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ADHD Diagnosis: Complexities and Caveats

ADHD

The Philippines has made significant strides in mental health awareness, thanks to professionals, advocates, and service users’ efforts. Initiatives such as the Philippine Mental Health Act (R.A. 11036) and the recognition of the rights of psychosocial disabilities under the Magna Carta for Disabled Persons (R.A. 7277) have played pivotal roles in this progress. Advocacy groups are also pushing for legislation like the Neurodivergent People’s Rights Act (H.B. 9787).

Despite these advancements, stigma and misunderstanding surround neurodevelopmental disorders, particularly Attention Deficit Hyperactivity Disorder (ADHD). This is a developmental disorder characterized by patterns of hyperactivity, inattention, or a combination of the two. A diagnosis is given based on the severity of symptoms, level of impairment, and the presence of symptoms since childhood. Globally, ADHD affects 5-7.2% of youth and 2.5-6.7% of adults ,,; but Philippine figures are unfortunately scarce and outdated.

Consider a young boy in his Grade 1 classroom, labeled as “makulit,” “pasaway,” and even “bad,” while he struggles with symptoms of ADHD that go unrecognized. Similarly, imagine a woman in a bustling high-rise building, where her difficulties staying organized lead to exclusion from important email correspondences and social gatherings, all because her colleagues are unaware of her ADHD diagnosis.

Unfortunately, ADHD is still so often shrouded in stigma. Those grappling with the disorder find themselves wrestling to keep pace with the demands of daily life, be it at school, work, or social settings.

Recognizing ADHD as a genuine challenge and not a character flaw, is vital for supporting individuals and dispelling misconceptions.This condition, when properly diagnosed, can be life-saving, paving the way for individuals to alleviate suffering and reclaim their power. But however well-intentioned, there is still a risk of overdiagnosis- an issue that is particularly prevalent in the realm of ADHD, but also within the realm of mental health diagnoses at large. Overdiagnosis can occur due to various factors, ranging from clinician practices to caregiver influences, but this often looks like overprescription of medications and unnecessary interventions. In the case of ADHD, changes in criteria in the

Diagnostic and Statistical Manual of Mental Disorders between its fourth and fifth editions have contributed to this concern- it added examples of symptoms seen in adolescents and adults, lessened impairment criteria, and revised the age of onset.

We must also remember that for children, a certain level of kulit is normal and developmentally appropriate. It is a quintessential part of childhood, after all — to dash around, create chaos, and indulge in one’s imagination. However, what distinguishes ADHD diagnosis is the severity and persistence of symptoms over time to the point that there is impairment.

Context also may play a role in facilitating overdiagnoses and misdiagnoses. While legislative progress and heightened awareness have improved access to care, our “digital by default” age has introduced new challenges, further complicating the diagnostic process for mental health disorders. For example, during the pandemic, the proliferation of misleading TikTok videos about ADHD posed a significant risk, as many individuals were facing attention challenges. A study revealed that over half of these videos were misleading, with non-healthcare professionals being the primary uploaders, potentially leading to widespread misinformation and self-diagnosis among their viewers.

On the other hand, many individuals may go undiagnosed until much later, their struggles well-masked by societal expectations and coping mechanisms. There exist gendered differences in the diagnosis of ADHD: boys are significantly more diagnosed with ADHD compared to girls due to differences in presentation. Girls with ADHD often exhibit the inattentive type, which may not manifest as disruptive behavior and consequently may be overlooked for treatment unless their symptoms significantly impact their daily functioning.

And with any diagnosis, whether physical or not, early intervention is crucial. Effective treatment during childhood can significantly improve symptoms and overall functioning, leading to better outcomes. Unfortunately, if left untreated until adulthood, ADHD can result in chaotic lifestyles, other co-occurring mental disorders, and challenges in various aspects of life.

The journey towards an ADHD diagnosis can be unexpectedly complex. For individuals who resonate with ADHD symptoms, every step of the way demands cautious decision-making. It is crucial to be discerning with the information you consume and the healthcare providers that you trust. Ensure that they are equally diligent.

Self-reflection is also essential. Clarify your “why” behind seeking a diagnosis—It could be that receiving ADHD treatment might help you lead a much more fulfilling life. It could also be that you want relief from years of overcompensation. Whatever your “why” is, seeking a comprehensive assessment is essential in this process to tailor-fit treatment to your unique brain. It is not a one-size-fits-all diagnosis, however general the diagnostic manual may make it appear to be; a detailed picture of how your mind works, pinpointing your strengths and challenges, will help specify what you need.

