Social Gambling

• • Similar to social drinking
• • Fun, relaxation, leisure
• • Sets monetary limit
• • Does not bet more than he can afford to lose
• • Losing is “part of the game”
• • Gambling does not cause problems to home, work or social life

Problem Gambling

• • Similar to drug abuse
• • Gambling behaviour interferes with personal life, studies or work, or affects family
• • Gambling behaviour causes problems or negative consequences
• • When a person bets more than he can afford to lose

Pathological Gambling

• • Most severe pattern of excessive gambling behaviour
• • The person loses control over his gambling
• • Has great difficulty stopping gambling
• • Gambling behaviour has become destructive
• • Personal life, work, studies, family suffers severe damages

Reasons Behind Gambling Addiction

Some may ask why many pathological gamblers continue to gamble despite experiencing negative consequences, which can be severe (e.g. wiped out savings, a mountain of debt, and strained family relationships). There may be several factors perpetuating the gambling behaviour. One is due to the fact that addiction is related to the imbalance of chemicals (neurotransmitters) and abnormal circuitry of the brain, as shown in studies. After a period of engaging in the addictive behaviour or substance, there is a loss of control, and impulsivity develops or worsens.

Additionally, research has found that cognitive distortions, or thinking errors, play an instrumental role in the maintenance of gambling behaviours.1,2 A common theme underlying all these distortions is the failure to recognise or appreciate the independence of events in the world of gambling.

People, in general, are uncomfortable with the unknown and would try as best as they can to derive reliable patterns and trends to make sense of things that are happening around them. This usually works in the real world as one can quite accurately and reliably predict an outcome based on another event (e.g. if the sky is darkening, it is probably going to rain). Some distortions (especially superstitions) may also be rooted in one’s cultural beliefs.

Common Cognitive Distortions

Besides prolonging the gambling behaviour, research has also indicated that pathological gamblers experience and endorse more cognitive distortions than non-pathological gamblers.2 It is also important to note that it is usually not the type of games per se that directly causes the distortions but the gambler’s perception towards gambling. Most games, however, do give gamblers an impression that it is possible to predict or control outcomes, and most people (even social gamblers) who gamble do, to a small degree, have such distortions. The main difference is that the pathological gamblers would usually experience more of them and endorse them more rigidly and passionately compared to the non-pathological gamblers regardless of the types of games they play. Some common cognitive distortions would include:

1. Illusion of control:

the belief that one has the ability to predict outcomes and that skills and experience improve one’s chances of winning A punter at the race course may think that he/she can predict the outcome of horse races by studying the terrain, weather, jockey or the form of the horse. A casino gambler may believe in the utilisation of certain strategies (e.g. predicting future results based on the observed “patterns” of previous outcomes, doubling up, etc.) to enhance their chances of winning. The underlying belief is that gambling is a game of skill rather than a game of chance.

2. Superstitions:

the belief that rituals, number combinations or special objects can improve luck in gambling A gambler may believe that his luck will improve eventually, and that he needs to continue gambling or risk losing out if his/her luck comes. Other examples are the belief that some number combinations (e.g. birth dates, number plates of vehicles involved in accidents) are particularly lucky, or the belief that luck in gambling can improve if certain items (e.g. lucky charms, lucky t-shirt, etc.) are worn or brought into the gambling venue.

3. Misinterpretations:

where losses are perceived as near-misses and a sign indicating that a win is coming soon When a jackpot player gets, for example, two apples and a banana, there may be a strong belief that the third apple is coming soon if he/she gambles “a little longer” or “a little more passionately”. Another example is when someone who bet on 1233 but 1243 came out as the winning number for the lottery draw.

4. Other distorted beliefs

Other distorted thinking/beliefs in gambling could include the belief that chance is self-correcting, meaning that a win is definitely in the pipeline because it has not happened for a long time. An example is a gambler who believes that the likelihood of winning from a “hungry” slot machine (a slot machine that has just paid out a huge amount of money) is a lot lower than the likelihood of winning from a full machine (a slot machine that has not paid out for a long time). In truth, however, there is no way to predict when slot machines will give one winnings. Winnings are determined by a Random Number Generator, which creates thousands of random pictures per second.

Treatment of Pathological Gamblers

Treatment at the National Addictions Management Service (NAMS) is based on an integrated, multi-disciplinary approach which combines medical and psychosocial therapy to guide the problem/pathological gamblers and their families through the journey of recovery.

Comprising psychiatrists, counsellors, medical social workers, nurses and psychologists, the NAMS multi-disciplinary team works together to render help from various angles. Individual as well as group therapy sessions are available to the patient as part of treatment. To address gamblers’ cognitive distortions, cognitive-behavioural therapy (CBT), an evidence-based psychotherapeutic approach, has been shown to be particularly effective. Family and friends can help the problem/pathological gamblers by making information and resources related to treatment readily available. They can also provide healthier support by being emotionally present for the gambler (e.g. care about how he/she is feeling), rather than provide financial bailouts, which may perpetuate the gambling behaviour. They can also call the Problem Gambling Helpline at 1800-6-668-668 to speak to NAMS paracounsellors for advice and support on a confidential basis. In conclusion, it is important to note that problem and pathological gambling are treatable and that one should not hesitate to seek professional help.

