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Anxiety and The Body

Anxiety and The Body

Anxiety refers to a state of anticipation of alarming future events. Anxiety is usually a normal transient response to stress and may be a necessary cue for adaption and coping, the body’s protective mechanism known as the ‘fight or flight response’.

However, anxiety can become pathologic, where it is excessive and inappropriate to the reality of the current situation. It is often described by many as a distressing experience of dread and foreboding. 

 

Anxiety is manifested in the affective, cognitive behavioural and physical domains. The affective states could range from edginess and unease to terror and panic. Cognitively, the experience is one of worry, apprehension and thoughts concerned with emotional or bodily danger. Behaviourally, anxiety triggers a multitude of responses concerned with diminishing or avoiding the distress. 

 

Physical Manifestations of Anxiety

Stimulating the autonomic nervous system results in an array of bodily perturbations.

List of Anxiety symptom

Several nervous system structures are involved in fear and pathologic anxiety.

The amygdala is responsible for initiating the fight-or-flight response. When activated, the amygdala triggers a series of changes in brain chemicals and hormones that puts the entire body in anxiety mode.

Left untreated, over time the affected individual’s body physically responds more frequently and intensely to worries. Co-morbid depression often sets in. One’s ability to meaningfully function academically, occupationally and socially gets hampered, leading to a deterioration in the quality of life. 

 

Treatment of Pathologic Anxiety

The first point of contact for many patients would be their general practitioners or even the hospital Accident & Emergency department. It is important to evaluate and rule out underlying medical illnesses that may mimic an anxiety disorder, such as thyroid disorders, heart rhythm disturbances, gastrointestinal diseases or alcohol withdrawal. The doctor may order some basic investigations, such as a thyroid function blood test or an electrocardiogram (to check one’s heart rhythm). Once medical causes have been excluded or identified and treated, persisting anxiety symptoms would warrant a psychiatric consultation. 

A prescription of anti-depressants such as Selective Serotonin Re-Uptake Inhibitors (SSRIs) to aid in the balancing of the brain neurotransmitters may be suggested. Anxiolytics such as benzodiazepines e.g. Clonazepam may be used in the initial phase of treatment, and thereafter only short courses are prescribed to reduce the risk of dependency. 

Cognitive-Behavioural Therapy (CBT) involves cognitive restructuring and anxiety symptom management. Cognitive interventions are aimed at challenging and correcting the inaccurate and maladaptive thought patterns that maintain anxiety disorders. Symptom management techniques e.g. relaxation and breathing re-training procedures, help to eliminate anxiogenic bodily reactions. 

 

Tips to control anxiety

 

Lifestyle adjustments to one’s hectic pace of life need to be made to break the vicious cycle of stress and worry. Developing a healthy routine with regularly scheduled self-esteem-raising activities, ensuring adequate rest and nutrition as well as maintaining social connections are pivotal for mental wellness. 


 

References

Massachusetts General Hospital, Handbook of General Hospital Psychiatry, seventh edition, chapter 13: Anxious Patients. 

Kaplan & Sadock’s Concise Textbook Of Clinical Psychiatry, fourth edition, chapter 6: Anxiety Disorders.

Anxiety symptoms stem from the very helpful ‘fight or flight response’. CBT4Panic. (n.d.). Retrieved December 1, 2022, from https://cbt4panic.org/anxiety-symptoms-stem-from-the-very-helpful-fight-or-flight-response/

The fight or flight response symptoms. CBT4Panic. (n.d.). Retrieved December 1, 2022, from https://cbt4panic.org/the-fight-or-flight-response-symptoms/

How Does Anxiety Affect Your Brain? (n.d.). Retrieved from https://www.xcode.life/genes-and-health/how-anxiety-affects-brain/

Hundreds of anxiety symptoms explained. AnxietyCentre.com. (2022, November 20). Retrieved December 1, 2022, from https://www.anxietycentre.com/anxiety-disorders/symptoms/

Psychreg. (2022, July 30). Anxiety disorders: Causes and treatments. Psychreg. Retrieved December 1, 2022, from https://www.psychreg.org/anxiety-disorders-causes-treatments/

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. 

