Burnout: The Secret Ingredient

Why Some People Get Burnt Out While Others Don’t

Do you dread going to work and feel exhausted by it?
Do you think that you are unable to perform at work?
Have you become more cynical or critical at work? 

If your answer to any of these questions is a “yes”, you might be experiencing burnout. These are the three dimensions characterizing burnout in an occupational context.

Burnout is not a psychological disorder, but an occupational phenomenon that negatively affects a person emotionally, physically, and mentally due to chronic workplace stress that has not been successfully managed.

Burnout affects 37% of Singaporeans in the working world. People working in high-intensity and emotionally taxing jobs, such as healthcare and law, are more susceptible to experiencing burnout. So what causes burnout to occur? 

Here are some factors commonly associated with burnout: 

  • Work-life imbalance  

  • Perceived lack of control in job-related decisions 

  • Dysfunctional workplace dynamic  

  • Lack of social support from family and friends 

  • Unrealistic expectations from higher-ups 

  • Lack of recognition for work done 

  • Long working hours  

“I’m burnt out, so what? So is everyone else right?”

Job burnout has significant consequences on both our physical and mental health, e.g. increased vulnerability to illnesses, alcohol or substance misuse, insomnia, and depressive symptoms. Professional consequences such as job satisfaction and absenteeism may arise as well. These consequences have detrimental impacts on our lives and it ought to be taken seriously. Burnout is unlikely to resolve by itself and will only worsen if it is not addressed. It can last from weeks to even years! Therefore, we should take active steps to prevent burnout or address burnout as soon as possible and seek help whenever needed.

Everyone experiences stress at various points in our lives and we know that stress often leads to burnout. If that’s the case, why doesn’t everyone experience burnout? Why do some people get burnt out while others do not?

The secret ingredient is emotional intelligence (EI).


Emotional intelligence is the ability to control the emotions of oneself and others, to distinguish them from each other, and to apply this information to guide one’s own thinking and action. Research has shown that people with high EI tend to better cope with stress and achieve individual success, thereby preventing burnouts, while people with low EI are more likely to experience burnouts.

Let’s take a look at how the four aspects of EI helps to prevent burnout:

1. The ability to accurately perceive, assess, and express emotions 

Being self-aware of your emotions helps in understanding the sources of your feelings, attitudes, and rationales, as well as their effect on others. This will enhance your ability to seek different responses and avoid pent-up negative emotions that would lead to burnouts.  

2. The ability to promote thinking using emotions

Changing our perspective of a situation can help relieve stress as we see a troubling issue as just a problem to solve. Directing our negative emotions such as anxiety and frustration into problem-solving mode rather than allowing the situation to affect us during and after work will prevent us from feeling stressed up constantly. The ability to think before you act in an emotional event would allow you to find suitable solutions more quickly and apply emotional resources reasonably, thus minimizing the possibility of failure. 

3. The ability to understand emotion and emotional knowledge 

Empathy enables us to recognize, understand, and care about others and their emotional reactions. As we experience the world through others’ perspectives, we enhance our ability to gain trust and influence others. This means that we are likely to find the help we need when our stress level gets out of hand.

4. The ability to regulate and manage emotions.

Adjusting our perception of the work environment and the emotional stimuli from the environment enable us to remain calm, control impulses, and behave appropriately under stress. This prevents us from acting rashly or making any impulse decisions. Some people can even regulate the intensity and duration of certain emotional experiences to accomplish what they want to achieve.

“Well, I understand that emotional intelligence is important, but what should I do to cope with burnout? What can I do to manage my emotions?”

Fret not, we’ve got some practical tips for you! Let’s take a look at how we can manage stress and avoid burnout:

Ψ Don’t be too harsh on yourself

We often put immense pressure on ourselves to do better at work or to seem productive at all times, especially for those who have high expectations of themselves. Many times we overthink or become anxious for situations that have yet to come or might not even happen at all. We understand that sometimes we can't help but place high levels of stress on ourselves, especially in a society that places a great emphasis on performance and to always be prepared. However, it is equally important to treat yourself kindly. We should strive to strike a balance between performance and our well-being. Performance is important, but without you, there can be no performance. We should celebrate our small victories and milestones, not be afraid to take breaks whenever necessary and practice mindfulness when we catch ourselves overthinking or being anxious, as we continue to work hard through our journey. 

