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MENTAL HEALTH IN CHALLENGING TIMES

MENTAL HEALTH

DR TAN E-CHING

TAKING CARE OF OURSELVES IN DIFFICULT TIMES

The importance of mental health has come under increasing focus both locally and worldwide in recent years. The rates of depression and anxiety have risen exponentially, especially during this period of the COVID-19 pandemic. Given the prevalence of mental health issues both worldwide and on our shores, the importance of forging a culture of wellness cannot be understated.

In my practice where teens and adults come for counselling and therapy, I have noticed an unmistakable rise in the number of people seeking help for anxiety, insomnia and depression in recent years. The COVID-19 pandemic has caused significant stress among Singaporeans, especially working Singaporeans who shoulder the responsibility of providing for their families. The government has created a new inter-agency task force in response to the mental health needs of Singaporeans, highlighting the extent of the impact that the pandemic has had on Singaporeans’ mental health.

For many, the pandemic brings about a deep sense of uncertainty about the future, due to unemployment and worries about potential job losses. Others find adjusting to this “new normal” very challenging. They feel isolated and burnt out because of prolonged hours of working from home. Others find themselves juggling multiple roles while simultaneously working from home, adding to the stress and anxiety.

TWO MAIN ISSUES

Underscoring all these challenges that we are facing right now are two main issues, the first of which is loneliness. Global statistics show a rising sense of loneliness among all age groups. Increasing social media usage exacerbates this sense of isolation as people scroll through social media, taking in the veneer of the posts put up by friends exhibiting the best facets of their lives.

Second, many people have a deep sense of deficiency, a feeling of not being good enough. There is a constant sense of unease within as they dwell on past regrets or worry excessively about the future. These feelings are understandable and are part of our mind’s natural instinct to keep us safe. This served us well when humans were hunter-gatherers thousands of years ago, when predators and other potential dangers were lurking around every corner. But in our modern society, excessive rumination and anxiety can actually hamper our journey towards good mental health.

HOW STRESS CAN MANIFEST

Unfortunately, many people are grappling with loneliness and stress in these current times, feeling trapped in negative thought patterns. Stress can manifest in our bodies in a variety of ways – you may find yourself feeling more moody, irritable or aggressive towards others. You may also find yourself struggling to concentrate on your tasks, lacking motivation or feeling withdrawn from others. Stress can also manifest as physical symptoms, such as changes in your appetite and sleep patterns.

It is important to seek a medical consultation to exclude any medical conditions which can give rise to the symptoms described above.

THREE EVIDENCE-BASED STRATEGIES

How do we break free from the tight grip of stress? In my practice, I guide the teens and adults who see me in building the crucial skills of mental resilience. Good mental health is built on the foundation of mental and emotional resilience and these are skills that can be learnt. Let me discuss three evidence-based strategies.

1)Mindfulness

I find that having some understanding of mindfulness goes a long way for teenagers and adults who are stressed, anxious or going through a challenging period of time in their lives. Mindfulness is an age-old practice that involves paying attention to the present moment, with kindness and compassion.

A mindfulness programme is currently prescribed by the National Health Service in the United Kingdom for patients with mental health problems like depression and severe anxiety. However, even if you do not have a mental health issue, mindfulness can still be highly beneficial to you. Top companies such as Google and Facebook recognise the importance of mindfulness, and are offering free mindfulness programmes in their offices for employees.

Scientific research

Mindfulness is rooted in scientific evidence. Over the last 10 to 15 years, many research studies1 2 3 4 conducted by renowned scientists in the field of neurophysiology have found that mindfulness training improves brain functioning in areas related to attentional control, self-regulation, sensory processing, memory and regulation of the stress response.

Many people have the misconception that the brain in adulthood is “static” and unchangeable. In reality, our brains are powerfully dynamic machines. The concept of “neuroplasticity” refers to the ability of the brain to reorganise itself, both in structure and function. Mindfulness has been proven to successfully rewire the brain by strengthening synapses associated with emotional regulation and attention.

Besides improvements in mental wellbeing, mindfulness has also been shown to improve physical health. Problems like high blood pressure, heart disease, peptic ulcer disease, migraines, temporomandibular joint (TMJ) disorders and other types of chronic pain problems can be improved through mindfulness practices.

Incorporating mindfulness into our lives

Evidently, for those who wish to live a more centred life, mindfulness has the potential to create both short- and long-term improvements in the way our brain works, and improve our physical health at the same time. Given all the benefits that mindfulness can bring to our physical and mental health, how can we incorporate mindfulness into our daily lives?

One way to practise mindfulness is through a formal mindfulness practice, also referred to as meditation. Spending just 10 to 15 minutes a day meditating comfortably in a quiet room can make a world of difference to your mental landscape. To create a conducive space for meditation, make sure to reduce distractions by turning off your electronic devices. You can also consider dimming the lights, putting on soothing music and diffusing aromatic essential oils around the room. The bottom line is to listen to your body and what it needs to feel comfortable before you begin meditating.

There are many ways of engaging in a mindfulness practice. You can choose to focus on your breathing, letting yourself breathe naturally while feeling the sensations of your chest rising and falling. You can also choose to allow your attention to rest on the sounds around you. Alternatively, some people prefer to silently recite a word or phrase to keep their focus of attention within. Internally reciting phrases such as “I am calm” or “I am good enough” can serve to decrease anxiety, increase self-worth and positively shape the way you perceive yourself.

Do not worry or beat yourself up if you find that thoughts are still intruding into your mind space. Self-compassion is an equally important facet of healing which I will delve more into in later paragraphs.

