How to Forgive Someone

The Art of Forgiveness

How do I forgive someone when they have brought me so much hurt?

Who hasn’t been hurt by the actions or words of another? Be it from your family or friends (or even a stranger!), we are likely to encounter situations where others say or do something that hurts us deeply. When this occurs, it is normal to experience and to cling onto feelings of anger, resentment, and pain. On the other side of the same coin, forgiveness is challenging – in fact, it is one of the toughest things to do.

What is forgiveness?

Even the term “forgiveness” is a tricky one. Forgiveness does not necessarily mean entirely forgiving the person or condoning their actions. Instead, forgiveness means that you make an active decision to accept what has happened rather than hanging onto the “could’ve” and “should’ve”. It involves letting go and freeing yourself from the hurt and pain that others have caused. Forgiveness can even lead to feelings of understanding, empathy and compassion for the one who hurt you and brings a kind of peace that helps you go on with life.

Why should I forgive others? Why should I make the effort to forgive when holding onto the negative feelings seem so much easier? 

Forgiving someone can certainly be difficult and it is even harder when the other party does not seem apologetic. Despite this, forgiveness is the healthiest path forward. Forgiveness comes with an array of positive benefits on our mental and physical well-being, including increased self-confidence, optimism, reduced stress, and having a more positive outlook on life.

How do I forgive someone? Understanding and Letting Go of Anger and Resentment

One way to look at the situation is from an acceptance and commitment therapy (ACT) approach. ACT involves acknowledging and accepting unwanted experiences that are beyond your control and committing to engage in concrete actions that will improve and enrich your life instead.  

ACTing Towards Forgiveness

Let’s take a look at how the 6 core processes of ACT can be helpful with the process of forgiveness:  

1. Cognitive Defusion  

Cognitive defusion involves learning to recognize that thoughts, memories, feelings, and other cognitions are simply bits of language and images that are nonthreatening, nor are they hard truths and facts. To do so, take on a third-person perspective when looking at what is going on in your mind – just like stepping back and viewing your reflection in a mirror! Separate the unpleasant and unwelcome cognitions from yourself. The opposite of this is known as cognitive fusion, where you get entangled in your thoughts, memories, and feelings. 

Rather than replaying the event and wallowing in anger, there’s a better way to cope. One method is through journaling, which turns thoughts and worries into mere words that are not related to you. 

It sounds difficult, that’s for sure. But with practice, you should ultimately learn to face negative experiences and come out the other side with a decreased fixation on the hurt and pain experienced.

2. Acceptance  

When others cause us any form of hurt, it is normal to experience negative emotions. In fact, it is often these intense emotions that make it so hard to forgive someone. Whenever we experience hurt and anger, it is practically instinctive for us to try to avoid it and quash them. After all, no one enjoys wallowing in negativity. Rather than suppressing those emotions, try practicing accepting them instead. Acceptance involves allowing those unpleasant experiences to exist and embracing them without trying to deny or change them. It does not necessarily mean endorsement or justification, but simply acknowledging that you don’t have power or control over the past. 

For example, you may feel resentment towards your parents for failing to spend time with you as a child. You may feel upset and resentment as a result. However, it has already happened and there is nothing you can do to change the past. So, if you’re feeling angry, it is okay to acknowledge that you feel that way.  

By opening up and allowing your unpleasant feelings to come and go without struggling with, running from, or giving them undue attention, we find ourselves much less bothered by them. This also enables those feelings to move on more quickly, instead of hanging around and bothering us. 

3. Contact with the Present Moment  

How often do you find yourself mindlessly going back in time, revisiting something that happened and imagining all the other ways it could have panned out? 

This step requires you to re-focus on your present environment and self in a non-judgemental manner, and less on what has happened in the past or may happen in the future. When you experience the present world with more openness, interest, and receptiveness, you will have a greater ability to behave in a manner that is more in line with the values that you hold. 

Let’s say you are upset at a friend who stabbed you in the back. You may spend time reliving the moment, critiquing your friend’s actions, or regretting not telling them off.  