Ψ Mindfulness  

Engaging in mindfulness practices is proven to reduce anxiety and relieve stress, and is increasingly used to reduce the risk of burnouts. Here is an example of a mindfulness activity that you can practice for a few minutes each day: To stay focused on your breath flow, and be fully aware of your senses and feelings at the moment. This can be hard at first, but practice makes perfect! This practice would allow us to face situations with an open mind and remain calm, fully aware of our thoughts and emotions so as to act rationally and come up with suitable solutions.

Ψ Know your limits

It is important to know how much workload you can take on just like knowing how much you can eat in a meal. You can get indigestion if you eat too much and similarly, you will suffer consequences when you overestimate your abilities. Discuss with your supervisor to reach a compromisation of work to be done and expectations to be met, or seek help if the demands are beyond your capabilities. Set goals and to-do lists based on the urgency and important matrix to avoid being overwhelmed with work all the time.  

Ψ Change your perspective of the situation

Do you perceive the situation to negatively impact the things that you value? Or do you see it as just another problem to solve at work? Reevaluating your perspective to determine whether you are feeling distress or eustress can greatly influence your stress level. An issue that causes you to be stressed out at work can be seen as a challenge to improve yourself that should not bother you after work. 

Ψ Seek social support 

Don’t hesitate to ask for help when you need it! Reach out to any of your family members, friends, or co-workers whenever you feel overwhelmed. The support you can get from them might just be what you need to pull through. If your company provides an employee assistance program, don’t be afraid to take advantage of such services. You may also wish to seek professional help with one of our clinical psychologists to help cope with your burnouts or any other issues you have affecting your mental health!

You are not alone. Annabelle Psychology is home to Care for Yourself™ - an employer-funded Employee Assistance Program. This program provides employees and managers with access to counselling and psychological services based in Singapore to help them manage personal and work-based issues. For more information, click here.

Struggling With Food During Festive Seasons

How can you cope with disordered eating when surrounded by food?

Food has traditionally facilitated social interactions throughout human history.

It is no surprise then that food is integral to many holidays we celebrate, such as Chinese New Year reunion dinners (cue lou hei celebrations – but no verbal exhortations whether or not auspicious or propitious!), Thanksgiving feasts (think Turkey), or Iftar (or more commonly known as “buka puasa”) where we get to stuff ourselves with the delicious rendang that Nenek makes. 

Having to face these delicious foods would make most drool, but for someone with an eating disorder, this could be a terrifying experience. Being in a situation abundant with food is likely to trigger anxious thoughts in someone with an eating disorder, especially if they have only just begun the recovery process. The enticing smell of good food, abundance of appetising snacks, pressure of having to eat and judgment from relatives adds stress on top of the person’s struggle to handle their eating disorder. For example, people with binge eating urges might find it difficult to control their urges when faced with large amounts of food. Coupled with the provoking questions relatives tend to ask (“ah girl ah, you so thin why you never eat anything at all ah?”), it is only normal that negative thoughts begin to surface.  

But what are eating disorders? 

Eating disorders are psychological conditions characterised by unhealthy and disordered eating habits and are often associated with anxiety and depression.


Social media’s relentless portrayal of extreme thinness as the ideal standard of beauty has been named as one major factor responsible for the increasing prevalence of eating disorders. Another major cause of Eating Disorders is the desire for absolute control over an aspect of their lives - especially the individual has little to no control over other things. 

The three common presentations of eating disorders are: 

Ψ Anorexia Nervosa: persistent restriction of energy intake below minimal requirements

Ψ Bulimia Nervosa: binge eating with compensatory behaviours to prevent weight gain such as purging, fasting, or excessive exercise

Ψ Binge Eating Disorder: binge eating without compensatory behaviours

 
 

So how can we cope or help those around us cope with their eating disorders during such trying times? Here are some tips you can adopt or help your friend with.