References 1. Okuda M, Balan I, Petry NM, Oquendo M, Blanco C. Cognitive-Behavioral Therapy for Pathological Gambling: Cultural Considerations. Am J Psychiatry. 2009 166:1325-1330 2. Myrseth H, Brunborg GS, Eidem M. Differences in Cognitive Distortions Between Pathological and Non-Pathological Gamblers with Preferences for Chance or Skill Games. Journal of Gambling Studies. 2010 26 (4): 561-569

The fact that foods have a direct effect on mood is not new. It was first recognised during the early 1900s. The past 60 years have demonstrated an irrefutable link between poor psychonutrition and mental illness.

Depressive Disorders and Nutritional Deficiences

Research shows that chronic anxiety and depressive disorders have a basis in nutritional deficiencies. These deficiencies have a number of causes, but are most often triggered by an individual’s inability to absorb sufficient vitamins, minerals and other nutrients to support your nervous system, the most sensitive part of the human body. Damage to our nutritional pathways also contributes to malnutrition.

Wheat, barley and rye contain gluten which causes severe inflammation and allergic reactions in the intestines in virtually all of us. At worst, it triggers coeliac disease which destroys the lining of the small intestine, making it almost impossible to absorb the nutrients in food. These, together with dairy and sugar, are now our staple diet.

Over 50 years, our average consumption of sugar has gone from 2kg to 50kg. Our love affair with soft drinks, sweet and processed foods that is ensuring massive sugar loads are exhausting our biochemistry, acidifying the body, and causing hypoglycaemia and diabetes. Hypoglycaemia was linked to psychosis and other schizophrenic-like symptoms as early as 1915, yet we have ignored the dangers and continue to accept high sugar intake as a norm.

Add to this the increasing levels of toxins in the food chain, including insecticides, herbicides, heavy metals and drugs, and we have a nutritional disaster that has already started to affect the fabric of society in many ways.

How Malnutrition Affects Thoughts and Depression

Let’s look at how the resultant malnutrition affects moods, thoughts, depression and anxiety. Where do you feel emotions in your body? In reality we all have a different perception of what an emotion is. For instance some people feel anger in the chest, others in the head. Some feel love in the area of the heart, others in the stomach or head. How you perceive an emotion depends on how your nervous system works and what your perception was when you first put a label on an emotion.

There are many factors in this perceptual determination of emotion, including your experience of life during the first critical five years. But a big part of the perception is based on how well your nervous system is functioning. If you break down how you perceive emotions, you will be able to define it in terms of muscle tightness in certain parts of the body, pressure, or temperature. Most people even say a particular emotion has a certain colour, shape, or weight. Your nervous system is quite complex and sensitive to tiny variations in biochemistry. It comprises literally billions of nerve cells, interconnected through a complex set of intercellular connections. The signals transmitted within these cells are essentially bioelectrical. But to move from one cell to the next requires a reaction through the release of a set of biochemicals known as neurotransmitters. If something disturbs the availability of these neurotransmitters, or the way they work, the way you perceive the world changes. Antipsychotic and antidepressant drugs work by modifying the use of these neurotransmitters.

At the extreme end of these changes, your perceptions change. Senses no longer work properly. The signals transmitted to muscles, gastrointestinal tract and other organs are not delivered correctly. Even mild disturbances in the biochemical pathways will cause low energy levels, mood swings, anxiety and depression. Once your average anxiety levels reach a level of 5 on a scale of 10 you are already in trouble.

The Role of Food in the Nervous System

Now, here is the important part. The biochemical reactions that ensure the correct transmission of signals through the complex nervous system depend on supply of chemicals that can only be derived from the foods we eat. They need to be supplied in the correct amount at the right time when they are needed. Cut the supply of precursor chemicals required to manufacture neurotransmitters and your nervous system malfunctions.

In today’s fast food and pre-packaged food environment, you can eat five times the amount of foods normally required, but still be malnourished. The incidence of anxiety disorders and depression is increasing at an alarming rate. Everything from minor anxiety and panic disorders, all the way through to ADHD, ADD, bipolar disorder and the schizophrenias, are on the rise. We are all susceptible unless we take measures to reverse the effects of global toxicity and find sources of high nutrient value foods.

We are not saying that malnutrition is the only basic cause of these disorders – it is not. There is always an emotional memory component to the problem. But 30 years of experience has shown that the biochemical contribution to anxiety disorders is between 50% and 90%, depending on the severity of the problem. The malnutrition we are facing will have devastating consequences on our future as a species.

We all know that decadent treats instantly boost our moods. Although we all have different preferences when it comes to our “happy foods”, ice cream, cakes, chips, and pasta are generally on top of our list. But do these food really boost our mood, or does our palate simply play a trick on us?

“Yes, there is a connection between the food you eat and your mood,” explained Ms Lauren Ho, Dietitian and Nutritionist at Singapore Heart Foundation. “Food contains a myriad of nutrients and compounds which can bring about changes in our brain chemistry, leading to altered behaviours and moods.”

