Surviving Childhood Traumatic Experiences

Surviving Childhood Traumatic Experiences

Growing up, we experience many new, unexpected encounters – and many of those encourage new behaviours to form which we then can classify them into separate clusters in our memories. One may be happy events which are unthreatening in nature and we classify them fondly in our memory banks as loving and cherished events which fosters our well-being as individuals. Another one may be unexpected, tumultuous events which we can classify as possibly threatening and classifying them under life-skills might be helpful when we run into a similar scenario again – for instance, how did we cope when a friend we were having coffee with unexpectedly fainted?

However, there exists a third category of events which is unsettling, and is not in the normal scale of events – the crisis. As we all currently are gripped with the ongoing crisis of the Thailand boys’ soccer team caught in a cave during the monsoon storm, we need to also understand the mental and emotional changes they might be facing, not just the physical and physiological demands their bodies will be making on them.

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During the initial phase of the crisis, one’s body and mind is thrown into a ‘flight-or-fight’ response whereby the priority is to keep one alive – so when we are faced with a crisis our internal system cries ‘Danger! Danger!’ and we utilise tunnel vision to get to safety. Once that is done, our bodies then send out signals that indicate we are safe and it’s time to let down our emotional and mental guard, and usually that’s when we become aware of being physically tired and drained, as our system does a ‘internal maintenance check’ and demands fuel in terms of rest and food and water.

However, in cases whereby these resources are scarce, or very little, it is useful to utilise a ‘mind over matter’ approach to help the body utilise its own resources – and done in a mindfulness manner can help calmness spread over not just our internal self, but can affect those in our environment in a positive, way too. In a way, this was encouraged by the Thai coach who taught the boys mindfulness techniques to keep calm. This approach also gives the panicked brain something useful and congruent to focus on.

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Once rescued from the crisis scenario and environment, we need to be aware that our brain processes events differently and we might be impacted via nightmares, not being focused at work or school, having difficulty sleeping or eating, and at various points during the day we might become reminded of the stressful event seemingly without a trigger and the memory which washes over us can be an extremely anxiety-provoking event. It’s important that once we leave the scenario of a crisis we take the time to not just do a physical examination of our body, but also complete an on-going ‘internal maintenance check’ of our mind.

 One of the ways as mentioned above is to be able to calm our minds with mindfulness on a regular basis. By practising this, when we are caught unaware during a trigger memory, we can utilise the mindfulness method to help us calm down.

Another one is to keep a daily journal of thoughts that arise from the trigger memory – the most debilitating feelings we tend to associate with crisis and trauma is fear and helplessness – and those two feelings tend to hold us in paralysis. Once we are able to become aware of the strength of these feelings which hold us in a grip, we can then consciously decide to process them – either with a trusted friend, or in cases whereby the re-experience is intense or we are concerned that it will become debilitating, to process them with a trusted professional such as a mental health counsellor.

Download Teleme’s mobile app and consult a psychologist

 

Ms. Usha Ponnudurai

Ms. Usha Ponnudurai

Psychologist

 

What is Post-Traumatic Stress Disorder (PTSD)?

What is Post-Traumatic Stress Disorder (PTSD)?

PTSD is a condition that develops in some people after experiencing an event which is dangerous or life-threatening. Feeling scared is a natural response during a traumatic event because it triggers a ‘fight-or-flight’ response to protect us from harm.  Everyone will experience a range of reactions after traumatic event but most people will recover from these initial symptoms.  However, those who continue to experience problems may be suffering with PTSD and may feel stressed or frightened even when they are not in danger.

Signs and Symptoms

Not every person who goes through a traumatic event develop PTSD. Symptoms usually begin within 3 months of the traumatic incident although they may begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

Image Source: Reader’s Digest

PTSD can be diagnosed and treated by psychiatrist, psychologists & counsellors.  The symptoms in adults are as below. Although it is normal to experience these symptoms after a traumatic event, these symptoms should NOT remain after 1 month such that it affects their ability to work or drive them to depression or substance abuse.

