The worldwide prevalence of Obsessive-Compulsive Disorder is about 1% to 2%. It occurs worldwide, including Bangkok, Thailand, with similar symptoms across multiple cultures. The average age of onset is about 20 years old and usually does not occur after the age of 35. It often affects women more than men.
OCD is often regarded as an anxiety disorder, although DSM-5 places in its own category along with other disorders, such as body dimorphic disorder and hoarding disorder. It is characterized by uncontrollable obsessions and compulsions. Obsessions are considered unwanted thoughts, while compulsions are the behaviors that people engage in to try to get relief from the anxiety-provoking obsessive thoughts. Compulsions are often repetitive and ultimately only provide temporary relief from the unwanted obsessive thoughts.
For example, a person with obsessive thoughts regarding cleanliness (fear of germs or disease) may repetitively wash his or her hands in hopes of satisfying the obsessive thought. However, the compulsions only serve to further engrain the obsessive thinking. In addition, some may avoid people, places, or things that trigger the obsessive thinking. This avoidance behavior can become debilitating, as people with OCD may miss work and avoid other responsibilities.
Only about 20% of people with OCD will improve without treatment. Those with early onset if OCD may have it for a lifetime if they do not seek out psychological treatment. OCD may be exacerbated by co-occuring disorders, such as substance abuse and addiction or depression. Some with OCD may abuse drugs or alcohol in an effort to self-medicate their OCD.
OCD should be taken seriously as about 50% of people with OCD will have suicidal thoughts and 25% will attempt suicide.
OCD usually affects the entire family of those with it and may lead to individual suffering from OCD to become socially isolated as those around him or her have difficulty tolerating his or her behavior.
Recent research has found that OCD occurs more often in those living at higher altitudes, which is believe to be connected less exposure to sunlight. Additionally, “night owls” were found to have higher rates of OCD. Again, this is connected to diminished exposure to sunlight, as these individuals often sleep throughout the day and leads to a disruption in their circadian rhythm.
People who are overly sensitive to anxiety of display a high fear of fear usually have poorer treatment outcomes for OCD.
Person-centered therapy, cognitive behavioral therapy (CBT), and exposure therapy may be effective in improving symptoms of OCD. Medications, such as SSRIs, are also effective in providing relief from OCD.
However, those with a high sensitivity to anxiety may respond well to exposure therapy. Exposure may evoke too much anxiety in these individuals which they may see as failure of treatment. This, in turn, may cause them to drop out of treatment, according to research.
Treatment of OCD is available in Bangkok, Thailand. There are multiple psychologists, counselors, and psychiatrists who are qualified to provide treatment of OCD. Lighthouse Human Services in Bangkok offer psychological treatment for OCD.
Although there are people may grow out of ADHD in some cases, it often persist into adulthood. Indeed, some researchers argue that it is a lifelong disorder that many adults have simply learned to manage and have only learned improved coping skills over time. That is, they have not grown out of it, but there improved coping skills means that ADHD no longer causes significant problems in their lives.
In this regard, ADHD may be considered unique from many other mental health disorders, as it is not episodic. That is, it does not appear for discrete periods of time, such as is the case for some mental disorders like depression or anxiety. Indeed for those who have not learned to cope with it, problems often persist or worsen into adulthood resulting in lifelong impairment from ADHD. Furthermore, at certain transitional points in an adults life, such as when transitioning from high school to university or university to the working world, ADHD symptoms may worsen, complicating the transitional process.
In fact, many people with ADHD go undiagnosed until they reach adulthood. Although the symptoms were always present since childhood, due to the complexities of ADHD as discussed above, many adults did not have their ADHD properly identified as children or adolescents. Later in life, as adults, these individuals usually will recall a lifetime of ADHD symptoms beginning very early in life as children.
As in children and adolescents, comorbidity is very common. Adults with ADHD may also have anxiety disorders, depression, and substance use disorders. Although various treatments may be effective for ADHD in adults, medications remains the most effective treatment option. In addition, it is important to address comorbidities, such as anxiety and depression, as well as family or relationship dysfunction that often results from ADHD.
