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Trying Psychodrama Therapy For The First Time | My First Therapy with Sharmini Winslow

Trying Psychodrama Therapy For The First Time | My First Therapy with Sharmini Winslow

In a captivating video, Zula influencers Chow and Fauzi embark on a transformative experience of psychodrama therapy with psychologist Sharmini Winslow. The video, “Trying Psychodrama Therapy For The First Time | My First Therapy with Sharmini Winslow,” captures their journey as they delve into deep emotions and self-discovery. The 24-minute video on YouTube showcases their transformative session:

  • Sharmini Winslow’s Expertise and Background:
    • Sharmini Winslow, a respected psychodramatist, guides Chow and Fauzi through this groundbreaking experience, drawing on her expertise in psychodrama therapy.
  • The First-Time Psychodrama Experience:
    • Chow and Fauzi express their excitement and curiosity about trying psychodrama therapy for the first time. They embrace the opportunity to explore this therapeutic technique with Winslow, who creates a safe space for their journey.
  • Unveiling Emotions through Psychodrama Vignettes:
    • Under Sharmini’s guidance, Chow and Fauzi engage in psychodrama vignettes, externalizing their inner experiences and exploring their emotions more deeply. They express and confront unresolved issues, gaining valuable insights into themselves and their relationships.
  • The Transformative Power of Psychodrama Therapy:
    • Through their first-time experience with psychodrama therapy, Chow and Fauzi find themselves astonished by its profound impact on their emotional well-being. The video showcases their journey of self-discovery and personal growth.
  • Sharing Their Insights:
    • Chow and Fauzi openly share their reflections and insights throughout the video, providing viewers with a glimpse into their transformative experience.

“Trying Psychodrama Therapy For The First Time | My First Therapy with Sharmini Winslow” offers viewers an intimate and enlightening experience as Chow and Fauzi explore the transformative power of psychodrama therapy. The video captures their journey of self-discovery, providing valuable insights into the therapeutic benefits of psychodrama. As viewers witness their growth and transformation, they are encouraged to reflect on their own emotional landscapes and consider the potential for healing and personal growth through this powerful therapeutic modality.

EXPAT MENTAL HEALTH CHALLENGES

EXPAT MENTAL HEALTH CHALLENGES

“While the expat lifestyle can have a glamorous veneer, challenges often lie beneath. The experience of living overseas can be difficult and demanding, adding unique stressors to everyday living,” explains KRISTI MACKINTOSH, psychotherapist at Promises Healthcare, which provides holistic mental health and addiction treatment and recovery services to adults, adolescents and children suffering from all types of disorders. The clinic’s team of multidisciplinary specialists – including psychologists, psychiatrists and therapists, all with different expertise and specialisations – treat both local and expat patients on a daily basis.

In fact, studies show that expats as a group are 40 percent more likely to develop mental health conditions like depression, stress and anxiety, as compared to those who never move abroad.

“The challenging environment and less support than at home often leads to an increase in drinking, smoking, drug abuse – yes, even in Singapore – or self-harm to try and distract from the negative feelings.”

What’s more, the loss of the informal network of support from friends, family and acquaintances back home only compounds the stress and anxiety.

“Expats may often feel like they can’t share their difficulties because it seems like complaining or admitting to a failure. Isolation can lead to depression, and restrictions on travel and socialising because of COVID may have exacerbated feelings of social isolation for many expats.”

grief counselling family therapy in Singapore

How counselling can help – and tips to cope

“It’s important to be aware of the unique set of challenges that come with expat life and ensure you’ve got a good support structure in place,” says Kristi. “One of the most important things you can do is connect. Humans are social beings. While it may require more emotional honesty or reliance on those around you than you might usually be comfortable with, connection and support from others is important.”

Additionally, you can help reduce stress by:

  • getting enough sleep to help regulate your mental and physical health;
  • eating a balanced diet to prevent deficiency in minerals that may cause low mood;
  • staying active;
  • trying not to over-drink, over-eat or smoke; and
  • doing something that brings you joy – from reading a book to trying a new restaurant.

