Supporting Someone who has Been Abused

What is Abuse?

How can I help someone who is being abused?

Abuse refers to any forms of violent, cruel or demeaning acts against another person or animal to cause harm or distress.  

Types of Abuse 

“Physical abuse, sexual abuse, emotional abuse… that should be about it right?”

There are actually many more types of abuse than we think. There are at least 5 different types of abuse. The different types of abuse can be further subdivided according to: 

Ψ The nature of the abuse (e.g. physical, emotional, financial, or sexual)
Ψ The demographic of the victims (e.g. elderly, children, or intimate partners) 

Here are some types of abuse and the warning signs you should look out for.

---

Physical Abuse 

What are the signs?  

Some signs of physical abuse include sustaining physical injuries and wounds (e.g. battered faces, bruises, or cuts). In more serious cases, one can have broken bones, internal bleeding, or even punctures. More subtle signs include the perpetuator not allowing anyone to visit the victim, or isolating the victim, to prevent others from knowing about the abuse. 

What is physical abuse?  

Physical abuse refers to causing bodily injury to others intentionally. Bodily injuries can be inflicted by any violent acts such as kicking, hitting, scalding, strangling, choking, pushing, or slapping the victim.  

Physical abuse is often associated with domestic abuse or child abuse where battered partner or children find it difficult to break free from helplessness and passivity.

---

Emotional Abuse

What are the signs?  

Signs of emotional abuse include intimidation, manipulation, humiliation, criticism, name-calling, blaming, false accusations and trivializing of one’s concerns. Victims can also show signs of emotional agitation, excessive self-consciousness, social withdrawal or anxiety, and non-responsiveness to the perpetuator.

As seen from the examples above, verbal abuse is usually intertwined greatly with emotional abuse, whereby words are used to hurt someone emotionally. Other forms of non-verbal emotional abuse include neglect, love withdrawal and silent treatment.  

What is emotional abuse?  

Emotional abuse is often also called psychological or mental abuse.  

Emotional abuse refers to non-physical abusive behaviors that are aimed at undermining one’s mental well-being such as one’s self-esteem, dignity and sense of identity.  

---

Financial Abuse

What is financial abuse?  

Unlike the aforementioned types of abuse, financial abuse is less frequently heard of. Financial abuse refers to controlling or restricting one’s ability to use money or other financial resources. Victims are often excluded from financial decision-making as well.   

Financial abuse is common in domestic abuse and elder abuse where the spouse’s or elderly parents’ access to financial resources are being controlled. Financial abuse traps victims in the abusive relationship as they do not have the resources to survive by themselves.  

What are the signs?  

Some signs of financial abuse include controlling expenses and allowance without seeking one’s opinion or advice, have access to one’s bank account, creating joint bank accounts, using one’s money without permission or agreement, or sabotaging one’s opportunities to acquire a job or promote. 

---

Ways to support someone I know who is being abused:

1. Help them prioritize their safety 

Safety of the victim is of utmost priority. Help victims of abuse stay safe, especially those who are physically abused and/or are isolated at home. Check in with their safety at times and ensure that they are okay.  

In the case where you cannot contact them for a few days or if you see that the victim has incurred serious physical and psychological hurt, please inform the police so that the victim can be separated and kept safe from the perpetuator.

You can work together with the victim to come up with a safety plan as well. A safety plan is a code used by the victim to signal that they are in danger. This code should not be revealed to the perpetuator to ensure the safety of the victim. 

2. Help them seek professional help if needed 

Encourage them to approach someone who can offer professional guidance and advice. If they are willing and consent to getting professional help, you can help them contact the relevant helplines if necessary.   

If consulting relevant professionals seems intimidating and overwhelming for the victim, offer to accompany them for the visits as well.  

3. Lend support to them  

Lend them a listening ear and let them know you are there for them. Support is important for the victims as they will know that they are not alone and they can turn to someone else for help.   

Often, perpetuators of abuse aim to make the victims feel bad about themselves so they can easily manipulate them. They tend to limit the victims’ access to social or financial resources (e.g. through isolating them from their friends or preventing them from getting a job) so they have no choice but to be dependent on them. Victims then develop learned helplessness and often find it hard to leave an abusive relationship. Knowing they have someone else to rely on other than the perpetuators is thus a great source of strength and courage to them.  

---

What should I not do if I know someone who is being abused? 

1. Do not trivialize and invalidate their experiences and feelings 

Opening up and sharing about being abused take a lot of courage. If an abuse victim confides in you, treat their call for help seriously and do not make insensitive jokes or remarks that would make them feel worse about themselves and more afraid to approach others for help. Always be emotionally accessible and non-judgmental when a victim shares about their experience.  

2. Do not blame them for their abuse 

Victims are never responsible of the other party’s abusive behaviors as we are all accountable for our own actions. Instead, help victims know that we are all deserving to be treated with respect and dignity, and abuse should not be justified by any reasons. 

3. Do not make decisions for them   

They have the right to make independent decisions for themselves. Do not force them to leave the perpetuator. It is difficult for victims to walk out of an abusive relationship, especially if they are emotionally, legally or financially tied to the perpetuator.  

However, regardless of their decisions, let them know you will be here for them. Try your best to reason with them and talk them through calmly, but ultimately, they have to make the choice for themselves. 

What Are Cognitive Biases and How to Deal With Them

As human beings, we often fall prey various types of cognitive biases. As the word “bias” tends to have a negative connotation, many people often think that biases are a bad thing. You may be surprised, however, that these biases have actually evolved to serve many adaptive functions. 