Seeking consultations from various professionals, such as clinical psychologists and psychiatrists, can offer valuable insights and interventions for managing ADHD. Therapy is a crucial component of tailored interventions—it provides individuals with a safe space to learn more about themselves, as well as equips them with essential skills and strategies to cope with their symptoms. Additionally, executive function coaching can further empower individuals with ADHD to navigate daily challenges effectively and achieve their goals. Executive function coaching focuses on enhancing skills like organization, time management, and task prioritization- these are skills that are often affected by ADHD symptoms. By addressing these areas, your quality of life may be significantly enhanced.

Despite the leaps and bounds in mental health perceptions, access, and service delivery, there is still much work to be done. Whether for ourselves or others, there is no time like the present to advocate for better education on mental health concerns like ADHD. Indeed, it is an ongoing journey to challenge misconceptions, develop discernment, and embrace the complexities of these issues. However, it is essential to see the merit in all this effort, to recognize that finally receiving the proper help can save lives. By advocating for improved access to accurate diagnosis and comprehensive treatment, we can empower individuals with ADHD to finally thrive in their communities.

For Executive Functioning (EF) coaching and other clinical services, contact us at clinic@wethriveinc.com.

Sources:

https://lawphil.net/statutes/repacts/ra2018/ra_11036_2018.html
http://hrlibrary.umn.edu/research/Philippines/RA%207277%20-%20Magna%20Carta%20of%20Disabled%20Persons.pdf
https://hrep-website.s3.ap-southeast-1.amazonaws.com/legisdocs/basic_19/HB09787.pdf
Posner J, Polanczyk GV, Sonuga-Barke E. Attention-deficit hyperactivity disorder. Lancet. 2020;395(10222):450–462. doi: 10.1016/S0140-6736(19)33004-1.
 Song P, Zha M, Yang Q, Zhang Y, Li X, Rudan I. The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of Global Health. 2021;11:04009. doi: 10.7189/jogh.11.04009.
Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and metaanalysis. Pediatrics. 2015;135(4):e994–e1001. doi: 10.1542/peds.2014-3482.
 Merten, E. C., Cwik, J. C., Margraf, J., & Schneider, S. (2017). Overdiagnosis of mental disorders in children and adolescents (in developed countries). Child and adolescent psychiatry and mental health, 11, 1-11.
Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 7, DSM-IV to DSM-5 Attention-Deficit/Hyperactivity Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/ 
American Psychiatric Association. (2022). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Yeung, A., Ng, E., & Abi-Jaoude, E. (2022). TikTok and attention-deficit/hyperactivity disorder: a cross-sectional study of social media content quality. The Canadian Journal of Psychiatry, 67(12), 899-906.
Bruchmüller, K., Margraf, J., & Schneider, S. (2012). Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. Journal of Consulting and Clinical Psychology, 80(1), 128–138. https://doi.org/10.1037/a0026582 
 Ginsberg, Y., Quintero, J., Anand, E., Casillas, M., & Upadhyaya, H. P. (2014). Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. The primary care companion for CNS disorders, 16(3), 23591.

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To hear and be heard: ideas for meaningful conversations for nurturing life

The month of September is celebrated globally as Suicide Prevention and Awareness Month. To learn more about suicide and how we can support each-other, see this article. If you need to talk to someone or if you are in need of urgent help, please proceed to the nearest hospital emergency room, or proceed to the end of this article for the contact numbers of various local 24/7 crisis lines.

Stereotypes aside, as an organization providing psychological care, We Thrive’s work admittedly has a lot to do with conversations. It is something we take for granted, not always realizing that this very peculiar human capacity is one of the building blocks of human civilization (Crystal et al., 2023). Conversations are also one of the building blocks of human life: as psychologist Lucy Foulkes puts it, when conversations “allow us to learn something important about ourselves, about the other person, or about the world” (Foulkes, 2021), truly remarkable things happen. Such conversations, when they are “meaningful”, can turn even otherwise mundane chatter (what we label “small talk”) into subtle gateways for deeper interactions (Macquire, 2023). They make possible the flourishing of all those aspects of being human: sensing and holding our emotions (Lieberman et al., 2007), articulating the various aspects of the self (McLean and Morrison-Cohen, 2013), developing new behaviors and perspectives (Albright et al., 2016), relieving and easing painful experiences (Kardas, Kumar, and Epley, 2021), making sense of life as a whole (Tarbi et al., 2021), and much more. Speech of this kind has a literal healing effect, hence the well-earned stereotypical predominance of “talk therapy” methods in clinical psychological practice (Lindberg, 2023).  As social beings, as author Arthur Dobrin puts it: “With conversation, we find a place where we belong” (Dobrin, 2011).