Although it is natural for negative experiences to grab our attention (this is known as the negativity bias!), we also have to acknowledge that past events are irreversible. You could have responded better, you should have known better, but you cannot change the past — so why not try to accept what is happening right now? As you immerse yourself in the present, describe events to yourself in an objective manner as they occur without placing any judgments or labels on them. Doing so will free you from the hurtful past (or future) and give you more control over your behaviour. When you start focusing more on the present, you spend less time judging and criticising both yourself and others. 

4. The Observing Self 

When we think of our self, what commonly comes to mind is our physical self (our body) and our thinking self (our mind). This “thinking self” is always hard at work as we try to understand the world and problem-solve whenever we can. However, there is another part of our self that steps back and simply observes without getting involved in the battle of our thoughts. This is the “observing self”. 

The observing self is not a thought or a feeling per se, but more of an awareness that you are thinking and feeling because you are aware of your thoughts and emotions.  

“I am my body, and I am more than my body; I am my feelings and I am more than my feelings; I am my mind and yet I am more than my mind.” 

As we go through life, our thoughts and feelings constantly change: at times you feel anxious, sad, angry, or frustrated. Instead of dwelling about your thoughts and judging your own emotions, why not try to simply observe and be aware of your own flow of experiences without attachments and investments? When this happens, defusion and acceptance is fostered. The observing self will allow you to observe difficult thoughts, feelings, and memories as peripheral aspects of ourselves, but as they constantly change, they are not the essence of who we are. By engaging the observing self as we encounter unpleasant experiences, we often find that things we were dreading become much less bothersome than they were before, giving us the capacity to disidentify from pain and unhappiness, making experiences more bearable. 

5. Values – What matters to you? 

Now that we’ve learnt to embrace our internal experiences and to observe them non-judgementally, the next step is to get to doing. 

How do we do this? We use our core values to guide our behaviour. Think of values as the qualities you care the most about. They have to do with what sort of person you want to be, what principles you want to stand for in life, and what you ultimately experience as your true drive that you choose to work towards. Values help you to steer your actions toward what is meaningful to you and is important in motivating you to make significant changes so you can lead a fulfilling life. When we are guided by our values, not only do we experience a greater sense of purpose and joy, but we also see that life can be rich and meaningful even when “bad” things are happening to us. 

Sometimes, when we get caught up with life, we may lose track of our values or even be unclear of what they are. Although this is not ideal, we can acknowledge that it happens, and make an effort to be mindful of our values moving forward. 

How then, can we be mindful of our values? One way is to take some time to think about how you want to be remembered, or the things that you would disapprove of if others did them. Perhaps you may realize that you value empathy and compassion. While these values may clash with the hurt that you are experiencing, the reality is that we sometimes must prioritize one value of another, asking ourselves “What is most important at this moment in my life that will help me be the person I want to be so I can lead a meaningful and fulfilling life?”

6. Take Committed Actions According to your Values 

You’re almost there, this is the final step! 

Now that you have a clearer sense of the values you wish to live by, the last step is to engage in actual behaviors that are guided by your values even in the presence of obstacles. You can do so by setting goals that are in line with your personal values and beliefs. This allows you to create a fulfilling and satisfying quality of life! 

Committed actions means engaging in large patterns of effective action that are driven and guided by core values. To be effective, you must be willing to be flexible. Life will inevitably change, throw different kinds of challenges at you, and there will be occasions where your behaviours fall short. Being flexible means that you take the time to reassess your actions and get them back in line with your values. This can be achieved by setting realistic goals based on your values and gets easier with time and practice!

Indeed, forgiveness is challenging. The thought of forgiving someone who has hurt you comes along with a host of overwhelming emotions stemming from both the person and the event itself.

Conversely, forgiveness is also powerful. While we’re unable to change the past, we can control how we respond to future events. Applying these strategies will initially be tough, and that is alright. Your feelings and reactions are normal (and shared by many people in similar circumstances). Know that with patience and time, it will get easier!

Recognising Suicide Risk

Recognising Suicide Risk, Protecting Human Lives

What are the signs associated with suicide risk?

Suicide Rates in Singapore

In Singapore, suicide is among the leading cause of death among the younger population aged 10 to 29. In fact, there has been a rising trend of suicide, with the reported figure of 397 in 2018 being a 10% increase from 2017. This figure is 2.8 times higher than the number of transport accidents in the same year.

