Design a site like this with WordPress.com
Get started

how do teens “feed” their brains?

Following my last blog, I thought about creating a separate post that highlights the psychological development of teens. This period of development is often dubbed as the “adolescent storm”, and teens’ feelings and emotions are attributed to “raging hormones”. What’s often overlooked is the critical development process that goes on throughout this period.

According to psychosocial development, adolescence is a period of transition between childhood to adulthood, marked by physiological changes from a surge in hormones in puberty.

During adolescence, it is important for teens to experience the following tasks:

Additionally, there are 3 expected developmental changes:

  1. Increased risk taking behavior
  2. Increased sexual behavior
  3. Move towards peer affiliation, rather than primary family attachment

These tie in with Erik Erikson’s psychosocial stage of development: identity versus role confusion, which happens in this period of time. Gaining identity would mean that the ego is strengthened through integration of past experiences with current changes. But this may not happen all the time, as teens also experience an ‘identity crisis’, where alternative behaviors and styles are pursued before successfully molding the different experiences into a solid identity. This is a normative part of adolescence. Failure to gain identity may lead to role confusion, where an adolescent feels that he/she lacks a cohesive and confident sense of identity.

To understand more, here is a Youtube video explaining how the teen brain is wired to learn

The teen brain is basically a sponge. Knowing that, it is important to be INTENTIONAL in the things that we “soak up”. Whatever learning is going on during the teenage years is strengthened if it is repeated. And this is something teens could carry on into adulthood. This may become part of their identity as an adult.

So. How can we help our teen friends/family members/classmates/colleagues foster this sense of identity?

To guide this process — the journey within and outside — it would help for teens to get to know themselves a little bit more. A little deeper than what their parents, teachers, classmates or friends describe them to be.

If that is an activity that interests you (or a teen you know), I suggest trying out the VIA Character Strengths Survey

It is a self-assessment tool to help us understand our best qualities better. After taking it, you will be provided with a personalized in-depth analysis of your character strengths, and actionable tips to apply your strengths to find greater well-being.

I encourage you to take the survey and let me know what you think!

Advertisement

fostering JOY by understanding the teen brain

Ever wonder what makes a teen’s brain different? Why are teens so strongly opinionated and emotional? Are mood swings caused by raging hormones, or is there something else going on in their brain?

Screencap from YouTube (video embedded below)

Last December, I gave a talk for the Jesus Centered Life (JCL) 2021 Online Conference on “Fostering Joy by Understanding the Teen Brain”. The JCL Conference, organized by Parents for Education Foundation (PAREF) and Parousia Media, is an annual gathering of students, parents, educators and young professionals around the world to share ideas, inspiration and best practices on living and promoting the life centered on the gospel.

There was a buzz around this topic, since it was something many parents and adults wished to understand. Specifically, how the teen brain is wired, and how adults can use this understanding to help teens manage their emotions and overcome negative experiences.

It was quite a challenge, since I am neither a parent nor an adult handling teenagers. I was, however, knowledgable on the biological aspects of growth and maturation, and the psychosocial development of teens. This, coupled with some actionable tips to foster joy (that even adults can use), became the core of my talk.

Here is the video embedded below. Listen in as we dissect teens’ neuro-anatomical quirks, explore their thinking process, and find out what we can do to help them navigate the adolescent storm.

What did you think? Share your thoughts in the comments, or hit me up in the contact section. I’d love to hear from you!

~

I was also invited to be a panelist for a forum entitled “Asan ba si Joy?” (“Where can we find Joy?”) organized by Beyond Kilig, a community organization that shares teachings of the Catholic church. I was humbled to be along side such devoted and accomplished individuals, as we shared our experiences and insights on the times we sought, found and shared joy.

More importantly, this was another personal milestone, as it was my first “panelist gig”.

So, what did I talk about exactly? Here are some of my personal sentiments shared during the talk:

How do you cope with stress and burnout?

Stress is not necessarily something bad — it all depends on how you take it. Stress can be felt in response to change, and we all feel stress at some point in our lives. There can be positive stress, like planning for a wedding or a vacation, and negative stress, like dealing with our problems. Stress that is experienced beyond our capacity to handle it equates to burnout.

