When one has to live with debilitating chronic conditions or even degenerative disorders, it is natural that we place emphasis on seeing that the afflicted recover and receive the appropriate management. As our society rapidly ages, the number of elderly living with medical conditions or dementia is also increasing exponentially. However, the care should extend beyond the patients themselves. More often than not, there are other individuals involved, including family members and friends dedicated to supporting their recovery. Is it time we acknowledge their efforts and ensure they are coping well?
Caregiving can be exceptionally draining – both physically and emotionally – when a family member becomes a patient at home. Needless to say, we are unable to predict such unfortunate circumstances, and caregivers are often thrown into their roles without prior knowledge and preparation. This leaves them with no choice but to adapt and pick up new skills in order to commit to their caregiving responsibilities. However, this can take a toll on the primary caregiver as well as family relationships.
With a large part of their time allocated to caring for another person, caregivers are much more susceptible to fatigue and prolonged stress, with little or no time for self-care. It can be a big problem if the caregiver feels that there’s no support – family and social relationships can be compromised, thereby further reducing any support network that a caregiver can receive. This can lead to burnout and immense feelings of helplessness.
A survey by the Singapore Management University (SMU) with the support of Caregivers Alliance Limited (CAL), Enable Asia and the Singapore Association for Mental Health (SAMH), reveals that 3 in 4 caregivers are tired and exhausted caring for a person with mental health issues. Furthermore, the Family Caregiver Alliance estimates that close to 20 percent of family caregivers suffer from some form of depression. In addition, mental health disorders are even more common among dementia caregivers. A study conducted on mental health issues in those caring for Alzheimer’s patients found that the prevalence of depression was an alarming 34 percent, anxiety was 43.6 percent, and the use of psychotropic drugs was 27.2 percent.
Some other common problems that caregivers face include (but are not limited to):
Mental health concerns
Physical health concerns
High rates of negative affect including guilt, sadness, dread, irritation and worry
Ambivalence about care
Witnessing the suffering of relatives
Feeling isolated or abandoned by others
Risk of illness, injury, mortality
Adverse changes in health status
Dysregulation of stress hormones
Work/employment (e.g., reduction in work hours, family to work spillover, and work to family spillover)
Loss of time for self-care
Reduced quality of life
This is where family therapy comes in. Families might find therapy useful when they are adapting to a major change in the family such as dealing with a chronic illness or death in the family, or conflicts between family members in the caregiving process. Family therapy is a method to engage family caregivers in active and focused problem-solving approaches related to family caregiving to improve the quality of care, reduce burden and improve family functioning. Family therapy for caregivers, in particular, encompasses six core processes – naming the problem, structuring care, role structuring, role reverberations, caregiver self-care and widening the lens. Therapy is conducted in a way that is tailored to each household. Depending on the needs that caregivers and their families must address, the aspects that are challenging them will become the focus of intervention. Not covering all six areas doesn’t mean that the therapist isn’t taking a comprehensive approach – the core processes simply act as a guideline, and do not imply a rigid prescription of intervention work.
Conflicts and resentment often arise for anyone in the role of family caregiver, and these are exacerbated when trying to share tasks with siblings or other members of the family. Many a time, caregivers tend to bottle up their feelings and put up a positive front so as to avoid passing on any negative feelings to their care recipients. However, this can be extremely detrimental to their own mental and physical health in the long run. The main part of family therapy for caregivers, therefore, involves helping the caregiver and family members sort through challenging emotions and reach resolutions. Speaking about your feelings can help you find comfort, and allows you to gain further insight and through the guidance of the therapists, various emotional-coping strategies. Implementing them will certainly take some weight off your shoulders, and perhaps give you some enlightenment with regards to discovering new problem-solving strategies.
Undeniably, caregivers will benefit tremendously from any assistance in their caregiving responsibilities from family members. Family therapy is extremely beneficial in helping to improve the interactions and support network among family members, especially in providing new perspectives on problems that are seemingly unmanageable (part of which involves building trust, mutual respect and openness). This hence reduces the level of stress within the family and the level of caregiver burden, on top of enhancing communication skills and boosting a positive sense of empowerment.
Family therapy is focused on achieving precisely what is best for the whole family and its cohesiveness, and sorting out obstacles or issues challenging the family dynamics. It is important that you take the important step toward seeking help from professionals in order to achieve a better quality of life for yourself and your family.