Here’s a list of common cognitive biases and how you can avoid or overcome them:

Confirmation Bias 

We have the tendency to look out for and favor information that confirms our beliefs and values, all while ignoring or dismissing information that tells us otherwise. This is known as confirmation bias. It is in the human nature to want to be right. As such, we are prone to selecting information that aligns with our beliefs, making us believe what we want to believe. 

We have this bias to reduce cognitive dissonance — the discomfort we feel when faced with conflicting beliefs. To reduce this discomfort, our brain fine tunes the information that we take in, such that we only take in bits of information confirming that we are right. This bias also protects our self-esteem as it makes our beliefs seem more accurate. Thinking that we are right boosts our self-confidence and make us have a more positive self-image.  

However, it is important to be open-minded, to let your opinions be challenged, and to consider alternative perspectives. One way to avoid falling prey to the confirmation bias is to surround yourself with diverse groups of people and to be exposed to differing views.  

Hindsight Bias 

“I knew it all along!” “I told you this would happen!”

If you find yourself saying things like these, you are probably engaging in hindsight bias. As the saying goes, “hindsight is always 20/20”. Hindsight bias refers to the tendency to perceive events as more predictable than they really are and this usually happens after the events have already occurred.  

Similar to the confirmation bias, the hindsight bias helps to boost our self-confidence as it feels good to know that we accurately predicted something.  

Here are some things to keep in mind to avoid the hindsight bias. First, we should not only limit ourselves to one outcome but consider alternative outcomes as well. Next, reasoning why an event occurred can also help us realize that the event was not as predictable as we thought it was. For instance, we think that Team A will be the winner of a soccer competition. However, in reality, Team B had better players but their ace players decided to withdraw from the game at the very last minute that day. Team A eventually won and we think that we knew it right from the start. After reasoning that Team A may have won because of unforeseen events, we can see that the event of Team A winning is not that predictable after all. 

Negativity Bias

Negativity bias refers to the tendency to focus on negative events and stimuli more than positive ones. These negative events also stick to our memories for a longer period of time and influence the decisions we make. 

In the past, our ancestors had to hunt for food and compete to survive. Therefore, negativity bias was adaptive as it helped them remain alert to anything that could have potentially threatened their survival and well-being. However, today, this hard-wired tendency to focus on negative events is no longer as helpful to us. In fact, paying too much attention to negative events may trigger negative emotions and increased rumination.  

One way to avoid the negativity bias is to reinterpret negative events in a more positive light. For instance, we can shift our focus to the takeaways we can learn from a particular negative event. This way, we are reframing a negative event into a positive one.  

Self-Serving Bias 

Self-serving bias is the tendency to take credit for the positive outcomes we have experienced, but blame external factors for the negative outcomes. When we take credit for the positive outcomes and events that happen to us, this helps to boost our confidence. On the other hand, blaming external factors when we experience negative events helps to protect our self-esteem. However, the self-serving bias can backfire if we constantly point fingers at others or blame our own poor performance on situational factors - doing so hinders us from learning and growing as a person.

To avoid committing self-serving bias, it is important to learn from our mistakes and reflect on how we can improve. We should also not forget to credit others for our own success as well.  

Fundamental Attribution Error (FAE) 

FAE is the tendency to attribute others’ actions to internal factors and dispositional traits (e.g. their personality), while attributing our own behaviors to external situational factors that are beyond our control. For instance, when the whole class performed badly for an examination, we blame our own poor performance on a bad night’s sleep (an external factor) but think others did not perform well because they did not study hard enough (an internal factor). 

FAE can be adaptive as it protects our self-esteem by attributing negative events we have experienced to uncontrollable external factors but does the opposite for others. This makes us feel better than others and also does not make us feel disheartened when we experience negative events. However, excessive FAE can lead to the creation or perpetuation of stereotypes and prejudice.

To avoid FAE, we have to make a deliberate effort to put ourselves in the shoes of others and try to obtain a balanced view of others.  

Spotlight Effect 

The spotlight effect is the tendency to overestimate how much others observe and judge us. As the term suggests, it is the tendency to feel that the spotlight is on us all the time as though we are actors on a stage, especially focusing on our flaws, weakness and mistakes. The spotlight effect is highly correlated to feelings of nervousness and embarrassment. In some cases, it even leads to social anxiety and withdrawal.  

One way to avoid the spotlight effect is to recognize that everyone is preoccupied with their own matters (e.g. talking to their friends, focusing on their worries). Therefore, contrary to our beliefs, other people are unlikely to have the time to notice us and the things we do. Even if they did, they are unlikely to remember our mistakes for long.  

Being aware of the biases helps!

Interestingly, studies have also found that when people are aware of such biases, they are less susceptible to them. Why is this so? Simply put, when we are more aware about the existence of such biases, we end up making an intentional effort to avoid falling into their trap. Therefore, by simply knowing that these biases exist and exactly what these biases are, we are less likely to fall prey to them. 

Pandemic Fatigue

What is Pandemic Fatigue? What are some signs of it?

“Pandemic Fatigue” refers to a mental state where a prolonged, heightened state of fear & caution leads to a form of burnout. 

Pandemic Fatigue presents itself differently in different people. Here are some ways that it might manifest:

Ψ Feeling physically numb and socially withdrawn
Ψ Becoming irritable, sensitive, or impatient
Ψ Becoming less diligent about COVID-19 prevention measures such as handwashing, wearing a mask, or observing social distancing norms.
Ψ Reduced enjoyment from activities you used to like
Ψ Consumption more “comfort food” or alcohol
Ψ Constantly feeling tired and yet experiencing difficulties getting a good night’s sleep.