In our ongoing observance of Suicide Prevention and Awareness Month, we want to offer some practical points for reflection for having meaningful conversations, particularly those you want to check in on and support through difficult experiences.

The look and feel of a meaningful conversation

The main feature of a meaningful conversation is the experience of being “heard” — an experience which is, without exaggeration, “one of the most basic, yet potent needs we have as social beings” (Fowler, 2022). Most of us know from personal experience how painful not being heard can be, and how influential it can affect our own ability to hear others. Not being heard can have many precipitating factors: maybe there are basic differences in communication style (Khiron Clinic, 2021); or maybe the capacities of one or both people in the conversation to hold big or uncomfortable feelings are limited (Brosch, 2015). It could be some other factor, like adverse childhood experiences (Zlate, 2020), which are not within our present control. Whatever the case, when we are not heard, some of our most fundamental needs — the needs to feel that “we are taken seriously, that our ideas and feelings are acknowledged, and that we have something to share” (Nichols, 1995) — cannot be met.

So how do we get to meaningful conversations where we feel taken seriously, acknowledged, and feel that what we share has value? We may be tempted to offer advice right away or resort to offering affirmation.

But “problem-solving” is not the same as “hearing”, and our impulse to give instructions or shoo away difficult feelings with aspirations of pleasantness, while usually very well-intentioned, may not reflect the other person’s true needs. This is what is often meant by “toxic positivity”: when the resolution to be quote-unquote “happy” is not grounded in the present reality which might demand more emotional complexity.

So having said that, what does “hearing” actually look like? Thankfully, a few scholars have looked into this. In a series of studies, the concept of being “heard” — described by the authors succinctly as “a key variable of our time”, given our modern propensities for distractions — was operationalized according to five components (Roos, Postmes, and Koudenburg, 2021). Here, we will present how these were understood and some points for reflection to guide how we apply these to making our conversations truly meaningful. 

  1. Recognizing our “voice”. This is about “being able to express myself freely, that is, being able to say what I want to say.” In meaningful conversations, there must be that sense that, while some social filters might be appropriate in any given situation, we are able to say what we think or feel without fear of being criticized, demeaned, or thought poorly of. It is the sense that, right or wrong aside, what we say is welcomed.

Reflection: In our conversations, do we offer a sense of security that allows the other person to say what they need to say, and that we are willing and able to welcome what they say — even if they’re about something difficult and uncertain?

  1. Receiving “attention”. This is about feeling that the other person “focused their attention on what I said”. In meaningful conversations, there is a conscious effort to home in on the details, verbal or otherwise. It is the sense that what we say merits curiosity, and that there is a richness in what is being said that is worth patiently drawing out.

Reflection: In our conversations, do we offer expressions of interest that communicate to the other person that what they have to say is important, and that we really want to understand them?

  1. Receiving “empathy”. This is the perception that “the other tried to take my perspective and emotionally understand me.” In meaningful conversations, the affective contents of what we say — not just the words, but the conditions that led us to say what we say — are appreciated. It is the sense that the other person is resonating with us at a level that is deeper than the dictionary definitions of our statements, and that we are allowed to speak with more vulnerability, confident that, at the minimum, our vulnerability will be cared for.

Reflection: In our conversations, does our presence invite the other person to let their guard down, even a little, so that what they say communicates more truthfully what their hearts dictate? (At least to the extent possible, given the circumstance. Emotions are complex, after all!)

  1. Receiving “respect”. This is the feeling that the other person “valued what I said (my voice) and me as a person”. In meaningful conversations, while all human activity is prone to human errors of misunderstanding, we are taken and honored as we are. It is the sense that whatever prejudices there may be are set aside — or at least owned up to, honestly — and that the interaction is grounded in a commitment to the fact that we are human beings deserving of compassion.

Reflection: In our conversations, does our approach show the other person that we accept and honor them as they are, however and whatever they may be?

  1. Experiencing “common ground”. This is the perception that we can “understand each other’s point of view”. In meaningful conversations, there is a kind of exchange that allows both people’s perspectives to be influenced in a constructive way, allowing not just greater understanding of the nuances of these differences, but a greater appreciation of how such differences can lead to the same goals of cultivating a more meaningful life. While there may be significant divergences in the way we come to our conclusions, these conclusions are ultimately grounded on a desire for the greatest good — and that our conception of the “good” can be deepened and strengthened by one-another.

Reflection: In our conversations, do we communicate an openness to hearing the other person’s views, and an openness for our own views to be positively influenced by them?

