A bundle of nerves to rule them all: Unpacking the vagus nerve.

The vagus nerve relates to our capacity to function as social beings through maintaining our emotional regulation, fear response and social connections. We all constantly cycle through stages of disconnection, mobilisation and social engagement. Our Autonomic Nervous System adapts protection and connection from moment to moment.

However, patterns of protection can compromise our social engagement system. This article highlights some neuro-physiological explanations for why we are often not smooth and balanced. It also addresses ways to regulate and staying connected.

What is so special about the vagus nerve?

The vagus nerve connects the brain with the heart and other major organs and runs on autopilot without requiring intervention. This system regulates our heartbeat, breathing and other autonomous body functions such as digestion, body temperature and sexual arousal.

…the different branches are related to unique, adaptive behavioral strategies and articulates three phylogenetic stages of the development of the mammalian autonomic nervous system. These stages reflect the emergence of three distinct subsystems, which are phylogenetically ordered and behaviorally linked to social communication (e.g., facial expression, vocalization, listening), mobilization (e.g., fight-or-flight behaviors), and immobilization (e.g., feigning death, vasovagal syncope, and behavioral shutdown). 

Porges, Stephen W. (2010). The Polyvagal Theory.

Vagal branches are related to unique adaptive behavioural strategies that are essential for our survival. These strategies developed in three stages from immobilisation to mobilisation to social communication. As part of the autonomic nervous system, it is triggering the human defence mechanism that consists of fight, flight and freeze when there is danger or perceived threat.

It stimulates the body’s response when put under STRESS and it goes into shut-down mode when overwhelmed. However, our stress response is essential for survival, but needs to be tamed to enable social engagement.

How to understand your states of arousal?

The human survival mechanism is an integral part of our physiology. As such, the ability to sense and identify danger is inherently a valuable tool in our biological makeup and is termed “neuroception“. However, due to experienced trauma for example, the brain can map irregular associations resulting in a dysregulated nervous system. The first step, then is to recognise that this is happening.

“Trauma compromises our ability to engage with others by replacing patterns of connection with patterns of protection. If unresolved, these early adaptive survival responses become habitual autonomic patterns.”

Dana, Deb. (2018). The Polyvagal Theory in Therapy

Paying attention to states of arousal is vital, either in the moment or retrospectively. Consciously acknowledging when you experience one of the three defence mechanisms can make all the difference. If you find yourself uncharacteristically defensive (fight), feeling the overwhelming need to escape from a situation (flight), or rooted to the spot in a blind panic (freeze), it’s essential to understand the reasons behind these reactions.

Psychology and physiology merge in stages of the vagus nerve

My clients easily relate to the different stages of their vagal activation which can be described in terms of body and mind. The ventral vagal activation is represented by an open mind (“I may”, “may you be happy”) and an orientation towards others and the environment (posture, tone of voice, feeling warm).

Sympathetic arousal is reported as an increasingly narrowed mind with thoughts about taking action ranging from “I can” to “I should” to “I must” and simultaneously from feeling concerned/activated to anxious/angry to panic-fuelled/acting up. Body sensations include elevated heart rate, heavy breathing and feeling hot.

When the system becomes overwhelmed the dorsal vagal state of “I can’t” (“I collapse”, “I shut down”) takes over and clients of mine report to withdraw, self-medicate or zone out. This state is also characterised by a lack of connection, presence and self-control.

Due to the nature of the nervous system, we can feel each of these responses in varying degrees. A workaholic may have an active “flight” response, feeling a need to keep busy and seemingly unable to slow down. In someone else, a flight response may result in addictions – fleeing from emotions by making them go away with substances. 

Once identified, we can then understand what triggered the episode. Try to determine what happened immediately before the incident. Was it a comment, a specific tone of voice that someone used? Perhaps a smell or a particular situation made you feel overwhelmed.

How to cultivate the social engagement system?

We can take some steps to regulate and manage our nervous system. With a bit of practice using exercises that calm the nervous system and target the vagus nerve, we can maintain a healthy emotional balance.

In order to improve emotional wellbeing, it is important to understand how both internal and external factors impact mental health. Start by looking at your immediate surroundings. What elements spark joy for you? What aspects of your environment make you feel uncomfortable or overwhelmed? Think about what you can do to improve this environment. 

Even more important than the external environment is the internal struggle. One problem you may face is an abundance of self-criticism, overthinking and perfectionism. Practice snapping out of negative mental loops by

  • Simply letting your experience be: When you stub your toe, pause and feel the pain. No need to express it, stay with it – it is already there.
  • Simply letting go of any add-on experience: When you stub your toe, there is no need for anger, no need for cursing, no need for writing a screenplay about it.
  • Simply develop a more helpful attitude: When you stub your toe, pause and change your attitude. Does the leg of the kitchen table ask you to be more cautious or even to refurbish?

Directly Stimulating the vagus nerve can have tremendous effects on your reaction to stress. Breathing practices, yoga, physical movement, humming or singing, grounding exercises or working with temperature changes can all be valuable tools to help regulate your body when you catch yourself in a fight, flight or freeze response.

There is a wealth of information available for a more in-depth explanation of polyvagal theory and methods you can use to improve emotional well-being. Deb Dana has written an informative and helpful book on the subject, called “The Polyvagal Theory in Therapy.” Irene Lydon runs an exceptional YouTube channel outlining methods for improving mental health.