Why do we feel this way?

Different people are likely to experience pandemic fatigue at different periods of time. People who were affected by the pandemic or who entered into the heightened state of caution at an early stage are likely to experience an earlier onset of pandemic fatigue. Persons who did not witness first-hand the effects of the pandemic, or who were compulsorily subjected to precautionary or prevention measures without understanding the need for such measures, might also experience pandemic fatigue earlier.  

Feelings of complacency might also begin to emerge due to desensitisation through extended media exposure to COVID-19. Much like the principles behind exposure therapy, repeated exposure to pandemic-related news will eventually diminish the initial feelings of anxiety and caution. Consequently, we may begin to engage in behaviours that were initially inhibited by the anxiety responses such as not adhering to safe distancing rules or washing our hands as regularly as we did before. 

A toll on our emotions and mental health

Pandemic prevention measures such as social avoidance and distancing can make people feel isolated, lonely, and increase stress and anxiety. Long term worries about a pandemic takes a toll on your mental and emotional health and might result in the worsening of mental health conditions and chronic health problems. Changes in mood, tastes and preferences, sleeping patterns, increased use and reliance on substances such as alcohol and tobacco are typical effects. 

A prolonged stress response is also detrimental to the body as it disrupts the body’s natural functions. While natural stress hormones such as cortisol and adrenaline are useful body functions that brings about short term benefits (e.g., enhanced brain function, increased energy for immediate muscle action), long term stress might result in headaches, an inability to focus, digestive issues, insomnia, and a weakened immune system. This ultimately affects our overall daily functioning. 

I’m struggling with this “new normal”. How can I better adapt to this situation?

One suggestion is to adopt a “journey mindset”! Trying to predict when COVID-19 will end can be frustrating as it is surrounded by so much uncertainty; we should focus instead on the quality of the touchpoints in our daily lives. Try and make small improvements to each of these touchpoints, regardless of whether it is directly related to the pandemic (e.g. making an effort to pay more attention to social distancing in public places, not touching your face while in public) or to your own personal growth (e.g. mindful interactions with your interpersonal relationships, picking up a new skill or hobby). It is also helpful to lean on our social circles for mutual support through this difficult time. 

Some other suggestions include: 

Ψ Establishing fixed points in your daily routine (e.g. work, meals, family obligations), & fill up the other times with solo or group activities that you enjoy. 
Ψ If permissible, step outside of your house for occasional sunlight and fresh air, even if it is for a short while.
Ψ Limiting over-exposure to COVID-19 related news, especially when it feels too overwhelming. 
Ψ Managing your expectations of yourself and others. Recognise that the pandemic affects everyone in different ways. 

Don’t forget to create little pockets of fun and joy in your routine by doing things you enjoy such as a baking day once a week, or a self-care hour alternate day, or perhaps a virtual meeting with your friends every Sunday evening over drinks. 

How do I overcome feelings of isolation and loneliness?

In general, feelings of loneliness can be caused by the loss of one’s sense of purpose. This usually happens when boredom is coupled with feelings of a lost sense of self.

Here are some suggestions that you may find helpful in overcoming such feelings:

Ψ Reintroduce meaning and importance into your days by signing up for an online webinar or course to learn a new skill or upgrade yourself.
Ψ Check in with your loved ones frequently.
Ψ Do not be ashamed to ask for help if needed. If opportunities for real-life interactions are limited, connect with others on virtual support groups, communities, and even telehealth platforms.
Ψ Offering a helping hand to others can help us feel connected to others. 
Ψ During this time, there are also others that would benefit from your acts of kindness. Even if you do not feel “100%” or feel that you are unable to offer any real support, the mere act of showing concern and spending a few minutes each day with your loved ones will be deeply appreciated. 
Ψ Keep your mind stimulated with “active” hobbies such as playing an instrument, painting, or cooking, as opposed to more passive activities such as binge watching a Netflix show.
Ψ Turn more passive activities (e.g. reading) into something more engaging by creating or joining a virtual book club with your friends or an online community. 

Do not hesitate to seek help if you feel overwhelmed or when you simply need some guidance or someone to work through your thoughts and emotions with you. Seeking help is especially important if you find that your it is affecting your daily functioning to a large extent for an extended period and/or you are beginning to constantly experience feelings of worthlessness, hopelessness, panic attacks, or other atypical symptoms. 

Psychological Impacts of COVID-19 on the Elderly

The government announced on 10 March 2020 that it was suspending activities for seniors for 14 days, affecting some 290,000 participants. Current projections suggest that our fight against COVID-19 will be a long one, and suspensions like these form part of the measures necessary to slow and contain the spread of COVID-19.

(excerpts published as ‘Hello interaction, goodbye isolation’ in the Straits Times on 16 March 2020)

Although necessary, suspending communal activities presents our seniors with unique challenges, especially to their mental health. While a 14-day suspension may not result in the mental health issues brought about by isolation or loneliness, without knowing when our fight against the virus ends, we must be able to talk frankly about the impacts of our measures on our seniors.

The immediate impact of a suspension of activities on seniors is the fear of isolation or loneliness. Isolation or loneliness is a subjective concept and immensely personal in nature; seniors may view the temporary suspension of communal activities or the occasional loneliness as a form of isolation, even though they may in fact continue to have access to their family and friends. No matter the reality, their subjective reality is enough to trigger the detrimental effects of isolation.

There is a strong link between isolation and morbidity.