Being able to initiate and sustain such a potent human activity is one of our best means for promoting healing for ourselves and one-another. By cultivating these five components, we can be better placed to leverage the power of conversations to cultivate human flourishing both within and beyond our difficult experiences.

For mental health support services, email us at resilientteams@wethrivewellbeing.com or contact us to sign-up for sessions with our mental health clinicians.

If you need to talk to someone or if you are in need of urgent help, please proceed to the nearest hospital emergency room, or call these 24/7 crisis lines:

DOH-NCMH Hotline

0917-899-USAP (8727)

0966-351-4518

0908-639-2672

(02) 7-989-USAP (8727)

1553

Hopeline PH

0917-558-HOPE (4673)

0918-873-4673 (HOPE)

(02) 8-804-HOPE (4673)

2919

In Touch Crisis Line

0917-800-1123

0922-893-8944

(02) 8-8937603

References (in order of appearance):

  1. https://wethrivewellbeing.com/world-suicide-prevention-day-responding-to-suicide-with-resilience-and-compassion/ 
  2. https://www.britannica.com/topic/language 
  3. https://psyche.co/guides/how-to-have-more-meaningful-conversations 
  4. https://carolinemaguireauthor.com/how-to-make-small-talk/ 
  5. https://www.healthline.com/health/mental-health/talk-therapy#how-effective 
  6. https://pubmed.ncbi.nlm.nih.gov/17576282/ 
  7. https://www.tandfonline.com/doi/abs/10.1080/15283488.2013.776498 
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344154/ 
  9. https://www.apa.org/pubs/journals/releases/psp-pspa0000281.pdf 
  10. https://www.sciencedirect.com/science/article/abs/pii/S0738399121003335 
  11. https://www.psychologytoday.com/intl/blog/am-i-right/201112/conversation-makes-us-human 
  12. https://thedmcclinic.ie/blog-the-importance-of-being-heard/ 
  13. https://www.goodtherapy.org/blog/listen-up-why-you-dont-feel-heard-in-your-relationship-0810154  
  14. https://www.pacesconnection.com/blog/adverse-childhood-experiences-and-interpersonal-relationships 
  15. https://www.compassionate.center/docs/Why-listening-is-so-important.pdf 
https://psyarxiv.com/73jgn/
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Helping Out a Friend Through a Mental Crisis Using ALGEE

Have you ever heard of the statement “That’s what friends are for”? It implies the role of a friend as someone you can count on to help you out. So when a friend reaches out and opens up about a problem, it seems natural to listen, comfort, and support them as best as you can. But there are times when you may not feel confident enough to help them. You may feel like you don’t understand the problem very well because you have not experienced it, or you have probably dealt with a similar problem before but could not understand why your friend is struggling with it. Sometimes, the idea of saying something wrong and making things worse for your friend is daunting in and of itself. Fortunately, there is one way for you to help your friend in times of mental distress.

So how can I help my friend out?

Like with medical concerns, you can provide first aid for mental health concerns.

Mental Health First Aid (MHFA) is done to help someone experiencing a mental health crisis when professional help is not yet available. ALGEE is a tool that is used to provide MHFA. It won’t teach you how to become your friend’s personal therapist, but it will help you provide them with the support they need to cope with what they are going through in that moment of crisis.

ALGEE is an acronym that stands for the following: Assess for risks of suicide or harm; Listen without judgment; Give reassurance and information; Encourage appropriate professional help; and Encourage self-help and other support strategies.

How do you use ALGEE?

ALGEE can be done in any order, depending on what you think your friend needs at the moment. Below is an overview of how you can approach and what you can expect to happen in each step. 

1. ASSESS for risk of suicide and harm

This step involves observing for any signs that would tell that a person is in distress. Such signs can be a sudden change in behavior or an unusual reaction to a particular topic or situation. You should also be alert to mentions or jokes of your friend contemplating suicide, as well as self-harm behaviors such as cutting, engaging in excessive substance use (such as alcohol, cigarettes, or drugs), or doing risky activities that can harm them physically.

If you find out that your friend is actively hurting themself or has plans to commit suicide, then it is important to persuade them to get help as soon as possible.

2. LISTEN without judgment

People who are in distress want to be heard. That’s why it is important to give them the opportunity to say what they want to say uninterrupted. Keep an open mind about what they are saying, even when you do not agree with them. Avoid making speculations or giving advice, unless your friend specifically asks for your opinion on the matter.