While face-to-face consultations are the norm, we understand that as caregivers, you may be faced with time constraints or other concerns. Thankfully, with technological advancement, virtual consultations are also becoming increasingly popular. They are equally effective and allow for more individuals to connect with their family therapists with greater ease. Of course, the decision is entirely yours to make. If you find yourself struggling, or simply feel that you need a trustworthy individual to speak to, feel free to get in contact with us.
The COVID-19 pandemic is unprecedented. The ubiquitous influence of the pandemic has been—and continues to be— felt by individuals globally. Many experiences the fear of being infected or infecting others, disruptions in their daily routines, social isolation, the likelihood of unemployment, financial hardship and the looming economic uncertainty (Ministry of Health Singapore, 2020). As such, there is a detrimental impact on the mental health and wellbeing of individuals, including an increased risk of suicidal behaviour.
Globally, the prevalence rates for depression and anxiety in the COVID-19 pandemic were 28.0% and 26.9% respectively (Nochaiwong et al., 2021). Factors contributing to depression and anxiety include suffering, fear or potential death, grief and financial stressors (World Health Organization, WHO 2022).
Young people have been identified as at increased risk for suicidal and self-harming behaviours (WHO, 2022). Women’s mental health, compared to men’s, has been more adversely impacted by the pandemic (WHO, 2022). In addition, people with existing medical conditions such as asthma, cancer and heart diseases, have been found to be at higher risk for developing mental health disorders (WHO, 2022).
In Singapore, a study conducted by the Institute of Mental Health (IMH) (Ministry of Health Singapore, 2020) found that 8.7% of Singapore residents reported having clinical depression, 9.4% reported having clinical anxiety and 9.3% reported mild to severe stress levels. Older adults were identified as a vulnerable group, particularly, those who lived alone. Similar to the findings from WHO (2022), youths in Singapore were also identified as vulnerable to experiencing poor mental health in response to the pandemic. There is an urgency for countries to boost their mental health and psychosocial support services as part of the pandemic response plan.
According to the COVID-19 mental wellness task force, initiatives in Singapore include providing psychological support via helplines such as the National CARE hotline and a mental health help bot (‘Belle’), incorporating mental health materials in the school curriculum, fostering family resilience and supporting parents with parenting skills.
Here are some recommendations for mental health support during this pandemic:
Parents are encouraged to have conversations with their children about their children’s worries and responses to the pandemic. Parents have been found to underestimate such responses (Pfefferbaum & North, 2020). Such “talk time” can also help in trust and bond-building
Seniors can be equipped with digital skills and also expand their options for help and support i.e. the provision of telehealth counselling and support services (Brydon et al., 2022).
Health care workers can monitor their stress responses and seek assistance in relation to both their work and personal lives from a mental health professional (Pfefferbaum & North, 2020).
People can be encouraged to limit their consumption of news related to COVID-19 to once a day and to focus solely on credible news sources.
Having social interactions with family and friends and offering to help support one another during this difficult period can also be particularly beneficial.
Being outdoors and exercising are good habits for maintaining healthy wellbeing.
As restrictions are slowly easing around the world, it can also be challenging for most people to adjust back to when restrictions were first introduced (during lockdowns). With new changes and uncertainty, being mindful of one’s mental health and well-being is crucial. For example, larger social gatherings (e.g. group of 10) may seem overwhelming at first, therefore it is important for people to recognise their anxiety levels related to social gatherings.
Here are some suggestions that might help regulate your emotions as you enter this new season of Singapore opening up amidst the COVID-19 Pandemic (Black Dog Institute, 2022):
Gradually, increase your time spent in a larger social gathering at your own pace.
You can also start to focus on things that are within your ability and control. For instance, you can engage in different relaxation techniques such as deep breathing and focusing on being in the present in order to better cope with your stress levels (American Psychological Association, 2021).
it can be useful to discuss reasonable adjustments back to work with your managers such as flexible working arrangements and other training opportunities in order to increase work efficacy
Seek professional help if there are concerns regarding stress levels related to the easing of restrictions.
