Kristi Mackintosh Archives - Promises Healthcare


“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 |

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

Just want to stay in? It could be Cave Syndrome

Just want to stay in? It could be Cave Syndrome

If getting into the groove of post-pandemic living is proving stressful, you’re not alone. As the world heads out and about again, why do many of us want to stay at home?

How’s your social life looking? Has the recent lifting of rules got you packing your calendar with group meet-ups, mini-breaks and plenty of non-masky activities? There’s no doubt that the lessening of restrictions a few months ago was much welcomed in Singapore, but if the heady days of initial freedom and filling up on missed-out fun now feels done and (whisper it) a little bit tiresome, you’re not alone. After two years of waiting to go out again, why do so many of us just want to stay in? 

It could be down to peaking too soon. It might be due to having no new clothes to wear. It’s more likely to be as a result of Cave Syndrome, a non-medical term coined to describe the fear and anxiety that many of us are experiencing about re-joining society as Covid restrictions ease. “Cave Syndrome gets its name from the desire to stay secluded in our safe spaces, instead of venturing out,” explains Kristi Mackintosh, a psychotherapist at Promises Healthcare ( “It can range from simply being uncomfortable about socialising to absolute fear, and while some hesitancy is to be expected, this fear may start to jeopardise our lives and careers if not monitored and managed appropriately.” 

A certain comfort

While it may sound extreme, given the bizarre circumstances of the past few years, apprehension over rejoining society is completely normal. “In part, this is because generally, humans are creatures of habit. We grow accustomed to certain people, places and ways of being, and prefer to stay in the sanctuary of our bubbles,” explains Kristi. “It’s an evolutionary holdover from our prehistoric days when we lived in caves – a protective mechanism which keeps us feeling secure.” 

After two years of being in our caves and protecting ourselves, we’ve adjusted to a new baseline. Research suggests that all the changes we made to our daily routines due to the pandemic such as quarantining, avoiding crowds, only dressing from the waist-up and staring listlessly out of windows, have been transformed into long-term behavioural patterns. According to statistics, 49% of adults* admitted to being uneasy about adjusting to in-person interactions.

Another issue is that many of us enjoyed certain aspects of the pandemic – there was respite from office politics and crushing commutes; a hiatus from society and the endless judgement on everything from outfits to hairstyles; a pause on having to make big decisions as we managed day-to-day living; and greater control over our daily routines thanks to WFH. “Behaviour that is not natural for humans – like isolation, social distancing, and masking – had to be learned and practiced over an extended period of time,” continues Kristi. “As a result, a certain comfort developed.” It’s no wonder we feel a bit weird now.

Emotional toll

According to Kristi, there are certain groups of people who are likely to find the readjustment back to ‘normal life’ more difficult, such as those who were naturally introverted before the pandemic, those who had social anxiety, and those who are in the ‘ageing parent’ bracket and have just got used to staying in. “For this age group, they are often less tech-savvy, and may not have the resources to connect with friends and family once more,” explains Kristi. “Re-entering life will have hit this sector harder and can lead to feelings of sadness and hopelessness, and perhaps depression, making it tricky for them to re-engage again.”

Whether it’s you or someone you know who you think might be struggling, the emotional and psychological signs of Cave Syndrome will show up differently for everyone. Says Kristi, “Some may experience anxiety when engaging in activities outside of their home, while in more severe cases people may be unable to leave their home – if this is the case, please speak to your GP, a counsellor or psychologist.” 

The emotional toll can manifest in a number of symptoms too, ranging from nightmares to somatic symptoms like headaches, stomach problems, body pains and insomnia.

So, as the good times return, whether it be in the shape of a big blow-out party, a small brunch with friends, or Brix and a party bus, it’s important to consider your re-entry into the world more as a dial, not as a switch. Be mindful of your feelings, and know that you don’t need to go from 0 –100 straight away. 


According to Kristi, it can be helpful to implement some practical strategies to help you to feel supported as you go:  

  • PRIORITISE: Make time for your health, prioritising things that you can control, like sleep, diet and exercise. Where possible, try to decrease more negative coping strategies like over-drinking, over-eating or smoking
  • RELAXPractice stress-reducing, relaxing activities such as yoga, mindfulness or grounding techniques. Find something that works for you, start slowly and make it a regular habit
  • BREAK: Take a break from 24/7 news and social media
  • CONNECT: Stay connected with those whose company you enjoy, and who share the same values and interests
  • DON”T COMPARE OR COMPETE: Don’t pressure yourself to keep up with anyone else. The pandemic has caused many people to realise that they enjoy a more introverted or ‘smaller’ life and that is okay 
  • START SMALLGo for a walk with a friend (SG’s therapy gardens are a good place to start!) and slowly introduce more challenging situations into your days as you feel more confident
  • POSITIVE SELF-TALKCelebrate all of your successes, no matter the size
  • ACTS OF KINDNESSActs of service for others allow us to step out of our usual, often self-involved lives. It develops our compassion for others, in turn having a positive effect on our own happiness. Check out some of the brilliant initiatives that take place within the community by ANZA Action (
  • CHECK IN WITH OTHERSAlthough there may be a physical distance, reach out through phone calls or video chat to friends and family you might feel worried about. Say something like: “I notice you’re not going out much recently. Is everything okay?” or strategically invite them to join you in an activity you used to enjoy doing together. If they don’t appear to be adjusting over time, encourage them to speak to their GP, a counsellor or psychologist  
  • JUST DO ITHumans are inherently social beings, which means living in isolation for prolonged periods can be quite an ordeal which is why we shouldn’t let ourselves delay re-entry out of fear. Research strongly suggests that most people will bounce back eventually, and some will even grow as human beings – a phenomenon known as post-traumatic growth  – which sounds like it could be rather lovely, doesn’t it? 

*Statistics by the American Psychological Association
Image: Shutterstock

*This article was first published on ANZA Magazine’s website.