Show that you are actively listening by keeping an open and receptive body posture (that is, arms and legs uncrossed and palms resting comfortably on the lap or desk) and maintaining eye contact. You can also make appropriate verbal responses to show that you understand and follow what they are saying. Responses may be in the form of reinforcements (“I see.” or “Uh-huh.”), acknowledgements (“That’s tough.” or “I can imagine how confusing it is to be in that situation.”), questions (“What did you do to cope with that situation?”), and reflections (“This is what I heard from you. Am I understanding it correctly?”). If you’re talking with your friend through text or chat, you may need to rely more on verbal responses to better understand each other.

3. GIVE reassurance and information

In an effort to cheer your friend, you may sometimes find yourself telling them that everything will be okay or that they can do things if they only believe in themselves. However, people in distress may feel so overwhelmed and hopeless that they cannot see their situation improving or believe that they can act on their problems. To give reassurance, you need to make them see the possibility. You can do this by providing evidence and information. Are there ways to deal with their problem that they may not have thought of? Have there been situations that contradict a negative thought that’s been running through their mind? Helping them find evidence that there are things that can be done is an effective way of instilling hope in them.

There may be times when your friend thinks that undesired feelings or behaviors, such as lashing out at other people or being too afraid to speak in public, are their fault. However, such feelings or behaviors may actually be symptoms of a particular mental illness or of significant distress that could lead to a mental illness if untreated. Thus, it is important to emphasize that mental illness is real and the symptoms they are experiencing can be treated with the right help.

4. ENCOURAGE appropriate professional help

The earlier your friend gets help, the more likely they can recover. Find out what kind of support your friend needs at the moment and help them find professionals, agencies, organizations, or institutions that can make things a little easier for them.

If they need psychological help, there are various mental health services and programs available. Some universities and organizations offer free therapy sessions, although they may be limited in terms of slots or the number of sessions that can be availed. For long-term and more intensive help, paid therapy sessions in clinics and hospitals may be necessary. You can check out the directory of mental health facilities in the country created by #MentalHealthPH here. Additionally, 24/7 crisis lines come in handy whenever there is a need to overcome a mental crisis or to prevent a suicide attempt. A list of these hotlines can be found here. Regardless of whether payment is involved, simply being able to attend therapy is already a huge step towards healing.

5. ENCOURAGE self-help and other support strategies

Mental health services aren’t always available, and this can be a problem when your friend experiences a panic attack or suddenly feels overwhelmed by suicidal thoughts. Knowing how to deal with these emergencies helps them develop the skills to cope with crises on their own. Coping strategies such as breathing, grounding, and self-soothing techniques are useful during panic attacks. Utilizing tools for mindfulness and emotion regulation also helps practice control and lessen chaotic situations caused by outbursts. Exercising, spending time with friends and families, and engaging in hobbies and other recreational activities can help improve one’s quality of life. For some mindfulness breathing exercises, you can check out Circle of Hope’s Hingalangin videos on their Facebook page.

To see a demonstration of ALGEE, you can watch this roleplay video on YouTube.

Are there things I should consider when using ALGEE?

As a mental health first aid tool, the main purpose of ALGEE is not to diagnose your friend or solve their problem, but to help determine their needs and provide appropriate support. While your closeness can help your friend be more comfortable opening up to you, it is important to always be objective, express empathy, and abide by the principle of “Do no harm.”

Here are ways that you can do this.

  1. Keep what is said confidential, unless help from other people is necessary.

It takes courage for a person to open up about their struggles. Some people refuse to share what they are going through for fear of exposing themselves to the wrong people. Reaching out to you means that they trust you to keep what they have said only to yourself. Before going through ALGEE, it is best to set up a time and a place to talk to your friend privately. This will give your friend a chance to be vulnerable in a safe space. However, keep in mind that if there is a high risk that your friend would commit suicide, ensuring their safety by asking for help from other people and authorities is necessary.

  1. Do not force your friend to share their problems with you.

Sometimes, people are just not ready to talk about their problems. If your friend outright tells you that they do not want to talk, do not force them to. Instead, encourage them to talk to someone that they trust or assure them that you are available to listen to them whenever they are ready. You can also simply ask them what they need at the moment. Show them that there is someone who is willing to listen and help, and they have the option to choose who or when they seek help.

  1. Refrain from invalidating them or trivializing what your friend is going through.

Some people keep their worries to themselves because they believe that no one would hear them out or make the effort to understand them. When your friend opens up to you, listen well and try to see the situation from their perspective. If there are things they said that you do not agree with, do not reject or dismiss what they are feeling or thinking about. If you think that their problems are too simple, remember that every person is affected by situations differently. What may be easy for you may be too much for them. Likewise, if you have experienced a similar problem and have resolved it successfully, take note that what may have worked for you may not work for them. Thus, when providing help and support, consider their strengths and weaknesses.

