Depressive Reaction & Reactive Depression: Only One is Worrying.

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Throughout our lives, we experience a range of moods. Some of these mood states are more activating, while others are deactivating. One of the most deactivating mood state is depression. Depression is a cause of concern in societies around the world. It is one of the most common mental health issue faced by many people, regardless of gender, occupation and age. Less known to the population is that depression can be classified across a spectrum, from milder levels (depressive reaction) to critical level (reactive depression). It is essential to know the difference along this spectrum, as when the critical level is reached, professional help is often needed. I have seen many people keeping serious depression in the closet and try to self-cope. Many times, for them, the struggle remains recurring, as Winston Churchill said, “when the black dog comes to visit”.

Depressive reaction is a mood-related response most people can exhibit in a challenging situation. Like any mood state, such as feeling anxious, happy, sad and grieve, depressive reaction is temporary, and will come and pass in its own time. It feels like a flattened emotion, with little positivity present. Like depression, depressive reaction will also generate self-defeating thoughts (e.g., hopelessness, over-generalisation) and negative attitudes. But, unlike depression, depressive reaction does not last long, and the person will regain functionality as the mood passes.

Reactive Depression is a conditioned involuntary responses in the face of adversity, stemming from personal belief system and schemas. These responses are likely to be episodes when the depression comes in and stays over time. Reactive depression is likened to a knee-jerk reaction that got triggered, and stays triggered due to cognitive and emotional regulatory reasons.

To properly identify a reactive depression, these are some of the major symptoms:

  1. Duration: Can potentially last from days to months-on-end to even years. It is not a mood, but a state of being that carries the depressive emotion consistently as the norm.
  2. Functionality: The person has difficulty functioning normally or effectively on a daily basis. Activities that were once enjoyed or done easily becomes difficult.
  3. Intensity of thoughts: The person is strongly influenced by the negative thoughts in the head. These thoughts has control over the person, can be irrational and seldom challenged.
  4. Experiential avoidance: The person is resistant towards new experiences, new ways of thinking, behaving and exploring.
  5. Physical exhaustion: These negative mental states will eventually affect the physical state. Other symptoms such as insomnia, weight loss and bowel problems may result.

With these criteria as benchmarks, if you recognise these symptoms in the people around you, it is advisable to help them approach mental health professionals, click here to explore which is an appropriate profession. However, if it is only a passing mood state, do sit down quietly by yourself with the depressive reaction and ask why is it here? And what meaning it has for you? Such exploration will surface some personal truths and foster growth.

Original writings by The Realist, inspired by encounters in professional work in life coaching, physical therapy and PhD research.

 

 

 

 

Life Coach, Counsellor, Psychologist or Psychiatrist: Which one to approach when distressed?

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Mental distress is a human experience that can range across a wide spectrum. It can be a depressive episode that comes and goes regularly, a relationship argument that triggers anger issues, or suicidal attempts to end all the struggles right now. When a person is struggling with such distress, it can be confusing to know who to approach to resolve these issues. In my work, I have seen clients who have sought each of these professions, and they turned out very differently, with horror and success stories. Hence, I write this post to highlight the differences between each of these professions, in the way they are trained, and the likely approaches they adopt to help. Share this post with people whom you know will benefit from this knowledge.


1.Psychiatrist / GP – The Medical Professionals

This is the most common go-to I see in my clients. When someone is in psychological distress, such as anxiety, insomnia, depression, they see a doctor, thinking that psychological and physiology can be treated the same way – through medications. Psychiatrists are trained first as doctors, through a typical medical degree, and specialised into mental health. The primary mode of treatment from the medical system is medications, such as antidepressants and mood stabilisers.

Pros: Medications are highly effective in reducing psychological distress on a biochemistry level. This approach is highly suitable when an immediate treatment is necessary, such as to prevent drastic self-harm or suicide. The medications increases the concentration of “feel good” hormones that balances the activity of the brain, so negative thoughts and behaviours get reduced.