In some instances, ADHD result in positive effects, according to researchers. In those adults for whom ADHD is advantageous, it appears that these adults have developed unique coping strategies over the years. For example, they have learned to minimize the negative effects of ADHD, while possibly retaining the some of the positive aspects of ADHD. People with ADHD may be more creative and better at multi-tasking.
Nevertheless, adults who are able to learn to cope well with ADHD appear to have certain prognostic factors, which appear to predict better outcomes, such as not having a co-morbid mental health disorder, having strong psychosocial support, and living in a culture where ADHD treatment is readily available. This is illustrates the importance of improving awareness of ADHD in Thailand, as ADHD not only negatively affects children and adolescents, but adults and their families, as well. However, when adequate treatment and understanding is present, positive effects of ADHD may be enhanced, while the negative effects are limited.
Due to the many factors, such as mental disorders with overlapping symptoms (discussed above), co-occurring mental disorders, cultural norms (discussed below), and the subjective nature of diagnosing ADHD, reaching an accurate ADHD diagnosis can be tricky (and often controversial). As such, mental health professionals have developed a number of diagnostic assessments and tools to assist clinicians with making an accurate and more objective diagnosis.
Indeed, without such assessments and tools, an ADHD diagnosis is reached rather subjectively; that is, mental health professionals must rely solely on their professional opinions to determine if an individual meets diagnostic criteria as laid out by the DSM-5. These assessment instruments may reduce some of controversy associated with the legitimacy of an ADHD diagnosis, as they serve to limit the fallibility often attributed to clinicians by those skeptical of the existence of ADHD. In other words, skeptics may not believe the professional opinion of mental health professionals in regards to diagnosing ADHD.
Assessments instruments used for ADHD come in several different forms. For example, they may consist of simple “pencil and paper” checklists based on the diagnostic criteria of the DSM-5 (which are often self-administered), simple ADHD rating scales (in which perceived symptoms of ADHD are rated according to severity), complex multi-rater scales (which have more in-depth questions and rely on multiple sources, in addition to the individual suspected of having ADHD, such as parents, teachers, friends, or others familiar with the individual), semi-structured diagnostic interviews (which are typically administered by a qualified mental health professional), and CPTs or continuous performance tests (usually computer based tests which measure an individual’s ability to sustain focus over time).Research has found that CPTs are valid and reliable as a corroborative test for ADHD. Studies have shown that a CPT called the TOVA resulted in false negatives 10% – 15% of the time and false positives 13% – 30% of the time (Nass, 2006). Co-occurring disorders may result in more false positives and false negatives (Nass, 2006). Furthermore, CPTs are regarded as more cultural neutral, since they are language free and do not rely on perceptions which may be culturally influenced.
The present study will utilize a complex multi-rater scale, the Conners 3, and a continuous performance test called the TOVA to measure ADHD symptoms, as well as a simple rating scale to rate perceptions of ADHD and attitudes towards ADHD.
Although the DSM-5 only recognizes three types of ADHD (as described above), Dr. Daniel Amen, a psychiatrist, researcher, and rexpert in ADHD who was written several books on the subject, puts forth an alternative concept of ADHD. According to Dr. Amen, he conceptualizes ADHD as have seven different subtypes. Due to the many complexities of ADHD, I believe it is worth taking time to look at Dr. Amen’s ideas, as it may help the reader understand how complicated it can be for laypeople to identify, as well as for clinicians to accurately diagnose ADHD. Indeed, these complexities contribute to controversy surrounding ADHD.
According to Dr. Amen, the seven types of ADHD are as follows:
Classic ADHD is what people typically think of when they think of ADHD. Symptoms of this type of ADHD involve difficulty maintaining focus, impulsivity, hyperactive and impulsivity. This type of ADHD would be most close related to what the DSM-5 labels as ADHD, Combined Type.
Symptoms of Inattentive ADHD “are short attention span, distractibility, disorganization, procrastination. People with this type are not hyperactive or impulsive. They can be introverted and daydream a lot (Amen, 2001).” This type of ADHD would most close resemble what the DSM-5 calls ADHD, Inattentive Type.
People with Over-Focused ADHD usually have the common stereotypical symptoms of ADHD, as well as a problem with being able to shifting attention. People with this type of ADHD tend to get stuck into negative thoughts and negative patterns and/or behaviors. In addition, they may have great difficulty to shifting thoughts and tasks, as well as having a tendency to be inflexible.