Using subcortical processing to overcome performance blockages

Addressing emotional blockages is key to personal and professional change. Neurobiological techniques that target subcortical processing are effective in accessing what is hidden from our conscious minds. Embedding these focused treatments into the safe space of coaching and counselling provides significant transformational momentum. Here are three simple steps I follow with my clients:

  1. Becoming aware of the impact your childhood still has on your adult behaviour
  2. Recognising your signature triggers in order to process what you are stuck with
  3. Tapping into subcortical areas of your brain, you can unshackle your mind and body for good

Note: The actual processing of a blockage or trauma can be done in silence and without disclosure of any details.

Assessment using structured questionnaires

Some people are surprised to discover that the childhood they thought was happy had elements of neglect or smothering and even abuse. Questions like “Were you hugged as a child?”, “Did your caretakers tell you they loved of you?”, “Did your parents implement punishments such as slapping or spanking, denying food, or silent treatments?” can help you understand what was going on in your childhood and what was missing.

This process aims not to blame, accuse or condemn our parents for what happened to us. Instead, we are working to gain a much clearer understanding through observation and reflection. Sometimes, what was going on is what hurt us – parents who were violent, unpredictable, or anxious and smothering. Other times, it is the lack that can be hard to name, yet still has a crucial role in who we developed to be. It is often helpful to resist the temptation to confront your caretakers, siblings or childhood bullies to demand acknowledgment and apologies.

Often, we don’t have many memories of what happened during our childhood. As we start the healing process, we are tempted to dive in with full force. We may begin therapy, buy five different books about the different types of childhood trauma, and work to recover these buried memories. Remember that your body has its own intelligence. If a memory is buried or repressed, respect that. Memories may come up when you feel safe and ready – don’t push! Respect the healing process and the time it takes. Taking on too much at once carries the risk of re-traumatizing ourselves.

Key Areas to strengthen: self-nurturing and self-guidance

With the awareness of how our childhood wounds manifest today, we are better equipped to raise self-esteem, improve self-image (including body image), quiet the inner critic and heal from shame. 

Many people in my practice struggle with self-nurturing, which can be seen as feminine or mothering energy. Clients often find deficits remembering their own mother. Note that the nurturing part is not really missing, as many can take on a nurturing and care taking role with their own children, friends or colleagues but find it difficult to care for themselves. This tendency can show up in codependency, overworking, and inability to say no to others. 

Others tend to struggle more with the fathering side or masculine energy like setting effective limits and being disciplined in self-care. One common way this shows up in our lives is self-sabotaging bedtime procrastination which often manifests as overconsumption of news, alcohol, TV, online shopping or gaming. Staying up late despite sleep deprivation negatively impacts performance, mood and health. A lack of self-discipline may also show as setting unrealistic goals for one-self not being able or ever feeling ok with what was achieved.

No matter how your childhood wounds show up in your daily life, you can learn practical tools to manage them.

Healing can be done in silence and does not require exposure or talking

Part of the healing process is creating a sense of safety in your body and the world around you. It’s essential to tailor your healing journey individually in a way that gives you a sense of agency, independence and acceptance. A common misunderstanding persists that therapy requires the explicit purging of a patients inner experience – memories, images, thoughts, … It does not!

Breathing exercises like tai chi and yoga are popular ways of developing the mind-body connection and teaching your body to ground and stabilise. You can build a sense of safety with a therapist. This process can be done in silence, without the need to share the content of your past that you are not ready to share.

Subcortical Processing can help with trauma, work performance and sport blockades

While talking interventions like coaching and therapy aim to give a conscious understanding of the past are, it may be beneficial to explore tapping into the brain through other non-talking pathways. Trauma can sit deep in our body inaccessible to our rational (neo-cortical) brain.

EMDR is a popular intervention for PTSD based on using eye movements to help the brain reprocess traumatic memories. Randomised trials support the effectiveness of EMDR in treating emotional trauma and find that it can be a more rapid and effective treatment than cognitive therapy.

Neurofeedback and brainspotting are two additional treatments that target the subcortical or subconscious processing systems. These methods have a growing body of research that supports their effectiveness in treating trauma, but also support people with performance blocks in sport and leadership.

While both EMDR and brainspotting utilize vision in the sessions. EMDR uses eye movements while in brainspotting the gaze is in a fixed position. Neurofeedback often uses vision as a means to train the brain. Neurofeedback uses EEG to measure brain waves and provides feedback to teach the brain to produce the desired results.

All three methods can be highly effective as add-ons to counselling and coaching. In my practice I integrate Brainspotting in a comprehensive way with approaches that activate other areas of the brain in order to leverage full healing potential. Clients report great success with rewarding experiences, deep insights and liberating effects on their lives.

Far from over: How your upbringing impairs your work performance

As children many of my now adult clients were exposed to suboptimal parenting. What happened – and oftentimes what not happened – in the interaction with primary caregivers during childhood has left psychological marks. Childhood is the longest phase in life as is impacts who we are as professionals and how with think and operate at work.

Your childhood is past, but the effects are far from over

Many adults fail to see the true results of suboptimal parenting on their behaviour today. There are many reasons for this. One is that we often minimise our past. Even in cases of physical, sexual, and emotional abuse, people often say: “It wasn’t that bad. Other people have it worse.”

People frequently tend to believe that they are fine unless things are really bad. “If I can function, if I don’t have a mental disorder, if I have a job and relationships – I am fine”. In fact, suboptimal parenting can actually lead us to be outwardly successful. A child who has learned to perform – for love – can grow up to be a workaholic who doesn’t know how to rest. The adult might be outwardly successful with their strategies of adaptation, even when they suffer internally.