It is particularly evident that the COVID-19 pandemic has taken a toll on the well-being of Singaporeans and the rest of the world. The pandemic has highlighted the importance of mental health and wellbeing and there is an urgent call for countries worldwide to provide people with mental health and psychosocial support to help them maintain psychological wellness.
Some Local Helplines and support:
National CARE hotline (8am-8pm daily): 1800-202-6868
Brydon, A., Bhar, S., Doyle, C., Batchelor, F., Lovelock, H., Almond, H., Mitchell, L., Nedeljkovic, M., Savvas, S., & Wuthrich, V. (2022). National Survey on the Impact of COVID-19 on the Mental Health of Australian Residential Aged Care Residents and Staff. Clinical Gerontologist, 45(1), 58-70.https://doi.org/10.1080/07317115.2021.1985671
Nochaiwong, S., Ruengorn, C., Thavorn, K., Hutton, B., Awiphan, R., Phosuya, C., Ruanta, Y., Wongpakaran, N., & Wongpakaran, T. (2021). Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis. Scientific Reports, 11(1), 10173. https://doi.org/10.1038/s41598-021-89700-8
All of us have felt anxiety at some point in our lives, whether before a big test, public speaking, or a job interview. Anxiety is a perfectly normal emotion that serves the purpose of motivating us to prepare for a big event or protect ourselves from potentially dangerous situations. However, too much anxiety may put us at the risk of experiencing panic attacks. In this article, we will discuss the symptoms, causes, and strategies for managing panic attacks.
What are panic attacks?
A panic attack is a sudden episode of intense anxiety and fear that triggers strong physiological reactions. These reactions can feel so intense that the individual feels as though they are having a heart attack. Common symptoms of a panic attack include but are not limited to:
It is important to note that panic disorder can develop if an individual starts to fear the panic attack itself (i.e., worrying about when the next panic attack may happen or avoiding situations and places when the panic attack occurred).
What causes panic attacks?
Similar to anxiety, anyone can experience a panic attack. However, some of us may be more prone than others. Several factors play a role in increasing our risk for panic attacks:
Family history: Anxiety often runs in families. If you have a family member who has a diagnosed anxiety disorder or, tends to experience anxiety more intensely and frequently than others, you would be at a higher risk for panic attacks.
Mental health issues: Individuals experiencing burnout, intense anxiety, depression, or any form of mental illness are more prone to panic attacks.
Traumatic experiences: A past or recent experience of trauma can result in our bodies remaining in constant “fight-or-flight” mode—the physiological reaction of anxiety and fear—which may then increase the likelihood of panic attacks.
Substance abuse: Addiction to substances such as alcohol, drugs, and caffeine can put us at a higher risk for panic attacks.
How to manage panic attacks?
If you are experiencing panic attacks at an intensity and frequency that is distressing and debilitating, please seek professional help. Panic attacks can be treated with talk therapy, psychotropic medication, or a combination of both. If not, here are a few ways to manage panic attacks:
Stay calm: It is important to remember that while panic attacks can be scary and extremely uncomfortable, they will not cause you to die. When a panic attack comes, notice and name it as a panic attack, and remind yourself, “It’s just a panic attack, it will pass.” For those of you who are unsure if it may be a medical issue, please see a doctor to rule out such concerns first.
Practice grounding exercises: Grounding is a useful technique that helps us to detach from our anxiety, often with an added calming effect. It works best with regular practice, even when you are not experiencing a panic attack, so that muscle memory can kick in when you most need it. Examples of grounding include:
Notice the environment around you with all your five senses, such as what you can see, hear, touch, smell, and taste. Describe this to yourself, either mentally or quietly out loud.
Carry a grounding object (e.g., a rock, gem, ring, small toy) in your pocket. Hold the object and notice its size, shape, texture, and temperature of it.
Engage in slow, deep 4-2-4 breathing – inhale for four counts, hold your breath for two counts, exhale for four counts. You may also focus on your breath and notice the feel of the air entering your nostrils, the movement of your shoulders, chest, and stomach as you breathe, the feel of the air coming out of your mouth.
Avoid caffeine: Caffeine is a stimulant that can activate your body’s “fight-or-flight” response. Adding caffeine to your anxiety-ridden body would be akin to throwing a lit stick of dynamite into a house on fire.