Some comfort foods, usually those that are high in fat and carbohydrates, help us to alleviate negative moods and help us to feel good. This could be due to the relationship of carbohydrates with tryptophan and serotonin. The oral-sensory response to sweet/sugary food may stimulate the release of endorphins in the brain, inducing a sense of well-being, improving mood and alleviating pain.1

Eat Happy and Stay Healthy

Unfortunately, we usually equate unhealthy, rich, yummy foods with happy mood. How many of us reach for that pint of chocolate ice cream to pick us up whenever we are down and depressed? But it shouldn’t always be that way.

“According to some researchers, eating breakfast regularly may improve our mood and memory, increase our energy, and reduce our risk for overweight and obesity,” shared Ms Ho. A healthy and balanced breakfast consisting of whole grains, with a small serving of good fats, lean protein and fruits is a good way to start your day and boost your mood.

Serotonin or most popularly known as “happy” hormone is believed to be responsible for our mood changes. A brain chemical that relay messages between neurons, serotonin is known as a mood regulator. It is found to help improve our general mood, making us feel happier, relaxed and calm. Serotonin is synthesised in the brain from tryptophan, an amino acid. As more tryptophan enters the brain, more serotonin is synthesised in the brain, and this improves mood.2 To increase serotonin production, include tryptophan-rich foods such as fish, eggs, bananas, walnuts, sesame, sunflower seeds, and poultry in your diet. “We can also increase our tryptophan levels by eating more carbohydrates (e.g. wholemeal bread, brown rice, chapatti, oats), as they help to eliminate the competition by other amino acids to enter the brain,” she added.

Chocolates (especially dark ones), our favourite indulgence, have also been linked to an improvement in mood and concentration. Chocolates trigger the brain to release feel-good neurotransmitters, such as serotonin.

Nutrition Deficiency and Bad Mood

The same way that certain nutrients in foods help to boost our mood level, a deficiency of the same nutrients can deflate our energy, which causes our moods to take a nosedive. “The connection between food and bad mood is mainly due to nutrient deficiencies, which may lead to depression,” confirmed Ms Ho.

Many studies are linking the connection between vitamin B12 deficiency and depression. One of which was a 2009 study done in Pune in India, where it was found that “81% of urban middle class men were vitamin B12 deficient, and it was taking a toll on their neurosystem, leading to growing cases of depression.”3

A deficiency of magnesium, vitamin D, and selenium is also linked to depression. Magnesium deficiency may result in neuronal damage, which could manifest as depression. Stress, excessive dietary calcium, as well as a diet lacking in magnesium, may cause magnesium deficiency. On the other hand, vitamin D is needed to maintain adequate serotonin levels in the brain. One study showed that people who were suffering from depression improved as their vitamin D levels increased over a year. There are also studies reporting a link between low Selenium intakes and depression.

Do you Know?
There is evidence that caffeine intake is associated with various moods and feelings, e.g. an increase in energy, self-confidence, alertness and ability to concentrate. However, excessive caffeine can keep one awake and this can lead to bad mood.

References:

1 www.scq.ubc.ca/comfort-food-and-you/

2 www.webmd.com/food-recipes/features/how-food-affects-your-moods

3 http://articles.timesofindia.indiatimes.com/2009-10-10/pune/28112309_1_deficiency-vitamin-urban-middle-class-men

by Maripet L. Poso

1. Know Yourself 

Being able to understand your strengths, weaknesses, needs and limitations is the key to identifying your threshold. It is essential to recognise your strengths and be honest with your own limitations. Some people are better with creativity, others better at relating to people. As such, knowing your strengths and weaknesses is important so as to strike a balance between the two. Being aware of your strengths and weakness also helps build on acknowledging your own needs. Everyone’s needs vary across settings.As such, identify what your needs are in accordance to the task given.

2.Understand Stress
Stress is our body’s way of reacting towards demanding situations. In preparing for these, our body heightens in alertness, focus, strength and stamina.Some level of stress is healthy and gives us the energy and drive to perform (for instance, studying for a test, preparing for a presentation) or even to save our own lives (for instance not standing too close to the edge of a cliff or to push the brakes of a car to prevent a road accident). On the contrary, when stresses undermine both our mental and physical health, they can be hazardous. When responding to stress, your body responds through a ‘fight’ or ‘flight’ mechanism which activates resources to protect you. For instance when faced with a natural disaster such as a flood, your body would react to fight to save your family and loved ones trapped in the same situation or help you to flee from the disaster. Specifi cally, our body produces larger quantities of the chemicals such as cortisol, adrenaline and noradrenaline, which activates a higher heart rate, heightened muscle preparedness, sweating, and alertness – all these factors help us protect ourselves in a dangerous or challenging situation. It is important to note that our body response to stress varies across gender, personality and environmental contexts. Stress that lasts over extended periods can cause distress onto oneself and others. Particularly, it could impact on our relationship with others, mood, work, school or family life. Possible sources of stress include work, school, family, friends and environment. As such, being aware of what stress is, the source where it comes from, the possible body reaction towards stress and how it impacts our daily lives can act as cues for us to take action.

3.Know Your Goals
Goals are desired outcomes. To achieve what you want, it is important to set goals that are realistic and practical. Avoid aiming for things that are beyond your limits. Rather, understand your requirements and focus on them. It is also helpful to break goals to smaller achievable milestones along the way. For instance a long term goal of “wanting to build a successful business empire in five years” could be broken down to smaller goals such as “to decide on an area of specialisation and going for courses”. These smaller goals are designed to work towards the desired goal.