What are the warning signs of suicide?

As concerned family and friends, we must be attuned to some of the signs associated with increased suicide risk:

Ψ Health Conditions: 

People with chronic or terminal illnesses, as well as mental health conditions, may experience a sense of hopelessness about their life and future. Hence, those with physical and mental health conditions are at a higher risk of suicide. 

Ψ Situational Stressors: 

People who are going through difficult and stressful events, such as divorce, unemployment, imprisonment, or exposure to violence and death, are at a higher risk for suicide. These events may also place the individuals at a higher risk for developing psychological disorders that could affect their perception and further heighten their suicide risk.

On top of that, people with a history of substance abuse, physical or sexual abuse, social isolation, and past suicide attempts are also at a higher risk for suicide. 

Ψ Verbal Cues: 

Regardless of what you may think about suicide threats, never take them lightly. When someone you know says that they don’t want to live anymore, it should be taken as a warning sign. 

The following are other common verbal cues associated with clinical depression and suicidal ideation to look out for: 

  • Using more first-person pronouns (e.g., I, me, myself): This is reflective of someone who is focused inwardly, which is typically observed in people with high awareness and experience of psychological pain. 

  • Using more absolute terms (e.g., always, never): People who are clinically depressed tend to hold a black-and-white (or all-or-nothing) thinking pattern, suggesting impaired judgement and reasoning. 

  • Speech characterised by guilt and self-blame, isolation and loneliness, as well as feeling tired, trapped and being a burden: When someone is experiencing a lot of pain, each day may seem like a recurrence of the one before and they can find it increasingly difficult to get by as they are unable to break out of the negative loop. 

Ψ Behavioural Signs: 

Take note if you notice someone you know starting to withdraw from others, neglect their physical appearance or lose interest in activities that they used to find pleasure in. People who have thoughts of suicide also typically give away their treasured possessions, or make a conscious effort to visit their family members and close friends out of the blue. These are common signs of suicide preparations, such as having closure or saying goodbye to loved ones. Other forms of suicide preparations include writing a will, researching on suicide methods, or writing a suicide note. 

Understanding suicidal ideation and suicide attempts

Numerous studies have found that: 

  1. Most individuals who have suicidal ideation have mixed feelings about suicide; and 

  2. They may seek help before a suicide attempt. 

As such, we are able to intervene before a suicide attempt is made.

How Do I Help Someone Who Is Suicidal? 

Contrary to popular belief, talking about suicide will not increase suicidal thoughts, or put the thought of suicide in their heads. In fact, speaking about suicide helps individuals know that there are people who are concerned about them, and who would want to support and help. 

Granted, many of us are uncomfortable with the topic of suicide and we may not know how best to start a conversation about it. How then can you help someone who is suicidal?

Here are some helpful tips when talking about suicide: 

  • Invite the troubled individual to talk about their difficulties and listen without judgement. Withhold the urge to problem-solve or give quick solutions. Remember, they are not looking for advice.

  • Check on what the troubled individual have been doing to cope, and what resources they have available. 

  • Ask directly: “Are you having thoughts of suicide?” 

    • If they are, encourage them to seek immediate help. For example, they can contact the 24-hr suicide hotline provided by the Samaritans of Singapore (SOS). 

    • If they are not, do still encourage them to seek help from professionals, such as counsellors or psychologists. Offer your support by sourcing for suitable services together, or even accompanying them for their appointments. 

Singapore’s decision to decriminalise suicide attempt from 1 January 2020 was widely applauded as a move to support, rather than prosecute, people who are so overwhelmed by their difficulties that they attempt suicide. Indeed, when it comes to suicide prevention, much can be done to promote mental health awareness and encourage help-seeking. We can start by doing our part to support the people around us, and helping to protect the precious lives of those we love. 

How to Practice Mindfulness

What is Mindfulness?

How can I practice mindfulness in my daily life? Understanding mindfulness practice and its importance.

Mindfulness is about being present in your experiences in each moment, whether internal or external. Practising mindfulness is particularly important as too often we go about our days doing things automatically, or we get caught up in our worries, thoughts, or distractions, and fail to be fully immersed in our experiences.