Overall, please remember that the presence of panic attacks indicates high levels of anxiety. They are our body’s way of telling us that it is at its limit. Should you experience one, it would be helpful for you to reflect on your stress and anxiety levels, identify any triggers and manage them, as well as ensure that you engage in your self-care routine and practice adaptive coping strategies.
For many people, when they hear the word ‘Psychiatrist’, it would instantly conjure up an image of a doctor prescribing medicine for someone with a mental health condition. This is true to the extent that a psychiatrist is a medical doctor who has undergone training to become a mental health specialist. While prescribing medications are indeed part of the treatment process, what really goes on in between – from the first session to the very end?
On your very first session, your psychiatrist will most likely spend 1-1.5 hours with you to gain a better understanding of what you’re coming in for. Mental health conditions can be a touchy subject for many, and it is understandable that you’d feel hesitant to open up to a complete stranger right away. However, trust that your psychiatrist has your best interests in mind, and will do his/her best to provide optimal treatment. Don’t be afraid of being judged for your symptoms, rest assured that the psychiatrist’s office is a safe and non-judgemental space. The psychiatrist will want to know as much as you’re willing to share, and being honest with your psychiatrist will be extremely helpful for an accurate diagnosis and the development of an effective treatment plan. Just as what you’d expect when you seek a General Practitioner for physical conditions, your psychiatrist would start off by asking broader questions such as, “What brings you here today,” or “How can I help you?” For some individuals, especially if it’s their first time at a psychiatrist’s, open-ended questions like these may be nerve-wracking. You may feel a little overwhelmed, not knowing how to start or where to begin. However, there are no hard and fast rules as to how the session should flow. Simply communicating your symptoms and your concerns would be a great start, and your psychiatrist will guide you through the interview.
Your psychiatrist will also run through a history-taking process, paying special attention to your medical history, family history, your current lifestyle habits and general patterns of sleep. It is important to let your psychiatrist know if you’re on certain medications, as some may have side effects that may fuel certain mental health conditions. Avoid downplaying or dismissing any information related to your physical or mental wellbeing, the clue to an accurate diagnosis may very well lie in the details. As such, going for your first session prepared with a complete list of medications, dosages, and your compliance with them can be very beneficial. Many studies have also shown that genetics play a role in mental health disorders. If you have a family member who suffers from a psychiatric issue, be sure to let your psychiatrist know for him to have a clearer idea of the situation. If need be, your psychiatrist may also ask permission to speak with other family members.
Depending on the patient’s circumstance, the psychiatrist may conduct a physical check-up if necessary, or possibly laboratory tests to exclude other possible causes for your condition. These are done to confirm that what you’re experiencing are not due to other medical conditions which may give rise to similar symptoms. Hence, if your psychiatrist asks for these procedures to be carried out, don’t feel too worried! Questionnaires to further assess your symptoms may also be given, so do make sure to answer them as truthfully as possible.
Depending on the complexities of your condition, medication options or other forms of treatment may be prescribed. If you are given medications, the psychiatrist would counsel you on how you can tell if the medications are working. Over the course of your recovery journey, take note of how subtle changes to the medications made by your psychiatrist affects you. Do they stabilise or improve your condition, or do they seem to send you on a downward spiral? How have you been feeling since you started taking them? Whatever the outcome, keep your psychiatrist in the know of how you’re coping. In the same vein, it is very important that you do not adjust your medications on your own without seeking professional advice! Patients may get impatient if they’re not seeing the desired change after a while, but constant and unregulated changes can cause undesirable fluctuations, potentially worsening the situation. We need to understand that there could be catastrophic, life-threatening consequences if we do not take them seriously.
In general, psychiatrists usually work closely with psychologists and therapists, as some mental health conditions are best treated with both neuropharmacological support and psychotherapy. Thus, your psychiatrist may also refer you for psychotherapy if deemed fit. Depending on the level of care required to address the patient’s symptoms, psychiatrists may recommend treatment programmes if more intensive care is needed.
So you are going to see a psychologist for the first time – now what should we expect? The thought of having to step into a psychologist’s room for the first time can be nerve-racking, and understandably so. Oftentimes, individuals may be apprehensive and would wonder if talking to a complete stranger is really going to help, or if opening up your innermost thoughts to a stranger was too much of a risk to take. However, rest be assured that these mental health professionals are well-versed in psychotherapy methods to help you manage your issues as best as possible, and will work closely with you at a comfortable pace. Just like in the treatment of physical illnesses by physicians, patient privacy and confidentiality are also primary obligations for psychologists. In this article, we hope to give you a clearer idea of what you can expect from your visit to a psychologist, especially if it is your first session.
