Thursday, November 14, 2019

Self reflection vs self critical. What's the difference?

To solve a math problem, we need to know numeracy.  To solve an emotional problem, we need to known emotional literacy.  In this episode, we explore the difference between self reflection vs self criticism.  Knowing the difference, will guide us to be more reflective rather than too self critical.  This may help us in improving our self esteem, mental health, and our productivity.

Tuesday, November 12, 2019

How to provide psychoeducation around fusion vs defusion for our patients

Emotional literacy is so important for emotional processing, which is so important for managing one's emotion. Without emotional literacy, it would be like trying to solve a math problem without the knowledge of simple numeracy like numbers. This episode, we are going to explore the idea between fusion vs defusion of thoughts and how that can impact our emotional health.

Tips for final year Medical Students on how to survive and thrive in their medical career

Doctoring can be a very stressful job and hence, being able to understand and maintain our own health and wellbeing is extremely important. We explored with a group of final year Medical Students the biopsychosocial approach to self care and how relational skills can be used to achieve better relational and social health, in order to improve our own mental and physical health. If we, as Doctors are well physically, emotionally and socially, we are going to be much more effective in looking after our patients and community. Reference: 1 5LoveLanguages by Dr Gary Chapman 2 DUMB goals vs SMART goals by Brendon Burchard 3 Acceptance Commitment Therapy 4 Cognitive Behavioural Therapy 5 Emotionally Focused Therapy 6 Grant and Glueck study 7 The Gottman Institute

Sunday, November 3, 2019

How do we explain the concept of biopsychosocial to our patients

Family Medicine in my opinion is really a specialty of the biopsychosocial framework.  It is quite holistic in its approach.  Everyday, we assess our patients' physical health, emotional health, and their social health, including their relationships with the people around them.  So how do we explain the importance of this concept to our patients.  This is my attempt........

How to help our patients improve their relationships in order to help them with their mental health and physical health

In Family Medicine we often talk about the biopsychosocial framework and how to apply that to the care of our patients, but often, the social and the relational health component are neglected.  Here are some tips around how to improve one's relationships in order to improve one's overall health.

How to explain the importance of emotional literacy to patients?

For those who have worked in family medicine, especially in Australia, you will quickly realize that mental health is such a big part of our work.  One of the solution for this epidemic is to improve the emotional literacy for our patients and our community.  I try to explain it here in less than 45secs.  See what you think.  Please leave a comment below.

Saturday, March 2, 2019

Should I take a more CBT approach or ACT approach for my patients with mental health problems?

Let us first explore the some terms related to our "emotional world" and what it means.  This is emotional literacy, and it is very important for us to learn in order to solve emotional problems.  Just like learning numbers and numeracy to solve math problems, we need to learn emotional literacy in order to effectively solve emotional problems.

The human mind has a great ability to fuse, hook into, or buy into a story whether that story may be in a form of a movie, story book, or thoughts in one's head.  So when one is feeling sad, upset, happy, or angry, one may have fusion with a story in one's head.

So how can we change this?

We simple have 2 main options.  One is to change our story.  The other option is to unhook, detach, step back, or defuse from that story.  Traditionally, cognitive behavioural therapy (CBT) is more about understanding the story and helping a person to change that story into a more "positive" or helpful one.  Acceptance Commitment Therapy (ACT), is more about coaching a person to defuse or unhook from that story, and once unhooked, the story will natural has less grip on that person.

There are therapists who consider defusion or unhooking from thoughts a better strategy, and at the same time, I personally believe that thought defusion and thought challenge needs to go hand and hand.  Having said that, I do believe that if one is very fused with one's thoughts, it is much harder to do thought challenge effectively.  That is to say that one has to defuse from thought first in order for thought challenge to be more effective.

At a pragmatic level, if one is very fused with thoughts, I would lean towards a more ACT approach.  If one is already defused or detached from thoughts, I may take a more CBT approach.  I personally think that there is a lot of overlap between these two modalities in any case.

Helpful links and resources from the RACGP

Sunday, June 17, 2018

Self care for Docs: It is super important!

There are 3 main schemas that we see in people:

1sy (Onesie)= “If you don’t love me, like me, or do things my way, I am going to have a fit”. 
2sy= “If you are nice to me, I am going to be nice to you. If you do this for me, I am going to do this for you. It’s fair”.
3sy= “I care about you no matter what. I have unconditional positive regard for you”.

1sy + 1sy= a war
1sy + 2sy= a war
3sy + 1sy/2sy= Better outcome if we can balance the "care of others" with the "self care".

In the business of Doctoring, one needs to be a 2.1sy and above to be more effective. Whenever people are unwell, they often fall into the 1sy schema so if we are 1sy or 2sy, there will be unhappiness. 

In the business of parenting, one also needs to be a 2.1sy and above.

Whenever we fall below the 2.1sy level, maybe it’s time to take a holiday, reflect, and take care of our own needs first before looking after others.

Furthermore, many Doctors are 3sy wannabe. One can’t be a 3sy without good self care. It is not easy of course.

Wednesday, May 16, 2018

Counselling in a nutshell for Registrars

I would like to share some counseling ideas, as I believe that more Registrars can take on more of this work to help their patients better. 

1 Supportive counseling= Validation, acknowledgement, compassion, empathy, reflection, externalize thought and psychoeducation. Great for when people are in crisis and are in a state of vulnerability. Registrars are more than capable of doing this already in my opinion. It is super important in my opinion. This is foundational. 

2 CBT (Cognitive Behavioural Therapy)= We teach people to be more aware of their thoughts, beliefs, and behaviours that lead to negative feelings, AND challenge or change those thoughts, beliefs and behaviours.  It is not easy for many as they are often too “fused” with their thoughts and beliefs. I believe that Registrars are getting some training in this through their training providers. I encourage all of you to build upon that through your career. It will also help you with your own life immensely. It is a bonus!

3 ACT (Acceptance Commitment Therapy)= ACT is more interested in the detachment from those thoughts and beliefs, rather than challenging or changing them through self awareness with values, self compassion, mindfulness, time, maturity, perceiving rather than judging, being present, seeing things through the lens of the here and now rather than the lens of the past (esp trauma and hurts), and taking value based actions. It is not easy but it can be cultivated. 

4 IPT/EFT (Interpersonal Therapy/Emotionally Focussed Therapy)= Interpersonal skills and relational skills training which require all of the above skills plus others.

5 An eclectic approach=all of the above.