1. Form a support network 

One doesn’t have to go through the struggle alone. If you’re suffering from an eating disorder, turn to a friend and reach out whenever you experience your triggers. Share your feelings and talk about them.

If someone close to you is going through a tough time, be there for them. Ask about their thoughts and feelings at the moment and actively listen to what they have to say. Acknowledge and validate the feelings that they are experiencing. It’s okay if you don’t understand what they are going through, just being there is enough for them. Avoid making judgments about their body shape or passing commenting on the choice or quality of food (eg. fat content, calories, etc).

2. Come up with a sustainable plan  

Come up with a plan for situations you anticipate might be stressful and list ways to overcome them. Think about your potential triggers and come up ways to cope. For example, if sitting near a particular relative triggers your urge to watch what you eat for fear or judgement or reprisal, it’s alright to (politely) move away and sit someplace else.

Your plan can also include foods you want to eat or wish to avoid. Employ helpful coping statements such as “I don’t have to eat all of this food now because I am in control of myself” or “I don’t have to restrict myself from having this food because I have a plan, and I know that my plan works”.

Give yourself permission to eat whatever you feel like eating, within reason of course. By unnecessarily restricting your intake of certain foods, it could lead you to feeling out of control and powerless around food. Instead, give yourself permission to enjoy the food in front of you and remind yourself of your coping statements.

3. Practice mindful eating  

Enjoy your food in a different manner. Slow down your eating process and think about what you’re eating and where your food comes from. Describe them in terms of their taste, texture or smell and savour the experience. Choose a few foods and repeat this process, each time thinking about what and why you enjoy them.

Mindful eating is also recognising when your body is full. Our bodies send a signal to our brains when it is full, but this signal arrives at our brain only after about 20 minutes. Learn to recognise and differentiate what are your body’s hunger signals versus your emotional hunger triggers.

4. Have some self-compassion  

It is incredibly brave to face a situation like this head-on. Recognise that you are stepping out of your comfort zone and challenging your unhealthy thoughts and behaviours. It’s alright if you don’t succeed at first in your plans. You are strong and extremely courageous for doing this!

Instagram Therapy

Is it Therapy?

Is Instagram therapy enough?

It is important to first clarify is that “Instagram therapy” is not a form of psychotherapy. In fact, it is not “therapy” at all!

Psychotherapy requires committed engagement with trained psychologists who utilise evidence-based techniques and approaches to investigate a mental health concern and work with the client collaboratively to reduce or minimise the impairment or impact of the mental health concern. Therapy must be specific and customised as no two persons are completely alike; we each have unique life experiences and circumstances.

This means that the content or engagement published on Instagram or Facebook should not be regarded as therapy. At best, such content should be regarded as a type of psychoeducational content.

And as with all other kinds of purported educational content, we must think about how the content is delivered and whether they are credible or helpful.

According to the internet, there are roughly 1 billion users on Instagram, 1.2 billion users on Tik Tok, and 2.9 billion users on Facebook. Social media has become a ubiquitous medium for content consumption that can be harnessed for a good cause.

But not everything you read might be applicable or useful, or worse, true.

Many users of social media use these platforms to follow or create interesting content, advance personal or professional goals, or associate with like-minded people. It should come as no surprise that content creators want to create content that users want to consume, focusing on the usual metrics of increasing likes and followers or monetising their followers. There is a ton of mental health information that is shared online every day, often by self-proclaimed experts with little experience, research, or actual clinical practice, often with the aim of gaining followers or likes.

Over time, many come to rely on these celebrity psychologists for their ‘daily dose’ and mistaking that as a connection with the psychologist on some level, or worse, regarding that content as online or group therapy.

Some say that mental health channels on social media are like self-help books: addictive, unhelpful, and designed to keep you coming back for more.

It is against this backdrop that we should analyse things that we consume on the internet.