Emotional Neglect

This denial is particularly true in cases of emotional neglect. In these cases, there often aren’t “bad memories”. However, parents who never hit or yelled can still have left lasting emotional scares. It’s what was not there, that causes problems to the work performance. Children are not only harmed by receiving what is bad for them, but also by not receiving what they need: appreciation, playfulness, joy, carefree being (often traded in for a rigid focus on grades, discipline and performance). Emotional abandonment is just as damaging as physical abandonment.

Smothering / Possessiveness

The flip side of emotional neglect is smothering. Parents who do not give their child freedom, who are overly protective and oftentimes intruding into their lives. Damage is done to the sense of Self when the opportunities to explore skills and boundaries are limited by an overpowering parent. The child’s individual experience of emotions is frequently taken out of hand, twisted, amplified or muted – replaced or overwritten by the parent’s or desired experience.

Typical challenges at work

Many people have a mixture of abuse, neglect, and enmeshment/smothering in their childhood. At work and in private, the adult can struggle with boundaries, discipline, balance, and self-care:

  • Not recognizing red flags in work relationships – being unclear about professional boundaries
  • Being perfectionistic, setting unrealistically high standards, investing too much time to reach an optimal outcome, doing too much and doing it too diligently
  • Catering for everybody’s needs but your own
  • Finding yourself being caught in the middle – feeling unable to assert yourself, voiceless, powerless
  • Always carrying GUILT, wherever you go, whatever you do

52% of the participants in a Nottingham Business School study that was cited in People Management Magazine agreed that their individual productivity had been affected by their trauma. The majority in the study reported that their employers were not able to respond to their needs helpfully.

  • Dealing with authority figures: either being afraid of authority figures or resistant to being controlled
  • Chronic emptiness can lead to difficulty in finding fulfilment at work
  • Catering to everyone else’s needs, people-pleasing, or an inability to say no
  • Procrastinating and struggling to start new projects as well as under-performance

Upside of Perfectionism

Some of the traumatic long-term effects actually manifest as benefits at first: People pleasing, perfectionism, and over-performing can be highly valued by managers. Colleagues will appreciate the person who is always helping out, often excelling every task and unknowingly engaging beyond boundaries.

In these cases, it may seem like there is no downside. But our bodies and minds are paying the price. Seemingly unrelated issues such as back pain, skin problem, digestive issues, blood pressure, and even injuries that are taking forever to heal can all be tied to the effects of stress and repressed emotions.

The Body Says No

The physician Dr. Gabor Mate wrote When The Body Says No: The Cost of Hidden Stress, merging his experience with his patients and scientific data. He says: “When we have been prevented from learning how to say no, our bodies may end up saying it for us.”

Recognising the role our own developmental trauma plays in our lives is paramount. The parenting we have been exposed to is not our fault. The aim is not to blame, accuse or condemn what we have lived through. The aim must be to regain the power to observe, learn and grow. 

Our trauma does not need to control us. Instead, we can get to a place where we can emerge as an embodied, present adult who responds to situations with insight, knowledge and wisdom.

Happy Birthday Pandemic! One year of mental health struggles

Happy Birthday Pandemic! You brought us one year of mental health challenges and the stress of just wanting to make it through somehow – knowing that this is the least empowered mindset to be in.

Congratulations, you grew bigger and already developed a real character full of surprises. With only one year of existence you keep everyone on their feet. You manage to draw attention 24hrs a day and need a whole new infrastructure just to cater for your needs. Unfortunately you also caused a majority of us a steep decline in mental and physical well-being.

Several surveys confirm that your birth of COVID-19 caused “postpartum” stresses like breakdowns, burnout, anxiety, low mood, depression, insomnia for many. Your unpredictable and sleepless nature required us to redefine our caring responsibilities. And believe me, we would not always agree and oftentimes slip. We had to rearrange work, cancel play, socially distance and adapt new standards of hygiene only for you.

A recent free article in the FT highlights a survey on the effects of the pandemic on office workers’ mental well-being around the globe. The UK and Hong Kong ranking top and second on mental health being most negatively affected. Financial Services and media being represented industries amongst others.

While for many participants flexible work arrangements also brought upsides like reduced time to commute, the possibility to workout during daytime and engaging more with family, the same circumstances of “flexible” arrangements led to physical stress and emotional and mental imbalance.

Negative effects showed in unhealthy lifestyle choices, overworking and the dissolution of boundaries regarding time, space and social environment. Moreover, restrictions to public life and leisure activities contributed heavily to the feeling of being trapped at home, limited in self-care choices and the pursuit of hobbies.

My experience with clients mainly in Hong Kong, but also via Zoom from Australia, Japan, Singapore, India, Europe and Central America goes hand in hand with the findings of the survey. However, a few big stressors have to be added from my professional perspective. Many struggle with:

  • Worrying, anxiety and sadness about the impossibility to see and involve their family and friends. Zoom does not help to look after children or to accompany someone to the hospital or a doctors visit. Stress is often exacerbated when we have not heard from loved ones in a while or can’t reach them. Leaving us helpless and powerless.
  • The lack of support from educators and employers regarding the setup and proper management of working and learning remotely with proper parental control and at times always-on expectations – Sunday like Monday. An avalanche of adjustments to life has to be dealt with and often within the shortest timeframe.
  • Long distance relationship being emotionally tested by the uncertainty of travel restrictions, tough cash-flow decisions when considering to move or to stay and the nightmare of literally feeling out of touch. Spontaneity is a concept long gone, the zest of life often losing the battle with mechanically functioning along the scheduled tasks lined up from morning to nighttime.
  • Short distance relationships being tested by simply having nowhere to go, for example when one partner takes a few days off – at home. The unfulfilled longing for a few hours of solitude and creative expression. But also the unfulfilled longing for being able to miss our partners and our craving for romance.

