Wednesday, November 9, 2016

Insomnia Treatment in Malaysia


Insomnia Meaning:
Insomnia is a lack of sleep due to insufficient sleep quality or quantity. The insomniac’s major complaint is awakening during sleep, followed by difficulty falling asleep. An insomniac may sleep but experience poor sleep quality, also known as nonrestorative sleep. As a result of a lack of quality sleep, impairments are experienced in social and occupational functioning.

The three types of insomnia are sleep insomnia involving difficulty falling asleep, sleep maintenance involving awakening during sleep, and late insomnia involving early morning awakenings. Insomnia can be episodic lasting for a period of one month within 3 months, or persistent lasting longer than 3 months. Recurrent insomnia is two or more episodes within a year. Insomnia disorder is one of the major three groupings of sleep disorders under DSM-5, together with hypersomnia and arousal disorders.


Insomnia Symptoms:
The DSM-5’s major criteria for a diagnosis of insomnia, in brief, are (APA, 2013):

  1. Dissatisfaction with sleep quantity or quality, with one or more of the following symptoms: difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening 
  2. The sleep disturbance causes significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning 
  3. The sleep difficulty occurs at least 3 nights per week, is present for at least 3 months, and despite adequate opportunity for sleep 
  4. The insomnia does not co-occur with another sleep disorder 
  5. The insomnia is not explained by coexisting mental disorders or medical condition
Insomnia is a precursor to, and comorbid with, a number of mental and medical disorders. To ensure proper treatment, DSM-5 recognizes that one or more disorders may be present at the same time. A medical condition such as chronic pain or mental disorder such as breathing-related sleep disorder may be the cause of the insomnia. However, DSM-5 does stipulate that the insomnia should be clinically significant on its own to warrant a diagnosis.


Insomnia Treatment:
Medication is the most commonly used treatment for insomnia. A class of sedatives called hypnotics is typically prescribed. Benzodiazepine has a high risk of side effects and long-term dependence, and therefore is recommended for short-term use. Nonbenzodiazepines are more commonly prescribed today but still have a risk of side effects and are habit forming. Doctors will first try non-drug approaches to treat insomnia. These may include mind relaxation exercises and avoiding stimulants before bedtime such as caffeine. Despite the complications, insomnia worsens when patients go off medication for insomnia.

Psychotherapy approaches (Such as CBT-I) include stimulus control to teach the association between the bed and sleeping, sleep restriction to restore sleep regulation, and cognitive restructuring to address anxiety-related thoughts that lead to a lack of sleep (Mitchell, 2012).
While almost half of us report being kept awake by stress or worry, increasing evidence suggests that a large proportion of chronic, long-term insomnia is caused not by environmental factors but by the very worry we feel about getting our prescribed eight hours. In short, this sleep performance anxiety – our worries about getting enough sleep – is stopping us from getting the sleep we need. Thus, sleep performance anxiety issue should be addressed first during the therapy session.
Study also finds that those highly suggestible to clinical hypnosis can have deeper sleep after hypnotic suggestion.


Message from Hiro Koo:
Our psychological hypnosis approach will combine psychotherapy and clinical hypnosis methods to deal with your insomnia problem. First, we will do an initial consultation (Include brainwaves analysis method) to find out the root cause of your insomnia problem. After that, we will recommend the most helpful method to deal with your insomnia. Please drop me an email if you need more info: [email protected]



Source:
http://www.theravive.com/therapedia/Insomnia-Disorder-DSM--5-780.52-(G47.00)
http://www.healthista.com/want-better-sleep-worry-less-about-how-much-youre-getting/

Monday, November 7, 2016

为何失眠?如何治疗失眠?何谓睡眠表现焦虑? | 无药无副作用 | 马来西亚

来中心找我看诊的病人里,有50%以上都面对失眠问题。
或许是基于“催眠”二字出发,让人觉得对治疗睡眠问题来说是最理想的选择吧!因此,很多人都是因失眠问题来向我寻求解决方案。当然,我并不是指这想法是错误的,许多研究与实例亦证明临床催眠疗法确实对治疗失眠问题颇好。

