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What Are Panic Attacks and How To Manage?

What Are Panic Attacks and How To Manage?

Written by: Dr Elaine Yeo, Senior Clinical Psychologist

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:

  • Heart palpitations
  • Sweating
  • Trembling or shaking
  • Shortness of breath
  • Chest pain or discomfort
  • Feeling dizzy
  • Fear of losing control or going crazy

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.

The Power of Physical Presence in Therapy

The Power of Physical Presence in Therapy

Therapy is an indispensable tool to recovery, or in helping one gain deeper insights and achieve self-actualisation. In light of the ongoing COVID-19 pandemic, traditional face-to-face therapy has been forced to take on various forms, including sessions conducted via telephone or through video-calling platforms. Of course, therapy serves the same purpose, regardless of whether it is conducted in person or otherwise. However, there is definitely something restorative about being able to connect with a therapist physically. Humans are innately social creatures after-all, and sometimes when things get tough, a little more human interaction and comfort can go a long way. 

 

Physical presence in therapy certainly provides a deeper sense of connection, in contrast with virtual therapy where one might feel more distant and detached. It may seem bearable at the very beginning, but as you progress through the sessions, having to interact with your therapist through a screen all the time can get frustrating. Similar to how students may have trouble coping with online school and home-based learning, virtual therapy has some form of hindrance when it comes to relationship-building with your therapist. For most psychotherapy methods, it is indeed possible to shift them online. However, for others such as psychodrama, it may not be entirely ideal. How expressive and comfortable can you get, when you’re struggling to follow your therapist’s directives through the small screen and having to deal with technological lags? 

 

Seeing your therapist in person also allows for him/her to detect any subtle body language and somatic movements. These are all non-verbal cues that may be lost through telecommunication. Non-verbal cues are just as important as verbal ones, and can provide your therapist with greater insights. Non-verbal signals can serve to convey your feelings along with what is being said, and can either reinforce or contradict verbal messages. Ignoring them would be very much a failure to be fully engaged in a conversation. Moreover, seeing you in person provides therapists with the ease to identify any form of dissociation. During the session, clients may not necessarily attune well, and may not be fully present in the moment. The client may be engaging with the therapist, but seemingly thinking about something else that is going on in their life at the same time. This does not mean that the session is unhelpful or “boring”. While this could simply be attributed to the lack of presence, it could also point towards other concerns regarding the client’s state of mind. Fragmentation can occur especially when one is recovering from a past trauma and can be brought to the forefront, causing incomprehensive emotional reactions when triggered. Fragments of self are usually suppressed, often attributed to the lack of a sense of safety when it comes to expressing their inner needs or desires. When these feelings start to show during therapy, therapists can identify them through common tell-tale signs such as a switch into dissociation, noticeable body movements (twitching, scrunching of fingers or toes etc.). Body language is not definitive, but can offer clues about one’s thoughts and feelings. With telecommunication, it is more often than not impossible to see the client below shoulder-level, thus making it difficult for therapists to assess any somatic movements that may be occurring. 

 

Another issue with telecommunication is the lack of control over the therapeutic environment.  In a traditional face-to-face session, the clinician has considerable control over the environment, and is able to ensure a private, safe and quiet space for the entire duration of the session. This limits the number of distractions and allows for both the therapist and the client to concentrate on psychotherapy. Moreover, in a clinical setting, furniture is often set up in particular ways to facilitate clinician-patient interactions. For instance, seats may be arranged such that the clinician would be facing the client at an angle of 45 to 90 degrees, and approximately 2 to 3 feet away. Facing the client directly can feel somewhat threatening for some, and this angle allows for the client to feel more at ease. Additionally, it allows for both parties to break eye contact naturally (intermittently) without seeming antisocial or distracted by having to do so actively. In contrast, having a session online or through telephone allows for less control over interactions and the client may be more exposed to external distractions or undesirable interruptions. This also leads us to our next point, where teleconsultations also increase the risks of privacy breaches. 

 

Due to the lack of environmental control, having a consultation via telecommunication methods can be a challenge especially for those who do not have access to their own private space. For individuals living with others, there could be situations that compromise client confidentiality, including potential eavesdropping or having others walk in on them. Not only does this make the session extremely disruptive, it can be a huge concern for many considering that mental health concerns are sensitive topics. Clients must make the extra effort to find a suitable place and time for them to speak with their therapists freely and with ease. As such, physical presence in a controlled clinical setting may have the upper hand.