4.Know Your Priorities
Doing things one thing at a time instead of over committing to several responsibilities and
opportunities can provide respite from stress. Manage your own time effectively based on what you can do than hope to do. It would be helpful to also learn to say ‘no’ when you can’t commit to an opportunity provided. This way, you can focus your energy and strengths on what you already have to work on.

5.Know Your Support
A problem shared is problem halved is an old cliché. The knowledge of who you can confide in, ventilate to and spend time relaxing with is an important tool to alleviate stress. Family, friends an even faith are potential buffers against stress. There is no shame in talking to someone about a stressful task or event. Being able to talk it out helps bring out fresh perspectives that can help you come up with more solutions to a problem, thereby reducing stress levels.

6.Know the Balance
It is important to have a balance between work and play. In doing so, we can ensure that the level of stress that we face is of a manageable and healthy level. If you need help, don’t be afraid to ask so that the work load can be shared evenly. It is important to fine tune the way we work when we realise that our levels of stress are increasing. As such, seeking professional help from therapists, organisational psychologists or counsellors could be a way of reducing some of the tension and anxiety that one could be experiencing.

7.Know How to Relax
Remember the old adage, “All work and no play makes Jack a dull boy.” The daily routine work,
whether office work or household work takes a toll on your mind. As such, take time out to engage in activities that you enjoy. You might like catch a movie, spend time with friends and family, listen to music, read books, follow a sport or maybe play a sport. Relaxation techniques such as yoga, meditation, and deep breathing are exercises that could induce the body’s relaxation response, a state of restfulness which is the opposite of the stress response. When practiced regularly,
these activities lead to a reduction in your everyday stress levels and a boost in your feelings of serenity. They also increase your ability to stay calm and collected under pressure. Try these out. You will feel the difference. In a nutshell, individuals who have made the effort to adopt these habits have reported to enjoy a more fulfi lling life, make more meaningful relationships with others, and perform better in school or at work.

Today’s youth have more choices of activities and entertainment alternatives as compared to the generations before. As youths become more digitally sophisticated, online gaming has become a popular choice of entertainment among them. However, in the past years, as more problems start to surface in relation to online gaming, there has been much concern arising among school counselors, teachers, youth workers and parents.
Mental health specialists in various parts of the world have also begun to develop treatment for Internet addiction, and research in this area has also emerged in recent years. Although it is difficult to establish exactly just how widespread Internet addiction may be in Singapore, a recent longitudinal study1 conducted among primary and secondary school students reported the prevalence of gaming addiction at about 9%. This is similar to the prevalence rates of between seven and 11.9% as reported in other countries.

Peer Acceptance
Thru Online Gaming
Looking at the variety and the new developments in video and online games that have sprung up in recent years, it is no wonder why just about anyone, and in particular youths, are attracted to this highly engaging, challenging and stimulating activity. The games nowadays are often beyond just being mindless activities, but actually require much strategic planning and skills advancement, and in many games, often involve teamwork among fellow game-players as well. Some online games involve analytical and problem-solving skills, which can allow youths to learn and develop these skills in the process of having fun. Online gaming, when done in moderation, can serve as an activity for leisure, learning and entertainment.
Adolescence is a challenging period when one seeks novelty and challenges in the process of forging one’s individuality. Adolescents also tend to place importance on peer acceptance and approval. Gaming online with peers can help foster social interaction through the online platforms in game-play. Online gaming then becomes a common interest topic which allows one to feel accepted within the peer group. In addition, it can serve to enhance one’s self-esteem when a youth becomes good and skilful in the game and perhaps even do well in gaming championships.
At the same time, online gaming has its negative consequences, especially when one develops Internet addiction. Internet use can include anything from surfing the net, to emailing and engaging in chatting and social networking services and of course, to online gaming. Internet addiction, though not a diagnosis within the Diagnostic and Statistical Manual-Fourth Edition (DSM-IV), seems to share similar symptoms as other behavioral addictions.

When Gaming
Becomes Disruptive
When online gaming becomes more than a hobby and one starts to game excessively, serious problems and impairments can occur. Youths we have treated at the National Addictions Management Service (NAMS) have reported many adverse effects from excessive gaming, such as a drop in school grades, or worse, suspension or expulsion from school. Some also neglected their self-care and personal hygiene.
In serious situations, with impairments to various aspects of one’s life, psychological disturbances such as anxiety and depression can also develop. Therefore, online gaming addiction can certainly be worrying, especially for parents. Parents can, in fact, play a huge role in helping to prevent or manage excessive gaming and gaming addiction. In preventing excessive gaming, parents can find ways to set limits and boundaries such as making agreements with the youth on hours spent on gaming, and ensuring that the youth includes time for other leisure activities, studies and other priorities. The key is not in merely limiting the hours spent on gaming, but also to include other activities and priorities to maintain a healthy, balanced lifestyle.
Encouraging other healthy activities that include real-life interactions, e.g. sports, games, social gatherings with friends and family and excursions, can help to introduce more choices for leisure and entertainment for the youth. These also provide excellent opportunities to enhance family relationships and friendships, as well as for the child to develop critical social, problem-solving and stress-management skills to deal with real world problems.