For many, the concept of mindfulness begins and ends with seated meditation. However, there are many ways in which we can practise mindfulness throughout the day. An easy way to incorporate meditative practices into your day can include taking pauses throughout the day to empty your mind, and focus on your breathing or external sensations. Whether you are eating a meal, washing your hands, commuting or using devices such as your phone and laptop, taking a moment to be mindful during these daily activities can greatly improve your mood.

Learning to pause

In our fast-paced world, learning to pause can do wonders for our mental and emotional wellbeing. Learn to take a few slow, deep breaths, purposefully lengthening the exhale. You can count silently as you breathe, for instance, by counting to four on the inhale and counting to seven on the exhale. This breathing technique has been shown to activate the parasympathetic nervous system and deactivate the “fight or flight” response.

Then, take a moment to observe your surroundings, bringing your attention to your senses, thoughts and emotions. Refrain from making judgements about your thoughts and feelings and simply observe them with curiosity and kindness. This helps you to centre yourself in the present. You can also take some time to gently challenge negative thought patterns and unhelpful beliefs, for instance, by asking yourself about the assumptions you are making about the situation. Learning to practise as I have described above helps us to live life with greater awareness and allows us to engage in our tasks in a calmer, more focused manner.

2)Self-compassion

Besides mindfulness, the second evidence-based strategy to break free from stress is through self-compassion. Research by Professor Kristen Neff from the University of Texas5 6 and others have found that self-compassion increases emotional resilience and wellbeing.

According to Prof Neff, there are three main components of self-compassion. Firstly, there is self-kindness. Depending on their upbringing and environment, some people have very high expectations of themselves and develop a harsh “inner critic” who reinforces negative core beliefs at every opportunity. This leaves them with no room to make mistakes and they often develop a catastrophising “all-or-nothing” mindset. Self-kindness encourages people to engage with their inner critic, bringing awareness to the faulty assumptions they make while gently introducing new core beliefs.

The second facet of self-compassion is common humanity. You can draw strength from acknowledging that just as you are not perfect, nobody is. When you are going through a difficult time, it is important to remember you are not alone, because everyone has their own struggles to deal with. Recognising that we are all part of the human family with different struggles and challenges often gives rise to a feeling of empathy and connection.

Mindfulness is the third facet of self-compassion. Mindfulness and self-compassion are interlinked, because mindfulness is needed for you to understand the inner workings of your mind in order for you to build a better relationship with your deeper self. While practising mindfulness, you may feel the instinct to judge yourself harshly or overreact to certain thoughts. However, it is important to simply be present with your thoughts and observe them as if you are a caring friend, quietly watching your thoughts but not being identified with your thoughts and emotions.

3)Self-care

The final evidence-based strategy I wish to introduce is self-care. As the saying goes, “We cannot pour from an empty cup.” Taking the time to nourish and refresh ourselves regularly is vital to our mental wellbeing. This includes developing healthy physical habits such as following a healthful diet that is low in high-fat, high-sugar and high-caffeine foods. In addition, we should cut down the time we spend on our electronic devices such as phones and computers.

Sleep hygiene is also key to living a healthy life. Give yourself around half an hour to unwind before bed and avoid using your electronic devices an hour before you go to sleep. Another important healthy habit is to exercise. Exercise helps to boost your energy levels and your mood by releasing “happy” hormones like endorphins into the body.

Finally, nature heals and restores. Even if you have only half an hour to spare in your day, spending that time immersed in nature can do wonders for your mind, body and spirit.

Importance of seeking professional help

Should you be feeling increasingly withdrawn or depressed despite taking steps to self-care, it may be time to seek professional help. A professional in the mental health arena can work together with you to examine your emotions and their causes. Many people, even those without any mental health problems, find that therapy is very beneficial as they integrate the skills they learn into their lives. What you wish to bring into therapy is completely up to you, be it relationship problems, unresolved trauma or simply a desire to understand yourself better.

CONCLUSION

In these current times, stress is all-pervasive in our pressure-cooker society, but it can be managed in a healthy way with the right skills. Remember to always treat yourself with compassion and kindness, and take the time for self-care. Our journey towards a more wholesome and integrated life starts with setting our inner compass and bravely taking the first step.

Gain a better understanding of your mental health. Discover how it is affecting your “going concern” as an accountant and the implication on ethics, via a two-hour webinar: 


Dr Tan E-Ching is Medical Director and Founding Director, Hallmark Health.


1 Hölzel, B. K., Carmody, J., Evans, K. C., Hoge, E. A., Dusek, J. A., Morgan, L., Pitman, R. K., & Lazar, S. W. (2010). Stress reduction correlates with structural changes in the amygdalaSocial cognitive and affective neuroscience5(1), 11–17. 4

2 Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter densityPsychiatry research191(1), 36–43.

3 Lazar, S. W., Kerr, C. E., Wasserman, R. H., Gray, J. R., Greve, D. N., Treadway, M. T., McGarvey, M., Quinn, B. T., Dusek, J. A., Benson, H., Rauch, S. L., Moore, C. I., & Fischl, B. (2005). Meditation experience is associated with increased cortical thickness. Neuroreport, 16(17), 1893–1897.

4 Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., Urbanowski, F., Harrington, A., Bonus, K., & Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic medicine65(4), 564–570.

5 Neff K. D. (2009). The role of self-compassion in development: a healthier way to relate to oneselfHuman development52(4), 211–214.

6 Neff K. D., & McGehee, P. (2010). Self-compassion and psychological resilience among adolescents and young adultsSelf and identity, 9(3), 225–240.