 

Nevertheless, this article in no way aims at undermining the efficacy of tele-health, nor to allude that tele-therapy is ineffective or pointless. Considering the need for physical distancing during the pandemic, telecommunication is undeniably crucial in limiting the spread of the virus. Putting that aside, traditional in-person therapy can have its barriers too, limiting people from attaining the mental health support they need. Individuals with disabilities may find accessibility to be a significant problem at hand, and find it difficult to travel for therapy without having others to rely on. Others include parents who are unable to find suitable childcare options, all while juggling work and mental health care. For those struggling with social anxiety and agoraphobia, it can also be extremely intimidating and overwhelming for them to step out. In fact, some research has shown that virtual and in-person therapy, depending on the treatment goal, can be equally effective. In adults, cognitive behavioural therapy was shown to be similarly effective both in vivo and virtually (Khatri et al., 2014). There is also evidence that youth with anxiety disorders respond positively via telehealth (Khan et al., 2020). Traditional face-to-face therapy and tele-therapy both have their perks, and we acknowledge that it also boils down to individual preferences. If you’re unsure as to which treatment option to opt for, do feel free to contact us.

 

References:

  1. Brenes, G. A., Ingram, C. W., & Danhauer, S. C. (2011). Benefits and Challenges of Conducting Psychotherapy by Telephone. Professional psychology, research and practice, 42(6), 543–549. https://doi.org/10.1037/a0026135 (Accessed 06/09/2021)
  2. Khatri N., Marziali E., Tchernikov I., Shepherd N. Comparing telehealth-based and clinic-based group cognitive behavioral therapy for adults with depression and anxiety: A pilot study. Clinical Interventions in Aging. 2014;9:765. (Accessed 09/09/2021)
  3. Khan, A. N., Bilek, E., Tomlinson, R. C., & Becker-Haimes, E. M. (2021). Treating Social Anxiety in an Era of Social Distancing: Adapting Exposure Therapy for Youth During COVID-19. Cognitive and behavioral practice, 10.1016/j.cbpra.2020.12.002. Advance online publication. https://doi.org/10.1016/j.cbpra.2020.12.002 (Accessed 09/09/2021)
  4. https://www.nataliarachel.com/articles-practitioners/shifting-to-tele-therapy-attuning-without-physical-presence (Accessed 07/09/2021)
What Does Journeying with a Psychiatrist for My Mental Health Issue Look Like?

What Does Journeying with a Psychiatrist for My Mental Health Issue Look Like?

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. 

 

It is natural to feel nervous or uncomfortable about seeing a psychiatrist, but don’t let these emotions hold you back from getting the help you need. We hope that giving you a better sense of what to expect will help alleviate your concerns, and give you the courage to seek professional help.

 

References:

  1. Psychiatrists and psychiatry. Healthdirect.gov.au. (Accessed 21/05/2021)
  2. What Questions Do Psychiatrists Ask? | PHS San Diego (Accessed 21/05/2021)
  3. What to Expect During Your First Psychiatry Appointment (Accessed 22/05/2021)
Understanding Imposter Syndrome

Understanding Imposter Syndrome

Imposter Syndrome is a shockingly common psychological phenomenon experienced by an estimated 70% of the population. Chances are you’ve probably had such a mindset at least once, but perhaps you couldn’t pinpoint the exact words to describe the feelings you had. Imposter syndrome, as defined by the American Psychological Association (APA), is where “highly accomplished, successful individuals paradoxically believe they are frauds who ultimately will fail and be unmasked as incompetent”. In other words, it’s when you feel like you aren’t worthy of what you have accomplished, and are not good enough to be where you are. Successes and accomplishments are thought to be attributed to sheer luck, rather than one’s actual skills and capabilities. While this psychological pattern was initially thought to be applicable to women and women only, studies over the years have shown that men are equally as susceptible to the same psychological pitfall. This phenomenon is rarely spoken of –  individuals with imposter syndrome usually suffer in silence, and this is a likely case of them being afraid to be exposed as a “phoney”. 