It’s Time to Talk About … BURNOUT!

It’s Time to Talk About … BURNOUT!

Dr Joseph Leong & Dr Sean David speaks with an editor at Expat Living about Burn out. Read on to find out the details.


 

We’ve all been there – wired on coffee, exhausted, struggling to keep pace with hurdles and deadlines, before hitting the inevitable brick wall. When can we identify a state of “burnout”, and what does psychology have to say about it? We asked DR JOSEPH LEONG and DR SEAN DAVID from Promises Healthcare about this as current mental health issue.

burnout and mental health issues promises healthcare
DR JOSEPH LEONG

What does being “burnout” mean in a clinical context?

Joe: Burnout is an occupational phenomenon. It’s not classified as a medical condition but conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterised by feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficiency.

While we recognise that students and homemakers can also suffer similar anxieties, burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life. Sean: American social psychologist Christina Maslach, who is well known for her research on occupational burnout, stated: “What started out as important, meaningful and challenging work becomes unpleasant, unfulfilling and meaningless. Energy turns into exhaustion, involvement turns into cynicism, and efficacy turns into ineffectiveness.”

The behavioural manifestations of burnout may be procrastination on tasks; “presenteeism” at work, which is when a person is present at work while they’re disengaged or unwell; sleep and appetite disturbances, or even maladaptive coping methods such as increased smoking and drinking.

If burnout is not addressed early or adequately, it can lead to other mental health issues including major depression, anxiety disorders or even escalate to the severity of suicidality or illicit drug use. This will inadvertently have a profound impact on the afflicted person’s social and family life.

burnout and mental health issues promises healthcare
DR SEAN DAVID

Is there treatment for burnout? What “work hygiene” or mental habits can be cultivated to help keep our cogs turning?

Sean: The first step is to recognise when one has reached a stage of burnout, and not brush aside their inability to function due to just “stress”. Increasing awareness of the warning signs of impending burnout and avenues of help internally within one’s company, and externally using community resources or virtual self-help is important. Psycho-education reduces the stigma associated with seeking help for mental health conditions.

The second step is to analyse the specific causes of burnout for that unique person’s life situation. There are systemic and individual factors that can predispose, precipitate and perpetuate burnout.

The third and most crucial step is to take action and make lifestyle changes in accordance with the identified root causes of burnout.

Prescribed medications by doctors to aid sleep or relieve anxiety may also be abused. This can result in addiction. The first step is awareness that this could happen to anyone despite the belief that one knows their limits.

Joe: Some people cope by drinking, smoking or taking some pills to solve their “ills”. These coping strategies may temporarily relieve distress but are not healthy long term and can do more harm than good.

What distinguishes a clearly appropriate medical-use case from an addictive dependency on prescribed medication?

Joe: Chronic distress should be managed in a holistic way rather than self-medicating. Seeing a therapist or a counsellor to learn new skills or change one’s thinking would be helpful.

Appropriate medication use is within the doctor’s prescription weighing the indication, benefits, alternatives and risk of using or not using.

One should be honest with the use of medications and not doctor-hop or collect various medications from different doctors without revealing what was given by another doctor. Bringing all the medications during the consult will help in active use of the medication and reduce the dependency on medications.

burnout and mental health issues promises healthcare

How can employers instil and facilitate better mental health practices? How can we negotiate healthier working styles with our bosses and colleagues?

Joe: I recommend a frank discussion about what is working well and what is not. A person will do well with tasks where he or she is strong and interested in doing them, whereas other tasks may cause too much distress and dysfunction.

Sean: Fostering a positive and supportive working environment is encouraged, for example, allowing employees to have autonomy over their job scopes. Trusting them to make appropriate flexible work arrangements, especially if they are parents or care-givers, can ensure better work life balance and happier employees.