  1. Give your friend the control that they need through options.

One of the reasons why people usually feel distressed is because they feel that they cannot control their situation. Thus, if solutions are imposed on them, the feeling of having a lack of control will increase. If you have a solution in mind, ask first if they are open to hear advice. If they are, assure them that your advice is simply a suggestion and is open to modifications until they find one that they are comfortable with.

  1. Improvise, adapt, and overcome.

There are times when it can’t be helped to expect something from your friend or from the situation. However, it is important to be open to the possibility that things may not go your way. Something may keep your friend from getting help despite your agreement or keep the situation from improving as you both hope. Identify the challenges, seek alternatives, and try again. And remember, it’s okay to make mistakes!

  1. Watch out and prepare yourself for compassion fatigue.

While being there for a friend during their toughest times is admirable, there are times when their problems, emotions, and negative thoughts can get to you too. When you feel overwhelmed with helping your friend or are starting to feel affected by what they’re going through, you may be experiencing compassion fatigue. It is important to be mindful of the symptoms of compassion fatigue and to prepare yourself to prevent it or address it when it comes. Remember to take a break if you have to and to take care of yourself first every once in a while. It’s also important to not be too hard on yourself if things don’t go as well as you hope. If your friend deserves compassion, then don’t you deserve some as well? You can practice some self-compassion exercises to help you combat compassion fatigue.

Using ALGEE is a great way to create a mental checklist of what you can do to help out a friend during a mental crisis. However, this does not mean that you have to strictly abide by it or be overly concerned if you skip a step. The most important thing about helping a friend is being there for them and showing them that you care.

References:

Altta Wellbeing. (2019, September 30). ALGEE – 5 letters, 1 life saved every time. https://wellbeing.altta.co.uk/algee/

Jorm, A. (2016). Key Elements of Mental Health First Aid. Alan J Fisher Centre for Public Mental Health. http://cpmh.org.za/wmhd/wp-content/uploads/2016/08/Key-Elements.pdf

Martinelli, K. (2023, February 20). How to Support a Friend With Mental Health Challenges. Child Mind Institute. https://childmind.org/article/support-friend-with-mental-health-challenges/

Mental Health Foundation. (n.d.). How to support someone with a mental health problem. https://www.mentalhealth.org.uk/explore-mental-health/articles/how-support-someone-mental-health-problem

Thurrott, S. (2021, June 11). Watch for These Key Warning Signs of Compassion Fatigue. Banner Health. https://www.bannerhealth.com/healthcareblog/teach-me/watch-for-these-key-warning-signs-of-compassion-fatigue

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Navigating the Road to Healthy Boundaries

Boundaries

Have you ever driven a car? Driving is a useful yet rigorous skill to learn.

Similar to driving, setting healthy boundaries is a rewarding skill that can help us go places. We are the driver navigating our way through the busy district of interpersonal relationships. Learning to set healthy boundaries needs conscious effort, and it can make us feel a mixture of excitement and fear – like driving for the first time.

Following the rules

Since childhood, we have been taught to follow the rules: obey the elders, be agreeable to our peers, consider others’ feelings, and be mindful of how others view us. These rules usually remain with us until adulthood as we continue to defer to our parents, comply with our supervisors, and yield to our partners. More so, these rules help us maintain harmonious relationships with others.

The downside of rigidly following these rules is developing our fear of interpersonal conflicts. The need for belongingness and acceptance drives us to indulge others even with a heavy heart. Some demands
can make us feel uncomfortable, but we do them anyway to avoid the guilt and anxiety of saying no.

Sometimes people misinterpret the rules of social relationships. We become compliant instead of compromising to maintain “conflict-free” relationships. Giving in to the backseat drivers can be exhausting; we have to take the wheel ourselves.

Keeping safe distance

Being too close to other cars raises the chance of collision. The same goes with having little to no personal space. It may appear counterintuitive, but saying no to others can improve our relationships.

Boundaries are the limits we establish for ourselves on our participation in social activities to preserve our integrity. They make us feel comfortable genuinely expressing ourselves and still safe around others. They are not meant to keep people away but to provide us enough space to assert our needs, wants, and expectations of others.

Dr. Sheri Jacobson, a retired senior therapist and founder of Harley Therapy in the United Kingdom, listed the adverse effects of having poor boundaries. We become vulnerable to stress, anxiety, depression, and burnout. While we try to avoid interpersonal conflicts, we may still have bad relationships. Others can take advantage of us even unintentionally at times. Our frustration, resentment, and anger will eventually accumulate, and passive aggression may seem like the only way to stand up for ourselves. The worst case is losing our own identity as we prioritize others more than
ourselves.