If you feel that you’re not coping or you’d like some extra support with your mental health, reach out to your GP or a professional counsellor or psychologist for therapy in Singapore.

Promises Healthcare
#09-22/23 Novena Medical Centre, 10 Sinaran Drive
6397 7309 | promises.com.sg

*This article first appeared on Expat Living Magazine’s website. 

Post-Traumatic Stress Disorder: Treating Its Debilitating Effects

Post-Traumatic Stress Disorder, or PTSD, is a mental health condition characterised by the failure to recover from exposure to a traumatic event, bringing about intense, disturbing thoughts and feelings related to the experience. Contrary to the widely-held belief, victims of PTSD need not necessarily experience the traumatic event first-hand – PTSD can also arise from witnessing something shocking, terrifying or disturbing. Similarly, PTSD triggers can have a broad spectrum, and the cause differs for everyone. Not everyone has to go through extreme, drastic events such as a war to develop PTSD – the condition can also be brought on by other distressing experiences such as abuse, accidents, assaults, or even adverse health or childbirth-related experiences. 

 

How is PTSD diagnosed?

As with most other mental health disorders, clinicians use the Diagnostic and Statistical Manual of Mental Disorders as a guideline to diagnose PTSD. The diagnostic criteria below are specific to adults, adolescents, and children older than six.

 

Criterion A: Stressor

(one required)

The person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

  • Direct exposure
  • Witnessing the trauma
  • Learning that a relative or close friend was exposed to a trauma
  • Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B: Intrusion Symptoms

(one required)

The traumatic event is persistently re-experienced in the following way(s):

  • Unwanted upsetting memories
  • Nightmares
  • Flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders

Criterion C: Avoidance

(one required)

Avoidance of trauma-related stimuli after the trauma, in the following way(s):

  • Trauma-related thoughts or feelings
  • Trauma-related external reminders

Criterion D: Negative Alterations in Cognitions and Mood 

(two required)

Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect
  • Decreased interest in activities
  • Feeling isolated
  • Difficulty experiencing positive affect

Criterion E: Alterations in Arousal and Reactivity

Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

  • Irritability or aggression
  • Risky or destructive behaviour
  • Hypervigilance
  • Heightened startle reaction
  • Difficulty concentrating
  • Difficulty sleeping

Criterion F: Duration (required)

Symptoms last for more than 1 month.

Criterion G: Functional Significance (required)

Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H: Exclusion (required)

Symptoms are not due to medication, substance use, or other illness.

Two Specifications

Dissociative Specification 

In addition to meeting the criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:

  • Depersonalization: Experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).
  • Derealization: Experience of unreality, distance, or distortion (e.g., “things are not real”).

Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although the onset of symptoms may occur immediately.

 

How PTSD May Go Undetected

Not all individuals will have their condition diagnosed and recorded on paper. The pervasive misconceptions about its complex cluster of symptoms can hinder one from seeking treatment, or simply realising that one may be suffering from PTSD. 

In the early onset of the disorder, attempts to weather the storm by turning to short-term coping mechanisms may include binge eating or distracting themselves with their favourite TV shows. However, this is not effective – nor is it healthy – in the long run. In addition, people with comparatively “less traumatising” experiences may feel as though they did not “earn” the diagnosis, considering that others might have gone through worse. This behaviour of downplaying one’s trauma can hold them back from seeking early treatment, as it may seem more convenient to adopt the mindset that they can quickly get over it in due course. With avoidance being the hallmark of PTSD, many victims turn to therapy only after long periods of struggling with the disorder, as if therapy were the last resort. But with delayed treatment, these individuals run the risk of having to navigate symptoms that, with earlier treatment, may never have developed in the first place.

 

Treatment Options for PTSD

Psychopharmacological Treatment

At present, the evidence-based pharmacological treatment for PTSD involves the use of Selective Serotonin Reuptake Inhibitors (SSRIs), which include medications such as Sertraline and Paroxetine. While there are also other medications available, these two are currently the only ones approved by the FDA for PTSD.

