a lingering pandemic, employment, war) that are beyond our control. She adds; “Once you realise that the power to change lies within the space between your ears, you can possess an unpolluted mind and the world can appear much more manageable.”

Promises Healthcare provides a comprehensive range of psychiatric, psychological & physical wellbeing services for children and adults.

*This article first appeared on ANZA’s website.