Paying attention to the signs

As you journey through setting healthy boundaries, you need to look out for the signs of being a people pleaser. According to Nedra Glover Tawwab, a therapist and author of Set Boundaries, Find Peace, poor
boundaries manifest in four ways:

1. Neglecting self-care

Whenever you accommodate others’ wishes, you give a part of yourself to them – your time, energy, and resources. A telltale sign of having poor boundaries is not having enough of these for your own. It is neither selfish nor inconsiderate to give yourself some space. Remember, you cannot run with your gas tank empty or battery drained. You have to take care of yourself first to take care of others.

2. Overwhelmed

People with poor boundaries feel overwhelmed most of the time as they tend to accept more tasks than they can manage. They constantly worry about fitting everything into their schedule. You need to know your limits and work only within your limits. Going beyond them results in exhaustion and burnout.

3. Resentment

People who are compelled to do something may feel annoyed. Worse, those taken for granted feel hurt, bitter, and angry. Resentment will pile up and negatively affects your relationships in the long run. The little things we used to enjoy doing for and with others start to feel like duties – boring and tiring. Note that relationships should not be a burden; instead, they should be one of your sources of happiness, hope, and support.

4. Avoidance

When you cannot assert yourself, you will likely respond to resentment by avoiding others. It is passive aggression to ignore or cut off people. Delaying responses and bailing out of trips are some avoidant strategies that can isolate you. These are not helpful because they do not convey to others why you evade them; hence, they will continue to ask you favors.

Map to healthy boundaries

When you recognize the warning signs, hit the break and take the route to setting healthy boundaries. Adapted from Tawwab, you can follow this roadmap:

1. Identify your boundaries

The first step in setting healthy boundaries is to know your wants, needs, and expectations. Observe yourself and reflect on your emotions and thoughts.

  • Do you want to do this?
  • Are youcomfortable doing that?
  • What do you need?
  • What do you expect others to do to you or for you?

Ask these questions to know more about yourself and your limits. Honesty is crucial in this step.

2. Communicate

People are not mind readers; you have to tell them our boundaries. More importantly, you must state them clearly and directly – not just signals of maybe’s or I-don’t-know’s. In doing so, others become aware of how you want to be treated. You may beat around the bush because you find confrontations agonizing, but indirectly communicating our boundaries can only be confusing.

3. Deal with the discomfort

Setting boundaries can initially elicit some discomfort. You may feel guilt for being “selfish” or “mean.” You may feel fear that your future interactions will be awkward. You may also worry about saying the right words in the right tone at the right time. However, practice can make it feel easy and natural. Remind yourself that you are setting boundaries for your wellbeing. Engage in other self-care activities as well to improve your mood while learning how to say no.

4. Follow through

Despite feeling some degree of discomfort, you have to commit to honoring your boundaries. Consistency is key. Show people that you take your boundaries seriously, and they should, too. Immediately speak up when others go overboard. Tell them how you feel about it and what you prefer them to do. Do not let anyone slide, as it only encourages others to continue disregarding your boundaries.

The roadmap may appear short and straightforward, but it can be a long and winding road. You may find yourself going in circles, and it is definitely okay. When this happens, pull up and refer to the map to find your way again. You can also ask a reliable friend to hop in for a while and help you stay on track.

Establishing healthy boundaries leads to an enjoyable life. You become true to yourself, and others learn to honor your decisions. You get the most out of your relationships because you are respected – by yourself and others.

Now that you know the rules, the signs, and the map, may you continue to share your adventures with others while enjoying some healthy space for yourself.

References:

American Psychological Association (n.d.) Boundary. APA Dictionary of Psychology.
https://dictionary.apa.org/boundary
Jacobson, S. (2015, March 24). The Psychological Cost of Never Saying No. Harley Therapy.
https://www.harleytherapy.co.uk/counselling/saying-no.htm
Tawwab, N. G. (2021). What the Heck are Boundaries?. Set Boundaries, Find Peace: A Guide to Reclaiming Yourself. Penguin Random House LLC

Categories
Blog Everyday Thriving General Thrive at Work Thrive in School Wellbeing Practices

Feeling ‘Sabaw’? Here’s the Science Behind it & 5Ways to Overcome it

sabaw

If you’re a student or young adult, you must have reached a point of disorientation
from having too much schoolwork to do or too many work engagements to finish. If you’re a parent, you may have either heard your child saying “Sabaw na ‘ko,” as if they could no longer listen to whatever you were about to say, or you may have felt “sabaw” yourself with all the things that need to get done around the house. Thing is, all of us must have experienced being sabaw at least once in our lives, and probably multiple times when we stay in an environment where there is too much going on.