The first step to manage stress is acknowledge it, and understand that it really is part of life. You are not alone in experiencing it — everyone has these moments. Next, identify what is causing stress. Usually, it’s a problem. Ask yourself “what can I do to address this problem that is causing stress?” Is the solution within your control? Is it out of reach? The answers to which will guide you on how you can deal with the stressor. Next, identify tasks and prioritize. Utilize time management strategies. And of course, engage in a healthy lifestyle. Lifestyle practices such as proper nutrition, adequate sleep and regular exercise allow our minds and bodies to handle stress better.

How do you find joy amidst difficulties?

Finding joy, for me, is not a goal, but a process. We can find joy through our actions. I find joy through doing my work. Joy may not equate to happiness. Rather, it may be fulfillment, gratefulness, contentment, or most importantly, it may be progress.

Can we find joy by just sitting down and waiting for it to come? Have we found joy by not actively seeking it? Think about that. We could easily take the day off to avoid work and relax, but that would only provide temporary relief. Joy, for me, came after a 36 hour shift or a toxic day, where I was grateful to have an opportunity to fulfill the needs of my patients, content for work that was accomplished, and hopeful that my experience aids my progress in becoming the doctor I want to be.

How did I develop this mentality? It was through learning about the saints. The St. Josemaria Escriva, Blessed Alvaro del Portillo and St. Joseph prayer cards I prayed every single day as I drove to work. I asked for help to bear the workload and endure whatever difficulty. Work felt lighter as I learned to offer up my work to them. It didn’t matter what case I was faced with, I felt confident that I could handle it.

The saying “do your best and God will do the rest” also comes to mind. It heavily implies that we have to actively work towards things — not just pray and wait for things to happen. In one of my exams in med school, I opted not to study for a section (Histology LOL) because I ran out of time. I told myself “maybe I can just pray and the answers will come to me“. Lo and behold, I got zero out of ten. That made me realize that prayer alone is not enough, especially in circumstances that are within our control.

What concrete steps can we take so we can determine or focus on what could truly make us happy?

Ask yourself — what do i value?

Is it family? Work? Friends? Spirituality? Once you find out what you value, align your actions towards living those values. If you value time, make a schedule, or practice good time management. If you value productivity, do tasks that bring a satisfaction and fulfillment.

Happiness is not always found in material things. As Marie Kondo fondly explains, we should throw out things that “do not spark joy“. We can be grateful for the things that we have now.

~

Still here, readers? I’m glad you are! Hope this topic sparked joy, or created a synapse that can withstand pruning. It’s always a delight sharing my thoughts and knowledge with you. See you again in the next post.

here i am

I’ve been gone for a while (okay, for more than a year) and I’ve definitely missed making infographics and sharing psycho-education nuggets. In the year off, I studied for 2 of the most important exams in my career — the psychiatry boards.

All the hard work paid off and last January 2022, I was conferred as a diplomate of the society.

So, here’s to more years of promoting mental health awareness through psycho-education.

milestones pt. 3

For my last entry for this month, I’d like to share how my lecture series came full circle. I ventured out 2 years ago to lecture about mental health to high school kids. This year, I was invited again to give another lecture to senior high students from the same school.

This time, I knew what I was going to do. This time, I came prepared with 8 months of teaching experience under my belt.

Side story: back in January, I was recruited to teach Psychiatry in one of the medical schools in our city. At that time, I was set on saying “no” because (guess what), I thought I couldn’t do it. Well, life always has its way of dropping the worst challenges at the worst times, only for them to turn out to be one of the best experiences ever. I took the job.

Certainly, teaching a class of 100-200 students was nothing that I “ever dreamed of”. Never in my career did I ever consider teaching, more so, teaching 200 students 2-3 times a week. But.. never have I found so much joy. I was happy. I was content. I felt passionate teaching these students (most of whom do not speak good english).

I found that I could relate to the students, empathize with them, and encourage them to take more interest in Psychiatry. Fast forward to mid-pandemic, where classes were moved online. I am still affiliated with the school, and I still find joy in teaching these kids. Even if none of their webcams are on. Hahah.

So, back to my 2nd lecture stint at this posh private school.

This time, I felt more confident. The topic assigned was one that I’ve lectured many many times before. And fortunately, I’ve learned how to make it more interesting.

Here’s the title slide to my lecture, “The Process and Pitfalls of Making a Psychiatric Diagnosis”. And, there I am, in my favorite yellow pandemic blouse. Of course, I couldn’t wear my confidence-boosting seminar shoes, so, department store pearls had to do. LOL

Title slide for my lecture on Psychiatric Diagnosis (September 2020)

This lecture was quite special because it was my first outside of an affiliated institution after graduating residency. (Thanks again for this opportunity, Niña)

It was also my first time flashing my credentials. I’ve always wondered how that would make me feel. I thought I’d feel too boastful or proud. On the contrary, it made me feel inspired. I felt inspired to learn more and achieve more, so that I can teach more.