There is no end goal or result in Mindfulness. Mindfulness is about being in the present moment. When we are not engaged in worrying about the past or future, the inadvertent result is that we are likely to feel calm.

Mindfulness can be practised with these simple activities that everyone already does on a regular basis.

Mindfulness Activities

1. Breathing 

  1. Sit comfortably in your chair. You may wish to keep your eyes open or close your eyes.

  2. Breathe. Pay attention to the air as it enters your nostrils and into your lungs.   

  3. Is the air warm? Cool?  

  4. Then breathe out through your mouth. Notice your chest and belly deflate as air leaves your lungs.  

  5. Repeat these steps for 1 minute.



2. Walking 

  1. Start walking. Being in a park or place with lush greenery helps. But it doesn’t matter if you do not have access to such places – wherever you are works just as well. 

  2. As you walk, look around and observe your surroundings. There are colours that are dark, and there are colours that are light. Where are they placed within your field of vision? 

  3. Breathe. Feel the temperature of the air – is it warm or cool? 

  4. Touch your earlobes gently as you hear the sounds that are around you. Isolate a sound that you hear.  

  5. Stop walking; close your eyes. Try and listen to that sound for a few moments. What do you hear? 

  6. Open your eyes. As you look around your surroundings, observe whatever object your gaze lands on. Notice the level of detail of that object.   

  7. Continuing walking. As you walk, what sounds do your footsteps make? Can you feel a breeze as you walk? 

  8. Focus on making observations with your eyes, ears, skin, feet, nose:  

    • Where are you walking to? What’s around you? Are there any flowers? How many people are there around? What’s on the floor? Is the floor wet or dry? Is the weather sunny or cloudy? Are there any markings on the floor? Can you hear any sounds of nature despite being in a concrete jungle – are there birds? Which point of your foot lands first? Do you drag your feet? 

  9. Notice the movements of your toes, feet, legs, arms, chest. Notice where your eyes wander to. 



3. Washing of Hands 

  1. As you turn on the tap, put your hands under the running water. Remain still. Is the water cool or warm? 

  2. Rub your hands slowly under the running water. Feel the water in between your hands as you rub, and how your palms touch each other as you rub to and fro. 

  3. Listen to the sound of running water. How does the water sound as your hands go under the tap? 

  4. Look at your hands: do you recognise the marks, scars, lines, nails? 

  5. Focus on making observations with your eyes, ears, hands, palms:  

    • What is the colour of the soap? How would you describe its smell? What is the first action you do when you start washing your hands? Does the soap foam up? What colour does it become? Was the water warm or cold? What colour is your skin turning? Do you see the different shades of colour on your skin?  



4. Mindful Body Scans 

  1. Lie on your back in a comfortable position. Face the ceiling or sky if you are outdoors. If you cannot lie down, you may wish to sit on a chair with your feet resting on the floor. 

  2. Breathe and be still. If you have to move or adjust your position from time to time, that is fine. As you breathe in and out, notice the rhythm of inhalation and exhalation and the way your chest rises and falls. You don’t have to change the way you breathe or hold your breath but remain aware of your breath as you continue to inhale and exhale. 

  3. Now close your eyes. Bring your attention to your body and how it feels. The texture of your clothes against your skin, and the parts of your head, back and legs that rests upon the surface you are on. 

  4. Imagine that you are outside of your body and looking at yourself. Look first at your toes. How do you feel as you look at your toes from the outside of your body? Now shift your gaze upwards as you work systemically from the bottom up: 

    • Your toes and the rest of your feet 

    • Lower legs and calves 

    • Knees 

    • Thighs 

    • Your pelvic region (buttocks, tailbone, pelvic bone, genitals); 

    • Abdomen; 

    • Chest; 

    • Lower back; 

    • Upper back (back ribs & shoulder blades); 

    • Hands (fingers, palms, backs, wrists); 

    • Arms (lower, elbows, upper); 

    • Neck, Face and head (jaw, mouth, nose, cheeks, ears, eyes, forehead, scalp, back top of the head); 

    • Lastly the “blowhole” located on the top of your head – imagine a point on head where air goes in and out like a whale’s blowhole. 