  • At least one re-experiencing symptom (such as flashbacks, bad dreams or thoughts)
  • At least one avoidance symptom (such as staying away from things, places or events related to the traumatic event)
  • At least two arousal and reactivity symptoms (feeling tense, frequent angry outbursts, easily startled or difficulty sleeping)
  • At least two cognition and mood symptoms (negative self-thoughts, guilt feelings, loss of interest in previous favourite activities or feeling detached from friends & family)

Children react differently compared to adults and their symptoms may include the following:

  • Bed wetting
  • Keeping silent or even regressing to not being unable to talk
  • Acting out the scary event
  • Unusually clingy to the parents

Risk Factors which increases the chance of getting PTSD

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  • Living through dangerous events such as war or natural disasters
  • Getting hurt or seeing another person hurt in the event (such as car accident)
  • Childhood trauma which has not been forgotten
  • Having minimal or no social support after the event
  • Having extra stress after the event (such as loss of a loved one or job, chronic pain from an injury sustained at the event)
  • Having a history substance abuse

Treatments and Therapies

The main treatment for PTSD is a combination of psychotherapy, counselling or medication.

Medications

In severe cases, anti-depressants or medication to help with sleep may be prescribed by a psychiatrist.

Psychotherapy

Psychotherapy involves being connected with a mental health professional such as a counsellor or psychologist who can provide professional support.  The sessions can be one-to-one online or clinic consultation and can also be in a group session.  It is important to have support from family and friends during the treatment period and also deal with any outside issues such as job-related problems, substance abuse or relationship issues.

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Effective psychotherapy involve education about recognising the symptoms and teaching skills to help identify the trigger factors.

  1. Cognitive behavioural therapy (CBT) can involve:

(a) Exposure therapy to help people face and control their fear by gradually exposing them to the trauma they experienced in a safe way.

(b) Cognitive restructuring to help people make realistic sense of the bad memories and gradually remove any bad feelings of guilt or shame.

  1. Relaxation and anger-control skills
  1. Guidance to better sleep, diet and exercise habits

Treatment goals

It may be very hard to take that first step to help yourself.  Set realistic targets and break up large tasks into smaller achievable ones.  Take one step at a time and aim for gradual improvements.  Do not be shy to reach out for help and support from your family, friends and mental health practitioners.

 

Download Teleme’s mobile app and consult a specialist

 

Ms. Usha Ponnudurai

Ms. Usha Ponnudurai

Psychologist

Mr. Ko Teik Yen

Mr. Ko Teik Yen

Psychotherapy & Hypnotherapy

Five Positive Ways to Manage Stress

Five Positive Ways to Manage Stress

You can’t avoid stress in your daily life but you can manage it. Don’t ignore stress as stress can lead to major health problems and it affects your health mentally and physically. It can lead to mental health problems such as depression or anxiety and physical health problems such as acne, hair loss, fluctuations in weight and life-threatening heart attacks.

Create a list of positive ways to manage stress to keep your stress levels in check and low. Here we have listed 5 things that you can do.

1) Take Charge of Your Health

check-up

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Taking care of your health helps you both mentally and physically. Focus on healthy habits such as healthy diet, exercise 3-4 times a week and go for body check-up annually. The best way to reclaim control of your life is by taking charge of your health.

 

2) Make a Change

clean-desk

Image source: Iris

Start with a small positive change. It can be as simple as cleaning up your work desk or your bedroom, step away from your work desk for 5 minutes and take a walk or take 5 minutes to do simple exercises at your work desk or simply go for a short vacation. A small positive change can make a difference to the stressors in your life.

 

3) Laughter is the Best Medicine

laugh

Image source: Shutterstock

Watch funny videos, movies or talk to a funny friend who keeps you happy. Do whatever it takes to give yourself time for laughter each and every day.