Morbidity is a term used by mental and other health professionals to describe illness or disease. In fact, isolation is used as one of the risk factors in predicting the development of morbidity. The detrimental effects of isolation are even more pronounced in seniors, where the protective factors of employment, access to technology, and strong social support networks, do not generally exist. By contrast, seniors are often associated with risk factors such as frailty and neurodegenerative disorders, or the lack of strong social support networks.

Sustained isolation brings about increased levels of stress and emotional distress, which in turn puts physical and mental strains on the body. Specific examples of illnesses and diseases that are associated with isolation include depression, Alzheimer’s disease, heart disease, including high blood pressure, and a general decline in cognitive functioning. One longitudinal study in Singapore found that isolation was associated with a greater risk of death in Singapore and was more predictive of mortality than even living arrangements or social networks. With more than 41,000 seniors above the age of 65 living alone in Singapore in 2015, we must take care that we do not mitigate an immediate crisis by substituting it for a longer term one. The number of seniors above the age of 65 living alone is projected to increase to 83,000 by 2030.

However, our seniors do not merely face the feelings of isolation or loneliness. As much remains unknown about COVID-19, there is also a general anxiety among the population, including seniors, about its prognosis and mortality rates. In the face of escalating case numbers and fatalities amidst the widespread media coverage on COVID-19 especially among the vulnerable and the elderly, given that much remains unknown about the novel coronavirus, it is inevitable that fears of dying and death are stoked. And when combined with the effects of isolation or loneliness and being unable to externalise their anxieties, the anxieties and isolation become more pronounced.

To cope with their anxiety and low mood, our seniors may develop unhealthy coping behaviours such as excessive smoking or drinking, maintain a poor diet, or experience a decline in exercise or physical activity.

These behaviours are unhelpful and contribute to other long-term health issues, and they tend to persist even after the period of isolation is over. We must therefore continue to keep an eye out for our seniors, given especially that no one can accurately predict how COVID-19 will continue to impact us.

However, it is not easy to design alternative activities to allow our seniors to continue to feel engaged outside of their usual social settings. Seniors hold on very dearly to their sense of independence and freedom, to the extent that some seniors may choose to live by themselves or away from their families. These seniors tend to form strong external social networks, and the communities that they participate in become an integral part of their identity and serves as a powerful protective factor against the detrimental effects of isolation.

It is important to remember that many seniors take part in community activities as a way to cope with their unique set of circumstances in the first place. In recognition of the role that strong social networks play in combating depression and isolation, many of these activities were specifically designed to promote “gotong royong” or a sense of community.

It is commendable that extensive efforts have been made to extend these activities to all our seniors, given that strong social networks have been found to be effective in reducing symptoms of depression. Seniors who were engaged in social activities were associated with positive health outcomes were more likely to be happier, live longer, and experience fulfilment. Furthermore, social activity also slows cognitive and physical decline. Like muscles in our body, our cognitive functions gradually weaken if it is not put to regular use. Retirees who had more social interaction and engagement through some form of work involvement or volunteering reported better cognitive performance, fewer depressive symptoms and overall better mental health and life satisfaction compared to those who did not.Other studies have also found that socialisation was associated with a delay in memory loss, cognitive impairment and reduced the risk of dementia.

Returning to the impact of the suspension of activities for seniors, the potential loneliness or isolation experienced from the suspension of a single routine activity cannot be considered “in isolation”. A change in a single key activity is a significant deviation that might impact on all their other activities for the day. For example, seniors typically structure their entire day around these activities that take place at the same place or activity centre, involving the usual suspects (i.e. their friends). While some seniors might be able to adapt or find substitutes for their routine activities, there will be many who find it difficult to give up routines that were honed through years of practice. Without a routine activity to “anchor” their day, seniors may not be able to plan or follow through on activities for the rest of their day,even if those activities have nothing to do with the routine activity.

One strategy is to give our seniors a sense of purpose;

that they are very much an important tool in Singapore’s fight against COVID-19. Providing seniors with accessible and regular updates on our fight against COVID-19 and empowering each senior with an individual action plan are useful measures that can help mitigate their sense of loss from the suspension of activities. For example, seniors could be appointed as COVID-19 ambassadors responsible for disseminating information on COVID-19 to their social networks, and to check-in regularly with other seniors to address or escalate any health or other concerns to the authorities. These informal social network models tap on existing social media and chat platforms and are already effectively employed in our armed forces to boost camaraderie and reduce AWOL numbers. Seniors can continue to engage one another in small coffeeshop groups,alleviating some of the impact from the suspensions. This approach is preferable to the usual prescriptive approaches of encouraging seniors to “look on the bright side”, as emotional regulation is a finite resource that is scarce in the battle against COVID-19 without an end date in sight.

Seniors should also be encouraged to maintain the non-affected portions of their daily routine. The gap created by the suspension of activities should be positively reframed as an opportunity to try new activities or crafts such as baking, gardening, mah-jong, reading or other individual activities that the person has always wanted to try. There are plenty of options available if seniors can be persuaded to perceive the gap as a welcomed development.

There is also a role for family and friends to play. Seniors who were previously very independent and mobile may develop feelings of isolation or loneliness now that they are unable to engage in their usual social activities. They must recognise the enhanced impact that COVID-19 has on seniors, and wherever possible increase the number of engagements with their senior family members or friend. Engagement may take the form of phone or video calls, visits, or small-group activities to keep our seniors socially active. This form of social interaction will go a long way in assuring our seniors that they are still cared for, and they can reach out for emotional or other support during their time of need. This will help to prevent and reduce negative feelings and thoughts that might arise from loneliness or isolation.If the feelings of isolation or loneliness persist, it is advisable to seek help from a mental health professional.

