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.
The anonymous author of this article is a person in the recovery of Major Depressive Disorder and Borderline Personality Disorder. The views of the author are not those of Promises.
I have struggled with Self-Harm since I was a kid. Most of us are aware of the tantrum’s kids put up when they are upset. They hit others, drop to the floor, scream, and cry. When I felt overwhelmed by certain emotions, in particular anger or sadness, I would use my hands to hit my head. I had trouble identifying and regulating my emotions. My primary school counsellor told me that I have anger management challenges when I shared with her how I find myself unable to control my anger and would hit myself or the well. Little did I know that these behaviours were early signs and symptoms to what would become a diagnosis of Major Depressive Disorder and Borderline Personality Disorder given to me in my 20s.
When the word ‘Self-Harm’ is mentioned, most people think about ‘cutting’. A very common and increasingly concerning the mode of coping for persons in distress, more so for young people, even children. Fortunately, I never turned to ‘cutting’ until I was 23. I was actively suicidal from the stress of battling my illness while also trying to excel in my degree. I began with a penknife and one cut. Soon, that one cut led to many and I found myself with a new problem.
I struggle with Self-Harm till this very day; however, I have come a long way with the help of medications and therapy to reduce the frequency of Self-Harm. I have been trying to replace Self-Harm with healthier coping methods such as exercise.
When I do not wear long sleeves, I end up exposing the scars on my wrists to the world. Generally, I tend to feel ashamed of my scars and it took me some time to embrace them. However, responses from others who have noticed my scars have caused discouragement to me and led me to feel ashamed once again. Ironically, this does not deter me from ‘cutting’; instead, it increases the urge because I develop self-hatred and feel like I deserve to be punished and scarred for my behaviour.
Through this sharing of my experience, I hope to send a message of love to peers who are challenged with Self-Harm, whatever form it might take on. I also want to raise awareness among members of the public on what were some unhelpful words and behaviours people have made towards me, more so out of a lack of awareness rather than a lack of concern. I have learnt to forgive them, and at times have also made the effort to voice my discomfort over their words and actions. Here are five things people have said or done to me that were completely unhelpful, and very likely also to be unhelpful to anyone else challenged with Self-Harm.
1. Touching me without permission I get it, you notice the scars and you get worried. Without thinking, you grab my arm and go “what is this? Did you cut yourself?”. Leaving the question for later, the very act of grabbing my arm to look at my scars without permission is a big ‘NO’. I am hypersensitive to my scars and it takes much courage for me, even till today, to deliberately lift my arm to show my scars. What may surprise you is that, often, this act comes largely from my own parents and also the professionals I see for help. It is good practice to always ask someone for permission if you wish to touch them, even if it means to give a hug. Because some of us who have challenges with trauma and dissociation are hypersensitive to touch. Hence, do be mindful of those around you and remember: If you do not like people grabbing you to see something (on you), it’s the same and perhaps even more, for those of us learning to accept our scars.
2. “Doesn’t it hurt?” No, it doesn’t. This answer may come as a surprise to many, but when I am under extreme stress and emotional distress, the act of physically inflicting hurt on myself gives me relief. The greater the physical “pain” the greater the relief. For me, this goes for any act of self-harm be it ‘cutting’, punching the wall, or knocking my head against the wall until it starts bleeding. I can only compare this to someone who meets with an accident. The body goes into shock to the point the person may have a broken leg; however, he or she is not feeling any pain. I do not have a formal education in psychology or biology, but I believe my brain “shuts down” the part that feels pain which aids me to self-harm without feeling the actual pain.
3. “The scars are so ugly! Why do you enjoy this? Can’t you stop?” This is a three-part question, but it often comes to me in one line of questioning. First, I want to say that I do not enjoy this. Not at all. I would love to have clear and beautiful skin too. Every time I look down at my arm to see the scars, I feel hatred towards myself. “How could I do this to myself? I am a horrible person”. And yet, I find that I cannot stop. A coping method I have turned to, since childhood, to cope with the traumatic experiences and intense emotions is self-harm. It has become the default and almost automatic ‘subconscious’ act whenever I am in distress.
4. “It doesn’t look too bad” I know that this statement is in direct contrast to the one above. But I have had this said to me by peers and sadly, professionals. There is not much need for me to elaborate on this statement as it is obvious that it is unhelpful. This statement makes me feel like a failure and makes me want to hurt myself even more. The ‘Depression voice’ is always on standby, ready to jump in with a “See, you are useless at even trying to hurt yourself? You call that a cut?! You are a coward. Go and do it again”.
5. Taking away or hide the sharp items that I could use to hurt myself This is probably most relatable to parents and caregivers supporting someone who is challenged with self-harm. It is very natural to become protective and do what it takes to stop your loved one from hurting themselves. “If I take away their means to hurt themselves, then they have no choice but to stop, right?” Unless you tag along with your loved one 24/7, it is very easy to drop by the nearest bookstore to buy a new penknife. More importantly, in doing so, you are taking away the one thing that I have which keeps me from jumping out of my window or overdosing on my pills. Until I learn to safely stop self-harming in therapy, to take it away from me by force, will throw me into an emotional turmoil that will only make me feel worse.
