Common psychological issues & their solutions

Dr Adeel Arshad, a psychiatrist at Riverina Specialist Psychiatry, Australia highlights common psychological issues and their solutions. Dr Adeel has special interest in treating individuals with culturally and linguistically diverse background (CALD) and raising awareness about healthcare inequalities

 SN: What is the difference between mental and psychological health?sni

Mental and psychological health are two different terms but are simultaneously interconnected. Mental health refers to an individual’s ability to think clearly, process information and cope in stressful situations. Whereas, psychological or emotional health refers to how an individual responds or manages his emotions or feelings in stressful situations. For example, feelings or emotions experienced due to rejection, loss of loved one or trauma.sni

SN: Which psychiatric issues are common among Pakistani adults? Also have the issues changed or worsened over the years?sni

According to WHO, approximately 24 million people in Pakistan need psychiatric assistance. Even with the increased presentations, the number of available psychiatrists remains 0.19 per 1,00,000 patients which is the lowest in the world. There has been limited improvement in psychiatric healthcare facilities too. Depression, anxiety, substance use disorder and schizophrenia are some of the common issues faced by Pakistani men and women.sni

There has certainly been an increase in psychiatric presentations over the years due to increased psychosocial stresses; poor living conditions, accommodation/financial/family worries and inequality of healthcare. Also living in an environment where progress is mirrored through materialism has led to further acute stress with limited focus on self-care.sni

SN: What is the effect of mental health on overall well-being of an individual?sni

Mental and physical health are interconnected. Poor mental health affects the individual and his family and relations too. This usually starts with poor performance, lack of happiness, social withdrawal and breakdown of friendships and relationships and further leads to poor appetite and personal hygiene. This eventually increases the risk of physical health problems related to heart, stomach and hormones.sni

SN: Some people tend to think a lot about a certain situation or an event. When will it be considered overthinking?sni

Overthinking in itself is not a mental health disorder. We all overthink sometimes about work, a heated family argument or some past mistake. These worries are completely normal. But one must seek professional help if overthinking causes constant distress and impacts daily life. In this case, there is a chance that it is due to complex psychological condition, commonly related to anxiety disorders. Generalized anxiety disorder, post-traumatic stress disorder, panic disorder, social anxiety disorder and specific phobias are some examples.sni

SN: Is it true that women are more likely to overthink and be affected by it?sni

There is limited evidence to suggest that women overthink or have more mental health issues than men. They may respond to emotions differently like women tend to externalize emotions. Moreover, the way mental health issues present in men and women from the sub-continent may be different. For example, depression presents as constant physical health symptoms like headaches, body aches and lack of energy.sni

SN: Does overthinking lead to negative thinking?sni

Yes, it can result in negative perceptions about one’s self. Hence impacts mood and can further lead to depression and social withdrawal.sni

SN: Suggest some effective ways to stop or manage overthinking.sni

Firstly, understand and look into the potential triggers. Then make changes to avoid them. Breathing exercises, regular physical activity, meditation and healthy routines can release natural endorphins that can help with mood. Consulting a therapist or getting online cognitive behavioral therapy (CBT) can be effective too. CBT works by challenging negative thinking patterns. For moderate to severe conditions, combination treatment; psychological therapy and medication is recommended.sni

SN: It is common nowadays to say someone has obsessive-compulsive disorder (OCD) if he/she is organized or concerned about cleanliness. What actually qualifies as on OCD?sni

OCD means presence of obsession, compulsion or both for a consistent time period which impacts an individual’s routine activities. For example, somebody feels dirty and is stressed that this can lead to major physical health problems or any other adverse outcome. This thought of being contaminated is considered an obsession as it is causing him to have anxiety or distress. Then he tries to ignore or neutralize this thought by compulsion; a repetitive behavior (handwashing, showering again and again) aimed to prevent or reduce anxiety or distress. These obsessions or compulsions are time-consuming and impact social, occupational and other important activities.sni

SN: What is the treatment for OCD?sni

Most effective treatment is a type of cognitive behavioral therapy called exposure and response prevention (ERP). It is usually done by a clinical professional; psychologist, social worker or mental health counselor. Also medications are prescribed by a physician or a psychiatrist. They work together with the therapist to develop a treatment plan. Seek professional help when symptoms start interfering with daily life.sni

SN: Which steps do you think can ensure that mental health of employees is taken care of in an organization?sni

This depends on various factors like job sector (public or private), type of work, type and personality of an individual and home and office environment. To take care of employees’ mental health, organizations must make mental health training mandatory for them. There should be mental health managers just like fire safety wardens so those struggling can get help. In many countries, every organization has an Employee Assistant Programme (EAP). This can be anonymous so employees can seek help when required without any self-stigma.sni