5. Mindful Conversations 

This last one is a group exercise. Mindful listening is an important skill as people crave but are seldom fully “heard” or “seen”. Mindful listening also offers us the opportunity to shift the focus from ourselves or own responses onto the person speaking. 

  1. Gather around several of your friends and/or family. Sit together in a comfortable space (please observe safe distancing rules!). 

  2. Think of one stressful event that you experienced recently. Take turns to speak and share what that stressful event was in the group. 

  3. If you are speaking, speak without reservation or fear that anyone is judging you. If you are listening, listen intently without judgment or forming opinions.  

  4. Notice your bodily sensations, your thoughts and the feelings that flash through your mind before, during, and after each person has spoken.

General Tips for Mindfulness: 

  1. Set aside a few minutes for each activity (at least 20 minutes for the group activity). This ensures you have sufficient time to fully immerse yourself in a mindful experience. 

  2. During each activity, focus on at least 3 of your 5 senses (sight, taste, smell, touch, sound).  

  3. Do not try to ‘push away’ unwanted thoughts or distractions 

  4. Simply take cognisance or accept the thoughts or distractions that flash across your mind. 

  5. Let whatever feeling or emotion you experience simply be. 

  6. Then return your focus back into the experience of simply being mindful and aware of where you are. 

  7. While it is normal to experience distractions during mindfulness activities, practise bringing your attention back onto the mindfulness exercise. Focusing on your senses helps with redirecting attention. With practice, you will be able to effortlessly redirect your attention onto an experience of your choosing. 

  8. Remember to approach Mindfulness exercises in an open and non-judgmental way. Treat your experiences as they are, and acknowledge the distractions, thoughts or even judgments you may experience – these are normal and will arise from time to time. 

Supporting Someone who has Been Abused

What is Abuse?

How can I help someone who is being abused?

Abuse refers to any forms of violent, cruel or demeaning acts against another person or animal to cause harm or distress.  

Types of Abuse 

“Physical abuse, sexual abuse, emotional abuse… that should be about it right?”

There are actually many more types of abuse than we think. There are at least 5 different types of abuse. The different types of abuse can be further subdivided according to: 

Ψ The nature of the abuse (e.g. physical, emotional, financial, or sexual)
Ψ The demographic of the victims (e.g. elderly, children, or intimate partners) 

Here are some types of abuse and the warning signs you should look out for.

Physical Abuse 

What are the signs?  

Some signs of physical abuse include sustaining physical injuries and wounds (e.g. battered faces, bruises, or cuts). In more serious cases, one can have broken bones, internal bleeding, or even punctures. More subtle signs include the perpetuator not allowing anyone to visit the victim, or isolating the victim, to prevent others from knowing about the abuse. 

What is physical abuse?  

Physical abuse refers to causing bodily injury to others intentionally. Bodily injuries can be inflicted by any violent acts such as kicking, hitting, scalding, strangling, choking, pushing, or slapping the victim.  

Physical abuse is often associated with domestic abuse or child abuse where battered partner or children find it difficult to break free from helplessness and passivity.

Emotional Abuse

What are the signs?  

Signs of emotional abuse include intimidation, manipulation, humiliation, criticism, name-calling, blaming, false accusations and trivializing of one’s concerns. Victims can also show signs of emotional agitation, excessive self-consciousness, social withdrawal or anxiety, and non-responsiveness to the perpetuator.

As seen from the examples above, verbal abuse is usually intertwined greatly with emotional abuse, whereby words are used to hurt someone emotionally. Other forms of non-verbal emotional abuse include neglect, love withdrawal and silent treatment.  

What is emotional abuse?  

Emotional abuse is often also called psychological or mental abuse.  

Emotional abuse refers to non-physical abusive behaviors that are aimed at undermining one’s mental well-being such as one’s self-esteem, dignity and sense of identity.  

Financial Abuse

What is financial abuse?  

Unlike the aforementioned types of abuse, financial abuse is less frequently heard of. Financial abuse refers to controlling or restricting one’s ability to use money or other financial resources. Victims are often excluded from financial decision-making as well.   

