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.
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.
There is often much confusion between the terms psychiatrist and psychologist. People may use these terms interchangeably, but this is not to be the case. While both psychiatrists and psychologists treat people suffering from mental health issues and behaviour disorders, they are not the same. When should I see a psychiatrist? Is psychiatry and psychology even the same thing? Who should I see first? Such thoughts may run through your mind when mental health treatment is brought up. In this article, we hope to clear the doubts and achieve greater clarity on who they really are and how they differ.
Before we begin, if you’re reading this article to find important insights on seeking help from a mental health professional, we would like to commend you for taking the necessary steps to help yourself or your loved one. Making such a decision can be very daunting, and your mind might be in a disarray with constant worries of familial, societal and cultural stigma. However, it is ever so important to remember that there is no shame or embarrassment in wanting to help yourself or your loved one get better. Mental health is equally as important as physical health and seeking help is a sign of strength rather than weakness.
What’s the Difference Between a Psychiatrist and a Psychologist?
Fundamentally, the biggest difference between the two is in the approach they take towards treating mental disorders, and the capacity to prescribe medications. Unlike psychologists, psychiatrists are trained medical doctors at their core. Amongst the network of mental healthcare professionals, psychiatrists are certified to provide neuropharmacological support that is deemed essential in stabilising certain mental conditions, such as where chemical imbalances in the brain are involved.
As medical doctors, psychiatrists play a crucial role in the diagnostic process, as well as the prevention and treatment of emotional, mental, behavioral, and developmental issues. While conducting assessments, they may also involve relevant physical examinations, blood tests, or pharmacogenomic testing to narrow down the scope of diagnosis. While psychiatrists specialise in the mental phenomena, such physical examinations cannot be omitted entirely especially if they provide important clues to help them rule out other possible physical conditions.
Psychiatrists also have the capacity to assess your medical history. Physical and mental wellness go hand-in-hand – psychiatrists will need to grasp the full picture before finalising on a diagnosis. On the Huffington Post, Carol W. Berman, M.D., a clinical assistant professor of psychiatry at NYU Medical Center in New York City, writes, “Because we learned how the body interacts with the mind, we can rule out physical disorders as a cause of mental illness. This is important, since a person may have a hyperactive thyroid, for example, which can trigger panic attacks, anxiety, insomnia, or anorexia. We can look at thyroid blood tests or have a patient consult an endocrinologist if we suspect the problem stems from thyroid disease.”
In contrast, psychologists are not trained medical doctors, and thus cannot conduct any physical examinations nor prescribe medications. Clinical psychologists however, possess an accredited Master’s in Applied Psychology at the very minimum, and can make a diagnosis for the patient if he thinks he has a mental health condition.
Psychologists typically make use of various methods of psychometric testing, personality tests, observations and interviews to come to a conclusion. But that’s not all – psychologists also engage in psychotherapy treatment, with common forms including cognitive behavioural therapy (CBT). Psychotherapy aims to help clients identify their key issues and concerns, before moving on to create a treatment plan to achieve the desired outcomes. Often conducted over several sessions, psychotherapy equips the individual with problem-solving and emotion-coping strategies to overcome the problem. For example, if a client comes in hopes of seeking help for social anxiety, psychotherapy (such as CBT) would be greatly beneficial in tackling maladaptive, limiting thoughts and behaviours that fuel negative emotions.
While there are differences in qualifications and the methods of treatments applied by psychiatrists and psychologists, it is key to note that they still work closely together. For the optimal treatment of certain mental health conditions, psychiatrists may refer you to psychologists for concurrent psychotherapy. Likewise, if a clinical psychologist determines your condition to be better managed with medications, a referral to a psychiatrist can be expected. Often once a proper diagnosis is done, the psychiatrist and psychologist may work together to build a treatment plan for the patient, focusing on managing symptoms through the use of medications and psychotherapy.
Who Should I See First?
Where physical symptoms may be severe, or where it may be hard to take basic care of yourself, turning to a psychiatrist would be a good option. After all, psychiatrists are trained medical doctors who can also work with your primary care doctor (if any) to provide optimal treatment. It is also suitable for individuals who are unsure as to whether their physical symptoms are linked to other underlying medical conditions. In such cases, psychiatrists will be able to detect a medical mimic. To put it simply, take for example a presenting complaint linked to the shortness of breath. While it may seem like a panic attack, it is crucial to eliminate any other clinical suspicions of lung diseases such as pulmonary embolism.
On the other hand, you may choose to make a trip to see a psychologist if you think you have a less severe mental condition. For individuals seeking to overcome phobias or resolve difficult issues in life, it may be more effective to undertake psychotherapy. A Psychologist can help you work through your problems, deal with emotional challenges or cope with particularly traumatic life events so as to make positive changes in your life.
We can all play a part in alleviating our own or our loved one’s suffering by increasing our understanding of mental health disorders. If you’re still struggling with making a decision after much thought, making the first step to contact a professional would help. You can be assured that the team at Promises will serve with your best interests at heart, and will work closely with you to provide optimal treatment.