So when you next scroll through the pages of your favourite Instagram Therapists or Psychologists, please bear these in mind:

Ψ Is the content from a reliable source?
Ψ What are the factors motivating the content creator to produce this content?
Ψ Does this person spend more time on clinical practice or on social media?

Also:

Ψ Social media is not a substitute for therapy.

  • Reading information online can help you understand or learn something about yourself, but it is not a replacement for formal therapy.

Ψ No therapy can be done over social media.

  • While well-meaning psychologists might create content to educate the general public, others blindly produce or reproduce material to attract likes and followers with the intention of aggressively promoting their services.

Ψ Social media should not be relied upon during a crisis.

  • Such content should be viewed purely for what they are – generic, non-specific and informational in nature that serves a vital psychoeducational purpose within the community.

  • Because non-mental health professionals are very likely the target audience of such psychoeducational material, it must go without saying that psychologists and other mental health professionals should abide by regulatory, professional, and ethical guidelines when dispensing mental health information whether on online or during clinical practice.

When presented responsibly, psychologists on social media help to break the stigma associated with mental health. They break down complex mental health conditions into digestible bite chunks for any person with a smart device to consume. They explain difficult psychological disorders and concepts with infographics, animation, and beautiful pictures. The amount of useful information that is put out by some of these professionals who have dedicated years of their lives to acquire their knowledge and expertise is staggering.

And of course, some are visually beautiful presented and simply a delight to consume.

Keep calm and scroll on!

 

Annabelle

Dealing with Work Stress

Work Stress

When stress becomes excessive

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It is important to know that it is normal to feel stressed from time to time. Some people find that stress is an excellent motivator at work, but there can be too much of good thing.

There are many reasons why work might be a source of stress. Perhaps a relationship at work is causing us sleepless nights, or we were passed over for that promised promotion, or our ever-increasing workload has become a problem. In our new reality, given that working from home has become part of our working lives, we might struggle with working from home because of an unconducive home environment. Or perhaps we might struggle from how different everything has become after the pandemic.

Whatever the reason, it’s important that we identify and address these stressors. Do any of these symptoms of unhealthy stress apply to you?

If work is causing you to experience unhealthy levels of stress to the point that it impedes your daily functioning, there are some practical steps you can take to address work stress. You could:

Ψ Speak to your employer. Have a conversation with your line manager and openly discuss any problems you’re having at work. Stress often decreases your ability to work productively – your supervisor has an incentive to ensure your health and comfort. 

Ψ Talk to a trusted friend or family member. Often times, accepting help from others could allow you to manage stress better. You might feel better if you have a strong support system to rely on when things feel difficult. 

Ψ Establish boundaries. Consider some level of separation between your home and professional life. For example, not being contactable at weekends or not checking work e-mails at home. Establishing a work-life balance takes time and effort, but the results will pay off eventually. 

Ψ Take some time off work. It’s important that you take time off for yourself occasionally. Doing this prevents overwork and burnout. Disconnecting in a way that fits your needs and preferences allows you to return to work in a better state. 

Ψ Reconsider negative thoughts. When you’re stressed, it’s easy to develop tunnel vision. You might start overgeneralising (e.g. everyone is always like this), magnifying (e.g. I couldn’t do this and therefore I’m incompetent), or minimising (e.g. My boss complimented me but I’m sure he didn’t mean it). These thinking patterns are unhealthy and may lead to further stress. But with conscious effort you can reconsider and reframe negative thoughts, thereby relieving stress. 

Ψ Develop healthy coping mechanisms. It might be tempting to crack open a beer or reach for another cigarette, but these coping mechanisms might lead to negative consequences like poorer health. You might consider exercising more often or other relaxation methods to deal with your stress instead. 

If you do not find that these methods work for you or if you are concerned about the high levels of stress you are facing, our clinical psychologists at Annabelle Psychology are here to help and work with you in an empathetic and collaborative manner to help you best cope with the stressors you experience. Should you have any inquiries, please feel free to contact us and find out more!

Recognising Suicide Risk

Recognising Suicide Risk, Protecting Human Lives

What are the signs associated with suicide risk?