Financial abuse is common in domestic abuse and elder abuse where the spouse’s or elderly parents’ access to financial resources are being controlled. Financial abuse traps victims in the abusive relationship as they do not have the resources to survive by themselves.  

What are the signs?  

Some signs of financial abuse include controlling expenses and allowance without seeking one’s opinion or advice, have access to one’s bank account, creating joint bank accounts, using one’s money without permission or agreement, or sabotaging one’s opportunities to acquire a job or promote. 

Ways to support someone I know who is being abused:


1. Help them prioritize their safety 

Safety of the victim is of utmost priority. Help victims of abuse stay safe, especially those who are physically abused and/or are isolated at home. Check in with their safety at times and ensure that they are okay.  

In the case where you cannot contact them for a few days or if you see that the victim has incurred serious physical and psychological hurt, please inform the police so that the victim can be separated and kept safe from the perpetuator.

You can work together with the victim to come up with a safety plan as well. A safety plan is a code used by the victim to signal that they are in danger. This code should not be revealed to the perpetuator to ensure the safety of the victim. 


2. Help them seek professional help if needed 

Encourage them to approach someone who can offer professional guidance and advice. If they are willing and consent to getting professional help, you can help them contact the relevant helplines if necessary.   

If consulting relevant professionals seems intimidating and overwhelming for the victim, offer to accompany them for the visits as well.  


3. Lend support to them  

Lend them a listening ear and let them know you are there for them. Support is important for the victims as they will know that they are not alone and they can turn to someone else for help.   

Often, perpetuators of abuse aim to make the victims feel bad about themselves so they can easily manipulate them. They tend to limit the victims’ access to social or financial resources (e.g. through isolating them from their friends or preventing them from getting a job) so they have no choice but to be dependent on them. Victims then develop learned helplessness and often find it hard to leave an abusive relationship. Knowing they have someone else to rely on other than the perpetuators is thus a great source of strength and courage to them.  

What should I not do if I know someone who is being abused? 


1. Do not trivialize and invalidate their experiences and feelings 

Opening up and sharing about being abused take a lot of courage. If an abuse victim confides in you, treat their call for help seriously and do not make insensitive jokes or remarks that would make them feel worse about themselves and more afraid to approach others for help. Always be emotionally accessible and non-judgmental when a victim shares about their experience.  

 

2. Do not blame them for their abuse 

Victims are never responsible of the other party’s abusive behaviors as we are all accountable for our own actions. Instead, help victims know that we are all deserving to be treated with respect and dignity, and abuse should not be justified by any reasons. 

 

3. Do not make decisions for them   

They have the right to make independent decisions for themselves. Do not force them to leave the perpetuator. It is difficult for victims to walk out of an abusive relationship, especially if they are emotionally, legally or financially tied to the perpetuator.  

However, regardless of their decisions, let them know you will be here for them. Try your best to reason with them and talk them through calmly, but ultimately, they have to make the choice for themselves. 

Psychological Impacts of COVID-19 on the Elderly

The government announced on 10 March 2020 that it was suspending activities for seniors for 14 days, affecting some 290,000 participants. Current projections suggest that our fight against COVID-19 will be a long one, and suspensions like these form part of the measures necessary to slow and contain the spread of COVID-19.

Although necessary, suspending communal activities presents our seniors with unique challenges, especially to their mental health. While a 14-day suspension may not result in the mental health issues brought about by isolation or loneliness, without knowing when our fight against the virus ends, we must be able to talk frankly about the impacts of our measures on our seniors.

The immediate impact of a suspension of activities on seniors is the fear of isolation or loneliness. Isolation or loneliness is a subjective concept and immensely personal in nature; seniors may view the temporary suspension of communal activities or the occasional loneliness as a form of isolation, even though they may in fact continue to have access to their family and friends. No matter the reality, their subjective reality is enough to trigger the detrimental effects of isolation.

There is a strong link between isolation and morbidity.

Morbidity is a term used by mental and other health professionals to describe illness or disease. In fact, isolation is used as one of the risk factors in predicting the development of morbidity. The detrimental effects of isolation are even more pronounced in seniors, where the protective factors of employment, access to technology, and strong social support networks, do not generally exist. By contrast, seniors are often associated with risk factors such as frailty and neurodegenerative disorders, or the lack of strong social support networks.