Cons: Medication are just temporary stop-gap measures, with possible chances of forming dependency and addiction. I have clients experiencing severe mood swings and insomnia once the medications are reduced, which is not surprising because medications does not change the internal cognitive and emotional processes. The same patterns of thinking generating the distress will still happen once the biochemistry is reverted.

Indeed, research has shown that interventions using medications and therapeutic sessions have significantly higher improvements and less relapse rates, as compared to using medications alone.

I believe that a psychological distress is contributed by both biochemistry and dysfunctional patterns of thinking. And once formed, these 2 factors self-perpetuate into a negative spiral. Hence, the best way forward is to include therapeutic sessions. The latter three professionals are trained to provide these therapies.


2.Psychologist – The Scientist-Practitioners

My doctorate is in the field of psychology. Psychologists are first trained as a scientist of human experience, then a practitioner to help. Most psychologist have no practical experience in helping during the undergraduate years. Their orientation is to approach a client as a scientist-practitioner, and will be unethical to practice any therapy that has not been supported by science.

Pros: Any strategies adopted by a psychologist are backed by science and has been tested with many subjects. The chances of treatment success is high. Treatments are also highly based on scientific approaches, where pre and post-intervention assessment scores are systematically obtained and compared to determine treatment success.

Cons: Many psychological experiences cannot be generalised. What is supported by science may not work on the specific client. Under a psychologist, the client can only be treated with strategies that work on the majority of the population. There is a chance that the client can be better helped with an alternative therapy, which is hard to research on and so cannot be adopted by the psychologist – which encompasses many useful therapies other professions use (e.g., Hypnosis, NLP and Narrative Therapy). Counsellors and life coaches, as elaborated later, are not confined by these requirements.


2.Counsellor – Past & Present Orientation

Counsellors are getting to mainstream psychology. Counsellors are trained primarily as experiential practitioners, and less of being a scientists; hence, they are more flexible to attend fully to a client’s experience without the red tapes. They focus on helping an individual come to terms with life challenges by focusing on the past and present. They have wide access to many different approaches that have shown treatment success, which may or may not include those adopted by psychologists. Counsellors also treat milder levels of distress, such as time management, confidence, forgiveness, as well as tougher distresses, including mood dysfunctions and relationship problems. GP/psychiatrists and psychologists are more inclined to treat at-risk and near-clinical cases.

Pros: Counsellors provide a more personal touch to the treatment process. Some of my clients detest to the process of scientific measurements because those numbers do not represent how they really feel inside. A change in the numbers did not necessary make them feel okay to be let off the therapy. Some clients prefer a more personal approach.

Cons: Counsellors focus heavily in the past and present, including heavy exploration of the past. My experience as a life coach demonstrates that the conversation about a past problem is very different from the conversation about a positive solution-focused future. I have clients who relate to me counselling experiences that were so invested in past abuses, that they left the session not knowing how to move forward. And over time, it becomes a negatively geared therapy process. Life Coaching provides the “what now from here?” answer.


2.Life Coach – Present & Future Orientation

Life coaching is my preferred profession because I believe true treatment success has to be one that is unrestricted and authentically personal. It has to also include invested growth elements so that the clients not only improved from a -5 to 0, but also from 0 to +3. The client will leave being a stronger and more resilient person.

Life coaching has most of the skills and therapeutic knowledge a counsellor has. But a life coach focuses on creating a positive future, from a distressed past and present. The focus on moving forward is intense, and the client will be consistently challenged to be empowered. A frequent question we use is “knowing all these are happening or have happened, what is one small step you can take right now to change your future?”. Life coaching is a thoughtful and challenging process because the client has to truly show up authentically and start climbing up the rut.

Another key strength of a life coach is that we produce clients who can eventually self-coach. I see most clients not more than three sessions, with efficient treatment success, and little relapse rates because they know how catch themselves as they realised they are slipping.

Pros: A truly empowering and personal therapeutic process to restructure the thoughts and emotions to be more functional, without needing the use of medications.

Cons: Life coaching is not suitable for highly unstable or clinical clients, with a thick traumatic past.