Many of us are absorbed in an endless, self-defeating rat race. The nature of modern society has instilled in us a “winner/loser” mindset, and its systems highly prioritise external rewards and punishments as measures of our personal success and social worth. This oftentimes forces us to shift our perception of self-worth from the satisfying efforts of personal endeavour, to the critical imperative of achieving yardsticks of success defined by the rest of society. When we are constantly striving to win a race while focusing on external factors largely beyond our design or control, we’re surely putting ourselves at a disadvantageous position.
The overwhelming pressure to conform to societal expectations, or to outrun others in the race of life, can make one particularly susceptible to depression if negative emotions are not managed well. As we aim for perfection – as most people would – we need to understand that total perfection is unattainable. The more we believe that we have failed to reach a certain state of “perfection”, the greater the extent to which we experience low self-esteem, self-hatred, and depression. Depression can be extremely debilitating to one’s mental health. Apart from the diminishing enthusiasm for life and self-esteem, depressed individuals may self-isolate and pull away from their social circles, making it all the more difficult for them to get the help they need.
Perhaps one of the healthiest things we can do for ourselves is to accept who we are. Self-acceptance might just be the antidote to excessive self-resentment and discontentment. It is important that we fight against influences that force us to conform to certain standards rather than to accept ourselves. Presented below are a couple of talk therapy methods that we use to guide you towards achieving that.
What is ACT?
Acceptance and Commitment Therapy (ACT) is a form of talk therapy suitable for the treatment of individuals displaying symptoms of depression. As its name suggests, it’s core aims are to help individuals accept whatever is beyond their control, and to commit to actions or habits that will serve to enrich their quality of life. ACT helps us to clarify what is genuinely important to us (i.e our values), and thus assists us to set more meaningful and life-enriching goals. Along the way, it also guides us to practise useful emotion-coping strategies such as mindfulness in order to equip us with skills to handle negative emotions effectively and healthily. While the number of ACT sessions may differ for each individual, the benefits acquired by clients are largely similar:
Learning to be fully present in the “here-and-now”, and to stop obsessive worrying over the past or future
Become aware of what they are avoiding (be it consciously or subconsciously), and to increase self-awareness
Learning to enjoy greater balance and emotional stability, and to be less upset by unpleasant experiences
Learning to observe thoughts such that one does not feel held captive by them, and to develop openness
To develop self-acceptance and self-compassion
Clarifying one’s personal values and taking the appropriate action towards his goals.
You may be wondering, does it really work? The good news is that ACT is considered to be an empirically validated treatment by the American Psychological Association (APA). Through program evaluation data, research has also shown that Veterans who completed ACT treatment phases displayed a significant decrease in depression in addition to improved self-awareness and a better quality of life.
What is DBT?
Apart from ACT, another alternative for the treatment of depression is Dialectical Behaviour Therapy (DBT). While originally used for the treatment of Borderline Personality Disorder, DBT has since been adapted to treat other mental health conditions including depression, anxiety, and post-traumatic stress disorder. A type of cognitive behavioural therapy, DBT aims to help individuals who struggle with emotional-regulation and are exhibiting maladaptive or self-destructing behaviours. It is not an uncommon sight for persons with depression to engage in substance-abuse or self-harm. As such, DBT helps to build on distress tolerance, such that people who struggle with these are able to handle negative life-circumstances better and to avoid falling back on such devastating coping methods.
DBT can be considered a holistic approach to depression treatment. Apart from tackling maladaptive behaviours, it encourages a shift in the clients’ perspective on life, for it equips them with the necessary skills to cope with intense emotions. In short, it empowers you to cope with them with a positive outlook. DBT also recognises that interpersonal effectiveness is key, and hence it strives to help these troubled individuals to reconnect and enhance their relationships with others.
ACT Versus DBT
ACT and DBT are both highly effective methods of treatment for depression. Both forms of psychotherapy allow for individuals to tackle the notion of suffering head-on, and to avoid suppressing undesirable or uncomfortable feelings. Both promote psychological flexibility, and encourage people to behave in a conscious or effective way towards their life-choosing directions. The practice of mindfulness is also a commonality between both therapy methods, and it plays a crucial role in ensuring that persons are well aware of their values, goals and emotions.
However, overlaps between the two are considerably limited too. The main differences between ACT and DBT would be that DBT leans towards a more educative approach while ACT emphasises an experiential one. Perspective wise, DBT adopts a biosocial perspective on behaviour while that of ACT is contextual. Moreover, the underlying philosophy behind each form of therapy also differs. DBT philosophy is dialectical (i.e using logical reasoning and analysis), while the philosophy behind ACT is functional contextualism. With that said, the analysis of clients’ experiences, the use of languages as well as experiential exercises will be different for each type of therapy.
Caregivers with a family member affected by addiction problems are often exhausted, drained dry of their empathy and compassionate capacities.
They recount countless cycles of suspended hope followed by just as many broken promises as they watch the affected person return time and again to their compulsive addiction despite a seemingly obvious trail of destruction behind them.