Lastly, we should remind our seniors that it is normal to feel distressed or isolated during this period. We should also ostensibly acknowledge that our seniors are making an important sacrifice and contribution to Singapore’s fight against COVID-19. Their sacrifice, together with our front-line workers and healthcare professionals, will keep us and our loved ones safe.

Back to All Notes

Religion and Therapy

Religion and Therapy

(and should they ever mix?)

There exists a long-standing debate on the compatibility of religion and psychotherapy.

Much like how religion and science are often viewed as antagonistic in their attempts to explain the human condition, religion and psychotherapy are often perceived to be at odds with each other in the mending of the psyche.

Given that over 80% of Singaporeans consider themselves religious, many patients are interested in discussing their religious concerns with their psychologist. Indeed, an extensive body of research has consistently demonstrated the benefits of religion on one’s mental health. When used in an appropriate context, it can enhance one’s stress resilience, impart meaning to life, and serves as a source of social support. People who are more religious have also been found to be less susceptible to depression and are better able to cope if they do become depressed.

However, we must respect the diametrically opposed starting points of psychology and religion, keeping in mind that the two disciplines have fundamentally disparate presuppositions, methodology, and social roles.

Thus, their conflation can lead to tension, misunderstanding, and unnecessary strive that diminishes the effectiveness of psychotherapy.

The introduction of spiritual and religious content into psychotherapy runs the risk of replacing, diluting or deviating from the evidence-based intervention models that undergird psychology as a scientific discipline. There is also the possibility that psychotherapists may unintentionally alter their clients’ religious values or beliefs. All of this could potentially undermine the therapeutic alliance.

Psychotherapy should not draw from any authority in any faith tradition but must instead be scientifically grounded and validated

Here are some do’s and don’t’s that every clinician should abide by:

Ψ A clinician must respect a patient’s religious faith and spiritual beliefs and commit to establishing a religion-agnostic and spiritually sensitive therapeutic relationship with patients.

Ψ Clinicians should and must strive to deliver psychological services taking into account the full circumstances of each patient, including any religious and spiritual beliefs and commitments.

Ψ A clinician must be deliberate in their attempts to learn about how their patients’ religion shapes their worldview, and how it affects their experience of and management of mental illness.

Ψ The importance of religion as a social institution and the central role that it plays in the lives of our clients must also be acknowledged by the clinician.

Ψ However, clinicians must be aware of the potential risks associated with integrating religious or spiritual interventions into clinical interventions. This means that religious and spiritual issues should not be the central focus of psychotherapy. A range of problems and ethical dilemmas usually accompany the unification of religion and psychotherapy and could seriously impede the attainment of efficacious and ethical intervention.

In the ultimate analysis, clinicians must provide psychotherapy in a religiously agnostic manner that does not promote any one religion or belief.

Back to All Notes

Alcohol and Sleep

Credit: FoundMyFitness Clips

Alcohol and (the lack of) Sleep

Alcoholic beverages are well-known for their sleep-inducing properties - thanks to the anti-anxiety properties of alcohol which help suppress arousal and stimulation - and are commonly used as an over-the-counter somnogen (which is just a fancy word for sleep aid).

Indeed, low doses of alcohol at around 1 to 2 standard drinks (one standard drink equates to one can of beer, half a glass of wine, or one nip of hard liquor) may help us to fall asleep faster, reduce the incidents of awakening shortly after we fall asleep, and increase the amount of time we spend in rapid eye movement (REM) sleep – the stage of sleep when our eyes dart around under our eyelids in a rapid movement, as its name suggests; it is also the stage when our memory is consolidated, and which helps with concentration and learning.

However, there is more to the story.

At moderate doses (2 to 4 standard drinks), alcohol reduces the amount of brain-boosting REM sleep. Doesn’t sound like a good recipe for a good night’s sleep, does it?

At high doses (more than 4 standard drinks), it can have a rebound effect on the later stages of sleep, leading to longer periods of awakening while also decreasing the amount of REM sleep. Now that is really bad.

Furthermore, since alcohol is a diuretic, which means that it acts as a signal to your kidneys to expel more water from your body, the consumption of alcohol prior to sleep is usually associated with frequent late-night toilet trips and sleep disturbances. Losing the extra fluid would also leave you feeling dehydrated.

Consuming moderate to high amounts of alcohol before bed can also constrict the air passage, leading to episodes of apnea, whereby a person's breathing is interrupted during sleep. The risk is heightened in those who have a tendency to snore in their sleep.

So, while small volumes of alcohol can help you to wind down after a busy day, too much of it can equal a fitful night's sleep.

At the end of the day, folks, you don’t have to drink to have a beery (… ok sorry) good sleep.

Back to All Notes

Survival Guide: The Holiday Season

As with the trains of the Deutsche Bahn, like clockwork, the holidays are upon us (again) this time of year. Many will be looking forward to the Christmas and New Year breaks; some will be bracing for the impending deluge of parties and festive foods, and yet others may take the opportunity to escape from the madness of it all (check out this handy guide on nearby destinations).

But some associate the holiday season with misery, stress or disappointment. And with good reason.  

Holidays are like a giant (salty) mirror that amplifies our daily struggles with loneliness, existential thoughts, or coming to terms with finances (yes, the holiday season can be expensive). Here are some techniques to help us enjoy the holiday season.

1.       Manage your expectations. Accept that there is no perfect way to enjoy a holiday. Nor does it have to be “as good as last year’s”. As circumstances change and evolve, and so too must our traditions and rituals. Cherish the important ones, but never at the expense of your mental well-being or your wallet. Be flexible about which traditions to change or hold on to. For example, Christmas or reunion dinners do not have to always be at the swankiest restaurant every year.