What a wonderful feeling.

The lecture went great, by the way. Even if I was technically speaking to a class of 2. They made me this collage, which I love so much!

Awesome collage done by the instructors at the school

I feel so honored that many of you read my posts. It warms my heart whenever someone says they “learned a lot” from my blog. I’m happy that I’m able to communicate with you through this channel. And I’m happy that you appreciate me as well.

I started this blog with no readers in mind. It was merely a platform to direct my patients to, whenever they’d need psycho-education. Funnily, that never happened, as I had to curate the psycho-education to each patient.

So, I dared myself to post again on Facebook. Something that I haven’t done in a long time. I held my breath after I posted “8 Mental Health Tips in Quarantine“. I was even afraid someone would criticize it, and tell me those tips weren’t ‘scientifically based’. But, hello, what has science have to say about this pandemic anyway. Every bit of it is still a mystery.

So, I told myself I’d be happy if it got 1 like or 1 share. The numbers didn’t matter, as long as it would reach the people who needed it the most. Lo and behold, it was one of my most ‘popular’ posts on Facebook. And, it inspired me to continue posting more.

Thank you to all who appreciated my psycho-education nuggets. Thank you to those who have been following me. Thank you for sending over the kindest words. I’ll do my best to continue bringing you good mental health content.

Looking forward to a fruitful 2021.

Let’s talk!

Hit me up through the contact form, or send an email to mindfulnugget@gmail.com

milestones pt. 1

In a previous blog post, I described how I was extremely shy and self-doubting. I was always the student who lacked oral participation. I refused to speak up even if my grades depended on it.

In 2018, I was invited to give a talk to high school students (at a posh private school) about the biological aspects of depression (check that out here). I initially declined, thinking I wasn’t credible enough. I was still in my 3rd year of residency then, and felt like I didn’t have enough (or any) credentials to be speaking in front of high-schoolers (who probably knew more english than me). However, after much thought, I decided what the heck, it’s worth a try.

Of course, this came with so many doubts, like: What if nobody listens? What if they think I’m boring? What if they won’t engage in the discussion? What if they won’t learn anything? What if I’ll make a fool out of myself? What if I’ll shame the person who invited me over?

I was excited, though, and spent nights preparing. I did my research and verified facts. Thesaurus.com was my helpful buddy in converting medical jargon into easy-to-digest words and phrases. I made colorful slides so they wouldn’t seem boring. And, I even studied in case someone would grill me. On the day itself, I wore a white coat so that they’d believe I’m a doctor.

I was so nervous, and the last thought I had before kicking in to ‘lecture mode’ was here goes nothing.

“What is Depression?” – title slide from my lecture on the biological causes of depression – November 2018

Well.

Guess what.

I had a really good time. We all did. Everybody listened and participated. The students–and facilitators–were very interested, and asked a lot of questions. They all said they learned a lot. And. I didn’t make a fool out of myself.

Keeping it together for the kids lol

Little did I know that this stint would open many doors for me. For one thing, it helped me gain confidence. I made me think “Hey, I think I can really do this” and “I will less likely suck at something if I work hard and prepare for it.”

My newfound confidence carried over into the next year, when I accepted an invitation from KALFI (Kalingayan Youth Foundation Inc.) LEAD Cebu to talk about mental health.

Funnily, I was able to re-use my previous lecture for this one, since the topic was about depression as well. It was refreshing to engage with the young and bright minds of the leaders and learners.

Mental Health Talk about depression with the KALFI LEAD members and Minglanilla parish youth – July 2019
Certificate of appreciation from KALFI LEAD – July 2019

Thank you KALFI LEAD Cebu for this opportunity. I am grateful to have you listen to my insights on mental health.

Later in 2019, I was invited again by the “KALFI Moms” (mothers of the KALFI leaders) to talk about understanding mental health in the youth. More specifically, I talked to boomers and Gen X to help them understand how millenials and Gen Z cope with stress.

This was quite interesting because I, a millenial, had to understand how boomers, Gen X and Gen Z each coped with stress, and then bridge our 4 generations to meet one understanding. Excerpts from the book iGen by Jean Twenge, PhD definitely helped.