从失眠者的脑波层面,我察觉到他们大多都面对焦虑与压力相关问题。
(脑电波检测并不是根据心理学诊断手册DSM的方法来操作的,我们有独特的解读脑波科学方法。当然脑波检测也不属于Diagnosis,而是让我更好的了解病人的潜意识状态的方法。)
而绝大部分面对失眠问题的病患都有着情绪管理相关问题。
睡眠问题大多来自于饮食习惯、工作压力与人际关系。
因此,在我让他们理解相关问题并协助他们进行情绪和心理层面调整后,问题都会得到极大的改善。
此外,也有一部分的人是因为“睡眠表现焦虑”症状而无法入睡。

什么是“睡眠表现焦虑Sleep Performance Anxiety”症状呢?
这是一种”担心睡不着“的心理状态;就好比说你平时能够顺畅地说话,然而一上台你就因为害怕而开始口吃和忘词的道理相同。整体的状况其实并不是你无法睡着,而是你心中害怕睡不着(就好比说害怕上台说不出话)然后就因而变得真的就睡不着了(就好像上台后真的说不出话来了)。


那么怎么改变这个问题呢?
如果说告诉自己不要害怕就能不焦虑了,那么世界上也不会有人面对任何问题了(开玩笑)。打个比方说,你害怕上舞台演说,那你应当怎么解决呢?
方法只有一个:做好心理建设,并且不断的练习,最终方才能掌握舞台演说技巧。睡眠表现焦虑的问题也一样。
所以说如果你面对的是睡眠表现焦虑问题,却一直使用药物来解决问题,那么你会发现成效或许颇为有限。这是因为真实的问题来源和你的心态有着绝大的关系。
药物是不会改变你的心态的,因此它的效力是有所局限的。它或许能让你镇定下来,却不一定能让你不再害怕。
再问一问你自己,如果你害怕蟑螂或壁虎,你又会如何解决呢?是选择逃避还是寻求帮助呢?
你要的不是每次都靠别人打死蟑螂,而是学习如何与之共处在同一个世上啊。

如果你愿意,心理治疗配合催眠疗法将帮助你克服你的失眠问题。
临床催眠配合心理治疗法能帮你改善你的心态,然后在运用你的潜意识让你放松,继而轻松入睡的。
有更多疑问,欢迎email我咨询更多:[email protected]



Saturday, November 5, 2016

如何寻找合格注册的马来西亚执业临床催眠治疗师?

如果你想要寻找一位合格注册的临床催眠治疗师帮助你解决身心问题,那在那之前请先了解如何选择适合你的临床催眠治疗师。

身为精明的消费者,你有权了解该催眠治疗师的:
1)催眠相关学术资格(比方说如果你因为焦虑症状需要求助,那么你可以询问该治疗师的催眠课程或其学术生涯内是否有学习过如何运用特定催眠技术帮助治疗焦虑症状的课程内容?)
 
2)是否有专业职业责任保险(Professional Liability Insurance or Professional Indemnity Insurance) 
 
3)是否有向本地催眠专业团体如AHPM/MSCH注册?据我了解,这两大团体都有一定的职业规范Code of Ethics。同时,他们的合格注册会员可以购买专业职业责任保险。
 
4)得了解催眠师可以被解读成Hypnotist或者Hypnotherapist,但两者给予的服务可以是截然不同的。Hypnotist或许懂得特定催眠技术,但不一定懂得如何处理临床案例或提供治疗。而后者Hypnotherapist通常则被训练提供治疗服务。然而不是每个催眠教学机构都有教导如何处理临床案例如焦虑(anxiety disorder symptoms)或心理创伤(psychological trauma)。有的Hypnotherapy training course课程主要可以帮助改变坏习惯或者增强自信心等等。虽然催眠师有时都用着相同的名号(Hypnotherapist or Clinical Hypnotherapist or Professional Hypnotherapist),但专精的领域与训练其实各异,所以消费者可以询问治疗师是否受训帮助某种身心问题,再考虑是否要进行治疗。
 


问题1:马来西亚有哪个催眠协会?
 