Mental distress can be seen as mild or severe, and its treatment approaches can be taken from the medical or therapeutic processes. Also, both biochemical and psychological processes have to be accounted for, if applicable. Depending on what a client is experiencing, the right professional has to be selected to obtain the best care.

Share and spread this knowledge, and raise the global awareness.

Original writings by The Realist, inspired by encounters in professional work in life coaching, physical therapy and PhD research.

 

Honour our Emotions

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Some say emotions make us human, without emotions, we are only living processors. Emotions are inevitable, involuntary, powerful and possessive. If left unobserved, they can take over our mind and body. Yet, to put a structure around emotions is only elusive. When asked “what is the best way to understand and handle emotions?”, I think people have to inquire into the art and science of emotions. The concepts I cover in this article will only be brief, and each will be unpacked in future posts.


“Find the silver lining in experiencing each emotion.”


This is one of my favourite poems that artfully captures the existence of emotions. From this poem, I will draw out its relevant scientific discourse.

The Guest House

This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.

Welcome and entertain them all!
Even if they are a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice.
meet them at the door laughing and invite them in.

Be grateful for whatever comes.
because each has been sent
as a guide from beyond.

— Jellaludin Rumi

1. Emotions are meant to be temporary. Emotions are adaptive temporary experiences that are generated by external/internal stimulus, to help us or to communicate with us. They are to be picked up to be processed, and let go and be given the time to be released.

2. To know emotions, we need mindfulness. The poem is written under the spotlight of emotional awareness. It is only with awareness, can we begin to understand our emotional presence, and how it is influencing our thoughts and behaviours.

3. Emotions bear purpose. Emotions have messages for us. Feeling angry tells us we are first hurt, then seek to protect. Depression tells us we are internal dejected, due to perceived lack of control despite trying. Anxiety tells us we are not prepared, obsessed with control and full certainty.

4. Emotions are contextually functional. Having understood purpose,  when placed in context, we see their functions. Anger functions as defence, depression functions as prompts for us to rest cognitively and emotionally, then re-conceptualise and instil personal control, and anxiety functions as energy to react to unexpected changes.

5. Make space and accept them as they are. Emotions are meant to be felt. Make space and create a bubble of acceptance for them. Don’t judge them, we all know the experience of getting more angry for being angry, getting more anxious for being anxious. Understand these emotions at their core and leave it at that level. At the same time, don’t let them consume all of you, for they are only messengers. Commit to valued actions and behaviours, while making space for emotions and use these emotions if they are contextually functional. If not functional at the moment, open your grasp and let them go at their own time.

6. Positive reframe. Find the silver lining in experiencing each emotion. “He may be clearing you out for some new delight.” Most of the time, each message would have a positive meaning for us. We have to look for what is working for us in this experience, and what can we learn from this.

Original writings by The Realist, inspired by encounters in professional work in life coaching, physical therapy and PhD research.

Living the “Good Life” is about being emotionally stable

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At some point in our lives, we will come to ask ourselves “what does living the ‘good life’ means for me?” For me, this question comes at a young age – late adolescence, leading me to seek knowledge and wisdom from scientific and spiritual sources. For others, it can come at a life crisis, when latent dissatisfaction boils up to an unbearable level. For simplicity, many people would answer “to be happy”. Without deeper considerations, some people do take it literally – the pursuit of pleasure. The social construct of happiness gives people the expectation to constantly chase after happiness, and fear from negative feelings, and negatives are bad – a myth we should all probably bust after watching Inside Out. But still, why chase after the positives?


“I believe a good emotional system has similar patterns, having the traits of emotional adaptability and stability.”


Research. The pursuit of pleasure can actually be a negative experience. A study, published in American Psychology Journal Emotions, found associations between the high variability of positive feelings throughout a normal week and worse psychological health, including lower well-being and life satisfaction and greater depression and anxiety. Albeit having positive feelings are generally linked to positive psychological outcomes, when they start fluctuating drastically, it becomes a negative experience. This association can be interpreted in a few ways: (1) high positive emotional variability causes emotional turbulence, and (2) people who are poor emotional regulators tend to fluctuate more than good regulators. The constant pursuit of pleasure may be leading to this fluctuation. If constantly chasing after positive emotions do not guarantee us long-term “happiness”, then what does?