Managing Your Kids’ Gaming Addiction
If a parent suspects that his/her youth is addicted to online gaming, the first thing to do would be to avoid over-reacting, but to remain calm and composed as one speaks to him/her in an open and clear manner, without sounding accusative or demanding. Parents may also want to speak to the youth to be open to seeking help. It may take continual motivation to prepare a youth to be open to receiving professional help. At the National Addictions Management Service (NAMS), we have counselors who specialise in working with children and adolescents facing addiction issues. Together with a multidisciplinary team of professionals, including psychiatrists, social workers, a family therapist and a psychologist, the counselors will work closely with the client and their parents/ caregivers as well to provide a comprehensive treatment service. Parents or anyone who wish to seek further professional advice and information may call our All Addictions Helpline on 6-RECOVER (6-732 6837). The helpline is manned by trained addictions counsellors from NAMS on Mondays to Fridays, 8.30am to 10.00pm. They may also log on to the NAMS website at http://www.nams.sg/ for more information.

Signs of Excessive Online Gaming
It is important too that parents monitor and look out for signs that may reveal that the youth is gaming excessively or has developed online gaming addiction. Some of these signs are:
• Preoccupation with online gaming activity
• Spending more and more time at the computer or at LAN-gaming shops
• Strong desire to game and heightened enjoyment while involved in the online gaming
• Inability to cut down on or stop the online gaming
• Irritability when not engaging in the gaming activity
• Heading out to spend time at internet cafes or LAN-gaming shops when restriction is set on computer time at home
• Lying to others about how much time is spent gaming
• Borrowing or stealing money for gaming
• Truancy and/or decline in school performance
• Neglecting friends and family
• Having more virtual pals, and fewer real-world friends
• Neglecting sleep to game online
• Neglecting self-care and basic functions and responsibilities e.g. personal hygiene and grooming,
and meals

It is not exactly known how one develops gaming addiction, and most youths do not even realise that he or she may have a problem. However, some studies2,3 do show that online gaming is highly rewarding and stimulating, and one can experience intense cravings, similar to those in substance dependence. Many youths gradually find the real world too boring and slow. Hence, they constantly go back to gaming to seek the stimulation, leading to the neglect of other priorities and healthy leisure activities. Some youths also turn to gaming as a way to cope with stressors and problems. Over time, they may lose the ability to cope with stress in other healthier ways and repeatedly return to the virtual world as an escape and a way to forget their problems.

References:
1 Gentile, D.A., Choo, H., Liau, A., Sim, T., Li, D., Fung, D. & Khoo, A. (2011). Pathological video game among youths: A two-year longitudinal study. Pediatrics, 127, e319-e329.
2 Koepp, M.J., Gunn, R.N., Lawrence, A.D., Cunningham, V.J., Dagher, A., Jones, T., Brooks,D.J., Bench, C.J., & Grasby. P.M. (1998). Evidence for striatal dopamine release during a video game. Nature 393:266-268.
3 Ko, C.H., Liu, G.C., Hsiao, S., Yen, J.Y., Yang, M.J., Lin, W.C., Yen, C.F. & C., C.S. (2009). Brain activities associated with gaming urge of online gaming addiction. Journal of Psychiatric Research, 43 (7): 739-747.

Ms June Tang is a Counsellor at National Addictions Management Service (NAMS), Institute of Mental Health (IMH).

Part of the struggle of sex addiction is that there will be “on and off” attempt to stop. At times, the addiction may stop for a short period of time, but in most cases, when the individual is under stress, he or she will go back to the old addictive behaviors. Dealing with sexual addiction is most illusive in the sense that anyone on a daily basis can drop everything to think about sex, scheme about sex, identify sexual opportunities and take advantage of them. This can produce intense biochemical rewards for this self-destructive behavior. Unfortunately, when they know that they are overwhelmed by these self-destructive behaviors, it gives way to guilt, remorse and promises to change.

Case Examples
1. Henry (not real name) is a 38 year-old finance executive from a multinational company. He spends all his spare time collecting thousands of pornographic pictures, stores them in his computer, and has been making sexual contact with women through the Internet over the past few years. He even meets some of these women for daytime sexual affairs and sexual liaisons when traveling on business. He justifies his behaviours by saying that “It doesn’t hurt anybody” and “I don’t love these women, so what difference does it make?”

2. Robert (not real name), in his mid-40’s, is an award-winning manager at a hardware production company. He does not see anything wrong with simple pats on the butt, commenting on a co-worker’s legs or breast size, or making out with secretaries in the lift at the company holiday party, although he tried to approach only women who do not work directly for him. Married for 11 years, Robert maintains several sexual affairs both at work and with various babysitters and housekeepers hired to work in his home. When he was younger, he was kicked out of a school fraternity when he was accused of having sex with a woman after she passed out from drinking. At the time, he felt that too much was made of the incident, because “after all, we were drinking together”.