Back to All Notes

2.       Schedule “Worry” Time. Especially in a group or larger setting, it may be hard to not worry about what may go wrong during the get-together. Common refrains include: “What if nobody likes the food I prepared?”; “Aunt May is going to talk about her son’s PSLE score and ask me how my daughter did…”; or “Grandma is going to nag about my weight.”

To control the frequency of worry, try this.

First, identify all the tasks or items that are within your “sphere of influence”; essentially, matters that you can do something about. Identify what needs to be done and complete those tasks. You’ll start to feel a whole lot better once you make a checklist and tick them off.

Then tell yourself this: “there are always going to be things that are not within my influence. I am going to allow myself to worry about it, for no more than 10 minutes. But after these 10 minutes, I shall leave my worries for my tomorrow self to grapple with” (or similar words… but you get the idea).

The intent of this Cognitive-Behavioural Therapy (CBT) tool is to compartmentalise and contain worries that are not within your control to a designated period during the day, thereby freeing up your “head space” for important, relaxing or fun activities. This tool has been found to be clinically effective in managing worries.

3.       Social Support. Social support is a powerful tool for stress relief. Interpersonal communication among family members allow us to take each other’s stands and think of how we can help each other. At the same time, it also prevents misunderstanding from arising. For example, gift exchange may be a tradition, but it could be a stressor for one who is going through a financial difficulty. If getting a present for everyone in the household is going to cost a hefty amount, talking to your family member ahead of time about your situation is going to help. This is to seek their understandings and maybe adjust the tradition according to needs. Gift exchange can be changed to “secret santa” such that everyone has to only buy one present.

Back to All Notes

4.       Coping with Unexpected Situations. Things do not always go in our favour (or similar sounding words to that effect), said Murphy. Plans often go awry.

However, it may be (mathematically) easier to adjust the way you handle emotions than to change the way others react. For example, you can’t control the people who make you angry, but you can control your anger and what you do with it. Here are some ways to cope with anger or stressful situations:

Ψ Emotion-focused coping: Reduce negative emotions (i.e. anger, fear, anxiety, aggression, depression, humiliation) by practicing meditation or by writing them in a journal. Another way could be to picture said others as cartoons while they are spewing offensive things: it takes some of the hurt away.

Ψ Problem-focused strategies: Remove or reduce the cause of the stressor through problem-solving. In time of stressful situations, think calmly of how to change the situation.

5.       Reframe your thinking. As with any social setting involving more than one person, there will be many situations, interactions, and verbal and non-verbal cues that make us susceptible to distorted patterns of thinking (eloquently described in Mandarin as 胡思乱想).

The first step in identifying maladaptive thoughts is to develop an awareness when you start to recognise the patterns of thinking induced negative or stress-inducing patterns of thinking. For example, “They must be gossiping about me”, “Why are they looking at me like this? Is it because I am fat?”, “She is boasting about her son again, I must not lose” and so on. The second step is to challenge those thoughts. Are the things you're telling yourself even true? Also, what are some other ways to interpret the same set of events? Which ways of seeing things serve you better? Instead of seeing things the way you always have, challenge every negative thought, and see if you can adopt thoughts that fit your situation but reflect a more positive outlook.

Back to All Notes

6.       Avoid conflicts. Sometimes, what is needed is just to walk away. Walk away from your triggers by excusing yourself: “after hearing what you said, I need to defecate” or call a trusted friend to rant.

If an argument is occurring between two persons (and one of them is not you), avoid taking sides. During this season especially, monitor your alcohol intake and keep a clear head about you. Listen if you are called upon to do so but do not share confidential or private titbits with another.

Keep conversations light and optimistic. If you know the person you are talking to is a fervent Trump supporter, don’t provoke that person by invoking the good name of the 44th President of the United States.

7.       Just say no. The easiest the express but the hardest to do. If large gatherings cause you great amounts of stress, it is okay to say no. Just say no. Offer to catch up with those you wish to individually or in smaller groups. Or spread or defer your engagements over a longer period of time. There is no stipulation that says you must visit ALL of your family and friends during the actual holiday period.

8.       Absent family members. Keep in mind that some family members may not be able to attend because of various reasons such as illness, service in the military, studying abroad, financial burden or other reasons. Acknowledge their absence by including them.

If a beloved family member has died, do not ignore or minimise the loss. Be truthful about your feelings and share stories about your loved one. It can be cathartic for family members to mourn together in this way.

9.       Make decisions based on goals, relationships or values. Establish a set of values that you strongly believe in. Then rank your priorities and relationships and make decisions based on them. For example, if controlling your spending has been an issue, make a budget plan and stick to it. If you are a family-oriented person, make more time for your family instead of packing your holiday schedule with colleagues or friends. If you believe that the way you have organising your time is not going to work, change it.

Practising mindfulness and interpersonal effectiveness skills will improve your ability to cope in social situations. Developing an honest understanding of yourself and your emotions, and focus on living in the present.

Back to All Notes

Coping with Sexual Assault

Credit: Millennials of Singapore

AWARE Sexual Assault Care Centre
6779 0282 (10AM to midnight, Mon-Fri)

KK Women's Hospital
6225 5554 (24 hours)

Singapore General Hospital
6222 3322

Tan Tock Seng Hospital
1800 7372 7500

Sexual assault is any unwanted sexual behaviour that makes a person feel uncomfortable, threatened or scared. Consent is key - if you did not consent to such behaviour, or withdrew your consent, and the other party continues to make unwelcome advances, that is sexual assault.