Title slide from my “Talk on Mental Health” to moms of high school kids – November 2019

Here I am below with the moms. It was a very engaging discussion, and I was glad to enlighten them.

With the “KALFI Moms” – November 2019

Later that year, another friend invited me to give a talk on the “quarter life crisis” and its impact on mental health. This was also a first, since I would be speaking to college students in one of the big universities in the city. (wow, 2019’s on a roll, huh)

Here is the official invitation to my segment on their Seminar for Social Good series. Confession: I had to look up “social good”, which means:

Social good is typically defined as an action that provides some sort of benefit to the general public. In this case, fresh water, education and healthcare are all good examples of social goods. … Social good is now about global citizens uniting to unlock the potential of individuals, technology and collaboration to create positive societal impact. 

https://www.socialchangecentral.com/what-is-social-good/
Invitation to the Seminar Class for Social Good talk from USJR

This was quite a challenge, since both were new concepts to me.

Luckily, I was able to use stuff from my previous lecture about millenials’ and Gen Z’s mental health, and stuff that I learned from training about stress management.

What I understood about the “quarter life crisis” was that it was stress felt by young adults after experiencing overwhelming amounts of change in different aspects of their life all at once. To deal with this, they should first acknowledge stress as it is, and recognize that it is equivalent to change. This “crisis” apparently occurs during their transition from a comfortable shelter to the outside world. Or, it could also take the form of an existential crisis, where they ask themselves “what is my purpose in the world?

I could go deeper into this in another blog post. In the meantime, here are some tips on handling stress at ‘thirtysomething’.

Here I am, keeping it together for the nth time around (wearing the same pants as I did during my first lecture lol–and wearing my ‘seminar shoes’ for a confidence boost)

Talking about how to handle a “Quarter Life Crisis” with university students – November 2019

I am proud to say that that lecture went pretty well too. We went a few minutes over time because the students asked a lot of questions. I used to dread being asked anything. But now I welcome it because I see it as a reflection of the audience’s interest in the talk.

Thank you to the kind people who organized this event. And thank you for inviting me over. It was an honor sharing my “expertise” with you. Hoping to do this again in the future.

~

It’s November 2020 now. Two full years since my first lecture stint. Time flies. I learned a looot along the way. More than I could ever imagine. The one thing that will stick with me for the rest of my life will be this:

Nothing good will ever come from rejecting an offer because you think you can’t do it. So, if it scares you–especially if it scares you–do it.

~

I’m happy that you’re still with me after a lengthy post talking about myself. This is part 1 of 3 of some personal milestones over the past 3 years. Hope to see you till the end xx

depression is not just a feeling

Yes, you read that correctly. Depression is NOT just a feeling.

Depression has many causes. And sure, a lot of those are related to internal struggles or external loss. But what is often overlooked is that depression has a biological cause, too.

Depression is more than just feeling sad. We can feel sad about a number of things, like getting a bad grade, missing a cab on a rainy day, when tickets to our favorite event are sold out, when our favorite pet passes away.

What makes feeling sad different from depression?

Depression—clinical depression—is a disorder, which means that it is an abnormal physical and mental condition. It is different from just any kind of sadness, and is usually triggered by a traumatic or stressful life event.

The DSM-5 requires 5 out 9 symptoms of depression to be present nearly every day for at least 2 weeks, causing an impairment in daily functioning.

Imagine it like this: On most days, you feel OK, And on special days, you feel HAPPY. But sometimes, bad things happen, which cause you to feel sad. Sadness lingers, but as soon as circumstances change, you don’t feel sad for long. How about feeling really, really sad—feeling depressed?

It’s like being in a pitch black room, no matter where you turn, you just can’t find the exit. It’s hard to describe, but it’s worse than being sad. You stay there for a long, long time. Depression is not a nice place to be.

So, what exactly causes depression?

There are 3 main biological causes: chemical imbalances, structural abnormalities and genetics

Chemical imbalances: The neurotransmitters

Serotonin

Serotonin is commonly known as the “happy hormone”. It is responsible for our good appetite, restful sleep, memory, and socializing behavior. More importantly, it maintains our good mood. 

In depression, serotonin is depleted. This causes a depressed mood, decreased appetite, disturbed sleep, forgetfulness and difficulty concentrating, social withdrawal and suicidal thoughts

Norepinephrine

Another neurotransmitter is norepinephrine. It might sound familiar because it functions similarly as ‘epinephrine’ in giving us energy. It boosts our mood and helps control pain. 