Temporal Lobe ADHD
This [ADHD] type has core [ADHD] symptoms along with temporal lobe symptoms. The [temporal lobe]…is involved with memory, learning, mood stability, and visual processing of objects. People with this type have learning, memory, and behavioral problems, such as quick anger, aggression, and mild paranoia.
People with this type of ADHD tend to have high-levels of sadness and dysthymia. They also have chronic low self-esteem, low energy, feelings of guilt, and/or moodiness. Although aspects of this type of ADHD may resemble depression, Dr. Amen states that it is not depression..
Ring of Fire ADHD
People with this type of ADHD “don’t have an underactive prefrontal cortex, as with Classic and Inattentive ADD.” In contrary, their brain tends to be overactive across all areas. Symptoms of this type of ADHD may include being sensitive to noise, light, and touch. They have epsiodes in which they display mean behavior. In addition, these people can be unpredictable, fearful, and anxious.
People with Anxious ADHD have all the standard symptoms of ADHD, but are also very anxious, tense, and may have physical symptoms, such as headaches and stomache aches. They may be overly negative, tend to imagine the worst case scenario in all situations, and may freeze an anxiety-provoking situations, most of all in social situations where they may be juedged by others.
These seven types of ADHD proposed by Dr. Amen, illustrate how difficult it may be to accurately identify ADHD. Dr. Amen believes these complexities lead to an underdiagnosis of ADHD. Indeed, such complexities would further complicate the identification of ADHD in cultures in which ADHD may be poorly understood. I believe that this is the case with the identification of ADHD in Thailand which most likely leads to an underdiagnosis of ADHD in Thailand.
As mentioned above, learning disabilities and ADHD frequently are present simultaneously; however, multiple other mental disorder often co-occur, as well. Common disorders that co-occur with ADHD include oppositional defiant disorder (ODD), conduct disorder, anxiety disorders, depression, disruptive mood dysregualtion disorder, intermittent explosive disorder, obsessive-compulsive disorder, tic disorders, autism spectrum disorder, and substance use disorder.
Perhaps, the most common disorder that may co-occur with ADHD appears to be ODD. Studies report that ODD is present in about 50% of children with ADHD (combined type), while conduct disorder is present in 25% of adolescents with ADHD (combined type). Since ODD is more apparent in ADHD combined type than inattentive type, there appears to be a link between the hyperactivity/impulsivity aspects of ADHD combined type and ODD. Note that if conduct problems are present in adolescents, a diagnosis of conduct disorder should be used instead of ODD, while ODD is used for children. The decrease in conduct problems (at least in diagnosable conduct problems), as indicated above, suggests that some children with ADHD and comorbid ODD learn to manage their conduct problems into adolescents, even though their ADHD continues persists (American Psychiatric Association, 2013).
Research has examined comorbidity with ADHD–specifically, ODD/CD (Oppositional Defiant Disorder/Conduct Disorder), depression, and anxiety. The purpose was to determine if comorbidity with ADHD may actually represent unique disorders; therefore, warranting a separate category of a mental disorder or at least a subcategory.
Researchers used Cantwell’s approach as a guideline to determine if a disorder represent a separate distinct disorder. This approach provides criteria for how a disorder could be consider distinct from other disorders. The guidelines are as follows: Clinical pharmacology, demographic correlates, psychosocial correlates, family factors, biological factors, response to treatment, and clinical outcomes.
Prior research by Jensen et al pointed toward evidenced to support the idea that ADHD with ODD/CD constitutes a unique subtype. Other research found that ADHD with mood disorders, as well as ADHD with ODD/CD may constitute subtypes of ADHD. It found that these clients responded differently to treatment. For example, ADHD with mood disorders responded to all treatments. ADHD with ODD/CD responded only to medications and behavior therapy may be contraindicated. Mood disorders wtih ADHD plus ODD/CD responded best to a combination of behavioral therapy and medication treatment.
ADHD with Mood Disorders
The researchers noted that ADHD with mood disorders responded much better to treatment than clients with just ADHD or clients with ADHD and ODD/CD. In some ways, comorbid mood disorders may have offered ameliorating effects on ADHD; thus, predicting better outcomes for these individuals.