A healthier mindset

It is all too easy being absorbed by a one year old, in particular if the baby is a superhuman pandemic. This birthday also marks one year of great and skilful adjustment. Discovering energy and the ability to deal with problems we did not know we possessed. Here is to not forgetting ourselves, our self-care and dignity!! Here is to celebrate one year of upholding, growth and wisdom. Cheers to having been able to adjust to the great challenges, to newly found strengths and to rediscovery of our true priorities like family and friendship.

Men’s Mental Health: Don’t suffer in silence!

The COVID-19 pandemic and its response measures have had severe consequences for the mental health of people worldwide.

Depression, and particularly male depression, has gone up all over the world. Parents with young children have had to juggle watching young children and working from home as daycares worldwide shut down. Travel restrictions meant that some haven’t seen their family, friends and partners for months.

For people who are living home, lockdown measures have meant little to no social interaction. The result is increased stress, loneliness, anxiety and depression. Coupled with anxiety regarding the health of ourselves and our loved ones, reductions or loss of income, and the state of the world,  and we have a recipe for a mental health disaster.

Download free MENS MENTAL HEALTH pdf-one-pager here

Loneliness

Many men have learned to rely on relationships based on “doing”: bonding with coworkers or sports with friends. While women are traditionally more comfortable talking on the phone, texting, and having video calls, many men reserve these communication forms for family and partners – at best. When this becomes the main or only form of communication, many men struggle.

Stress

Hong Konger’s livelihood has been tested for a while, not only by the restrictions due to the pandemic. While both men and women suffer from this consequences, many men tend to over-identify with their jobs. Not being able to earn, to provide or simply being busy invokes feelings of failure. Cathay’s mass lay-offs and the like will affect the economical landscape mid-term.

Anxiety

While men and women both suffer from stress, depression, and anxiety, men are traditionally conditioned to repress their feelings. While these attitudes are shifting, it’s not easy to unlearn lifelong habits. When men feel anxious asking for help or being vulnerable, their stresses pile up. The result can be severe and debilitating anxiety. 

Depression

Men’s depression or anxiety often go hand-in-hand and can go undiagnosed. On the surface, we may see irritability or self-medication with substances, alcohol or sex. Physical symptoms of depression such as fatigue or body pain (back pain, tooth aches, …) are also common in men.

The way male depression manifests is poorly recognized by our current diagnostic criteria and approaches. Traditional concepts of masculinity deter men from seeking help, making the problem worse. It’s evident that while reducing mental stigma is essential, it’s not enough. We must also understand that men and women require different solutions and tailor treatment options accordingly.

Getting well versus Staying well

As a society, we like quick and easy solutions. With men, this tendency can be even more pronounced. Stereotypically, men are more solution-oriented, while women might prefer to give more space for emotions and understanding. And if the problem is that we’re feeling bad, we need to find a solution towards feeling good, right? Reality is a little more complicated than that. While external conditions significantly influence our internal state, we can’t expect our mental health to depend on them.

The good news is that the common mental health issues in men can be treated and that we can apply many successful measures of prevention. Depression and Anxiety as well as Stress and Loneliness are manageable and treatable. Learning coping strategies can make future episodes shorter and less intense. Treatments can help you reduce negative thinking, create strategies to tackle problems and improve relationships.

Getting Well

  • Educate yourself
    • Understand what you’re dealing with can help you come up with the best coping mechanisms for you
    • There are many good videos, podcasts, and blogs that you can find online for free
  • Start noticing and open your awareness
    • Work on challenging your negative thinking
    • We all have stories and core beliefs that we picked up early in life that may be no longer serving us
    • Picking up a mindfulness practice can help you become more aware of negative thinking patterns. As you do so, you’ll learn to let go instead of becoming attached to them
    • Practicing CBT (Cognitive-Behavioral Therapy) sheets can help you change these thoughts at the core
  • Connection is King
    • Connect with yourself – remember The Matrix “…do you believe that my being stronger or faster has anything to do with my muscles in this place?…”
    • Connect with others – remember Along Came Polly when Mr Feffer speaks the truth: “…it’s not about what happened in the past or what you think might happen in the future – it’s about the ride! There is no point going through all this, if you not gonna enjoy the ride…”
  • Turn to a professional
    • Many men have a lot of resistance to going to therapy. It’s worth examing to see why that is. Are you ashamed of admitting you have a problem? Or is it that you’re afraid that if you talk about your pain, you will be overwhelmed by it?
    • A good therapist will make you feel heard and understood. They’ll also help you learn to solve your own challenges through new tools and coping strategies. 
  • Medication
    • Remember that medication takes time to work and isn’t a permanent all-encompassing solution
    • Medication can help you feel more stable so that you can build a stronger foundation for your mental health with therapy and other solutions.

Download free MENS MENTAL HEALTH pdf-one-pager here

Staying well

Remember that good mental health requires maintenance. While it may be tempting to drop all your new habits once you start feeling better again, this can backfire. Think of it as a diet: you can lose the weight, but if you start drinking soda and eating friend and sugary food all the time, you’re likely to gain the weight back. The same goes for depression and emotional wellbeing in general. Living a balanced, healthy lifestyle is just as important when you’re feeling good as it is when you’re struggling. 