So, why does being sabaw happen?

Being sabaw, or what we call a ‘cognitive overload’, happens when our brain cannot adapt to the amount of information given (often an amount that is too much), or to the too many tasks that need to be done at once. As a result, processing information and performing tasks becomes more difficult, and at worst, not even possible.

No matter how keen a person may be, they have a limit to how much they can process in a given amount of time. Even the most intelligent of people can process only so much.


When it comes to being sabaw, some respond with frustration while some may even respond to it lightly with humor (e.g., Nako, sabaw ka na naman, friend!). Regardless of what you feel about being sabaw, it can be reassuring to know that you don’t always have to be held back by it. So, here are five ways to overcome it:

Five ways to overcome being sabaw:

1. Try to stay away from distractions.

In the time of social media, it is so easy to be swept by the urge to check your phone, go to social media and check out what is interesting to see. Chances are, you may not immediately feel sabaw after browsing through your phone but you may feel it as soon as you get back to your important task, especially if what you had just consumed was heavy or engaging information. Eliminate other sources of distracting information by going to a peaceful environment, whether it’s a specific room in the house or a coffee shop with few to no distractions, and turn off/ silence your phone. Lastly, bring your phone back as a reward for completing a task.

2. Do one thing at a time.

Contrary to popular opinion, multiple studies have shown that multitasking is not very beneficial—it actually makes us less efficient and more prone to errors. The negative impact of multitasking to folding laundry while watching TV or listening to music may not be as felt as when you write an email while listening to a meeting. The disadvantage of multitasking is more clearly seen when tasks become more complex. One study had found that heavy multitaskers (those who believe that multitasking helps them with their performance) actually performed worse in the activity of multitasking than those who like doing one thing at a time. This is because the multitaskers had more difficulty organizing their thoughts and were slower in switching from one task to another—essentially, multitaskers are more highly like get into a state of sabaw in the midst of accomplishing tasks. So, learn to set other things aside and try to focus your energy and effort on one thing at a time.

3. Take breaks and don’t do other work in those breaks.

If you have freed yourself from distractions and learned how to do things one at a time, you may still find yourself feeling sabaw if you overuse your brain for a prolonged amount of time. Hence, taking a break is helpful regardless of how simple or how complex a task is. It’s just that you’re more likely to get sabaw sooner when you solve a series of calculus equations within an hour as compared to reading a light novel within the same duration. You can do anything during your break as long as it is not work. Meanwhile, the length of breaks that you need may depend on various factors such as your current health state (e.g. whether or not you’ve had enough rest, sleep, and energy), the complexity of the task, and the urgency of finishing the task. But if everything is kept constant, taking a break of 15-20 minutes every after 50-90 minutes is considered beneficial and can keep you from being
sabaw. Going beyond 20 minutes, of course, will not make you even more sabaw although it may affect other important priorities in your activity such as momentum and productivity.

4. Plot a schedule and write notes for reminders of activities that you need to get back to.

Sometimes the list of things that you have to accomplish can get very overwhelming. Even if you try to take breaks, you still get overwhelmed and fear that you’d hit that state of sabaw soon. If that does happen, then that is likely a result of too much mental activity consumed by the worrying of other activities that haven’t even started yet. To help bring you at peace and certainty, try to plot a schedule for the set of activities that you need to get done and put them on paper or in a digital note. Relying too much on our working memory for reminders and specific details can sometimes be disadvantageous given that our brain can only take in information at a certain capacity. Unnecessary worry and stress may ease when you have realistic schedules and plans in place.

5. Withdraw from other commitments or other activities.

There are many aspects in our lives that demand our attention, may it be school, work, family, community, and relationships. But sometimes, they can lead us to overcommitment. The initial consequence of overcommitting can be feeling sabaw at first, then burnout after. If you have done tip #4 and still find yourself overwhelmed, it may be possible that your schedule of activities and/ or commitments may be unrealistic and too tiring for you. In that case, learn how to let go by saying no, turning over the responsibility to someone else, ask for help to relieve the responsibility from you, or a combination of all of those. Our brains can only handle so much that when we force things, we may end up accomplishing less commitments than what we had initially expected because of too many sabaw moments and burnout.

References:

Supertaskers: Profiles in extraordinary multitasking ability
Executive control of cognitive processes in task switching
Give me a break