 

4) Join Meditation or Yoga Classes

meditate

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Meditation or yoga may be used to reduce stress, anxiety, depression and tension as both practices promote relaxation and calmness. It requires you to focus to achieve a mentally clear and emotionally calm state.

 

 

5) Help Others

help-others

Image source: Goodnet

Volunteer to help others take your mind off the stress in your life and you’ll cultivate an attitude of gratitude as you help others who are not able to get help for themselves. You’ll also feel happy and relieved to be able to help people or animals in need and you’re actually making a positive difference to their lives.

 

Reference: Beliefnet

 

If stress level is too overwhelming and you can’t cope with it, please reach out to one of our Psychologist below for advice.

 

 Dr. Khairi Rahman

Dr. Khairi Rahman

Psychologist

 

Ms. Usha Ponnudurai

Ms. Usha Ponnudurai

Psychologist

 

Ms. Sarah Zehan

Ms. Sarah Zehan

Psychologist

 

Study on User Experience with E-Counseling

Study on User Experience with E-Counseling

Below is a summary of how e-counseling is comparable to traditional face-to-face counseling sourced from an extensive study done by Berkeley Well-Being Institute and its references. Read more on the full study here.

Study 2 was conducted to examine user satisfaction with e-counseling. Read on the summary of Study 1 on changes in depression symptom severity amongst BetterHelp members from pre-treatment to 3-months post-treatment here.

Study 2

Given the potential accessibility, affordability, and effectiveness of e-counseling, Berkeley conducted a second study to gain insight on user experience with BetterHelp e-counseling. The present investigation reports findings from a survey that asked current members of BetterHelp to report their experiences with both e-counseling and face-to-face counseling. More specifically, it assessed whether BetterHelp e-counseling differs from face-to-face counselling with regard to:

1) Affordability

2) Convenience

3) Effectiveness

4) Fit

5) Accessibility

6) Progress

7) Satisfaction

8) Quality

9) Meeting needs

10) Therapeutic alliance

 

Method

Participants:

  • 48 participants (88% female)
  • Age: 22 – 65 years old
  • These participants responded to an account notification from BetterHelp inviting them to complete a survey post participation
  • Used BetterHelp for 3 months or more
  • To answer a series of questions with regard to their experiences on BetterHelp and also if they have been in face-to-face counseling
  • A subset of 38 participants (79%) had also been in face-to-face counseling and was asked the same series of questions regarding their experiences with face-to-face counselling

 

Measures:

1) Therapeutic Alliance

The quality of the therapeutic relationship was assessed using the Working Alliance Inventory (WAI) –short form (Munder, 2010). Questions were phrased to assess alliance with BetterHelp counsellors or alliance with face-to-face counselors. The WAI has been shown to have good reliability and validity (α BetterHelp = .94; α face-to-face = .97 in the present sample).

 

2) Satisfaction with Counselling

To measure satisfaction with counseling, items were developed assessing a range of factors that tend to affect satisfaction with counselling (see Table 2 for questions).

 

 

Table 2

Comparing BetterHelp to face-to-face counseling

To directly assess whether participants preferred BetterHelp when they compared BetterHelp to their experiences with face-to-face counseling.

 

Results

1) Therapeutic alliance

Using within group t-tests, ratings of therapeutic alliance were significantly greater for BetterHelp than face-to-face counseling.

 

2) Satisfaction

Descriptive statistics are used to clarify the percentage of people who were satisfied with each dimension of counseling for both BetterHelp and face-to-face counseling (see Figure 3). The results suggest greater satisfaction with BetterHelp e-counseling than face-to-face counseling. All analyses supported BetterHelp as being more satisfying than face-to-face therapy. In particular,

BetterHelp was found to be significantly more convenient, affordable, and accessible than face-to-face therapy.

Figure 3

Results for satisfaction with BetterHelp and satisfaction with face-to-face counseling shows that clients of BetterHelp are more satisfied with e-counseling than face-to-face counseling (see Figure 4).