3. Sally (not real name), a 41 year-old sales executive, has been in a long-term “monogamous” relationship but continues to seek anonymous sex outside of her marriage. Though promising herself that she will never repeat the same mistake, she continues to spend time looking for and engaging in different sexual encounters to meet her emotional needs. Each time she engages in a sexual encounter, she tells herself that it will be “her last time”. She consistently lies to her husband and makes up countless excuses about her absences from home. When questioned about these issues, she quickly becomes irritable, angry, and defensive.

How to Deal with Sexual Addiction

1.      Admit that you have a problem. Change cannot occur until you have admitted the need for change.

2.     Seek professional help NOW. Like dealing with other addictions, you cannot do it by yourself. Get help from professionals who have training and experience in dealing with addiction.

3.     Get help along with your significant other. This may happen in the later phase of intervention.

4.     Start joining some recovery support groups, preferably a sex recovery group.

5.     Finally, always keep your focus and do not give up if you fail or relapse. There is life beyond sexual addiction. I can testify to lots of people who get help and get well.

All these case examples highlight what Dr Carnes, an expert in sex addiction, calls the “three main characteristics in sexual addiction – shameful, secretive and/or abusive”. These characteristics slowly and certainly destroy the individual’s competency and effectiveness in the workplace, strip the person of his dignity and self-esteem, and hit him with shame, guilt and depression.

A growing body of clinical research seems to confirm what poets and songwriters have long proclaimed. There is real and direct link between our hearts and minds. Or to put it in the language of the white coated figure: psychosocial factors may present stronger risks for acute myocardial infarction than diabetes, smoking, hypertension and obesity. Which means that stress at work or home, along with your perceived ability to cope with life, can significantly increase your risk of heart disease. The mortality rate in heart failure patients with major depression is two and a half times higher than in heart patients without depression.

Depression Hurts The Heart

Yet depression in heart failure patients often goes undiagnosed. This is partly because of the overlap in the symptoms of the two conditions such as fatigue, loss of energy, poor appetite and sleep disturbance, and partly because many patients see depression as a character weakness or personality flaw, when it’s really a common clinical condition that affects as many as one out of five patients with heart disease. If you’re depressed or anxious, you are more likely to develop a cardiovascular problem. How, exactly?

A heart attack is caused by a blocked blood vessel to the heart, and depression is one of the known contributors to the development of such a blockage. Inside the blood vessels we find the lumen, where the blood is able to flow. Factors such as smoking, high cholesterol and depression can cause fatty deposits to accumulate on the wall, forming a plaque that juts into the lumen. If this plaque becomes damaged or ruptured, your body’s repair system shoots to the rescue, building a blood clot to patch up the gash.

But the clot also seals off the artery’s lumen, blocking the blood flow and leading to possible bypass surgery. Depression is a risk factor for heart disease, but heart disease is also a cause of depression. When your heart is heavy, you are likely to drink, smoke and eat the wrong things. Heart failure patients should be screened for depression and treated when depression is found to be present.

But it is not only up to the doctors. We all need to learn how to make our hearts happy. The heart is an easy organ to please. It all begins with proper exercise and nutrition and an innovative, enthusiastic lifestyle.

8 habits to keep your heart ticking happily!

1 Cultivate joy and positivity in your life for you mental and emotional well-being to help keep your heart at its best condition.

2 Eat wisely and moderately. Eat more servings of fresh fruits and vegetables. Include salmon in your diet as it contains omega-3 that benefits the heart. Soy protein is also a healthy-heart food alternative to help prevent cardiovascular diseases.

3 Spend time doing activities that bring you a sense of satisfaction and contentment: Listen to music that soothes and uplifts your spirits. Enjoy natural beauty in art or nature. Watch movies that make you laugh. Start dancing. Read.

4 Exercise regularly and moderately. Brisk walking is an excellent exercise for everyone, and an ideal walk can be up to 30 minutes in duration. The key in making sure your heart gets the best through exercise that it needs is routine.

5 Eat Chocolate! Opt for real dark chocolate as it is beneficial to the heart. A study has found that eating dark chocolate seems to make the blood vessels more flexible. But remember, too much chocolate isn’t good either!

6 Get a pet! Stroking your pet regularly can help relieve stress and heart problems, according to research. Walking a dog will help you get your regular 30 minutes exercise a day.

7 Have a laugh or join a group of laugh therapy! Whether it is a little giggle with your friends or a bellow from deep within, having a laugh may help you avoid heart disease, according to scientists.

8 Do community work! Helping others find happiness can boost your heart, too!

Love your heart. Do not postpone these simple heart-sustaining-appointments to keep it happy and healthy.

Suggested readings if you want to know more about this topic:

✤ Stella’s Mum Gets Her Groove Back – A True Story

  www.amazon.com (available in Bookstores in Singapore)

      www.StellasMum.com

✤  One Minute for Yourself – Spenser Johnson M.D.

✤    The Hurting Heart – Dr. Lim Yun Chin –
(Armour Publishing – Singapore)

    (Understanding the importance of our emotions when building a positive frame of mind and nurturing happiness in our hearts)

Since I was 15, I suffered an eating disorder called Bulimia. I did not come understand what I was going through till I was 35.

Nobody had told me that my binging at any hour of the day was something that needed attention. Eating was something that triggered two things in me: it soothed me when I faced emotional challenges and it served me to help contain my pain, unresolved issues, insecurity and confusion. It also served to another deep unconscious purpose: temporarily allowing me to forget the negative self-image I had about myself. I did not like myself, without realising it. Eating also helped me cope with the anxiety created by what other people thought about me and my body when I was out of shape.