Its’ depletion in depression causes us to feel very tired, like we don’t have any energy, even just to get out of bed. It also causes us to feel aches and pains. We may complain about headaches, back pain and stomach aches, even if there’s nothing really wrong there.

Dopamine

A third neurotransmitter is dopamine, or, the “pleasure hormone”. It is responsible for keeping us motivated and seeking reward. 

There is decreased dopamine in depression, causing anhedonia. Anhedonia means that we don’t want to engage in activities that used to make us happy. Aside from a depressed mood, anhedonia is another core symptom of depression.

Structural abnormalities: The brain

These are the abnormalities in our brain’s ‘hardware’.

Brain imaging has recently focused on the hippocampus as an important aspect of depression. The hippocampus is responsible for forming our memories and emotions. Here’s what goes on inside the brains of someone with depression.

Takeaway: There is 25% less gray matter in people suffering from depression than those who don’t. The longer a person stays depressed, the smaller the hippocampus becomes.

There are also sleep abnormalities in depression. There is an increased amount of dreaming, caused by an increased time spent in REM sleep.

Depressed people dream up to 3x as much, have high levels of stress hormones and wake up exhausted in the morning. Depressed people dream too much because they worry too much. Worrying keeps our brain up and running, and these thoughts come out in dreams. Dreaming a lot makes you miss out on restorative sleep, and keeps your brain active throughout the night (instead of resting). These lead to an exhausted brain and body, and many other symptoms of depression.

Neuroendocrine effects

Now, when our brain is stressed—from daily problems, school work, bad relationships, or even from feeling tired, it releases cortisol, the stress hormone. This stress triggers the decrease of neurons in the hippocampus, which contributes to the depressed mood. 

Sometimes, a decrease in our thyroid hormones, caused by a medical illness, can produce symptoms of depression.

Genetics: The serotonin transporter gene

The third biological cause for depression is found in genetics—the serotonin transporter gene.

Genes are made up of DNA. They are the basic physical and structural unit of heredity. An allele is a variation of a gene. Genetic abnormalities make us vulnerable to develop depression. 

The serotonin transporter gene regulates the amount of serotonin taken up by the brain. The differences in this gene affect how strong a stress response can be. Abnormalities lead individuals to be more vulnerable to depression.

Each person has 2 copies of a gene, 1 inherited from each parent. If a person has 1 short and 1 long copy, that person may get depressed over a stressful life event. For persons with 2 short copies, they fare far worse. Having 2 long copies, on the other hand, make a person much less likely to become depressed when faced with similar life stress.

~

While the exact causes of depression have yet to be pinned down precisely, it is important to remember that…

Fortunately, there are many ways you can seek help.

Medications that increase serotonin have an indirect effect on the growth of brain cells. They promote the release of other chemicals which stimulate neurogenesis—the growth of neurons.

Seeking support by connecting with a friend or a family member can strengthen our feeling of support. 

Therapy with a therapist, psychologist or a psychiatrist can help us identify our issues and work through them. 

Always remember…

You are not alone.

There is HOPE.

Anything is possible.

post script ~
this topic is close to my heart, as it was the first lecture i ever gave to people outside my institution.
i am so grateful for that opportunity, as it opened so many doors for me.
i’ll talk more about those milestones next month. stay tuned!

the problem with sleep

Let me tell you something about sleep

One of the most common complaints I get is “difficulty sleeping”. Insomnia is one of the most common presenting symptoms in psychiatry, and is present in almost all mental disorders. Not only that, stress and excitement with ordinary life events can also rob us of a few Z’s.

Losing sleep or lacking sleep can be very stressful and anxiety-provoking for some people. They put all their efforts into trying to go to sleep, only to remain awake throughout the night and into the next day. This cycle can repeat itself until the effects of sleep deprivation take its toll on them, and they eventually decide to seek medical consultation.

For some, sedatives (or “sleep meds”) are effective. They take a pill for a night or two, get a good night’s rest, and are able to carry on with their usual activities. They’d then just take meds as needed, for difficulty in sleeping.

For others, it can be more complicated. “The meds don’t work“, “I need something stronger“, “I’ve tried everything” are common complaints. Depending on the treating physician, the next step could be anywhere between adjusting their meds, or referral to a sleep specialist.

But what happens to a person who has been to a primary care physician, a neurologist, and a sleep specialist, yet still can’t find anything that works? Some of them get referred to a psychiatrist.