  • Monitor your early warning signs
    • As you become more familiar with your inner world, you’ll learn to recognize warning signs before things get bad
      • Less reading, more Netflix? Less Sport, more deep fried Food?
      • Recurring thoughts like “No one understands me.” or “I am a failure.”
      • And you might begin to pay attention to physical symptoms of fatigue, heaviness, tension or shallow breath.
  • Keep Social with friends, family or in a group of likeminded
    • Any group of common interest can provide a safe space where you can learn to be emotionally vulnerable while receiving support from others facing similar challenges.
    • Join a men’s group. There can be something profoundly healing about sharing openly in a group of men – precisely because it’s so unfamiliar to many of us. In a study of older men (usually considered non-responsive to therapy), the men’s group was a valuable tool in treating depression.
  • Make time for Self-Care
    • It’s crucial to find the strategies that work for you. In a study of 465 Australian men, eating healthy, keeping busy, exercising, humour and helping others were their top strategies for preventing depression. Other successful methods included spending time with a pet and self-reward.
    • Most of the things mentioned in this article can be forms of self-care: support groups, physical exercise, counselling & therapy, eating healthy
    • Self-care can be making sure you get some quality-time with your Self. Outdoors beats indoors, Walking meets Talking.  

 

Singaporeans’ struggle with wellbeing and the need to find a counsellor

Why it is important to find an English speaking counsellor in Singapore and how to do it.

According to an article published by the WHO in 2018, mental health is defined as, ‘a state of well- being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her own community.’

As per the latest studies conducted in Singapore, 1 in 7 people has been shown to have suffered a mental disorder in their lifetime. Statistics show that in Singapore, the three most common challenges with mental health are: obsessive-compulsive tendencies, depression & low mood and unhealthy lifestyle choices. 

According to my experience with Singapore-based clients, the most common issues are relationship skills and maintaining mental and physical sanity in the midst of career adjustments and family drama – often with family abroad and difficult to stay connected with in times of travel restrictions due to the pandemic.

Face- to- face therapy sessions have become slightly challenging owing to the fact that individuals are encouraged to socially distance themselves from one another. This has resulted in an increase in telehealth services, i.e. the delivery of health services via online video conferencing.

These services have an array of advantages such as; having access to a therapist from the comfort of your house. Having access to a therapist without having to leave the house has made it that much easier to seek the services of therapists.

The ability to access mental health services without leaving the house has also been advantageous in that most patients and doctors/ therapists are able to practice social distancing and keep themselves safe from contracting Covid- 19. This period of life has been difficult for most individuals since it’s brought about loss of jobs, financial insecurity, loss of loved ones and a lot of instability. Online therapy services have made counselling sessions accessible.

Steps to take

Counselling and online therapy can be tailor-made. It is up to the individual and his/her counselor to decide what type of intervention works for the individual. Some of the approaches include;

  • See a therapist / counselor – there are several types of therapy sessions available such as individual therapy, group therapy, family therapy and support groups.
  • Expressing gratitude – enables one to keep track of even the tiniest things that go well in one’s life and thus gives an individual the opportunity to shift their focus onto their agency: moving, shifting and placing attention.
  • Journaling – writing down helps to reflect and reappraise situations, feelings and experiences.  My tip is to try to write your observations in third person in order to take a step back from your own mind and the drama that it unfolds around the SELF / EGO.
  • Maintaining a supportive network – family, friends and colleagues can support you. It is important to identify a few – not many – people you feel safe to confide in.  Past trauma and adverse experiences can make it difficult to trust – that’s ok. Counsellors are an alternative as they have to adhere to ethical and professional standards of confidentiality and care.
  • Self-care – all to refresh the brain or in other words the connection of the mind and the body
    • Body – sleep!!!, physical exercise such as running, cycling, swimming, yoga or tai chi
    • Diet – less sugar, less fat (no deep fried), plant-based protein, experiment with ways of fasting
    • Meditation – focus attention or/and open awareness, be present – moment to moment, recognise your judgements

REFERENCES 

  1. IN FOCUS: the challenges young people face while seeking mental health help https://www.channelnewsasia.com/news/singapore/in-focus-young-people-mental-health-singapore-treatment-13002934 
  2. Mental health, strengthening our response https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response#:~:text=Mental%20health%20is%20a%20state,to%20his%20or%20her%20community
  3. Depression https://www.healthhub.sg/a-z/diseases-and-conditions/101/topics_depression 
  4. Depression https://www.singhealth.com.sg/patient-care/conditions-treatments/depression/overview 
  5. Teenage depression; signs, causes and treatment https://www.healthxchange.sg/wellness/mental-health/teenage-depression-signs-causes-treatment 
  6. IMH; wellness https://www.imh.com.sg/wellness/ 
  7. The state of mental wellness in Singapore https://adelphipsych.sg/the-state-of-mental-wellness-in-singapore/ 
  8. Types of mental health treatments https://www.psychguides.com/mental-health-disorders/treatments/types/ 

Lovingkindness – The neuroscience of wishing well

In this blog you will learn what Lovingkindness is and how evidence-based science demonstrates the psychological benefits for your well-being.

Added bonus: Understand what’s in for you to wish people well that you don’t like that much or let’s say would not vote for.

What is Lovingkindness?

Lovingkindness is the practice of wishing well. It is typically done as a guided meditation in feelings of goodwill and benevolence. The practice uses a set of phrases (such as “may you be at peace. May you be healthy.”) that we imagine saying to ourselves, loved ones, strangers, and even people we find difficult.

As we imagine saying these sentences, the goal is to connect with the positive emotions that arise. We’re not trying to manifest any reality (we’re not going to make anyone healthy by wishing that they are), but rather seeing how it feels to say these words to another person and genuinely mean it.