Caregivers learn to cope with the endless demands on their energies by blending the words uttered by the affected persons as a cocktail of lies, manipulation and attention-seeking antics to get what they want.In time, the cries for help from the affected person turn into cries for help by the boy who cried wolf and eventually fading into indistinguishable white noise.
Professor Lisa Firestone of the Glendon Association observes that there is a natural tendency for caregivers to minimise any suicide expressions in general.Responses such as, “Well, his past attempts weren’t serious.” or “He is just manipulating to get something.” are commonly observed.There is also a general tendency to not want the expressions to be true.In the case of addicts, words such as “I want to die” or “I am going to end my life” no longer convey the same meaning or gravity of their sense of desperation.
Why should we want to pay attention to an addict’s cry for help?
In Singapore, we lose 1.1 lives every day to suicide.It is still the leading cause of death for youths aged 10 to 29.While direct correlation evidence is still being researched on, studies in America have shown that more than 90% of people who kill themselves suffer from depression have a substance abuse disorder or both. Suicidality and addiction share a high concordance relationship.
When we overlay the statistics with a physiological lens, we note that both groups of persons have been observed in studies to have a dysfunctional hypothalamic-pituitary-adrenal (HPA) axis which essentially controls our body’s response to stress.
In a person with a normal functioning HPA axis, on the reception of a stressor, the hypothalamus in our brain instructs the secretion of the corticotropin-releasing factor (CRF) and vasopressin to stimulate our pituitary glands to produce the adrenocorticotropic hormone (ACTH).The ACTH, in turn, stimulates glucocorticoid synthesis and release (commonly referred to as cortisol) from the adrenal glands.This chain reaction provides a person the increased energy to handle the stress event and to do so without suffering from the pain and fatigue.When the stress event is gone, the body produces a negative feedback loop which then brings the body system back to homeostasis.
In a person exposed to a persistent or extreme level of stress, or in a person who frequently activates the HPA axis through substance use, the body starts to blunt the sensitivity of the HPA axis and blunt cell receptivity to cortisol in its efforts to return to and maintain homeostasis.This alteration to the sensitivity of the HPA axis affects our ability to tolerate physical and mental stresses and creates a need for a much bigger stimulus to activate the HPA axis (which may mean higher dosage of substance use); and when the HPA axis does react, produces a much bigger and exaggerated response (which may translate to more aggressive behaviours).
What Does This Mean In Practical Terms?
Many suicidal persons described having a voice in their head which is constantly there; telling them how much they need to seek fulfilment and comfort by reaching for the desired stimulus, whether it be a substance or a behaviour, of which one is killing themselves.Their mind starts to command them to constantly plan, to seek out and to take actions to soothe the unbearable lack that they are feeling.Eventually, the voice in the head goes from coaxing and persuading to being more intensive and aggressive towards the self to take immediate drastic actions.
The relief of death, a final refuge, becomes alluring and pleasurable and the fear of dying eventually transforms into the fear of not dying and becoming the loser, disappointment, and burden that they already believe themselves to be to their caregivers.This dual push towards drastic action and the need for an ever-increasing amount of substance in addicts leads to an increase in the risk level of suicidality.
What Can We Look Out For?
How then does the caregiver separate the wheat from the chaff amid the chaos that addiction has already wrought onto the family system to detect the risks of suicidality?
Below are some, though not exclusive, common markers to look out for. It is particularly useful to note changes in the content of the affected person’s expressions and any escalation or sudden extinction of intensity.
Intense Emotional Outbursts
Extreme Isolation or Withdrawal
The feeling of Being a Misfit in Every Way
Researching or Procuring Means of Suicide.
Self-Harm, Including Risky Substance Use or Behaviours.
Planning of Affairs.
Presence of Trigger Events
Loss of Primary Relationship.
Physical or Mental Health Conditions That Debilitate.
Abuse or Trauma Events.
What Can Caregivers Do On Observing The Signs?
Ask the Suicide Questions:
In the past few weeks, have you ever wished that you were dead?
In the past few weeks, have you felt that you or your family would be better off if you were dead?
In the past week, have you made plans about killing yourself?
Have you tried to kill yourself?
If the answers are yes to any or to all the questions, caregivers are encouraged to take the following first steps:
Be empathetic towards the suicidal wish.
The objective is not to agree with the act of suicide but to understand what has happened to lead the affected person to the conclusion that suicide is the only solution.
Find a genuine connection with the affected person.
However difficult that person might have been in your life, express what this person means to you personally and how the loss of this person would affect you.
Make a safety plan.
Ask the affected person to agree to not take or delay any action to harm themselves until they get to or you get them to professional help.
Professor Lisa Firestone observes that suicidal persons are generally ambivalent: a part of them wants to die but a part of them wants to live as well.There is often a process of the dividing up of the self within the person, between an aspect which is life affirming and engaging with the outer world; and the anti-self, which is self-critical, self-hating and ultimately suicidal.The key to recovery is to connect with and help strengthen that part of them that wants to keep on living.
6 Dazzi, T., Gribble, R., Wessely, S., & Fear, N. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361-3363. doi:10.1017/S0033291714001299