Executives, supervisors and managers must emphasize on the importance of emotional well-being in the meetings. Also offer workshops on resilience, timeout rooms like meditation, prayers and yoga, flexibility in timings and provide access to breathing or stress reduction apps. Having a mental health day within the organization can help too. Encourage employees to use their vacations and if anyone is struggling, sit down and make a return-to-work plan.  Moreover, arrange social events and fun activities for employees so they can build connections.sni

SN: Children/people who have suffered any kind of abuse need professional help to manage the trauma associated with it. Is there anything family members can do to help?sni

Parents, carers and loved ones must provide an environment where children feel comfortable to talk. It can be difficult in Pakistani society as the evidence suggests that more often than not, the trauma is inflicted by a close family member or a friend. Hence it becomes difficult for the child to share things due to fear of consequences. Moreover, anyone affected by trauma is allowed to talk about what happened, even if they become upset.sni

Do not insist on talking if they are not willing to. Tell them you are there to listen when they are ready to talk. Try to make sure there is someone else they can talk to if not you.  Also avoid making decisions for them and sharing their trauma to other family members when they want to keep it confidential.sni

SN: Why are some people more emotional than others?sni

Multiple factors can play a role in this. Genes, childhood neglect trauma, poor distress tolerance, impulsivity, untreated underlying psychiatric illness or personality disorders are some examples.sni

SN: What are the ways to gain emotional control?sni

Self-awareness is the first step. Understand your emotions whether you are feeling sad, anxious or hopeless. Then mindful exercises like breathing, meditation, praying or engaging in actions that calm us when we feel emotional can help. Challenging and reframing negative thoughts is important too. It will improve mental well-being by making one feel confident, optimistic and empowered.sni

Challenging involves recognizing thoughts and questioning their accuracy. For example, if you think you are a failure. Ask yourself what evidence do I have to support or refute this. Questioning the accuracy will help you realize these are just thoughts not facts. Then reframe this thought; instead of thinking I am a failure, think that I made a mistake but that does not define me as a person. I can learnand do better next time. Reframing can be difficult but gets easier with practice. One must be patient and persistent.sni

SN: How is social media contributing towards increasing psychological issues?sni

Social media has both good and bad sides depending on how it is used. It can help improve quality of life if used positively like to increase knowledge or learn skills. Unfortunately, in Pakistan this is often not the case. Social media platforms have led to an increased incidence of trauma in teenagers who are being exposed to mature content at a young age. Moreover, influence of social media personalities on young teenagers is resulting in negative outcomes.sni

Parents or carers are spending time and making videos of themselves on TikTok etcetera. Spending significant time on social media further perpetuates the risks as the behavior is somewhat normalized for the children to follow. Also it reinforces materialistic values which puts added stress on people to achieve unrealistic goals.sni

SN: What causes someone to have a narcissistic personality?sni

There is not one or exact cause. However, some factors like parenting style (either excessive pampering or criticism) can play a role. Other factors are family history of mental health disorders, unpleasant family life during childhood and lack of acknowledgment or excessive appreciation in earlier years.sni

SN: How can one deal with toxic or narcissistic family members?sni

Avoid confronting and forcing them to accept they have a problem. Instead focus on yourself, know your boundaries and set limits to what you can and cannot do for them. Furthermore, avoid conflict and have a distraction or safety net to go to when heated arguments occur.sni

SN: What causes a persistent feeling of emptiness?sni

Various disorders can lead to persistent feelings of emptiness like complex trauma, depression, social anxiety and lack of social connections.sni

SN: What sort of counselling should be given to couples before getting married in Pakistani society so they can have a better married life?sni

In Pakistani society, couples are unlikely to have counselling before marriage. But I think it is important for all couples to have emotional understanding prior to marriage. Accepting weaknesses is the key to a successful relationship. Then after marriage they must give each other time for self-care. Moreover, create an environment where one feels comfortable expressing feelings and being validated.sni

SN: How important is the relationship of parents for children to develop a positive personality?sni

Every individual is different. We can focus on kids being demanding, aggressive and attention seekers but we must reflect on our own parenting styles. Ask yourself these questions; do both of us (mother and father) have same parenting style, are we consistent with discipline, are we comparing the child with his siblings or with cousins and other children. Also are children getting confused due to our changing values and behaviors.sni

SN: How can a strong bond be created between parents and kids?sni

Know that having realistic expectations can have better outcomes. Almost every parent to some extent is aware of their child’s capabilities and inabilities. Encourage them to focus on strengths than weaknesses. Set clear limits on what are the don’ts from the start, ensure they are followed and make the consequence clear if limits are not followed. Acknowledge and positively reinforce good behavior with a gift or validation. It will also encourage children to repeat these behaviors.sni