In my PhD research, I work with emotions to subtler levels. I was looking at one of my measures one day on happiness and was astounded. The sub-facets of happiness are feeling “happy”, “content”, “fulfilled” and “satisfied”. The previous research tested a huge normative population with pool of words associated with being happy, and these 4 words hung together to measure happiness. I was wondering what about other emotions like “elation”, “delight”, “joy”, “glee” – words that are of greater positive valence. The former 4 words suggest to me a rather neutral state of having enough and living a meaningful and purposeful life, without much infusion of the mainstream happiness. I start to think that the public associate the former more neutral states with long-term happiness, but subconsciously they want that jolt of positivity that has possibly no link to the idea of happiness captured in this research.

Like a  good heart. The idea of having an undercurrent of life contentment, fulfilment and satisfaction, with little fluctuation in positive affect makes me think of a heart. A good heart is one that is adaptable and has a low heartrate variability, which means when stimulated, the heartrate does not deviate too much from baseline, and can return to baseline quickly. I believe a good emotional system has similar patterns, having the traits of emotional adaptability and stability.

How we got it all wrong? The general public seems to get the idea of happiness wrong. My experience is that people think being happy as having a big night out, throwing party balloons and laughing over drinks. It seems like a staple for weekends, and if without, they feel disappointed. I think people should start thinking what makes them happy in terms of their life satisfaction, contentment and fulfilment, and taking a more stable and centred approach to encounter life experiences.

Original writings by The Realist, inspired by encounters in professional work in life coaching, physical therapy and PhD research.

What to do when the voice in the head just doesn’t seem to shut?

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Overthinking, endless internal dialogue, excessive imagination and worry… These are internal processes that sometimes plague our lives that we cannot seem to control. We begin to lose track of the present, forget where we are and who we are with. And time begins to slip past before we know it. This is when we lose the monitoring and control of our mental processes, and the primal part of prefrontal cortex takes over. Losing mental acuity is losing our being, and it is important that we learn how to seize back that awareness.

In psychology, we call this cognitive fusion, whereby the mind has the life of its own. What I usually train my clients in is the process of cognitive defusion, to create the awareness, consciousness, seat of the soul (etc…) that we somehow lose along the way.

Try this the next time you feel mentally swarmed:

1. Create the Awareness. Slow down, lean back and open up your mind. Ask yourself “what am I thinking right now?”, and explicitly reply start with this phrase “I have a thought right now that I am thinking…”. And go along with growing this awareness for a while, until that train of thought slows down.

2. Assess Value. What value has this thinking got for you? Sometimes it helps us to plan, organise, conceptualise and create. Other times, it has absolutely no value, such as daydreams and replaying the past that can’t be changed.

3. Assess Functionality. Is this thinking process working for you at this moment? How is it making you feel? How are you evaluating its effect on you? Some individuals get depressed and anxious as they obsess into such thinking process. Others get distracted from the present that has bigger value for them. At better times, it does reduce their stress and spark their creativity.

4. Assess Time. Is this the best time to do this? Many thinking processes are invaluable to our development, but when the timing is wrong, such processes cannot be fully thought out. Rather than having a split-mind approach, write it down and save it for the right time.

Once your awareness is created, if discovered that the value, functionality and time assessments are inadequate, it is time to take specific actions/behaviours by means of getting up physically and do something that is of value to you that will take up your absolute focus and concentration, to break that mental state. In this process, you will seize back control and gain back mental acuity. In a future post, I will talk about using neuro-linguistic programming for breaking states, which is faster and more lasting.

Note that these tips are for everyday general distractions. I will use a more layered approach for serious cases of ruminations and catastrophising thinking, especially when infused with strong emotions.

Original writings by The Realist, inspired by encounters in professional work in life coaching, physical therapy and PhD research.