Personally, I’ve received a handful of referrals, especially the “I’ve tried everything” type. I’ve tried adjusting their meds, referring back to their sleep specialist, referring back to their neurologist, or teaching them sleep hygiene techniques.. Nothing seemed to work.

Fortunately, I was able to attend the workshop on CBT for Insomnia from the Beck Institute for Cognitive Behavioral Therapy last September. I learned that majority of the causes of insomnia are psychiatric and psychophysiologic (which is why we end up getting these referrals). What’s striking is that 9% of these are due to misperceptions about sleep.

Causes of Insomnia
(c) 2020 Beck Institute for Cognitive Behavioral Therapy
beckinstitute.org

What are these misperceptions about sleep?

First, let me ask you, which is more important: the length of sleep in hours, or the quality of sleep? If you answered the former, you might be misinformed about what constitutes a good night’s sleep.

Sleep 101

Before diving into the factors affecting our sleep, let’s first review the sleep-wake cycle, so we can get an idea of what ‘normal sleep’ looks like.

The sleep-wake cycle is regulated by the homeostatic sleep drive, and the circadian wake drive.

These 2 are related in that a decreasing homeostatic sleep drive, and an increasing circadian wake drive cause arousal. Conversely, an increasing sleep drive and a decreasing wake drive put us to sleep. These 2 factors cycle within 24 hours, such that we naturally fall asleep and awaken at certain times throughout the day.

Take a look at how the 2 interact in the graph below.

Sleep Wake Cycle
(c) 2020 Beck Institute for Cognitive Behavioral Therapy
beckinstitute.org

Sleep begins as the wake drive decreases, and the sleep drive increases. Wakefulness starts as the wake drive increases, and the sleep drive decreases.

Stages of Sleep

Sleep is dynamic, and we transition through sleep stages at 3-4 cycles per night, spending 90 minutes in each cycle.

Stages of sleep

Stages 3 and 4 are more prominent in the first half of the night, and decrease as the night progresses, while REM sleep increases over the course of sleep.

This is what a typical cycle looks like. Notice that Stage 4 occurs within the first 3 hours of sleep. Stage 4 is when restorative sleep happens. It’s when our body repairs any muscle or tissue damage.

Sleep stages
(c) 2020 Beck Institute for Cognitive Behavioral Therapy
beckinstitute.org

So. How many hours do we need to get a good night’s sleep?

Variable.

Sleep varies with age. In each age group, the number of hours vary as well. Infants sleep 2/3 of the day, while young adults sleep 1/3 of the day. Older adults sleep less. They even have less stage 3, 4 and REM sleep.

Here’s how the need for REM sleep changes with age.

REM need sleep changes with age
(c) 2020 Beck Institute for Cognitive Behavioral Therapy
beckinstitute.org

More REM sleep is required for better learning. That’s seen in infancy up to early childhood.

Notice how the number of total daily hours of sleep declines as we age. At 70 or 80 years old, sleep will never be the same as it was when one was 30. This is normal. This is an age-related decline in the number of sleep hours. It’s handy to keep in mind that older people can sleep for up to 4-6 hours only.

If you have an elderly companion at home, who’s worried that he or she is “not getting enough hours of sleep”, it maybe helpful for them to know that it’s normal to sleep less compared to younger persons. This tip might reduce their anxiety and “sleep worry”.

Sleep worry” is when we worry about getting good sleep, going to sleep at the exact time, having the exact number of hours of sleep, or practically anything related to sleep. This often happens in people with insomnia, and may stem from their beliefs and attitudes about sleep.

Insomnia as a symptom is the complaint of poor sleep quantity or quality, associated with problems falling asleep, staying asleep or early morning awakenings. It is the most common health complaint after ‘pain’. It may occur as a symptom of a medical disorder, a mental disorder, or as a disorder of its own.

Insomnia Disorder, according to DSM-5, is when the sleep problem causes significant distress and dysfunction in areas of work, social relationships, etc. The sleep problem should occur at least 3 nights per week, persists for at least 3 months, and occurs despite adequate opportunities for sleep. It should not be better explained by another psychiatric disorder, a medical disorder, a physiologic effect of a substance, or another sleep disorder (there is a range of Sleep-Wake Disorders listed in the DSM-5). The diagnosis is given when coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.

Sleep worry is a factor that perpetuates insomnia. Other perpetuating factors include dysfunctional beliefs and attitudes about sleep, such as unrealistic sleep expectations, misconceptions about sleep and sleep anticipatory anxiety.