Lovingkindness is the translation of the Pali word “metta.” It is one of the four Brahmaviharas in Buddhism – the others are compassion, empathetic joy, and equanimity.

Academic interest in lovingkindness meditation keeps growing. Researchers are conducting experiments regarding the benefits of lovingkindness for various disorders, including depression and anxiety and everyday issues like anger and relational conflict. The studies appear promising, showing a positive effect on happiness, self-compassion, and general wellbeing.

What are the benefits?

When we practice lovingkindness consistently, we might find that our positive feelings multiply in our day-to-day life. In turn, it can serve as an antidote for difficult emotions such as anger, depression, anxiety, and self-criticism. Note that practicing lovingkindness doesn’t mean that we are trying to hide our “bad” emotions or plastering a bandaid of positivity over them. Instead, we are trying to water and nurture the seeds of love, joy, kindness, and acceptance. We learn to divert our attention to the positive and expand those emotions.

Stephen Hofmann calls lovingkindness a practice that “leads to the path of happiness.” He notes that psychology has focused on trying to reduce negative emotions rather than increasing the positive. In a literature review, he and Paul Grossman and Devon E.Hinton conclude that lovingkindness can help treat social anxiety, marital conflict, and anger.

A randomized experiment on 38 individuals high in self-criticism showed the effects of lovingkindness in practice. The participants showed increases in positive emotion and self-compassion and reduced depression and self-criticism (Shahar et al. 2015). The effects lasted three months after the intervention. 

Another study on the long-term effects of lovingkindness meditation on PTSD and depression found similar benefits. After three months, there was a significant reduction in PTSD symptoms as well as depressive symptoms (Kearney et al., 2013). Similar benefits have been found in individuals dealing with Borderline Personality Disorder.

It’s becoming apparent that lovingkindness practice can be a powerful intervention.

Lovingkindness changes the brain

Practicing lovingkindness meditation doesn’t just make us feel good. It can have significant and long-lasting impacts on the brain. 

One brain imaging study examined expert and novice meditators as they engaged in lovingkindness meditation. The researchers introduced emotional and neutral sounds during meditation and found that the expert meditators had increased activation in brain areas associated with empathy and theory of mind (Lutz, Brefcynski, Johnstone, Davidson 2008). 

A 2012 experiment by Lee et al. went further and looked at the differences in brain activity when practicing lovingkindness meditation as opposed to concentration meditation. They found that experts in lovingkindness meditation showed a distinct neural response to sad pictures that was more in line with empathy and emotional regulation. That means that when we practice lovingkindness meditation consistently, we’re training our brain to be more compassionate in the future. 

Imagine what can happen when we train our brains to react with kindness instead of judgment and fear. Implications can include less conflict with our friends, family, and partner; fewer instances of road rage; more measured responses when a coworker annoys us. We can instinctively offer better emotional support. As our self-compassion grows, we learn to make healthier choices and forgive ourselves for making mistakes. A lovingkindness presence can feel like magic.

How to practice lovingkindness in daily life? 

There are several ways to practice lovingkindness meditation. The primary way they differ is by the first object of lovingkindness. Some people start by sending lovingkindness to a loved one, then moving on to themselves, and then turning to a difficult person. Others say that we should always begin with sending lovingkindness to ourselves. 

Both types of practice start by sitting in an upright but comfortable position. You can also practice lying down if that’s more comfortable for you. You can close your eyes or leave them open. Take a few deep breaths to calm down the body. Then, let go of trying to control your breath. 

Starting With Yourself

If you want to start with yourself, imagine that you were sitting across from yourself. As you do, repeat sentences such as “may I be well. May I be safe. May I accept myself just as I am.”

There are many phrases you can use, but try not to pick too many. Keep it simple. Stay with this feeling for a while. If you find that it is too difficult, try to imagine yourself as a young child.

After a few minutes of this, you can choose to practice sending your lovingkindness feelings to a benefactor, an acquaintance, a stranger, or someone you find difficult.

Starting With a Loved One

Some people find it too challenging to start with sending lovingkindness to themselves. An excellent way to change this is to begin by imagining a good friend, benefactor or loved one. You can picture your pet or anyone else whose presence inspires feelings of warmth in you. Repeat the phrases as you imagine your loved one in front of you (“may you be at peace…”). After several minutes, try to turn the warm feelings you’ve gathered towards yourself and then towards a challenging person.

As you will see, different people practice lovingkindness differently. You might focus on one or two people at a time or try to send out lovingkindness towards the world. Some people find this to be a very emotional practice, but it’s OK if you don’t feel anything in particular. It can be helpful to use a guided recording in the beginning. You can find a 20-minute Lovingkindness meditation guided by Sharon Salzberg here.

Bonus: Turning towards the difficult – wishing your enemy well

Some people report difficulty to wish others well, whom they deem not worthy or deserving. I can very well relate to this attitude and was grappling with it for long time – even questioning my capacity for compassion. However, it became clear to me that I can find the ability to wish well to actually everyone. Here the rational:

  1. If others – liked or not liked people – live healthier, live with more peace, find ease or may be with calm, the world in total will be healthier, more at peace and more calm and at ease. I am certain of that.
  2. If others – liked or not liked people – live happier, that does not mean that I lose part of my happiness or really that I lose anything at all. It’s not a trade off. If I wish you good health, then I will not be more ill due to my wish. It’s not a give and take situation. It truly is a win-win.
  3. If you want to be skilfully wishing well, first you need consider what actually moves and motivates malice, violence and wrong doing. Then you can counter the driving energy with your tailored wish. For example: aiming at narcissism would sound a bit like this perhaps: “May you live with ease, may you find happiness, may you find confidence (in someone else), …”

Note: here we must assume that this is a question of true, genuine, authentic happiness to be found and not a shallow “happiness” that some wear in disguise.