An expert on imposter syndrome and author of The Secret Thoughts of Successful Women: Why Capable People Suffer From the Imposter Syndrome and How to Thrive in Spite of It, Dr. Valerie Young categorises it into 5 main types: 

1. The Perfectionist

The broader definition of an imposter syndrome may sound superficially applied to intelligence and achievements, but as we delve deeper, we can see that it has close links to perfectionism as well. Perfectionists tend to set extremely high expectations for themselves, and for some even unrealistic ones. You may have heard something along the lines of “the higher the expectation, the greater the disappointment”, and this can hold true for these perfectionists. When expectations are set too high, these individuals tend to feel like a failure when they are thrown off by even the smallest mistakes or setbacks. Waves of self-doubt and inferiority can overcome them, making them feel like they are unable to measure up to other accomplished people when they overly fixate on their flaws. This group of people are thus also prone to developing anxiety due to the great deal of pressure they impose on themselves. 

2. The Superman / Superwoman

Individuals who fall under this category tend to overwork themselves (past the point of what’s really necessary) as they have convinced themselves deep down that they are phoneys. Fearing that they are unable to match up to real-deal colleagues, friends or family members, these people drown themselves in work in an attempt to achieve more. This can take the form of working extra long hours, feeling guilty and stressed whenever they’re not working, or feeling the need to sacrifice self-care for work. These are unfortunately merely false cover-ups for their insecurities, which may not even be a cause for concern. Needless to say, these individuals must take care not to over-exert themselves, as it can take a tremendous toll on their mental and physical health over time. 

3. The Expert

Experts base their competency levels on how much they know, or how much they can do. In a sense, they try to quantify their capabilities in order to prove their worth. Constantly haunted by the idea of not knowing enough, or being exposed to be unintelligent or underqualified, these people often underrate their current level of expertise. As such, they may strive to seek out additional trainings, certifications continuously and excessively in order to upgrade themselves and to attain success. Of course, there is no fault in focusing on self-improvement, but hoarding knowledge for false comfort isn’t the way to go.

4. The Natural Genius

This group of individuals are somewhat similar to the Experts, yet there are still slight differences between them. Instead of measuring their successes by how much they can do or know, these people measure their level of competence by the ease and speed of which they can achieve their goals. As the categorical name implies, these people believe that they need to be “natural geniuses”. They pressure themselves to achieve their goals fast, and if possible, on their first try. When plans fall through and they end up taking longer to master certain things, they start feeling an overwhelming sense of shame and worthlessness.

5. The Soloist

These people are highly individualistic – to the point where they feel like a failure whenever they have to seek help or assistance from others. They equate their self-worth to their productivity and ability to achieve results on their own. Hence, asking for assistance can seem like a sign of incompetency or weakness for them. 

For some, imposter syndrome can act as a motivational force for them to strive to achieve a better version of themselves. However, this can come at the cost of your mental wellbeing, developing into feelings of constant anxiety and even depression. A major issue with struggling with an imposter syndrome is that it deprives you of the ability to internalise your successes – you may very well be capable of achieving the goals you set, but the more you achieve, the more you feel like they were merely flukes. This brings us to our next point: how can we get past this imposter syndrome?

It is very important for us to first acknowledge our thoughts and put them in perspective. When you start feeling waves of insecurity, worthlessness and start downplaying your own abilities, try focusing on the facts. Focusing on the valid reasons and on your qualifications can help you see things in a different light, and realise that you’re truly deserving of your achievements. Let’s think this through – how many “flukes” will it take to convince you that you’re actually good at something? 

Instead of fixating on your mistakes alone, remember to celebrate your successes! We need to acknowledge that while we may occasionally miss the target, there will be times when we’ll hit the bullseye. A great start would be to start embracing your successes and allowing yourself to receive praise and recognition for them. For example, picture a scenario where someone commends or compliments you for achieving certain targets. A person with imposter syndrome would likely have an urge to ignore it, reject it, or simply brush it off awkwardly. However, the next time you encounter situations like these, try something new. Say “thank you”, bask in these moments and accept the recognition you deserve. 

Sharing your feelings with trusted friends and family members can be tremendously freeing too. Allow yourself to rely on your social network. Just as how others would approach you to share their feelings, rant, or to ask for assistance, don’t be afraid to seek them out when necessary. Bottling up your feelings can lead to further festering of negative, irrational beliefs that will ultimately do you more harm than good. Rest assured that seeking help isn’t a sign of weakness or incompetence. Alternatively, seek professional help from a mental health expert to help you break the cycle of imposter thinking, if you’re crippled by the fear of being found to be a phoney. Individual therapy can equip you with the tools to build on self-acceptance, confidence and to reframe your mindset to serve you better. At the end of the day, keep in mind that you’re not an imposter, you’re an original. 