Here are some common misconceptions about sleep:

If you want to evaluate your own beliefs about sleep, click HERE to answer the questionnaire on Dysfunctional Beliefs and Attitudes about Sleep (DBAS 16 Items).

Take note that these are beliefs and attitudes about sleep. They are variable, and are likely to change over time or under influence (a good one, I hope). Solely believing in them, or feeling strongly towards them does not constitute an insomnia disorder, or a mental disorder. If you are having problems with sleep that are interfering with your day-to-day functioning, please consult with a medical professional.

For some, sleep pattern can be regulated through behavioral techniques collectively called ‘sleep hygiene‘.

Sleep hygiene involves putting yourself in the best position to sleep well at night. It is not intended to induce sleep. I repeat, it is NOT intended to INDUCE sleep. Sleep hygiene does not involve sedating measures. Rather, it sets up our environment to be more conducive to sleep (i.e. more relaxing, more comfortable).

It is part of the treatment plan for insomnia disorder, but rarely works alone. It is usually used in conjunction with pharmacotherapy, psychotherapy, or both.

For those with minor sleep problems that do not constitute an insomnia disorder, sleep hygiene might help put you to sleep a little easier. Again, if you suspect that you have an insomnia disorder, please consult with a medical professional.

Here are a few sleep hygiene tips:

Before you get too sleepy reading this lengthy blog post (or maybe that’s a good thing?), please do share this information to a friend, a relative, a co-worker, or an elderly companion in need.

Being aware of the sleep-wake cycle and setting realistic expectations about sleep can go a long way in reducing sleep worry, and anticipatory anxiety about sleep. Which, in turn, may help a person suffering from insomnia. Even just a little bit.

Lastly, here are the PDFs available to download so that you can share these nuggets of information, spreading psycho-education to everyone around.

Let’s continue to spread mental health awareness for #WorldMentalHealthMonth2020

10 things you can do on world mental health day (10.10.20)

Let’s celebrate World Mental Health Day!

Wondering what you can do today to practice mental wellness? All of us can take part in advocating mental health today. May we do it for ourselves, a loved one, or the community.

Here are 10 things you can do on World Mental Health Day:

You can practice any or all of these whether you’re an office worker, a teacher, a programmer, a data analyst, or whatever occupation you’re in. Isn’t that beautiful?

This infographic is free to download in PDF that you can share with your family, friends and loved ones.

P.S. How timely that this is also my 10th post! 10th on the 10th of October. I am so grateful to be able to share these nuggets of psycho-education with you (even if this blog only has 0-10 readers hahah)

suicide is preventable

YOU can make a difference.

WARNING: This post may contain material that is sensitive. This post is for psycho-education purposes only, and is intended for lay-persons. Suicide prevention strategies are not included in the scope of this blog post, but websites for reference are mentioned. If you or someone you know is in crisis, contact your local emergency crisis hotline immediately, or dial-in PH numbers here. If you feel that you or someone you know is experiencing emotional distress, talk to a mental health professional as soon as you can.

Suicide claims the lives of over 800,000 people in a year. One death every 40 seconds. For each suicide, there are over 20 suicide attempts (1). In 2018, 48,344 Americans died of suicide. And, there were 1.4 million recorded suicide attempts in America alone. On average, there are 132 suicides per day (2). It is the 2nd leading cause of death for 10-34 year olds, and the 4th leading cause of death for 35-54 year olds (3). More lives are lost to suicide than any other single cause, except heart disease and cancer (4).

This is devastating.

Suicides should not be taken lightly. Suicide attempts should not be dismissed.

What can we do?

We must be aware that suicide is preventable. How? We must understand that there are warning signs and risk factors for suicide.

Warning signs are indicators that a person needs urgent help, and may be in acute danger. It doesn’t automatically mean a suicide attempt; nevertheless, it must be taken seriously and given much attention.

Here are the common warning signs of suicide:

Eight out of 10 people who display warning signs of suicide are considering the act. People who talk about suicide are 30 times more likely to kill themselves, compared to the average person.

There are also risk factors of suicide that we should be aware of. These are factors that make a person more likely to consider, attempt, or complete the act.

In psychiatry practice, it is very important to obtain these information from our patient’s history to guide the steps in our treatment plan. Suicide is a primary psychiatric emergency, for which urgent care should be provided.