In the study described above, 579 children were randomly selected from a clinical population and assigned to different treatment groups: meds, behavioral, combination of both, and community comparison. Treatment lasted 14 months. All children were previously diagnosed with ADHD, combined type. Other diagnoses were not considered and not children were excluded for having another diagnosis. Average age was 8.2 years. The researchers administered various tests to evaluate for each of Cantwell’s criteria (see above). Afterwards, multivariate analysis was used to evaluate the data, as well as treatment effects.
As described above, different subgroups responded differently to treatment. This has implications when providing treatment for clients with ADHD. Having a thorough understanding of the symptoms experienced by clients, will help clinicians make better choices when choosing treatment options. For example, it may be important to know when medication is most effective and behavioral treatment is less effective.
Other disorders which are more common in those with ADHD than in the general population, include disruptive mood dysregulation disorder, major depressive disorder, and anxiety disorders. According to the DSM-5, most children who meet criteria for disruptive mood dysregulation disorder will also meet criteria for ADHD. Although a minority of people with ADHD meet criteria for major depressive disorder and anxiety disorders, these disorders are more common in individuals with ADHD than the general population (American Psychiatric Association, 2013).
Culture is an extremely important part of every person’s life and nobody can completely escape its influence, whether one’s native culture or adopted culture. Indeed, culture is extremely powerful and shapes multiple aspects of society, as well as the individual. Although we feel ourselves unique (of course some cultures encourage this feeling more than others, such as individualistic cultures in comparison to collective cultures), we are inextricably tied to our culture and influenced by it in ways of which we may not even be conscious.
Although most people are aware of how culture may influence one’s taste in food and music, cultural influence goes far beyond this. In fact, culture shapes the way we think and even our perceptions of reality. A branch of psychology, known as cultural psychology or cross-cultural psychology is dedicated to studying how culture shapes our psychological processes and perceptions. One aspect of cultural psychology is the study of how culture affects mental health, as well as the influence culture has over our perceptions of mental health.
Cultural psychology, reveals how culture provides a framework or context which determines how mental disorders are expressed. Indeed, certain mental disorders may be more prevalent in certain cultures or even unique to a particular culture. That is, a mental disorder may exist within one culture only.
Mental disorders which tend to be unique to a particular culture are known as culture-bound syndromes. Hikikomori, koro, and anorexia nervosa are cited as examples of culture-bound syndromes. Hikikomori, which appears to be unique to Japanese culture, refers to a mental disorders in which the primary feature is extreme social withdrawal, while koro is culture-bound syndrome found in South and East Asia which is a phobia or extreme fear that one’s penis will shrink inside one’s body. Eating disorders, such as anorexia nervosa and bulimia are more prevalent in Western cultures or where Western-cultural influence is more abundant, leading some researchers to claim that they are, in fact, culture-bound syndromes.
Mental disorders which are found across the world regardless of culture are known as universal syndromes. Researchers purport that universal syndromes tend to have a biological root, meaning that culture place less of a role. Nevertheless, perceptions of these particular disorders by members of a certain cultures may be uniquely influenced by said culture. Universal disorders include depression, schizophrenia, social anxiety disorder, and bipolar disorder, for example.
ADHD appears to be a universal syndrome, although perceptions of the disorder or the degree to which it is pathologized or normalized varies widely across cultures. Although perceptions and/or attitudes toward other mental health disorders (such as major depressive disorder or schizophrenia, for example) may vary somewhat across cultures, perceptions and/or attitudes towards ADHD may vary much more widely than other mental health disorders. This may make ADHD unique in this regard.
Nevertheless, there are mental health professionals and researchers who claim that ADHD is simply a cultural construct. They cite the lack of “specific cognitive, metabolic, or neurological makers and no medical tests for ADHD” to support this assertion (Timmi and Taylor, 2004). Eric Taylor, a psychiatrist in the UK, argues that ADHD is a cultural construct. He states that there are “no specific cognitive, metabolic or neurological marker and no medical tests for ADHD.” Although this may be accurate to some degree, this is the case for most all mental disorders. Indeed, mental disorders may not be identifiable via standard medical tests, such as blood tests or tissue biopsies.