 

Figure 4

Finally, when asked how likely one would be to recommend BetterHelp to a friend or colleague on a scale from 0 (Not at all likely) to 10 (Extremely likely), participants reported scores ranging from 5 to 10.

Comparing e-counseling to face-to-face counseling

Descriptive statistics were used to directly assess whether people found experiences with BetterHelp to be better or worse than experiences with face-to-face counseling.

First, Berkeley assessed whether people would choose BetterHelp (e-counseling) or face-to-face counseling in the future (see Figure 5). Next, Berkeley assessed how participants compared BetterHelp to face-to-face counseling on each of the dimensions of satisfaction. The strongest effects suggest that BetterHelp members find BetterHelp to be more convenient and accessible than face-to-face therapy, and all analyses supported BetterHelp as being more satisfying than face-to-face counseling (see Figure 6).

 

Figure 5

Figure 6

E-counseling appears to address a number of significant barriers (i.e. convenience, affordability, and accessibility) that sometimes prevent face-to-face counseling from being effective. Notably, the present data further suggest that therapeutic alliance for BetterHelp e-counseling may be even stronger than face-to-face counseling.

While there are many reasons as to why this may be the case, Berkeley postulate that these strong alliances are formed when using BetterHelp as a result of BetterHelp counselors’ flexible availability. Face-to-face counseling is often limited to a pre-determined number of sessions (as defined by insurance companies or by financial capabilities).

Research has shown that the national average number of counseling sessions available to an individual is less than 5, despite knowledge that between 8-13 sessions are needed to see improvement (Hansen et al., 2002). BetterHelp counselors are able to quickly respond to members’ needs, with an average response time of 10.6 hours, and have more frequent interaction with members as compared to a face-to-face therapist, with BetterHelp members receiving an average of 3.7 sessions over the course of a week.

This study, like most survey studies, may have been affected by sampling bias. Only participants who were already using BetterHelp for 3 months were included in analyses. Because individuals who terminated treatment before 3 months were not included in pre/post analyses, results exclude those who may not have found BetterHelp beneficial and sought other forms of therapy in that time. It was essential for Berkeley to focus on this group to ensure that all participants were familiar with, and had the time to benefit from, the service; however, this approach may have led to a bias towards including people in the study who favoured BetterHelp e-counseling.

That being said, we should not discount the positive impacts that BetterHelp had on the members who chose to opt in. No intervention approach will work for everyone. Given the affordability and accessibility of Betterhelp e-counseling, Berkeley’s findings suggest that Betterhelp e-counseling represents an opportunity to have a bigger impact, across a larger number of people, for a reduced cost.

Reference:

Berkeley Well-Being Institute

Don’t suffer in silence. Seek help from a mental health professional online.

Download Teleme’s mobile app to consult a mental health practitioner online

 

E-Counseling: Viable Alternative to Traditional Face-To-Face Counseling

E-Counseling: Viable Alternative to Traditional Face-To-Face Counseling

An extensive study was done on how e-counseling is a viable alternative to traditional face-to-face counseling based on BetterHelp’s e-counseling platform. BetterHelp is the largest e-counseling platform worldwide and offers convenient and affordable access to professional counsellors for anyone who struggles with life’s challenges to get help anytime and anywhere.

Below is a summary of how e-counseling is comparable to traditional face-to-face counseling sourced from an extensive study done by Berkeley Well-Being Institute and its references. Read more on the full study here.

Research studies show that counseling is even more effective at improving mental health than other treatments, such as medication. While research has demonstrated the many benefits of counseling, access to counseling is still one of the largest barriers to getting this type of help, and the majority of research has only assessed the benefits of counseling delivered face-to-face. Telemental health, or the use of technology to provide long-distance counseling, is a field that is rapidly growing in response to this demonstrated and very urgent need.

Why people don’t seek for help?