SSRIs play a well-recognised role in the management of mood and anxiety disorders. Their mode of action involves raising the levels of Serotonin, a neurotransmitter vital in regulating mood, anxiety, appetite, sleep, and other bodily functions.

Of course, there is no one-size-fits-all. While SSRIs are typically prescribed to treat PTSD, there are exceptions depending on the patient’s medical history. Clinicians will have to consider the patient’s response to the drugs, existing comorbidities, and personal preferences. As such, medications have to be tailored to each individual’s needs. 

 

Cognitive Behavioural Therapy (CBT)

One of the more common forms of psychotherapy, CBT aims to tackle the maladaptive thought processes and emotions associated with one’s trauma. Trauma-focused CBT involves three main categories – exposure procedures, anxiety management procedures, and cognitive therapy. These aim to help individuals understand what they’re afraid of, learn healthy and effective coping mechanisms, and work through dysfunctional thoughts. 

Moreover, having a therapist or psychologist that is trauma-informed can be of great benefit. A trauma-informed therapist is knowledgeable about trauma and can understand and empathise with how the traumatic experience could have impacted the patient. Prioritising physical and emotional safety ensures a smoother clinician-client collaboration, which in turn aids in increasing the transparency and efficacy of treatment. 

 

Eye Movement Desensitisation Therapy (EMDR)

Eye Movement Desensitisation Therapy may be less commonly heard, but it is an efficacious, empirically validated treatment for trauma and other adverse life experiences. In a different vein from cognitive behavioural therapy, EMDR doesn’t focus on altering a client’s thought patterns or behaviours. Instead, it relies on one’s own rapid, rhythmic eye movements, allowing the brain to process memories and resume its natural healing process. Simply put, EMDR therapy involves guiding the client towards reliving triggering experiences in short phases while the clinician directs his eye movements. When the client’s attention is diverted as they recall the traumatic event, the exposure to negative thoughts and memories is less upsetting, limiting a strong or negative psychological response.

To have a more detailed read on EMDR, do check out our article: Treating Trauma With Eye Movement Desensitisation and Reprocessing (EMDR)

If you suspect that you may be suffering from PTSD, do reach out and seek early intervention for the betterment of your physical and mental health. 

 


References:

  1. https://cnalifestyle.channelnewsasia.com/wellness/pstd-post-traumatic-stress-disorder-symptoms-308861 (Accessed 19/04/2022)
  2. https://www.brainline.org/article/dsm-5-criteria-ptsd (Accessed 19/04/2022)
  3. https://www.apa.org/ptsd-guideline/treatments/medications (Accessed 19/04/2022)

 

The Neurobiology of TMS

The Neurobiology of TMS

Written by: Dr. Sean David Vanniasingham

Principles of Transcranial Magnetic Stimulation (TMS)

In the 1800s, world-renowned English physicist Michael Faraday discovered the principles of electromagnetic induction. Fast forward to the 21st century, Faraday’s discovery was harnessed into the clinical practice of transcranial magnetic stimulation (TMS) for the treatment of mood disorders. Based on Faraday’s Law, TMS can stimulate brain neuronal circuits with tiny electrical currents induced by a changing magnetic field.

 

Application of TMS in Singapore 

In Singapore, the practical application of TMS is employed in the form of repetitive transcranial magnetic stimulation (rTMS). In rTMS, magnetic pulses are delivered in trains at specific frequencies. “Fast” (high frequency e.g. 10Hz) stimulation increases cortical excitability for the treatment of depression. Whereas “slow” (low frequency e.g. 1Hz) stimulation reduces cortical excitability for treating anxiety disorders. Furthermore, TMS can be targeted at focused regions of the cortex for superior precision treatment of specific conditions e.g. rTMS at 1Hz to the right orbitofrontal cortex (OFC) reduces intrusive obsessions in obsessive-compulsive disorder (OCD).