Encouraging an open discussion with employers about work strengths and weaknesses can also result in a better allocation of suitable work tasks. Employers can distribute responsibilities fairly at work and put in place multisource feedback channels to keep the effectiveness of work policies in check.

Finally, reminders from company HR for employees to use up their annual leave benefits instead of the repetitive cycle of carrying forward leave may ensure that employees take adequate rest in the work year to recuperate.

Seeking help for “being stressed at work” might seem outlandish to some. What can you share with readers to change their mind?

Joe: Think about it as executive coaching or career counselling. If the job is not a good fit and has caused physical, emotional, psychological and social distress and dysfunction, changing to another department or a better job may be a better outcome in the long term.

Sean: Seeking help is not a sign of mental weakness but instead a bold action taken by you to see a change, and find fruitful meaning in life.

In the words of BKS Iyengar, “Change is not something that we should fear. Rather, it is something that we should welcome. For without change, nothing in this world would ever grow or blossom and no one in this world would ever move forward to become the person they’re meant to be.”

Three Steps Out of Burnout

#1 Recognise when you’ve reached a stage of burnout, instead of brushing aside your inability to function due to just “stress”.

#2 Analyse the specific causes of burnout for your own life situation. There are systemic and individual factors that can predispose, precipitate and perpetuate burnout.

#3 The most crucial step is to take action and make lifestyle changes in accordance with the identified root causes of burnout.

About PROMISES

Promises Healthcare is a multidisciplinary mental health clinic with a team of psychiatrists, psychologists, therapists and executive coaches (and a rehabilitation physician) who take on a diverse and multidisciplinary approach to treatment. Care and wellbeing of patients is at the heart of the service, and treatments are based on the latest clinically proven protocols in the field of neuroscience and psychology.

Dr Joseph Leong believes that recovery is possible for anyone. He looks beyond finding the best combination of medications to recommending talk therapy and psycho-social rehabilitation and community partnerships.

Dr Sean David Vanniasingham is experienced in general psychiatry, addiction medicine, and neurostimulation treatment. He is a firm believer in the biopsycho-social model approach in the holistic and recovery-oriented care of his patients.

Visions by Promises is the addictions treatment arm of Promises Healthcare, providing recuperative care programmes such as one-on-one counselling, group therapy, an intensive outpatient program, specialist groups, family therapy and medical detox.

Promises Healthcare is at #09-23, #09-18 & #11-16 Novena Medical Center, 10 Sinaran Drive.
6397 7309 | promises.com.sg


*This article first appeared in the October 2022 edition of Expat Living and on their website.

What is psychodrama and does it help anxiety?

What is psychodrama and does it help anxiety?

Since 2011, Sharmini Winslow has been a pioneer of psychodrama in Singapore and holds sessions with Promises Healthcare. After pursuing a career in dance and choreography, and founding her own Pilates studio, Sharmini discovered her natural affinity for forming connections with people – notably her close bonds with her Pilates students. Facing anxiety and feeling burnt out by the trials of running a business, she took a degree in counselling and eventually discovered the concept of psychodrama, where she found her own inner breakthroughs.

Here we find out more about this unique form of therapy and how it’s helped people with depression, anxiety and other issues.

Promises healthcare Sharmini Winslow anxiety help with psychodrama
Sharmini Winslow

Can you explain to us what psychodrama is all about?

Psychodrama is not drama therapy. Psychodrama has its own canon of theories and philosophies – it has a very coherent methodology. Jacob L Moreno was the psychiatrist who founded psychodrama and came up with a theory of personality, philosophy and methodology. It’s a very comprehensive way of working with clients that can also be adapted to work with other theories.

Psychodrama is basically taking whatever is in your psyche (“psycho-”) and putting it into action (“drama”) in the therapy room. We use objects and people to represent things or people from your life that you can interact with on the stage. In psychodrama, you can explore issues you want to deal with and the feelings that are coming up.