It took me a long time to realize that being in the right frame of mind played an important role in how I interpreted feedback from the outside world. Quite often, I would miss a positive comment or gesture by others, and at other times, I would overlook the fact that I rose to the challenge and accomplished something successfully – all because I had shut myself from the world. I was in a bad mood most of the time. There was little in my life to really be happy about, I suppose. I felt abused, put-down, and taken advantage of by the rest of society. I identified myself as a ‘victim’. As a result, I had a massive wall built around me. I was in prison. I trusted no one and always assumed the worst in every situation

There’s nothing like the first day of diet and exercise regime. Remember not to allow the size of your waistband to discourage you!

1 Be Aware That…

You didn’t become overweight overnight, and you won’t slim down overnight either. It took thousands of tiny lifestyle decisions to get where you are today and, by the same token, many tiny lifestyle decisions are going to help you slim. Think about every bite of food you take, every move you make and, little by little, those calories you shave off and those extra bits of energy expenditure will add up to a new slim you.

2 Educate Yourself

Read up on nutrition and eating habits, be aware of the damage that can happen if you continue an unhealthy diet. Make new choices if those past ones didn’t help you achieve positive results.

3 Be Responsible

Invest and engage in a life coach or counselor or a fitness trainer specialized in nutrition and wellness. Ask for help and be willing to be assessed. The coach or the counselor will help you to keep you on track of your goals and motivate you.

4 Remember Your Goal

5 Forgive & Let Go

Don’t punish that one biscuit indulgence by feeling a failure for the rest of the week — that is a certain way to sabotage your weight loss. Instead, forgive yourself, let go and get back on track.

6 Plan everything

If you fail to plan, you plan to fail. Jot down your exercise sessions in your diary and other commitments around them, not the other way around.

7 Reward Yourself

Focus on a ‘self’ reward’ that will help spur you on to achieving those goals:

•    Promise yourself daily treats for sticking to the program (an invigorating body scrub, fake tan or pedicure).

•   Promise yourself weight-loss rewards every time there’s a drop on the scales (a massage, facial, new lipstick or new outfit — in a smaller size).

• Promise yourself something spectacular when you reach your target weight.

8 Relax

Studies show stress can make you fat but rest, sleep and exercise can ease the stress and negative thinking.

Reality is key

It is important to create mini goals (S.M.A.R.T Goals) that you’ll be able to attain in the long run. Try setting realistic goals like drinking skim milk instead of whole   milk, or perhaps using less oil when you sautee your food. Anything that will keep you on the right path, but isn’t too ridiculous for you to stick to.

Progress is not perfection

Okay, so you thought you’d eat a little something that ended up turning into a lot of something. Keep in mind the progress you’ve made and jump back on your horse. Keep in mind that sometimes falling brings on a renewed sense of discipline and endurance for the future.

Creative visualization

Be proactive in creating a visual in your mind wherein you are slim, trim and wearing your best outfit.

Give life to your own Body Image Vision Board

Many of us are need visuals. Get into action and build a vision of the body you want to have. You can have it in your bedroom at home, or even download it on your Iphone or Ipad as a great reminder during the day.

Share your goals with others

•  Stella’s Mum Gets Her Groove Back – A True Story

(available in Bookstores in Singapore) www.StellasMum.com

• Be Your Own Guru – Olivia Stefanino, Capstone Publishing Ltd

• The Hurting Heart – Dr. Lim Yun Chin, Armour Publishing

Why is it that a cheerful heart is so important?

Although it is still often overlooked, emotional health is absolutely essential to our physical health and healing – no matter how devoted we are to the proper diet and lifestyle, we will not achieve our body’s ideal healing and preventative powers if emotional barriers stand in our way.

Nothing has a bigger tendency to ruin our health such as grief, anxiety, fretfulness, bad temper, etc. All these actually spell death. A spirit broken with sorrow weakens the nerves, it dries up the marrow in the bones, emaciates the body, and reduces it to a skeleton. It sucks life out of us.

In short, the joy and grief in the mind, and our passions have great influence over our bodies, for good or for bad. Therefore, in accordance with my work as a well-being and communication coach and trainer, we have to keep a handle on our emotions.

Are you aware that many things happen to us, physiologically, whenever we laugh and smile? You’ll be surprised to find out that research has shown that one experiences the same physiological benefits even when they force themselves to keep a smile on their faces.

Joy in your body brings health; something which sadness, despair, and depression do not. It can be hard to stay cheerful when you feel ill, but the paradox is that the more you focus on gladness, the more you create an internal environment for healing.

Happiness, The Best Form Of Cure

This concept was popularized by Dr. Norman Cousins who, for a number of years, was part of the medical staff at the UCLA School of Medicine. In the mid-1960s, Dr. Cousins was diagnosed with a strange, rare disease that destroyed the connective tissue of the body. Even though he was in constant pain and he felt like crying all the time, he chose to embark on experiments with the use of laughter to stimulate his healing. He searched for movies, jokes, and stories that were funny, and kept going through them. Over time, he realized that the more he laughed, the less pain he felt. He used joy to boost his immune system and endocrine system into proper functioning.