Mood disturbances such as depression are increasingly understood as disorders of connectivity in neural networks linking cortical and subcortical grey structures of the brain. Functional brain imaging has shown dysfunction in cortical regions such as the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC), as well as deep grey matter structures including the amygdala, nucleus accumbens, hippocampus and hypothalamus. These brain circuits are pivotal for executive functioning, regulation of emotions, reward processing and preservation of memory and cognition. They also link the nervous system to the endocrine system, which mediates the body’s response to stress. 

 

Neuroplasticity and TMS

Evidence suggests that TMS induces neuroplastic changes in these circuits. Neuroplasticity is the ability of the brain to reorganize itself by forming new neural connections. TMS helps readjust neurotransmitter (e.g. serotonin and dopamine) levels in a variety of brain regions. TMS also appears to exert a neuroprotective effect on the brain. Research has shown that TMS decreases brain inflammatory factors reducing oxidative stress on the brain. TMS also boosts the levels of brain-derived neurotrophic factor (BDNF), encouraging neuronal growth in regions such as the hippocampus which is vital for learning and memory. It is postulated that the anti-depressant properties of TMS may also help in normalizing the body’s neuroendocrine stress response system.

 

rTMS has achieved its place on international treatment guidelines as an augmentation treatment modality to be strongly considered in treatment-resistant depression. It is reported that 30-40% of depressed patients may have inadequate responses to anti-depressant medication treatment. The direct neuronal effects of rTMS may explain why rTMS may work for this group of patients. 

 

rTMS for OCD Treatment and other neurological disorders

In May 2022, the U.S. Food and Drug Administration (FDA) approved the use of the NeuroStar TMS system as an adjunct for treating adult patients suffering from OCD. Promising research is ongoing for the clinical application of TMS in treating Post-Traumatic Stress Disorder (PTSD), addictions, chronic pain, insomnia and many other neurological disorders.

 

TMS and recovery

With further advancements in TMS research and the incorporation of TMS in routine clinical practice, there is strong hope for recovery and the regaining of optimal functioning for patients afflicted by complex neuropsychiatric conditions.

 


References

1) Transcranial Magnetic Stimulation

Clinical Applications for Psychiatric Practice

2018 American Psychiatric Association Publishing, First Edition

2) The Science of Transcranial Magnetic Stimulation 

William M. Sauvé, MD; and Lawrence J. Crowther, Meng

Psychiatric Annals, Vol44, No.6, 2014

3) Repetitive transcranial magnetic stimulation increases serum brain-derived neurotrophic factor and decreases interleukin-1b and tumour necrosis factor-a in elderly patients with refractory depression 

Xiangxiang Zhao, Yanpeng Li, Qing Tian, Bingqian Zhu and Zhongxin Zhao

Journal of International Medical Research 2019, Vol. 47(5) 1848–1855

4) What is repetitive transcranial magnetic stimulation and how does it actually work?

Paul Fitzgerald, Professor of Psychiatry, Monash University

The Conversation AU, published May 13 2021

Benefits of Family Therapy in the Caregiving Process

Benefits of Family Therapy in the Caregiving Process

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  Secondary Stressors
  • Depression
  • Anxiety
  • 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
  • Anticipatory grief
  • Fatigue
  • Sleep problems
  • 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)
  • Financial strains
  • Relationship stress
  • 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

 


References:

  1. https://news.smu.edu.sg/news/2020/12/09/3-4-caregivers-persons-mental-health-issues-highlight-need-temporary-separation#:~:text=This%20survey%20by%20the%20Singapore,person%20with%20mental%20health%20issues. (Accessed 16/03/2022)
  2. https://au.lifestyle.yahoo.com/caregivers-take-care-of-person-with-mental-health-condition-help-wellness-031845657.html (Accessed 18/03/2022)
  3. https://www.apa.org/pi/about/publications/caregivers/practice-settings/common-problems (Accessed 18/03/2022)
  4. https://www.apa.org/pi/about/publications/caregivers/practice-settings/intervention/family-therapy (Accessed 18/03/2022)
  5. https://www.agingcare.com/articles/counseling-for-caregiver-burnout-126208.htm (Accessed 18/03/2022)