Counselling and Who Provides Them?

Counsellor is a broad term to describe professionals whose main job is to provide "talking therapy" to people with life difficulties or mental illness like depression and anxiety.

So who provides counselling?

Counselling are done by Doctors with a special interest in mental health,  Psychologists, Occupational therapist, Youth health workers,  Mental health nurses, Social Workers or Psychiatrist.

The main evidence based counselling is CBT but various versions of it can be helpful too eg ACT (Acceptance and Commitment Therapy)

Most people think counselling is just about talking therapy but it is probably much more than that.  The essence of it is to help you to understand yourself better and in turn, be able to regulate or manage your mind better rather than let it control you so to speak.

Remember that like acquiring any new skills, knowing is certainly not enough.  You have to apply that knowledge and then repetition, repetition and more repetition.....just like learning how to play the guitar/piano/typing or learning the timestable. For example, you might have learnt all the theory about on how to drive a car but this does not mean that you CAN drive a car.  If you have a counsellor, then they will act as your "personal trainer".  Remember, that you will still have to do the main work though....just like in an exercise program to lose weight.  The personal trainer can only guide, support and encourage you.  You will still have to do most of the work.

Is it your belief that dictates your reaction to an event?

When we overreact to something, it maybe worthwhile to step back, reflect, and ask, "Why did I react this way?"

"What is the belief that I have that makes me react this way?"

For example, one may feel extremely nervous about meeting new people.

If we ask ourselves, "What is the belief that I have that makes me feel this way?", then there maybe a number of possible answers.

If my belief is that I am better than everyone, would I have this reaction?  Probably not...

If I believe that I am good enough because I am learning from my mistakes and growing as a person, then will I still react that way?  Probably not....

If I believe that I am not good enough and people don't like me, then will I react this way?  Yes

Sometimes, the belief that I am not good enough, coupled with anxiety and fear, can lead to a fear of being judged, and the fear of not being good enough.  This is a common problem in our society.

The good news is, once we know our unhelpful beliefs, we then defuse from it or change it.

Can Sun exposure help with Depression?

We do know that on a rainy and gloomy day, our mood maybe a bit lower than on a day when it is sunny.  There is a term "seasonal depression" which is used to describe this phenomenon.

Hence, a little bit of sun each day can be therapeutic for your mood.  Be in nature.  Exercise in nature.  Too much sun will not be good for your skin obviously so balance is the key here.

How "acceptance" can help with Depression or Anxiety?

In our society, there is a bias towards fixing things rather than accepting thing as they are, or "letting things go".  Being able to fix things is our greatest strengths, but inherently, this is also our greatest weakness.  If the problem is too great and we cannot fix it, then we get very frustrated and stressed out!

One of the philosophy that is cultivated in Budhism is acceptance.  Accept and surrender to what is....IS.

So which philosophy is better?
To fix or to accept?

"Depends" is the answer perhaps, as we need both to manage our lives.   Just think about when you drive a car.  Is acceleration pedal more important than the brakes?  "Depends", as we need both to be in control of our vehicle.  So if fixing is like acceleration, and acceptance is like braking, we need to fine tune both skills in order to be in control of our lives.

In essence, fix what we can, and accept the things that we cannot.

Can Medications like Antidepressants Help Everyone with Depression?

The current medical approach to solve medical problems is to find the cause of something, and then fix it.  Like most things in life, this approach has its good and bad.  The great thing about this approach is that, if we know what the cause of the problem is, then we can fix the problem accurately and effectively.  The main flaw with this approach is when we don't have a full understanding about the problem, for example depression, then we are not going to be able to provide a complete solution.  In current medical thinking, we believe that depression and anxiety maybe due to chemical imbalance like Serotonin, Adrenalin and Dopamine in the brain.  However, this is not the complete picture as medications that "recalibrate" these brain chemicals, do not provide a complete cure for everyone with depression.  Having said that, there is still some evidence that it is effective in treating depression and anxiety for a proportion of patients.  However, there are controversies around this area, so we will see how the evidence evolves over time.

In Eastern philosophy to health, it focuses more on going back to the basics and look after one's body, and then, allowing the body to heal itself.

This requires that we aim for good nutrition, avoid toxins like smoking, alcohol and drugs, engage in regular exercise, adequate and good quality sleep, good fluid intake, and very importantly, a healthy positive mindset, good self understanding, and developing a high Emotional Intelligence (EQ).  One can achieve more resilience, and a higher EQ through counselling, including CBT(Cognitive Behavioural Therapy), ACT(Acceptance and Committed Therapy), interpersonal skills, and then most importantly, apply it in our every day life.

I encourage all sufferers to talk to your Doctor about counselling, CBT or ACT in addition to your medication needs.  There is good evidence that doing both i.e. taking medication as well as engaging in counselling, have the best outcome.

Thought of the Day on criticism

No one really likes criticisms especially the non constructive ones.  When someone criticize us, we naturally want to avoid or defend.  This may not result in a good outcome.

But what if we change the way we respond to a negative feedback.  Consider saying, "Thank you for the feedback."  It might be very liberating!

We sometimes don't need to run or defend.  We just accept through acknowledgement.  Try it next time and share your experience here.

What is Cognitive Behavioural Therapy (CBT)

Most of us can appreciate that if we have a negative thought eg I am not good enough, this can lead to a negative feeling ie we feel inadequate, sad and depressed.  This can then lead to a negative behaviour eg withdrawn and not wanting to go out.  This can then reinforce the original thought of I am not good enough and then the cycle continues into a vicious cycle.

CBT aims to break this cycle at the thought and the behaviour level.

It teaches us to validate and challenge our negative thought patterns into a more helpful and realistic one.