Understanding the risk factors and warning signs can help us help another. If you think someone is considering suicide, communicate your concerns with that person in an open and non-judgmental manner. Sometimes, LISTENING is more important than giving advice. Ask direct questions, ask for any specific plan(s) to carry out an attempt. The more detailed the plan, the greater the risk. Do not leave the person alone, and seek professional help right away.

Here are 5 tips from the Center for Disease Control and Prevention on what you can do if you are concerned for a friend or a loved one:

It may also help to be aware of protective factors, which, when present, make a person less likely to engage in suicidal behavior, by promoting resilience and social connectedness. Strengthening these factors, and providing support may help to reduce the risk of suicide.

One of the biggest barriers in preventing suicide is the STIGMA of mental illness.

I strongly encourage everyone to join in the community’s efforts to stop the stigma of mental illness. Let’s help one another decrease the barriers to seeking mental health care.

It’s okay to not be okay.

It’s okay to ask for help.

You matter.

You can make a difference.

Here are the references and additional resources for this blog post. It’s available to download in PDF form, where you can click on the links to view the articles.

Again, I want to emphasize that suicide, suicide attempts, and talking about suicide should not be taken lightly or dismissed.

If you, or someone you know, is experiencing emotional distress that is overwhelming, please consult with a mental health professional as soon as you can. Emotional crisis hotlines are also available 24/7 if you wish to speak with someone urgently.

You may visit my previous blog post on online resources (websites, email and contact numbers of available organizations in the Philippines) for mental health and tele-consultation here.

Remember, there is no shame in seeking mental help

Let’s help each other spread awareness of mental health, and stop the stigma of mental illness.

mental tele-health and online psychosocial support

There can be times when we feel alone and isolated. More so now that physical distancing hampers our sense of social connectedness.

Sometimes, we need someone to talk to, to make us to feel better. But sometimes, we may be hesitant to reach out to our friends and family. We may be afraid to share our innermost thoughts and feelings, we may fear being judged negatively, fear being stigmatized, or we may feel our closest ones are a bit ‘too busy’ for us.

Sometimes, it’s more comforting to talk to strangers. To people who don’t know us, and who we probably will never see again, words can flow so easily. Have you noticed that?

In these times when we want to maintain utmost confidentiality, we may feel more secure talking to mental health care providers — people who are trained to handle emotional crises, in whom patient-provider confidentiality is engrained.

Here are some organizations that provide FREE psycho-social support via 24/7 crises hotlines for mental health or emotional crises:

DISCLAIMER: This post and the author are not endorsed by, directly affiliated with, maintained, authorized or sponsored by any of the organizations mentioned. All information are registered trademarks to their respective owners. Phone numbers, email addresses, websites, and profile description were obtained from each organization’s social media platforms at the time of writing, and may be subject to change without prior notice.

Tawag Paglaum Centro Bisaya
National Center for Mental Health Crisis Hotline

Pre-COVID-19, clinic visits were the norm. With it came long waiting lines, difficulty finding parking spots, traffic woes, other physical discomforts, and the fear that we might bump into someone we know.

From the crisis of this pandemic, arose innovations in mental health care. Tele-consultation and tele-psychiatry helps provide these services to vulnerable population groups. It’s easy, accessible (with a mobile phone, data plan, or internet connection), and can be done in the comfort and security of a patient’s home.

Patients perceived tele-health as acceptable, convenient, efficient (1). Most agree that the pandemic has increased their willingness to engage in virtual care (2). And, for established patients, virtual visits are more convenient, and provide effective follow-ups, compared to physical clinic visits (3).

Here are some organizations that provide psychological or psychiatric consultations, as well as psychosocial support and crisis intervention:

Vicente Sotto Memorial Medical Center – Center for Behavioral Sciences Teleconsultation
Philippine Mental Health Association – Cebu Chapter
Philippine Mental Health Association Community Based Mental Health Program
Recovery Hub by Metro Psychiatry Inc.

Here’s a PDF copy of these resources that you can share with your friends or family members in need:

If you are experiencing an emotional crisis, and need to talk to someone urgently, the crisis hotlines are available 24/7 to receive your call. If you are experiencing mental symptoms that hamper your abilities to do daily activities, you may benefit from seeking professional help from a psychologist or a psychiatrist*.

Remember, there is no shame in seeking mental help.

Let’s help each other spread awareness of mental health, and stop the stigma of mental illness.

*for further information on what goes on during a psychiatric consultation, check out my previous blog post here