First things first, it is important to understand that psychotherapy isn’t merely a one-off session. While the duration of treatment may vary from one person to another, the American Psychological Association (APA) reports that “recent research indicates that on average 15 to 20 sessions are required for 50 percent of patients to recover as indicated by self-reported symptom measures.” The type and duration of treatment also heavily depend on the nature and severity of each client’s conditions, and it would simply be unfair to make an overgeneralised statement. Regardless, it would be beneficial to go in with an open mind, and to have an honest conversation with your psychologist. It really helps to trust that the process works, while acknowledging that it takes time.
Meeting the psychologist
At the beginning, the first few sessions would aim to help one identify the most pertinent issue that needs to be dealt with. The psychologist will talk through with you gathering some information on your life history, your family’s mental health history, the problems you are dealing with, and analyse those details – no matter how insignificant they may seem at first – that could have possibly led to emotional distress or coping difficulties. For the psychologist, being able to get a good grasp of the situation and seeing the big picture is vital for formulating the treatment plan and treatment process, as it will help to determine the type of psychotherapy that is best suited for you. The psychologist is trained to listen and analyse your conditions in order to help you with your recovery. As such, it is equally important that you don’t hold yourself back from being fully honest with your psychologist. To a large extent, the patient’s participation in the therapy is an important determinant of the success of the outcome.
While we fully understand that it can be unnerving, these mental health professionals are trained to help you work through the challenges you face, and the therapy room is very much a safe, non-judgemental space. Goal-setting is one of the key aspects of psychotherapy, and it is exceptionally important to set goals from the start that you can use to track your progress. You may start by identifying personally meaningful broad motives, hopes and dreams – having a clear direction in mind will better steer future sessions towards alleviating symptoms of distress and tackling the root cause of one’s concerns. Don’t worry if you feel the need to change your goals or take a different approach halfway through the treatment process. Psychotherapy is a dynamic process after all, and increased self-discovery along the way can certainly give you a better sense of what needs to be changed.
Different approaches to psychotherapy
There are several approaches to psychotherapy that can be implemented in the following sessions. Not strictly limited to one or the other, psychologists may make use of psychoanalysis and psychodynamic therapies, cognitive-behavioural, interpersonal, and other types of talk therapy. They can help you focus on changing problematic behaviours, feelings, and thoughts to build on healthy habits, or teach you emotion-coping strategies to cope with your symptoms. Forms of treatment like cognitive-behavioural therapy also aim to help individuals recognise negative thought and behaviour patterns, thereby working towards a positive change. Each session is essentially a problem-solving session. By allowing yourself to talk to your psychologist about your most difficult moments, your feelings and the change you want to observe, the psychologist is then able to make use of his/her expertise to assist you. Many mental health professionals don’t limit their treatment to any one approach. Instead, they blend elements from different approaches and tailor their treatment according to each patient’s needs.
To make the most of the treatment process, “homework” may sometimes be assigned as between-session tasks to clients as part of your treatment. A variety of homework assignments exist – sometimes in the form of practising new skills, habits, and other coping mechanisms, or someone who is dealing with complicated emotions could be asked to record your negative thoughts in nightly journal entries. When you return for your next session, the psychologist would then check in on your progress, and address any issues that may have arisen while you were completing your tasks. For some clients the benefits of therapy can be achieved in a few sessions, while for other clients they might need more to improve. Empirical evidence supports the benefits of homework in promoting positive symptom change and increasing patient functioning, that is, the quality of a client’s participation in therapy through active application of what they learn will lead to improvements in their conditions.
Was the psychologist right for you?
Often during the conversation with the psychotherapist, or after the session, you may feel a sense of relief, elation, or anxiety and exhaustion. However you feel, it is important to take note of those feelings. Did the psychologist put you at ease? Did he/she listen to you carefully and demonstrate compassion? Did he/she develop a plan to guide you with your goals and show expertise and confidence in working with issues that you have? For the treatment to be effective, you need to be able to ‘click’ with the psychologist, that is you are able to build trust and a strong connection with your psychologist.