Can you give an example of what happens in a psychodrama session?

We begin with warm-ups to help participants connect and feel comfortable with each other and the director. A protagonist is chosen either as a volunteer or by the group. The protagonist is the group member who wishes to explore a situation in their life. A scene is set and group members are chosen as auxiliaries to play the roles of people, things, emotions or anything of significance in the story. The psychodramatist, also known as the director of the drama, facilitates the unfolding of the drama on the stage. The stage is the space set apart specifically for the action to take place. The rest of the group act as the audience who witnesses the drama. These are the main elements in a psychodrama.

psychodrama promises healthcare Sharmini Winslow anxiety
Psychodrama class

In a drama, the protagonist might go to a scene from the past, the present or even a desired future. The protagonist usually experiences a new perspective; something in their psyche shifts and they can engage in the present with more energy and life!

In a psychodrama, we have many ways of facilitating healing and closure so we don’t re-traumatise people – that’s why it takes about 800 hours to become a qualified psychodramatist. There are protocols to follow to create safety and confidentiality, which is an important aspect of group therapy.

What do you think the main advantages of psychodrama are?

The main advantage of psychodrama is that it takes less time to get to the heart of the matter. It helps the client cut through the clutter of their intellectualisation and explore new problem-solving skills. It’s also a holistic form of therapy that embraces spontaneity and body awareness.

Psychodrama is relatively new in Singapore; does this cause any challenges? How do you address this?

There are many misconceptions and one of them is that you have to reveal your personal life to a group of strangers. In actual fact, great care is taken to build trust in the group, and if you’re still not warmed up you can participate as an audience member. I offer open sessions that allow people to experience what goes on in psychodrama. This helps to demystify it and make it more accessible. For those that want to dive deeper, I hold Personal Growth Groups that run for six to eight weeks. I believe that if people are willing to try it, they’ll enjoy it. But there’s always a hesitancy and fear about trying something new.

Is psychodrama more effective for certain kinds of people?

Psychodrama works best for people who are willing to be honest and open and want to deal with their issues in more creative ways.

Can it help with anxiety?

It helps with anger issues, depression, anxiety, stress, relationship issues, low self-esteem and even addictions.

What are some of your success stories?

I had a client who was too afraid to speak because of anxiety and his addiction issues. He was put into our group of men with addiction issues, and he was very quiet in this group. We started doing warm-ups and for the first time in his life people were relating to him as an equal, a peer. Nobody was talking down to him because nobody knew about his background except for me. He had become anxious as a result of years of drug use, and had some neurological issues.

After a few weeks, he started talking in short sentences and told us he had gone to a concert. All the guys in the group were slapping him on the back and cheering him on. His family was really grateful. He didn’t even do his own psychodrama, he was just part of the group.

What advice do you have for people who want to become professional psychodramatists?

Be patient! It takes many hours. If you’re committed to it, stay the course and don’t give up. Supervision is part of the learning process as it’s a very powerful method. Don’t neglect this important aspect of your training.

Want to discover psychodrama for yourself?

Sharmini is hosting an open session/introduction to psychodrama on 12 August for Expat Living readers – visit the Psychodrama website to sign up. She also holds training sessions for those interested in taking up psychodrama professionally. Sharmini is a Certified Psychodramatist, accredited by the American Board of Examiners in Psychodrama, Sociometry and Group Psychotherapy

For more information on psychodrama sessions, visit psychodramasingapore.org.

Promises Healthcare is at Novena Medical Centre, 10 Sinaran Drive, #11-16.
psychodrama@promises.com.sg | promises.com.sg

 


Dinesh Ajith

Dinesh is a seasoned writer and editor with seven years of experience covering travel, restaurants and bars. His interests include film photography, cheesy 90s monster flicks, and scouring the island for under-the-radar craft beer bars.


*This article first appeared in the July 2022 edition of Expat Living and on their website.