AWARE Singapore has also published a helpful resource on what sexual assault is.

If you are a victim of sexual assault, please don’t blame yourself for whatever that has happened to you.

No one has the right to violate you no matter how you dressed, or whether you are unconscious or not.

First Steps

Try and remember as much as you can about your surroundings when the assault occurred; the smallest details can make a huge difference. At the earliest opportunity, try and picture the offender’s face, features or clothing (distinct colours, features or brands for example).

If you were unconscious during the assault, try to remember what you can of what occurred before and after you became unconscious or assaulted, including your surroundings. Find out if there was anyone around whom you can ask for more information of what happened.

Lodge a police report and seek medical attention as soon as possible in case of STIs and pregnancy.

In order to gather and preserve evidence, a sexual assault forensic examination (commonly referred to as “rape kit exam”) can be done at either KK Women’s Hospital, Singapore General Hospital or Tan Tock Seng Hospital within 72 hours of the incident – these hospitals are best equipped to deal with sexual assault.

You are required to make a police report before doing the rape kit exam. If you are under the age of 21, your parent or legal guardian is required for the rape kit exam.

Although it is strongly advisable to make a police report and undergo the rape kit exam, do not feel that you must do so against your will (or at the insistence of your family or friends) if doing so causes you great distress. This may only end up worsening your mental health. Instead, persuade your loved ones to respect your decision.

Back to All Notes

Management

It is normal to feel strong emotions such as disgust or shame. Don’t avoid experiencing them.

Accepting that these feelings are unavoidable is the first step to managing what you are going through. When you are ready, open up about what happened to people you trust. In fact, keeping the fact of the assault all to yourself can be extremely suffocating.

There are countless testimonies published online (#MeToo movement) and support groups where survivors share their experiences – AWARE has one for female survivors (16 years of age and above) of sexual assault. You could hear from others on how they coped with their experiences. If you're not comfortable speaking to a group of people, you could share your story online anonymously with AimForZero or speak to a trusted friend. We all need an outlet somehow.

Sharing your experience and seeking comfort in the support of others can help you to cope with the debilitating incident. Here are some benefits of doing so:

Ψ Release pent up emotions
Ψ Receiving support from a support network (family, volunteers, welfare organisations)
Ψ Make sense of your thoughts and emotions
Ψ Greater clarity of what happened during the incident
Ψ One step closer to management
Ψ Spread awareness of this issue in society (without these small contributions, many others may continue to be oblivious)

Even if you really do not feel like confiding in someone, try and seek out at least one or two trusted confidants.

Back to All Notes

Acceptance (Not Avoidance!)

While it may be painful, recalling and accepting the incident is important. Avoidance only makes whatever you were avoiding more salient.

The harder you try to avoid it, the more likely that you will be reminded of it, or make it more salient in your head. Acceptance is not the same as blaming yourself for what happened. Rather, it includes being able to accept that what happened was out of your control.

Coping with Flashbacks

It is common to experience traumatic flashbacks. Prepare yourself by developing some awareness of possible triggers (e.g. certain smells). Once you are more aware of your triggers, it will help you make sense of what is happening and why.

During flashbacks, pay attention to physical sensations and what emotions you are feeling during these episodes. After, take steps to calm down, such as breathing exercises. Ground yourself in the present (e.g. tapping your arms, naming the current day) as this will help you realise that it is a flashback and not reality.

Don’t Isolate Yourself!

Stay connected with loved ones and join social activities. You don’t have to constantly talk about sexual assault or things related to it. You can do things that have nothing to do with the trauma itself.

If these activities bring you joy, they can be equally helpful. Participating in joyful activities isn’t avoidance. You can choose to accept that you are feeling low or down, and yet try to do something to lift your spirits.

Seek Professional Help

Sexual assault and trauma is linked to a bunch of mental disorders, depression, PTSD, anxiety disorders etc… If you feel unable to carry on with your everyday life due to the repercussions of the incident, seek help from a mental health professional.

Back to All Notes

For friends, family, loved ones of victims

Don’t blame them for whatever that has happened, pass judgments or express doubt on their story.

1. Be a listening ear. Listen to their narration of events, bearing in mind that effect of trauma may have had an adverse impact on their ability to accurately remember the relevant sequence of events.

2. Don’t downplay or trivialise the incident. This will (definitely) come across as doubting or invalidating their feelings. Let them feel whatever they must feel as part of their own process.

3. At an appropriate time, encourage them to seek help whenever they can (e.g. psychologists, counsellors), but let them do so on their own terms. Do not insist for them to seek help. Only encourage them to do so if it seems as though their distress is causing them to be unable to function daily or normally.

4. Provide emotional support whenever you can. A sexual assault experience can be extremely traumatic and effects can last for a long time. Think along the lines of “How can I be there for him/her?” rather than “What concrete steps do I need to take to help?”.

Back to All Notes

For others

Tips/Precautions

• Be mindful of your surroundings and the environment you are in. If necessary, take additional precautions if you have to walk in an unsafe area.

• Do not assume that someone else will look out for your safety. In bars or at parties, keep your drink with you. Leaving your drink unattended makes it possible for someone to spike them with date rape drugs or intoxicating alcohol. Know your limits and keep within them, especially when it comes to drinking in unfamiliar places. Being surrounded by familiar people does not make a place “familiar”.

• Sexual assault occurs even if you least expect it. Do not keep quiet if an assault is imminent. The shock may overwhelm and you may be too frightened, but always seek help immediately. Scream or shout for help if you have to.