To end off, the first session with a psychologist is understandably a bit intimidating and overwhelming, but the first step in the journey to recovery is a critical step to regain your mental wellbeing.
We are no strangers to feelings of anxiety – at certain stages of our lives or in particular situations, we would have experienced anxiousness and worry with relation to our careers, studies, relationships and even our environment. However, anxiety levels may go beyond the healthy norm for some people, and may instead develop into anxiety disorders that may have a debilitating effect on their lives. According to the American Psychology Association (APA), an individual who suffers from an anxiety disorder is described to have “recurring intrusive thoughts or concerns”, where the duration and severity in which the individual experiences anxiety could be blown out of proportion to the original stressor, resulting in undesirable tension and other physical alterations. In this article, we will be exploring a few types of anxiety disorders as well as how they can manifest within us.
Generalised Anxiety Disorder (GAD)
Generalised Anxiety Disorder is a psychological issue characterised by persistent and pervasive feelings of anxiety without any known external cause. People who are diagnosed with GAD tend to feel anxious on most days for at least six months, and could be plagued by worry over several factors such as social interactions, personal health and wellbeing, and their everyday routine tasks. For example, an individual with GAD may find himself experiencing headaches, cold sweats, increased irritability and frequent feelings of “free-floating” anxiety. Others may also experience muscle tension, sleep disruptions or having difficulty concentrating. Often, the sense of anxiety may seemingly come from nowhere and last for long periods of time, therefore interfering with daily activities and various life circumstances.
In contrast, Panic Disorders are characterised by the random occurrence of panic attacks that have no obvious connection with events that are co-occurring in the person’s present experience. This means that panic attacks could occur at any time, even when someone is casually enjoying a meal. Of course, panic attacks could also be brought on by a particular trigger in the environment, such as a much-feared object or situation. Some individuals have reported that panic attacks feel frighteningly similar to a heart attack, especially with the rapid increase in heart palpitations, and the accompanying shortness of breath. Other symptoms also include trembling, sweating, and feelings of being out of control. With these panic attacks bringing on sudden periods of intense fear and anxiety, it can be exceptionally terrifying when these attacks reach their peak within mere minutes. However, a notable difference between a panic disorder and GAD is that an individual diagnosed with panic disorder is usually free of anxiety in between panic attacks.
Obsessive-Compulsive Disorder is a disorder marked by patterns of persistent and unwanted thoughts and behaviours. Obsessions are recurrent thoughts, urges or mental images that cause anxiety. On the other hand, compulsions are the repetitive behaviours that a person feels the urge to do in response to an obsessive thought or image. One common example often exhibited in films is where an individual has an obsessive fear of germs. This person may avoid shaking hands with strangers, avoid using public restrooms or feel the urge to wash their hands way too frequently. However, OCD isn’t purely limited to feelings of anxiety due to germs. OCD can manifest in other ways as well, such as wanting things to be symmetrical or in perfect order, repeatedly checking on things (“Did I leave my stove on?”), or the compulsive counting of objects or possessions. While everyone double-checks their things and has their own habits, people with OCD generally cannot control their thoughts and behaviours, even if they are recognised to be rather excessive. They can spend at least 1 hour a day on these thoughts and behaviours, and will only feel the much-needed brief sense of relief from their anxiety when they perform their rituals. As such, OCD can be exceptionally debilitating to one’s mental health.
Social Anxiety Disorder
Persons with Social Anxiety Disorder, or SAD, experience high levels of anxiety and fear under particular or all social situations, depending on the severity of their condition. They are often afraid of being subjected to judgement, humiliation or rejection in public, causing them to feel embarrassed. As such, individuals with SAD may feel extra self-conscious and stressed out, and try to avoid social situations where they might be placed at the centre of attention.
A phobia involves a pathological fear of a specific object or a situation. This means that one may experience intense anxiety upon encountering their fears and will take active steps to avoid the feared object. Phobias may centre on heights(acrophobia), birds (ornithophobia), crowds and open spaces(agoraphobia), and many others. People with agoraphobia, in particular, may struggle to be themselves in public spaces, for they think that it would be difficult to leave in the event they have panic-like reactions or other embarrassing symptoms. In severe cases, agoraphobia can cause one to be housebound.