Over time, Dr Cousins had developed a cheerful heart which he found, was helping his health improve gradually. Hours of laughter each day contributed to more and more healing in his body, which was confirmed by consistent laboratory tests. Intervals of 10-minute laughers resulted in two hours of sleep without pain. He discovered, as he did this, that he began to get better. The day came when he went back to the doctors and they said, “We don’t know what happened, because this was an incurable disease; but as far as we know, you are completely cured.” He lived about another 20 years in which he wrote a book called ‘Anatomy of an Illness’. It spoke of a person’s mental attitude, cheerfulness or lack thereof that has a great deal to do with health. He also told about how laughter and joy could get one well.

His decision of submerging himself in joy, and allowing

his soul, mind, emotions and body to unite in harmony reminds us once more that a merry heart causes healing, just what Solomon told us 3000 years ago. All this also suggests that there is a relationship between the condition of the heart and our body. There is a relationship between physical and spiritual health.

“A man’s spirit sustains him in sickness, but a crushed spirit who can bear?”

We all know of people who struggle with sickness and weakness, yet when you meet them, they cheer you up – they make you feel better because they are strong and happy, even when they are wasting away physically. On the other hand, we also know people who are sick and crushed. When you visit them, you feel worse when you leave because they have sucked all the life out of you as well.

There is a relationship between your mental attitude and your physical well-being. How you feel, and what is in your heart, have direct bearings on your physical health. What is on the inside eventually manifests itself physically on the outside.

Would you like a cheerful heart and attitude?

Here below some suggestions as to how we can cultivate a cheerful heart:

Go ‘Gratitude’

An attitude of appreciation for everything around you, even the bad, does not cost money or time. Just a minute after you get out of bed, or just before bedtime will provide a good kick off for your day and bring a smile to your face! If it helps, create a list and read it to yourself everyday.

Cultivate A Forgiving Spirit And Find A ‘Gift’ In Everything That Happens To You

Be kind and gentle towards yourself and others. There are people who are suffering physically because they are angry, bitter and refuse to understand and move on from their past unhappy experiences. Practice the attitude of forgiving past or recent hurts. Let them go!

Dwell On Seen And Unseen Realities

Think of the times you achieved and succeeded in something. Anchor on those moments to maintain your cheerfulness and peace of heart.

Associate With Cheerful People

Some of us are messed up because we are hanging around messed-up people. Some of us are angry because we are hanging around angry people. We are bitter because we are hanging around bitter people. So hang out with the cheerful to stay cheerful.

Be a Load Lifter, Not A Burden Maker

Do not be one of those who make life hard for others. Instead, be a load lifter. Be the one who lightens moods.

Listen to good music

Music and lyrics have the power of lifting sad or preoccupied minds.

Live A Life Of Active Love

I came across this sentence once: a selfish man can never be cheerful. He can be happy, but never cheerful. Only a giver can be cheerful. Only a lover, somebody who invests in the lives of other people, can really be cheerful and positive about life. Get involved in the lives of other people and you will have a cheerful attitude.

Nurture a Childlike Attitude

Being childlike is not being childish. A childish behaviour is irresponsible but a childlike one is not. What are the qualities of a child? He is open and curious, eager to learn and enrich himself. He is eager to take risk and is not fearful of the unknown. He has no time to be depressed, not even few minutes! Cultivating an open mind and the willingness to learn will contribute to an enriching life of fun, and motivation. You will develop endurance and a positive tenacity in the midst of adversities.

Laugh More!

How much do you laugh during the day? Do you take life, an illness or injury so seriously that there is no room for joy in your life? Make a list of the things that make you laugh from deep down, the roll-on-the-floor belly laugh, the type of laughter and leaves you in tears. That is the laughter of healing.

Create your own “Laugh for Health” collection. Ask your friends and family members to send you clippings or jokes – anything to add to your collection and to give you fresh material. Make a commitment to spend time every day immersed in humour and laughter.

Learn to Coach Yourself

Some time ago I found myself asking that age-old question: are you an optimist or a pessimist? When you see a glass of water, is it half full or half empty? When you personally go through one of those weeks that we all go through eventually (and some of us go through regularly), do you remain positive and cheerful at the end, or are you negative? And what are the differences being positive or negative? Ask yourself these questions when you feel out of balance, and feel the need to re-establish the discipline of a cheerful attitude because it is important. Someone has said it before: between the optimist and the pessimist, the difference is droll; the optimist sees the doughnut, the pessimist sees the hole. It has been well said that the optimist is the person who invented the airplane and the pessimist the person who invented the parachute. You need them both. You need the positive aspect of life as well as that aspect of life that looks at the problem and says, “Well, life isn’t just a bowl of cherries. There are pits in there, too.” Healthy realism is the key.

Suggested readings if you want to know more about this topic are:

 Loving, Leaving, Learning –

Leonardo Buscaglia (Self- Help)

 The Road Less Travelled –

Dr. Scotts Peck (Self-Actualization)

 The Secret Gratitude Book –

Rhonda Byrne (Self-Help)

 How Full Is Your Bucket –

Tom Rath (Positive Psychology)