'Worrywart' learns to live in the moment
Chan On-ming, 29, started showing signs of separation anxiety and shyness in primary school. As Chan grew up, he was constantly anxious about his and his parents' health, his grades at school, meeting new people and the dark.
These fears became more pronounced when he went abroad to university. He was persistently worried, so much so that he could not sleep and was irritable and tired. Chan (whose name has been changed for reasons of patient confidentiality) sought help from a university doctor who prescribed an anti-anxiety drug, which he took whenever needed, such as during exams.
He did not make many friends because, worried about social situations, he would turn down party invitations. His anxiety would often spiral into more negative thoughts and he would think about past experiences.
The few close friends he had said he was a 'worrywart' and felt that his constant need for reassurance about everything was too much of a burden. Some found excuses not to socialise with him.
After graduation Chan found a job in a busy office. He suffered from depression and was prescribed an anti-depressant, which made him feel jittery and even more agitated.
Finally, a few years ago, the young professional was diagnosed as having general anxiety disorder. Worried about his future job prospects and ability to form and sustain relationships, he sought help from a psychologist, who suggested mindfulness meditation as an adjunct to his current cognitive behavioural therapy.
Mindfulness meditation is about paying attention to the present moment without drifting into thoughts about the past or concerns about the future, and without analysing or making judgments about what's going on around you.
Dr Helen Healy, clinical psychologist at The Middle Path in Hong Kong, says: 'Cognitive behavioural therapy has been found to be effective in the treatment of generalised anxiety disorder, but a significant number of people continue to struggle with residual symptoms.
'Recent research and theory supports the integration of mindfulness and acceptance-based treatments with existing cognitive behavioural treatments to improve the efficacy and clinical significance of such approaches.'
In mindfulness-based approaches, Healy says one learns how to observe and accept what is going on, rather than avoiding or fighting it. This can be more effective than solely focusing on negative thoughts, as in traditional cognitive behavioural therapy.
When Chan received invitations to social gatherings, his internal dialogue would usually be: 'People will be staring at me, they must think I am so weird, I can't do this, I must get out of here.' During counselling, he was encouraged to separate his feelings, internal dialogue and usual responses from the situation.
Through many sessions, the counsellor worked on getting him to change his irrational and negative thoughts into more rational ones, and to focus on his bodily sensations, thoughts and feelings whenever he started feeling anxious. Chan used to feel his heart pounding, palms sweating and throat drying before an anxiety attack. He was encouraged to break the cycle of negative thoughts using breath counting as soon as he felt his heart pounding, rather than when the anxiety had already begun.
The counsellor taught him to breathe from the abdomen, inhaling through the nose and slowly counting to five, then to hold his breath to a count of five and exhale slowly and fully, through the nose or mouth, to another count of five. This was repeated for up to five minutes.
Breath counting has enabled Chan to pay attention to his feelings at the present moment, without trying to change, justify or repress them. Therapists say that by doing this, the brain has less opportunity to build scenarios and apply internalised interpretations to forecast social responses.
After practising this technique and meditating for 15 minutes daily, Chan has been able to acknowledge and accept his feelings so that when they arise, he is able to let go and change his inner dialogue into something more rational.
These days, Chan focuses more on the brighter side of life. He says: 'When I talk to a group of people, I'm usually able to say to myself, 'Hey, I'm feeling anxious, but I'm still able to hold a conversation and look people in the eye'.'