How to find a Hong Kong-based counsellor in times of pandemic? update

Before choosing a therapist, start by assessing your current situation and what you hope to achieve in your sessions. Are you burned-out at work? Perhaps you’re struggling with low self-esteem? Your experience will manifest as feelings, behaviours, thought patterns and physical sensations.

Constant unexplained irritability can be a sign of anxiety and overwhelm. Pay attention to changes in appetite and disturbed sleep like insomnia. Stress and anxiety can show up as tense muscles, nausea, or headaches. Coping behaviors can include self-medicating with alcohol, distracting with social media, news and overworking.

Start with a quick self-assessment:

> What is your current challenge or struggle?

> What do you want to achieve in the process?

Once you’ve recognized the problem, think about what you would like to achieve. You might have a particular goal for therapy, like “I want to move past a second date with a partner” or one that feels more undefined, like reaching a better understanding of the connection between your childhood and current habits, relationship issues or emotional distress. Once you’ve figured out what you’d like to gain through therapy, you can set out to find the therapist that will help you.

Considerations for finding a counselor that suits your needs

Generally, when looking for an English-speaking counsellor, coach or psychotherapist, you want to check out several areas:

  • Qualification – the counselors’ education and professional qualifications, work experience and therapeutic approaches trained in
  • Personal fit – the likelihood of how you get along with your counselor might depend on some of your preferences and specialisations offered
  • Hands-on concerns – office location, working hours, punctuality and availability of session slots
  • Readiness for pandemic – in times of 3rd, 4th, 5th, 6th waves of new positive tested COVID-19 cases it is paramount that your counsellor caters for a smooth and flexible transition between facemask-to-facemask and online consultations.

Life in Hong Kong is often transient, there are several practical concerns that should matter regarding the mutually committed work. Consider the level of spoken English, general reliability and the length and frequency of absences. 

Qualifications and Professions

One of the first things clients typically look at when choosing a therapist is their legitimization. It’s important to distinguish the various types of counselors and therapists based on their qualifications.

A Psychiatrist is a medical doctor who specializes in Psychiatry. A Psychiatrist can diagnose mental disorders, write fit for work assessments, and prescribe medication. A Clinical Psychologist has a Doctorate – Ph.D. or PsyD in Clinical Psychology. A Psychologist can administer psychological tests and write reports and assessments. However, they cannot prescribe medication. Counsellors and Psychotherapist have frequently trained in therapy approaches that go along with their services offered – like Cognitive-Behavioural Therapy (CBT), Acceptance-and-Commitment Training (ACT), Couples Counselling, Mindfulness-based approaches, Trauma Treatment,

There are Master’s degrees in counseling that offer thorough training. Therefore, if you’re seeing a Counselor, ask what their qualifications are. A Life Coach is a different type of training. While some Licensed Counselors and Psychologists choose to obtain a Life Coaching certificate, many Life Coachs undergo shorter qualification periods. Some Life Coaching certificates can be obtained in just a few months, compared to many years it takes to become a clinical professional with medical and academic degrees.  

Consider the goals that you have set and your practical limitations. If you do not think that you will need medication, perhaps you don’t need to see a Psychiatrist. However, if you think medication might be part of your path, seeing a psychiatrist is important.

Practical Concerns

When choosing a counselor, you also need to factor in practical concerns. If your sessions demand a long and uncomfortable commute, your sessions will have a negative connotation in your mind. If your counselor isn’t fluent in your Native language, you won’t feel fully understood. Therefore, make a list of practical concerns you have, and bring them up in your initial session. Ask the counselor if they do online sessions if one of you will need to switch from face-to-face consultations to video conferencing.

However, Therapeutic Alliance is key!!!

While qualifications and practical concerns are significant, the most important thing you should pay attention to is how you feel during your sessions. Studies show that one of the most important factor in determining your therapy success is the relationship between you and your therapist – also known as the therapeutic alliance. The quality of the therapist-client relationship is a reliable indicator for positive outcomes – regardless of the therapeutic approach

The Therapeutic Alliance is king and queen of your therapy castle.

A therapist might have decades of education and experience, but if you don’t feel that they care about you, you might struggle to make progress:

  1. Your counselor should be warm and empathetic – making it easy to share openly
  2. You want to feel that they understand you and that they have your best interests are heart
  3. The positive working alliance models the way, you will experience what it’s like to have a genuinely trusting relationship

You also want to make sure that your practitioner is “walking the talk.” Your counselor should be a role model for behavioral change. Pay attention to clues that point to whether they’re living according to their life values, i.e. leading a healthy lifestyle with balanced sleep, diet, physical exercise and social network. A healthy sign is also when they are able to set professional boundaries to help you stay focused and committed.

The Best Way to Find a Good English Speaking Counselor in Hong Kong

Start by making a list of potential practitioners that you find through:

In your initial session, talk about your goals for the sessions. Ask them what approach they take. The specific method they use might not be as important as the fact that they have a structure and would be able to outline key concepts in the process if and when you ask. Pay attention to how you feel during your initial session. Do they make you feel at ease? Do you think that they understand you, or do you have to over-explain yourself? However, don’t let the session be a monologue by you. The counselor should be telling you about their approach, they must be able to let you know how they relate to you and how they feel and plan to continue with you.