  • Stigma surrounding seeking mental well-being support and lack of affordable care
  • Limited geographical access to trained professionals
  • Shortage of mental health professionals especially in rural areas

Benefits of e-counseling based on studies

  • People feel more comfortable, calm and relaxed during sessions and experience enhanced user satisfaction
  • People in need of counseling are more likely to seek out for help when e-counseling is provided as an option
  • Increased patient empowerment (i.e. maximizes flexibility of location of therapy as well as flexibility in scheduling therapy)
  • Increased clinical efficacy (i.e. allows therapists to see clients in less time)

To examine the benefits of e-counseling, changes in depression symptom severity amongst BetterHelp members from pre-treatment to 3-months post-treatment were examined in Study 1 and user satisfaction was examined in Study 2.

Counselors at BetterHelp are licensed, trained, experienced, and accredited professionals. BetterHelp members are able to choose from text, video, live chat, and phone counseling.

Study 1

Method

Participants:

  • 318 BetterHelp members (78% female)
  • Age: 19 to 72 years old
  • Pre-treatment levels of depression fell in mild, moderate, moderately severe, or severe ranges based on the PHQ-9 Scoring and Interpretation Guide (UMHS Depression Guideline)
  • Minimal levels of depression were not included
  • Used BetterHelp for between 90 and 104 days (3 months, plus two weeks) to ensure adequate time for treatment to take effect

Before members being e-counseling with BetterHelp (Time 1, or baseline), members were asked to complete the PHQ-9, probing current levels of depression. Between 90 and 104 days later (Time 2, or 3-month follow-up), participants were asked to again complete the same questionnaire.

At Time 1, 37% of the final sample presented with mild symptoms, 29% presented with moderate symptoms, 24% presented with moderately severe symptoms, and 10% presented with severe symptoms. Figure 1 displays depression symptom category at baseline based on the PHQ-9 Scoring and Interpretation Guide.

PHQ-9 measure:

  • The Patient Health Questionnaire (PHQ-9) is a validated brief self-report measure frequently used in clinical practice to monitor depression symptoms and severity which was used to assess severity of depression symptoms among participants at baseline and follow-up
  • PHQ-9 is a 10-item measure which asks a series of questions regarding how often, in the past 2 weeks, patients have been bothered by specific problems.
  • PHQ-9 is scored on a 4-Point Likert scale ranging from “0 – Not At All” to “3 – Nearly Every Day”

Results

Approach

Within-group t-tests – also known as paired samples t-tests – control for correlations between data sets and as such are the best choice when seeking to detect change between pre- and post-tests. Participants were split into four groups before analysis, based on severity of symptoms before treatment (these groups being mild, moderate, moderately severe, or severe).

Depression symptoms

Depression symptom severity was found to be significantly lower at Time 2 than at Time 1 across all four groups. Results showed that the largest improvement post-treatment was seen in participants who had the highest scores pre-treatment. In other words, using BetterHelp for 3 months (or more) significantly lowered members’ depression symptoms, and members with the most severe levels of depression before using BetterHelp experienced the most improvement in their depression after use.  

36% of members classified as having “Mild Depression” before using BetterHelp changed to the “Minimal Depression” classification level after use. 65% of members classified as having “Moderate Depression” were classified as having only “Mild or Minimal Depression” after using BetterHelp, and 67% of members classified as having “Moderately Severe Depression” were classified as having moderate, mild, or minimal levels after use.

 

Most impressive, 78% of members classified as having “Severe Depression” before using BetterHelp were no longer classified as having “Severe Depression” after use, with 15% of these individuals now being classified as having only “Mild Depression”, all within three months of use.

 

Next up on Healthtips by Teleme, second study examined by Berkeley Well-Being Institute on user satisfaction on e-counseling.

Study and reference by Berkeley Well-Being Institute.

 

Don’t suffer in silence. Seek help from a mental health professional online.