Sustained isolation brings about increased levels of stress and emotional distress, which in turn puts physical and mental strains on the body. Specific examples of illnesses and diseases that are associated with isolation include depression, Alzheimer’s disease, heart disease, including high blood pressure, and a general decline in cognitive functioning. One longitudinal study in Singapore found that isolation was associated with a greater risk of death in Singapore and was more predictive of mortality than even living arrangements or social networks. With more than 41,000 seniors above the age of 65 living alone in Singapore in 2015, we must take care that we do not mitigate an immediate crisis by substituting it for a longer term one. The number of seniors above the age of 65 living alone is projected to increase to 83,000 by 2030.

However, our seniors do not merely face the feelings of isolation or loneliness. As much remains unknown about COVID-19, there is also a general anxiety among the population, including seniors, about its prognosis and mortality rates. In the face of escalating case numbers and fatalities amidst the widespread media coverage on COVID-19 especially among the vulnerable and the elderly, given that much remains unknown about the novel coronavirus, it is inevitable that fears of dying and death are stoked. And when combined with the effects of isolation or loneliness and being unable to externalise their anxieties, the anxieties and isolation become more pronounced.

To cope with their anxiety and low mood, our seniors may develop unhealthy coping behaviours such as excessive smoking or drinking, maintain a poor diet, or experience a decline in exercise or physical activity.

These behaviours are unhelpful and contribute to other long-term health issues, and they tend to persist even after the period of isolation is over. We must therefore continue to keep an eye out for our seniors, given especially that no one can accurately predict how COVID-19 will continue to impact us.

However, it is not easy to design alternative activities to allow our seniors to continue to feel engaged outside of their usual social settings. Seniors hold on very dearly to their sense of independence and freedom, to the extent that some seniors may choose to live by themselves or away from their families. These seniors tend to form strong external social networks, and the communities that they participate in become an integral part of their identity and serves as a powerful protective factor against the detrimental effects of isolation.

It is important to remember that many seniors take part in community activities as a way to cope with their unique set of circumstances in the first place. In recognition of the role that strong social networks play in combating depression and isolation, many of these activities were specifically designed to promote “gotong royong” or a sense of community.

It is commendable that extensive efforts have been made to extend these activities to all our seniors, given that strong social networks have been found to be effective in reducing symptoms of depression. Seniors who were engaged in social activities were associated with positive health outcomes were more likely to be happier, live longer, and experience fulfilment. Furthermore, social activity also slows cognitive and physical decline. Like muscles in our body, our cognitive functions gradually weaken if it is not put to regular use. Retirees who had more social interaction and engagement through some form of work involvement or volunteering reported better cognitive performance, fewer depressive symptoms and overall better mental health and life satisfaction compared to those who did not.Other studies have also found that socialisation was associated with a delay in memory loss, cognitive impairment and reduced the risk of dementia.

Returning to the impact of the suspension of activities for seniors, the potential loneliness or isolation experienced from the suspension of a single routine activity cannot be considered “in isolation”. A change in a single key activity is a significant deviation that might impact on all their other activities for the day. For example, seniors typically structure their entire day around these activities that take place at the same place or activity centre, involving the usual suspects (i.e. their friends). While some seniors might be able to adapt or find substitutes for their routine activities, there will be many who find it difficult to give up routines that were honed through years of practice. Without a routine activity to “anchor” their day, seniors may not be able to plan or follow through on activities for the rest of their day,even if those activities have nothing to do with the routine activity.

One strategy is to give our seniors a sense of purpose;

that they are very much an important tool in Singapore’s fight against COVID-19. Providing seniors with accessible and regular updates on our fight against COVID-19 and empowering each senior with an individual action plan are useful measures that can help mitigate their sense of loss from the suspension of activities. For example, seniors could be appointed as COVID-19 ambassadors responsible for disseminating information on COVID-19 to their social networks, and to check-in regularly with other seniors to address or escalate any health or other concerns to the authorities. These informal social network models tap on existing social media and chat platforms and are already effectively employed in our armed forces to boost camaraderie and reduce AWOL numbers. Seniors can continue to engage one another in small coffeeshop groups,alleviating some of the impact from the suspensions. This approach is preferable to the usual prescriptive approaches of encouraging seniors to “look on the bright side”, as emotional regulation is a finite resource that is scarce in the battle against COVID-19 without an end date in sight.