Take some time to reflect on your first sessions. If both, you and your counselor feel confident in your ability to work together, book another session. Congratulations, you’ve found your counselor! 

Hugging – think Minuet not Tango

We are currently facing two pandemics that came along hand-in-hand: COVID-19 and the epidemic of loneliness and disconnection. As the worldwide death toll surpasses one million (nytimes.com 28/9) international travel has come to a standstill. Several countries around the world have enacted lockdowns of varying severity. Many adults who live alone went from seeing people every day to going weeks without talking to another person.

For the elderly, this isolation and loneliness are even more extreme, as many struggle to use technological tools to keep in contact with family and friends. While young adults used video calls and social media to stay in touch, many older adults went days without conversation or eye contact. This loneliness, in addition to anxiety about health and the state of the world plunged many into depression.

The majority of my clients in Asia, Europe and North America is disconnected from family and friends. Some of them and myself had to travel for sad and mournful occasions.

Self-regulation vs. interpersonal regulation

Individual ways we can take to calm ourselves: Yoga, breathing techniques, and grounding exercises can all be practiced during isolation. However, co-regulation (or interpersonal regulation) is also essential for all human beings – especially for young children with developing brains, who do not yet have self-regulation capacity. As all social beings we are wired for connection.

When we see someone act, our mirror neurons fire as though we were the actor. When we feel unsafe, a reassuring smile and the calming voice of a loved one can help calm our body down. Touch is a core aspect of this co-regulation process. One study found that holding hands with a loved one decreased the amount of pain a woman felt while receiving an electrical shock.

The truth is, we just can’t separate our mental health from the physical. Stress and loneliness affect our physical body directly. Studies show that loneliness can increase the likelihood of various diseases, from heart disease to Alzheimer’s. Hugging is a form of touch that helps us feel connected to others. When we hug, we feel loved, seen, safe, soothed and secure.

Today, the main wrench of the pandemic is: Just when we need human connection the most, we are told to socially distance.

Of course, we want to keep our loved ones safe and avoid unnecessary risks. And yet, the benefits of touch and human connection are more important than ever. Is there a way we can balance these two contrasting positions?

Approaching hugging rules scientifically

  • First, use common sense to determine when a hug or touch is actually needed. Now is not the time for networking and social niceties. If you meet someone new, hugs and kisses probably aren’t essential. Supporting a friend who is going through a hard time might be a different situation.
  • Wear a mask. The mask will be an extra layer of protection against respiratory droplets that you breathe out. In doing so, it will help protect your hugging partner.
  • Make sure you’re crossing over – both on their left or both on their right shoulder side (think Minuet not Tango). That way, you’re not breathing in each other’s exhaled air. 
  • Avoid touching each other’s faces while you hug. 
  • Don’t talk while you are hugging. Keep the conversation to before and after the hug.
  • If possible, hold your breath during the hug. 
  • Keep your hug brief. You can have an extremely effective hug in ten seconds. Hold each other tight, relax, and then let go.
  • Let children hug you at their level, rather than coming down to their height. That way, their faces should be at your knee, waist, or possibly chest level, making it less likely to spread germs in the air.
  • Don’t hug while either of you is crying, or if you have a cough or runny nose. 
  • Step away after the hug, and continue your conversation when you are standing several feet apart. 
  • Wash your hands after hugging, and avoid touching your face.

When Hugging Is Not An Option

There are other ways to calm your nervous system and get similar benefits that touch provides. If you have a pet, you can co-regulate with them. A study on the effects of human-animal relationships in children found that “touch, proximity, and mind-body interaction with animals have been found to contribute to stress reduction and trauma recovery.” 

Make sure to check in and keep in touch with loved ones, even when you’re not able to meet face-to-face. Text messages are great. Voice or video calls will be even better, as they will activate more of your senses as well as your mirror neurons. You can use this time to find alternative methods of showing care and keeping in touch. Try writing physical letters or even creating a scrapbook with memories and shared jokes.

If you don’t have an animal that you can interact with, hugging a stuffed animal or pillow can also simulate the feelings of safety and warmth you would get from human touch. Even if this hasn’t been your previous practice, we are in a unique set of circumstances. 

The benefits you will receive from gardening or taking care of indoor plants can also mimic some of the same bodily responses you get when caring for a loved one. 

Self-regulation techniques to calm your nervous system include stretching, humming, and embodied movement practices such as tai chi. Experiment with several different ones until you find those that work for you. 

During times of uncertainty and panic, it’s important to take precautions and stay safe. We don’t want to put our loved ones in harm’s way. Exercise caution, but remember to keep your emotional and mental health a priority. Keep touch and connection alive in your life as much as you safely can, for the benefit of us all. 

Awareness of Breathing. The antidote to living in our heads.

This is a guided awareness of breathing practice. The intention is to become aware of the tactile sensations of breathing from moment to moment: Paying attention and noticing the breath in movement and in stillness. This formal sitting practice can be done sitting on the floor, a mat, a cushion, a meditation bench or a chair.

The meditation provides an internal focus for attention. The breath and the body – as well as other foci – can be developed as an anchor to the present in the ocean of moving attention. Bringing back attention on purpose and moment-to-moment – gently and without judging. Perhaps noticing where attention has been pulled.

The breath as a symbol and direct experience of the arising and passing of all. The antidote to living in our heads. Helping to develop a skillset to detect the movement of attention – often triggered by obstacles and situations – as well as seeing reality as a construct and lastly to train the attentional muscle in holding a focus and bringing it back to the focus.