How to contribute to the cause

• Stay current on sexual assault laws. By educating ourselves on the many forms and types of sexual assault, when they can happen and what safety nets we have in place in society, we become more knowledgeable on the issue and can either help spread awareness, or strive for change in the community.

• Become an advocate for sexual assault victims. You can start small – from sharing with your friends and family about your experiences (if any) and how you survived. You can volunteer for AWARE, join a movement or speak up about the issue whenever you can.

• Know how to respond to sexual assault cases. For example, if a stranger approaches you for help or if you witness something happening, don’t be an apathetic bystander. Help the person. With people being more alert and informed, offenders will be more afraid to act out. Deterrence may not completely stop sexual assault, but it can at least reduce the number of cases and victims.

A Brief Note on Grief

Credit: Megan Devine, Refuge in Grief

中文版

Grief is a natural response to loss

Grieving is a completely normal reaction to loss. The passing of a loved one, the loss of a treasured relationship, or loss of use of a physical ability, or perhaps something more intangible like an opportunity or aspiration.

Everyone’s processing of grief is different, and it takes time. Sometimes, lots of time. There are different theories on the various stages or trajectories of grief a person may go through. Regardless of which, some common emotions during grieving are:

Shock, numbness, disbelief. Guilt. Fear and anxiety. Or sadness; extreme sadness.

Questions such as “What could I have otherwise done?” or “What if this happens to someone else I love?” may fan the flames of the ever-present anxiety usually accompanying grief.

All these are intense emotions that are overwhelming. How to cope?:

Ψ Allow yourself to feel the full spectrum of emotions that awash you. Don’t let anyone tell you that it’s not okay to feel what you are feeling, be it sadness, fear, shock or any other emotion.
Ψ Take care of yourself – remember to eat well and exercise. If you have a routine, stick to it.
Ψ Be gentle with yourself. Forgive yourself for things you may have said or done (or did not say or do). We are, after all, only human.
Ψ Talk to peers. Remember your Tribe, and that you are not alone in this world.

When should you seek professional help?

It may be a good idea to seek therapy from a mental health professional if you feel:

Ψ The intense emotions aren’t subsiding.
Ψ You don’t feel capable of coping with the overwhelming emotions on a day-to-day basis.
Ψ You have trouble sleeping.
Ψ Your relationships are affected by your grief.
Ψ You feel continually sad, depressed or anxious over a period of time.

Therapy centred around coping with grief involves helping you come to terms with what has happened; to process, accept and allow yourself to feel the emotions you are feeling. Your clinical psychologists may also work towards helping you forgive yourself if you are feel immense guilt. Stress management and relaxation techniques can help to cope with feelings of anxiety. You may be asked to think about how your basic emotional needs, such as love and belonging, were met before the loss, how your needs have been compromised by your loss, and how new steps can be taken to meet your needs.

There are, of course, differences in the way each human processes grief; the therapeutic techniques used will vary between persons. However, as with all psychotherapy, processing grief and loss is very much a collaborative effort between you and your psychologist.

After a (suicide) Attempt

After an Attempt

Credit: As/Is

Get Help if you are feeling suicidal

Samaritans of Singapore
Tel: 1800-221-4444 (24hr)

Surviving a Suicide Attempt

A suicide attempt is extremely traumatic.

Survivors feel disorientated, lost, not knowing where and how to go from here on. Others may feel intense waves of fear, sadness or anger. Some, after experiencing these waves, become seemingly emotionless. Numb. It is natural to have such feelings and thoughts.

Here is a list of steps to follow after a suicide attempt:

Inform

Call a loved one or trusted friend right away.

Our ability to actively care for ourselves are greatly affected by the circumstances that give rise to the attempt in the first place. Having survived the attempt, this ability is further compromised. Which means that you are going to need support. Reach out immediately.

After informing, go to the nearest hospital or medical clinic to seek medical attention. Even if the attempt does not result in you suffering from any physical injury however minor, you should still seek medical attention.

What to do at the Hospital or Clinic

Knowing what to expect greatly reduces the anxiety that comes with waiting in a busy medical facility.

Firstly, emergency staff are trained to assess and manage any injuries requiring immediate medical attention. This is known as triage. After treating these injuries, they will then arrange for a mental health professional to meet and have a chat with you about your mental health status. This may include questions on your mood, the presence of recent major stressors, and any concerns with your daily functioning. This is really just to assess your mental state and look for any further risks that you may be facing.

Occasionally, the hospital may require a detailed review by doctors with different specialisations. Depending whether such doctor(s) are on hand, you may be warded for further observation or admitted into a ward.

Reaching out to your Tribe (my what?)

We often do not realise how many members of our tribe (your family, friends, colleagues, peers - anyone who is a part of your larger network) actually do care about our safety and well-being. Even if you don’t ordinarily consider them to be part of your support network.

It’s common for people to worry over what to say to others after the attempt. You may want to start a conversation only after you feel comfortable enough to share about your experience, and even then, you can control how much you want to share. Confiding in a support group that you trust and feel connected to helps you process the experience and suicidal thoughts, or make these thoughts easier to manage if they return.

Going forward

You may find it helpful to write down thoughts and helpful tips to make your transition period easier (“journalling”, for example). These include things like knowing what you can do to make it easier to cope with things in the days following your discharge from the hospital, knowing who in your social support network you can reach out to, and most importantly, having a plan for dealing with suicidal thoughts should they come up again.

Things can change for the better if you allow it to.

Most importantly, seek support from a mental health or counselling professional if you feel suicidal. They will work together with you to create a safety plan or finding ways to cope. Things can change for the better if you allow it to.