 
催眠相关团体1 (MSCH):
这个催眠团体是Malaysia Society of Clinical Hypnosis (MSCH),大马临床催眠治疗师协会。据我了解,其正式会员主要是完成了Diploma in Clinical Hypnosis的临床催眠治疗师。
该协会一直在推广催眠运用于临床案例的效益,以下为一些相关新闻:
 
 
催眠相关团体2(AHPM):
事实上自然医学协会联合总会(FCNMAM or Gabungan Pertubuhan Perubatan Komplementari dan Alami Malaysia)(即被卫生部认证的自然医学协会联合总会),其下的大马催眠师协会Association of Hypnotherapy Practitioners Malaysia (AHPM)从过去到现在是唯一受Federation of Complementary & Natural Medical Associations Malaysia (FCNMAM)承认的催眠疗法组织。但这并不表示催眠治疗已经被卫生部正式认证了。我已经洽询了卫生部官员,目前催眠还没被认证属于T&CM约束范围。
然而据我了解,AHPM此团体仍然依据T&CM法令的范畴来教育会员,该协会的目标就是未来可以被卫生部正式认证。
AHPM不时也会为误解催眠的误导性新闻发声,以下的新闻链接看到AHPM所刊出的澄清:
 
 

*题外话:诉说我个人加入这些催眠协会的经历:
上图截取自马来西亚卫生部-传统与辅助医学于2016年刊登的消息(http://tcm.moh.gov.my/v4/modules/mastop_publish/?tac=36) -备注:联结已经过期
 
你可以清楚看见在2016年,催眠疗法(Hypnotherapy)被建议为传统与辅助医学的一部分。也因为上图2016年的资讯,我才认识到了AHPM这个团体。当时我被告知T&CM传统与辅助治疗法令即将生效,而AHPM这协会当时就广招会员并通知我们催眠师即法令生效后,催眠师必须向AHPM注册。会员的催眠学术背景各异,主要是以国际催眠团体所认证的文凭为入门条件。据我观察,会员不只是把催眠运用在clinical practice的治疗师,也包含了在corporate或spiritual领域使用催眠技术的从业员。
*然而在若干年后,我向卫生部求证后,了解到催眠其实在2020年都还未被T&CM法令归纳其中(AHPM过去的会长给我的解释是因为没有MQA/SKM认证的催眠课程,所以还没被认证)。所以严格来说,催眠师在目前是没有被政府卫生部规定需要向政府单位或任何特定催眠协会注册的。
卫生部T&CM部门某官员也透过电邮告诉我说,将来会有更多认证机制去认证不同的治疗。官员也提到他们主要会考虑认证MQA或者SKM认证的专业课程。
 
我同时也是MSCH的Life Member,因为我在当年读完Diploma in Clinical Hypnosis就加入了该协会。 据我观察,他们的会员大都偏向把催眠使用在clinical practice(如身心或医疗相关治疗)的从业员。
 
当然,身为一名执业临床催眠治疗师(Clinical Hypnotherapy Practitioner),不管催眠是否被卫生部认证,我的愿景当然都是希望临床催眠可以更好的被学术与医学界认可。 我仍然鼓励催眠师向专业催眠团体注册,从同业者身上交流与学习,也在必要时为催眠界发声与创造更好的醒觉运动来让大众认识催眠。然而MSCH或者AHPM的合格注册会员的催眠相关学术资格也截然不同,有兴趣了解合格注册的条件,可以亲自联系以上催眠协会。


问题2:临床催眠治疗师是不是医生?
催眠治疗师并不是医生而属于治疗师类别。只要是受特定如AHPM or MSCH团体认证的治疗师,他们有资格购买专业职业责任保险(Professional Liability Insurance or Professional Indemnity Insurance)。


备注:
1)我本身过去曾经是大马催眠治疗师协会AHPM的理事之一,所以对于催眠治疗师在马来西亚现状有所研究。以上事实绝大部分都是从协会团体或政府机构法令中所得来的资讯。然而讯息这些年来不断更新,最新消息还是得向有关单位求证才是。
2)以上协会都没有正式的中文名,所有名称都是来自网上搜索或友人告知的翻译。主要还是是以英马两种名称为准。
 
最后更新:16 November 2020