References:

  1. Sakulku, J. (1). The Impostor Phenomenon. The Journal of Behavioral Science, 6(1), 75-97. https://doi.org/10.14456/ijbs.2011.6
  2. https://dictionary.apa.org/impostor-phenomenon (Accessed 13/05/2021)
  3. https://www.verywellmind.com/imposter-syndrome-and-social-anxiety-disorder-4156469 (Accessed 13/05/2021)

 

What’s the Difference Between a Psychologist and a Therapist?

What’s the Difference Between a Psychologist and a Therapist?

Psychologists and Therapists are often misunderstood to be the same profession, but they aren’t one and the same. Both types of mental health professionals, however, do have a vast knowledge of mental processes. As a general rule, they may work closely together to conduct sessions with their clients and work to alleviate the individuals’ mental health status. In this article, we try to help you understand the difference between the two and explain how each can help with your mental health needs.   

Psychologists – not to be confused with Psychiatrists – are mental health professionals who are adept at the study of the mind, and are professionally trained in one or more subfields of psychology. In terms of their clinical orientation, psychologists can have different specialisations. To list a couple of examples, some specialisations may include the treatment of patients with affective disorders, addictions, trauma, or personality disorders. 

Psychologists are skilled at clinical interviews and comprehensive psychological testing and assessments, with common ones such as a Patient Health Questionnaire-9 (PHQ-9), or others including a Wechsler Abbreviated Scale of Intelligence (WASI). Clinical psychologists, while unable to provide neuropharmacological support, are able to make a diagnosis if a patient is suspected to have a mental health condition, before moving on to the treatment process. Generally speaking, psychologists tend to approach treatment by exploring the larger theoretical bases of human thought and behaviour. Through this, they work alongside the patient to sieve through difficult life events, long term anxiety or traumatic experiences, in order to trace back to a possible cause of dysfunction. The most common type of treatment used by psychologists is psychotherapy, or talk therapy. The treatment process certainly isn’t one-size-fits-all, for all individuals and their life experiences are different and unique in their own ways. Psychologists ensure that the course of treatment is tailored to each patient’s needs and goals, and help them work through their concerns in a holistic manner. Psychologists can often work in tandem with psychiatrists,  in order to provide the optimal treatment for a patient.

In contrast, therapists tend to work from a broader perspective. As social relationships are a significant contributor to one’s mental wellbeing, it is important that they are balanced and are not debilitating towards one’s mental health status. Thus, therapy often helps an individual to gain insights into his interpersonal connections, in addition to self-actualisation. Therapists can also have varying specialisations. For instance, a marriage and family therapist can help couples or families resolve interpersonal hardships, a child therapist can help a child overcome developmental disturbance, and a Cognitive Behavioural Therapist can aid one in switching away from destructive life habits. Regardless of their specialisations, therapists are, at their core, there to provide mental health support, focusing mainly on improving an individual’s well-being and their ability to cope with day-to-day stressors. 

Therapy can be exceptionally beneficial for persons who require skill sets involving emotion and problem-solving strategies, such that they are better able to cope with difficult times in a healthy manner without having their emotions rule over them. Therapists are in some sense, a guiding light for patients. By providing guidance and support, therapists can nudge one towards clarifying their emotions and helping them make better life decisions (not making the decisions on their behalf!)

Therapists, like psychologists, are unable to prescribe medications. A therapist’s goal is to help patients make decisions and clarify their feelings in order to solve problems. Therapists provide support and guidance while helping patients make effective decisions within the overall structure of support. 

Just like how your body can react to physical illnesses, issues with mental health (especially if they are persistent) can be debilitating too. Now that you have a better understanding of the differences between psychologists and therapists, how you do choose the right clinician for your mental health issues? A great first step would be to browse our list of professionals at Promises Healthcare and make an appointment with one whose speciality best suits your needs.


References:

  1. https://dictionary.apa.org/psychologist (Accessed 06/05/2021)
  2. https://positivepsychology.com/how-to-become-a-therapist/ (Accessed 06/05/2021)
  3. https://www.humanservicesedu.org/counselor-vs-psych-vs-therapist/ (Accessed 06/05/2021)