Seniors should also be encouraged to maintain the non-affected portions of their daily routine. The gap created by the suspension of activities should be positively reframed as an opportunity to try new activities or crafts such as baking, gardening, mah-jong, reading or other individual activities that the person has always wanted to try. There are plenty of options available if seniors can be persuaded to perceive the gap as a welcomed development.

There is also a role for family and friends to play. Seniors who were previously very independent and mobile may develop feelings of isolation or loneliness now that they are unable to engage in their usual social activities. They must recognise the enhanced impact that COVID-19 has on seniors, and wherever possible increase the number of engagements with their senior family members or friend. Engagement may take the form of phone or video calls, visits, or small-group activities to keep our seniors socially active. This form of social interaction will go a long way in assuring our seniors that they are still cared for, and they can reach out for emotional or other support during their time of need. This will help to prevent and reduce negative feelings and thoughts that might arise from loneliness or isolation.If the feelings of isolation or loneliness persist, it is advisable to seek help from a mental health professional.

Lastly, we should remind our seniors that it is normal to feel distressed or isolated during this period. We should also ostensibly acknowledge that our seniors are making an important sacrifice and contribution to Singapore’s fight against COVID-19. Their sacrifice, together with our front-line workers and healthcare professionals, will keep us and our loved ones safe.

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Religion and Therapy

Religion and Therapy

(and should they ever mix?)

There exists a long-standing debate on the compatibility of religion and psychotherapy.

Much like how religion and science are often viewed as antagonistic in their attempts to explain the human condition, religion and psychotherapy are often perceived to be at odds with each other in the mending of the psyche.

Given that over 80% of Singaporeans consider themselves religious, many patients are interested in discussing their religious concerns with their psychologist. Indeed, an extensive body of research has consistently demonstrated the benefits of religion on one’s mental health. When used in an appropriate context, it can enhance one’s stress resilience, impart meaning to life, and serves as a source of social support. People who are more religious have also been found to be less susceptible to depression and are better able to cope if they do become depressed.

However, we must respect the diametrically opposed starting points of psychology and religion, keeping in mind that the two disciplines have fundamentally disparate presuppositions, methodology, and social roles.

Thus, their conflation can lead to tension, misunderstanding, and unnecessary strive that diminishes the effectiveness of psychotherapy.

The introduction of spiritual and religious content into psychotherapy runs the risk of replacing, diluting or deviating from the evidence-based intervention models that undergird psychology as a scientific discipline. There is also the possibility that psychotherapists may unintentionally alter their clients’ religious values or beliefs. All of this could potentially undermine the therapeutic alliance.

Psychotherapy should not draw from any authority in any faith tradition but must instead be scientifically grounded and validated

Here are some do’s and don’t’s that every clinician should abide by:

Ψ A clinician must respect a patient’s religious faith and spiritual beliefs and commit to establishing a religion-agnostic and spiritually sensitive therapeutic relationship with patients.

Ψ Clinicians should and must strive to deliver psychological services taking into account the full circumstances of each patient, including any religious and spiritual beliefs and commitments.

Ψ A clinician must be deliberate in their attempts to learn about how their patients’ religion shapes their worldview, and how it affects their experience of and management of mental illness.

Ψ The importance of religion as a social institution and the central role that it plays in the lives of our clients must also be acknowledged by the clinician.

Ψ However, clinicians must be aware of the potential risks associated with integrating religious or spiritual interventions into clinical interventions. This means that religious and spiritual issues should not be the central focus of psychotherapy. A range of problems and ethical dilemmas usually accompany the unification of religion and psychotherapy and could seriously impede the attainment of efficacious and ethical intervention.

In the ultimate analysis, clinicians must provide psychotherapy in a religiously agnostic manner that does not promote any one religion or belief.

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