So please, next time you notice someone with scars that look like they might be from the act of cutting one-self, please be gentle and kind to the person. Be extremely mindful of what you say. Perhaps, a guiding thought could be: If you cannot entertain the idea of causing pain to yourself, imagine how much pain the person must be in to be able to cause harm to themselves. When I self-harm, it is a desperate means for me to stay alive. It is a cry for help: for attention, for love, care and non-judgemental support.
If you know a loved one who self harms please do gently prod him/her towards seeking help from a trained professional.
Although society has made some headway in reducing the stigma and misinformation about general mental health issues, the public’s understanding of self-harm remains decades behind. Let’s debunk some common myths about adolescent self-harm.
Myth: ‘Self-harm means cutting right? Only emos and goths do that.’
Self-harm refers to a range of behaviours that are purposely inflicted to cause damage to the body. It can include cutting, but also refers to scratching, picking at wounds, burning, pinching, hitting, head banging, and minor overdosing. Self-harm can also be in the form of excessive risk-taking that is above and beyond typical adolescent risk-taking.
It is a misconception that only ’emos’ and ‘goths’ self-harm. Although self-harm can be part of adolescent subculture experimentation, it is more often a sign that a teenager is experiencing unmanageable distress. Self-harm becomes a way of coping with distress that provides temporary relief from emotional pain.
Myth: ‘Self-harm is all about attention-seeking. If a person was really depressed enough to cut themselves then they would probably just commit suicide.’
Self-harm is not about attention-seeking. It is often a secretive and private behaviour. For a teenager, self-harm is a way of coping with unmanageable distress, and can be a medium to communicate that distress to others. Self-harm should never be dismissed as attention-seeking.
A person who cuts themselves is not necessarily suicidal. Cutting behaviour can be suicidal, non-suicidal, or a mix of both. It is important to remember that suicide risk is not static. A teenager who displays non-suicidal self-harm can become suicidal at another point in time.
Myth: ‘I can punish my teen so that they stop self-harming. That will solve the problem.’
Punishing a teen for self-harming does not solve the problem. Cutting is a symptom of a deeper issue – unmanageable distress. Stopping the cutting via punishment may actually worsen their distress, especially if the teen lacks healthy and effective coping strategies.
Here are some suggestions for what you can do instead of punishing your teen:
Written by Leeran Gold, Psychologist in our Forensic Service.
At Promises Healthcare, we are committed to helping you through your journey to recovery. Discover a new life and find renewed hope. If you or someone you know needs mental health support, please contact our clinic for inquiries and consultations.
For after-hours crisis support contact your local mental health service or emergency services.
In Singapore: IMH 24-hour helpline +65 6389 2222, Ambulance 995.
Let’s take a look at some common mental health myths about youth suicide and set the record straight.
Attempted suicides are just a cry for attention.
A suicide attempt should never be dismissed as ‘just a cry for attention’. A young person is highlighting that their level of internal distress is unmanageable and unbearable. They need help, not judgement. A young person can feel even more isolated and misunderstood if those around them fail to take their actions seriously. Never ignore or minimise suicidal behaviours and seek professional help as soon as possible.
Teens who cut their wrists must be suicidal.
Cutting is a form of self-injury that can either be suicidal or non-suicidal. In both cases, the cutting is a sign that a young person is not managing their internal distress in a healthy way. Any young person who self-injures should undergo a full suicide risk assessment by a registered mental health professional.
If I ask a young person whether they are feeling suicidal, it might put the idea in their head.
This is a particularly dangerous myth as it discourages discussion of the issue at hand. Talking about suicidal feelings will not encourage a young person to commit suicide. When having the conversation try to stay calm and non-confrontational. Remain open and genuine, and remember the overall message – it is ok to talk about feelings, and there is help available. Show that you care and avoid judging the young person. If you are uncomfortable or unsure about having the conversation, get in touch with a mental health professional for some tips and guidance.
At Promises Healthcare, we are committed to helping you through your journey to recovery. Discover a new life, away from addiction and find renewed hope. If you or someone you know needs mental health support, please contact us today for inquiries and consultations.
For after-hours crisis support contact your local mental health service or emergency services.
In Singapore: IMH 24-hour helpline +65 6389 2222, Ambulance 995.
What can I do to help my teen?
In addition to regular professional mental health support, here are some things you can do to help your teen:
– Show that you care
– Be non-judgmental
– Accept your teen’s feelings
– Suggest distractions
– Learn basic first aid
– Encourage them to communicate their feelings
– Ensure an authoritative balance in your parenting style
– Guilt trips
– Punishing your teen for self-harm
What can the school do to support my teen?
Ask to see your school’s policy on self-harm management. If your school does not have a policy, get in touch with your treating psychologist who can provide the school with resources and psycho-education. Make sure the school counselor sees your teen regularly, and that they are aware of any safety and risk issues.
If you suspect that your teen is self-harming, seek professional help as soon as possible. Contact Promises Healthcare for a confidential enquiry today.
If your teen is in any danger, contact your local ambulance service on 995. You can contact the Institute for Mental Health 24-hour hotline on 6389-2222.