It encourages us to change our behaviour in order to promote a more positive emotion.  To better understand the behavioural approach, try this simple exercise.  Look up, shoulders back, chest out, and try to be sad.  Now look down, slump, and try to be sad.  If you did this exercise correctly, you will find that it is more difficult to be sad while looking up and easier to be sad when you are looking downwards.

So, in summary, if we can change our negative thought patterns, and reinforce this with a positive behaviour, then we can increase our chances of breaking the cycle of negative mood.

Cause #5 of Depression and Anxiety: Physical Factors

Physical Illness

Physical problems can affect your mood.

These include sleep apnea, nutritional deficiencies eg folate and B12 deficiency, thyroid disorders, sleep deprivation, certain medications, premenstrual syndrome, chronic pain, chronic diseases to name a few.

Your Family Doctor will need to rule out these physical factors as a routine part of your assessment of mood disorders including depression and anxiety.

Cause #4 of Depression and Anxiety

Drugs and Alcohol

People with depression or anxiety can turn to alcohol or drugs to cope but these can often be "short term gain and long term pain".  They may help short term for you to escape from your problems but in the long term, they may make you more depressed and anxious.

Please talk to your Family Doctor and see how they can help or refer you to specific support groups or organizations if required.

Cause #3 of Depression and Anxiety

Environmental Factors

So far, we have discussed the other two causes of depression and anxiety, namely genetics, and personality.  The third cause of depression and anxiety is our environmental factors.

These are difficult problems in our lives such as financial difficulties, work stressors, relationship or marrital conflicts, parenting stressors, family conflict, loss of a loved one, or "loss of something".  Essentially, environmental factors are challenges that cause us to maladjust and somehow, we have to adjust to that again.

Learning ways to problem solve what you can, and accept what you can't will help here.

Cause #2 for Depression and Anxiety: Personality

Your Personality

Understand one's own personality will help you to regulate it better.  Every personality will have its good and bad, strengths and weaknesses.  Once you understand yourself, you will be better equipped to nurture your strengths, accept and manage your weaknesses.

For example, if you are a bit of a worrier and a perfectionist, there is good and bad in that.  Most high achievers are actually anxious and perfectionistic individuals.  One can also view an anxiety trait as a very powerful tool.  However, one do need to foster its strengths and manage its weaknesses.

A perfectionist who is self critical and fear failure will naturally be very prone to stress.  A perfectionist who has a better understanding and acceptance of self, and who is self compassionate and embraces failures, will probably do very well!

Cause #1 for Depression and Anxiety: Genetics

Genetics

From my experience, this is probably one of the most important factor.  Anxiety and depression are highly associated with a positive family history.  It is difficult to conclude with certainty whether this is truly genetic, or whether it is due to family conditioning, but I suspect that both factors are probably important.

The analogy I use for genetic factor is this.  If life is 30 units of stress, then someone with a very strong family history of depression and anxiety might produce 60 units of stress.  Everyone has a threshold at which they develop unhealthy stress and anxiety.  However, someone who is producing more stress chemicals will obviously be more vulnerable to developing depression and anxiety.

The higher the genetic component is for one's depression and anxiety, the more likely one will need medications.  My analogy here for medications is that it "recalibrates" the stress chemicals or.  Unfortunately, we still don't have a clear idea of exactly how antidepressants work.

The power of a thought

Most people can understand that a thought can make you feel sick.  For example, if a student before their exam has a thought, "Oh my god, Iam going to fail", he or she will feel sick, and sometimes, if it is severe enough, he or she may even feel like vomitting.  So if a thought can make you sick, it is reasonable to assume that the reverse is true as well.  A thought can make you feel better.

This is the power of a thought!

This is one of the essence of Cognitive Therapy.

Replace some of your limiting beliefs with this one

If other people can do it, I can do it too.

If we are so self identified with our conditioned mind, this can be very self limiting.  The belief that if other people can do it, I can do it too will help to remind us, and open our minds up to the world of possibilities.

Replace one of your limiting beliefs with this one perhaps.

Is Anxiety related to Depression?

In my experience, anxiety can often coexist with depression.  For some people, anxiety is the the main problem and overtime, due to the problems that the anxiety creates, this will then lead to depression as a "secondary" phenomenon.  On the other hand, some people have a predominant depressive disorder.  They often feel flat, sad and "sluggish" and due to the dysfunction and problems that these symptoms create, these can then lead to stress and anxiety.

Knowing which one is more predominant can help us as Doctors, to manage the problem with certain types of medications if this is appropriate and also helps us to focus on certain areas in the counselling approach to the problem.

These points will be further elaborated in future publications.

Do you have Depression?

Most people with depression do not often present to their Family Doctor and say, "Doctor I have depression".  They often present with tiredness, feeling fatigued, poor sleep, unmotivated to go to work, poor concentration, and problems in their personal relationship.  Other symptoms include hopelessness, worthlessness, feeling flat or on edge, insomnia, broken sleep particularly early morning wakening, poor appetite, poor libido and even thoughts of self harm.

I, as a Family Doctor, on a practical level define depression simply as persistent flat mood that is severe enough to affect your work performance and relationship.  Let's face it, most of us feels flat or sad from time to time.  This is quite "normal".  However, when it is intense and protracted enough to affect your function, ie affecting your relationship and work performance, then we say that there is a problem and we need to manage it.

So next time you feel persistently flat, stress or anxious, then consider speaking to your Family Doctor about it early.  The earlier we can intervene, the better the prognosis.  Intervention, does not necessarily have to be medications as specific counselling like CBT(Cognitive Behavioural Therapy) and ACT(Acceptance Committed Therapy) maybe extremely effective in managing depression.