Suicide is among the leading cause of death among the younger population aged 10 to 29 in Singapore. In fact, there has been a rising trend of suicide, with the reported figure of 397 in 2018 being a 10% increase from the year before. This figure is 2.8 times higher than the number of transport accidents in the same year.

Numerous studies found that: 

  1. Most individuals who have suicidal ideation have mixed feelings about suicide; and 

  2. They may seek help before a suicide attempt. 

As concerned family and friends, we must be attuned to some of the signs associated with suicide risk:

Ψ Health Conditions: 

People with chronic or terminal illnesses, as well as mental health conditions, may experience a sense of hopelessness about their life and future, putting them at a higher risk of suicide. 


Ψ Situational Stressors: 

People who are going through difficult and stressful events, such as divorce, unemployment, imprisonment, or exposure to violence and death, are at a higher risk for suicide. These events may also place the individuals at a higher risk for developing psychological disorders that could affect their perception.

On top of that, people with a history of substance abuse, physical or sexual abuse, social isolation, and past suicide attempts are also at a higher risk for suicide. 


Ψ Verbal Cues: 

Regardless of what you may think about suicide threats, never take them lightly. When someone you know say that they don’t want to live anymore, it should be taken as a warning sign. 

The following are other common verbal cues associated with clinical depression and suicidal ideation to look out for: 

  • Using more first-person pronouns (e.g., I, me, myself): This is reflective of someone who is focused inwardly, which is typically observed in people with high awareness and experience of psychological pain. 

  • Using more absolute terms (e.g., always, never): People who are clinically depressed tend to hold a black-and-white (or all-or-nothing) thinking pattern, suggesting impaired judgement and reasoning. 

  • Speech characterised by guilt and self-blame, isolation and loneliness, as well as feeling tired, trapped and being a burden: When someone is experiencing a lot of pain, each day may seem like a recurrence of the one before and they can find it increasingly difficult to get by as they are unable to break out of the negative loop. 


Ψ Behavioural signs: 

Take note if you notice someone you know starting to withdraw from others, neglect their physical appearance or lose interest in activities that they used to find pleasure in. People who have thoughts of suicide also typically give away their treasured possessions, or make a conscious effort to visit their family members and close friends out of the blue. These are common signs of suicide preparations, such as having closure or saying goodbye to loved ones. Other forms of suicide preparations include writing a will, researching on suicide methods, or writing a suicide note. 

How Can I Help? 

Contrary to popular belief, talking about suicide will not increase suicidal thoughts, or put the thought of suicide in their heads. In fact, speaking about it helps them know that there are people who are concerned about them, who would want to support and help. 

Granted, many of us are uncomfortable with the topic of suicide and we may not know how best to start a conversation about it. Here are some helpful: 

  • Invite them to talk about their difficulties and listen without judgement. Withhold the urge to problem-solve or give quick solutions. Remember, they are not looking for advice.

  • Check on what they have been doing to cope, and what resources they have available. 

  • Ask directly: “Are you having thoughts of suicide?” 

    • If they are, encourage them to seek immediate help. For example, they can contact the 24-hr suicide hotline provided by the Samaritans of Singapore (SOS). 

    • If they are not, do still encourage them to seek help from professionals, such as counsellors or psychologists. Offer your support by sourcing for suitable services together, or even accompanying them for their appointments. 

Singapore’s decision to decriminalise suicide attempt from 1 January 2020 was widely applauded as a move to support, rather than prosecute, people who are so overwhelmed by their difficulties that they attempt suicide. Indeed, when it comes to suicide prevention, much can be done to promote mental health awareness and encourage help-seeking. We can start by doing our part to support the people around us, and helping to protect the precious lives of those we love. 

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 it?  

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 it?  

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 it?  

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. 

What should I do if I know someone 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. 

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. 

Biases are essentially mental shortcuts. As we are constantly bombarded with information, these shortcuts allow us to make quick decisions and judgements to help us prevent information and cognitive overload.  

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. 

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.

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.

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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.

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Alcohol and Sleep

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.

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