Download Teleme’s mobile app to consult a mental health practitioner online

Practitioner in the Spotlight: Dr Khairi Rahman

Practitioner in the Spotlight: Dr Khairi Rahman

If you’re going through a stage in life where you can’t function well or feel good, professional help can make a difference. Always know that you’re not alone when you’re facing difficulties or problems in life. Four out of ten Malaysians suffer from mental health issue in the course of their lives and psychologists believe that the number will continue to rise. Even if you’re not sure if you’d benefit from help, it won’t hurt to explore the possibility.

Here, we speak to Dr Khairi Rahman from Pantai Hospital on how one can seek help from a professional regarding mental health and what you can do to manage your mental health on a day-to-day basis.

 

1) What are the signs that a person needs the help of a mental health professional? After all, we all feel unhappy, anxious or depressed sometimes.

It is fairly normal for most of us to feel unhappy, anxious or depressed sometimes.

Nevertheless, much of those experiences should be temporary in nature and are often associated with certain causal or definitive factors. Once those causal factors have been identified and addressed appropriately, this temporary negative mental state of health would fade away.

However, this may not be the case with prolonged unhappiness or being in a depressed state where there are no apparent reasons or external factors causing one to be in such a state of mind.

Common signs and symptoms requiring the help of a mental health professional include heightened irrational behaviours (such as increased drinking or smoking or sleeping a lot more than the usual), inability to focus well at work or even carrying out simple tasks, crying episodes for no apparent reasons, prolonged loss of appetite, avoiding or shying away from friends and others, and very commonly, not having pleasure doing things that they used to love to do before.

2) If you determine that you need professional help – should you choose a counsellor, therapist, psychologist or psychiatrist?

Help can come from many different mental health professionals depending on the background of the case.

A psychiatrist would the most appropriate when the person requires medication or medical intervention. Most cases that falls under the scope of mental illness benefit from psychiatric intervention.

Majority of the other mental health cases may benefit with the help of psychologists, therapists, counsellors or even experienced pastors. Again, these are fairly dependent on the nature and background of the cases.

3) Are there affordable ways to help oneself manage your mental health without going to a professional, such as talking to good friends, reading self-help books, taking a break, travelling and going for meditation?

The affordable ways mentioned above (including regular workouts) are some of the recommended homework or assignments normally given by most mental health professionals. It is very important to note that it’s best to have your own therapist when you want to deal with something that’s temporarily in your way.

Dealing with critical situations which affects your mental health (stress and anxieties are of one the common ones) would need a lot of cognitive and behavioral changes and decision making. This is exactly where the challenge is for many of us out there, and your therapist should be able to help you rationalize matters and assist you with various therapy techniques and appropriate counseling interventions.

4) It is said that prevention is better than cure. When it comes to physical health, we have been advised to have adequate sleep, exercise regularly and eat healthfully. When it comes to our mental health, what can we do on a day-to-day basis then?

This remains very subjective as there are many levels of tolerance, stress and anxieties. For example, working and earning a decent income may be a normal and healthy life to some people but it may not be comparable to another person who’s thinking or working hard to provide food and shelter for his family on a daily basis.

Hence, taking control of situations would certainly make a person well and proven. Try to be in control and understand your strengths and weaknesses to know how it’s best to deal with situations. This may make you or even change you to be a different person in perspective.

Another way one can deal with situations is by being assertive. We have often heard of this word but many of us don’t realize it’s true meaning. There are some powerful words that comes along with the word “assertive”. For example, confident, positive, bold, decisive, strong-willed and determined.  Pick up these behavioral traits, practice it often and it may change you cognitively as well as behaviorally. It’s proven to be a good mental exercise for many of us. However, there are still people who choose not to practice it and take a different path by being non-assertive, defensive or aggressive.

Lastly, one should be spiritually healthy, well and active.

Download Teleme’s mobile app and consult Dr Khairi today

 

Dr. Khairi Rahman

Dr. Khairi Rahman

Psychologist

 

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