Taylor reports that brain imaging studies are not able to determine if there are abnormalities in the brains of children with ADHD and that any differences found are inconclusive; that is, the differences cannot be said to be the cause of the ADHD symptoms. Furthermore, comorbidity is very high in people with ADHD; therefore, it could be argued that many other factors cause ADHD symptoms observed. Perhaps, ADHD-like behaviors are better explained by other disorders, according to Taylor.
Taylor believes that the only way to explain the rise in the prevalence of ADHD is by a shifting cultural perspective. He believes that changes in culture have led to an increase in ADHD diagnosis. For example, there are many factors that adversely affect the mental health of children and people in general. This includes breakdown in families (more single-parent families), parents less willing to discipline their kids (i.e., teach appropriate behaviors), schools which are over-stretched, and an economic system which emphasizes individuality and competiveness. Taylor believes that many families lead a “hyperactive lifestyle,” as well, which leads to children learning hyperactive behavior. Taylor concludes, that all of this combined may be more difficult to change than to simply create a disorder and blame the child.
Taylor goes on to argue that a medical model for ADHD is not helpful. He believe it simplifies the problem and leads to doctors, parents, and teachers disengaging from social responsibility. Instead they come up with a “cultural disorder” in which they purport to have a cure.
On the other side of the argument Timimi believes that ADHD is neither a genetic disorder nor a social construct, but rather the interaction of the two which results in ADHD. Timimi cites research which points out that there are difference in brain structure, especially in regards to the dopamine system. Furthermore, he states those from all socioeconomic statuses are affected by ADHD, which he believe supports the idea of it being an actual disorder. He goes on to state that two studies 20 years apart in the UK showed that rates of ADHD have been mostly stable over time.
In short, he admits that social factors may play a role, but he does not believe that ADHD can be relegated to a cultural or social construct. He believes that it is more complex than that. Timimi also states that in the UK, ADHD is more likely to go underdiagnosed; however, he acknowledges it can be over diagnosed in some cultures, such as in the US.
However, some research has found a correlation between socioeconomic status and ADHD, with those coming from a lower socioeconomic status having higher rates of ADHD. In fact, financial difficulties was found to be the strongest predictor of ADHD. This, however, does not necessarily mean that ADHD is not an actual disorder and simply the result of a disadvantage upbringing. For example, people from lower socioeconomic status are at greater risk for many disorder, such as diabetes and schizophrenia (Russel et al., 2015).
What is more likely is that there is an interplay between environment, genetics, as well as psychological and sociological factors which either leads to the development of ADHD symptoms or an exacerbation of the symptoms. Furthermore, those from disadvantage backgrounds may not have timely access to appropriate treatment which may cause ADHD to worsen, as well further lead to other complicated problems, such as depression, anxiety, or substance abuse (Russel et al., 2015).
Although ADHD is found across multiple cultures, diagnostic rates vary widely. For example, rates in France……USA…..Korea…… This variability in diagnostic rates is believed to be due differences in what is regarded as normal childhood/adolescent behavior versus abnormal behavior across various cultures. For example, diagnostic rates in Mexico are believed to be lower, as Mexican culture tends to be more tolerate of behaviors that may be considered ADHD, such as hyperactivity and impulsivity. On the other hands, cultures where children are expected to sit quietly and inhibit their impulses, such as in the USA or Japan, diagnostic rate are often higher. Indeed, misdiagnosis is always a possibility. Some cultures may result in under diagnosis of ADHD (such as in Mexico) or over diagnosis (such as in the USA).
In addition to cultural influence on perceptions of ADHD, culture may have an influence on a society’s propensity to medicate ADHD. Although the United States consume about 80% of the world’s Ritalin, the International Narcotics Control Board reported that Iceland consumed slightly more Ritalin per capita than the United States. Furthermore, the consumption of Ritalin has increased a great deal all across the globe in multiple nations surveyed. The one exception was Israel, where consumption rates dropped slightly (Singh, 2008. One may deduce that the increase in consumption or Ritalin across the globe points toward greater awareness of ADHD and pharmacological treatments.
However, even within a particular culture diagnostics rates can vary. In the United States, Reid revealed in his study that ADHD rates tend to be higher in certain ethnic groups (1998). For example, ADHD rates in African-Americans and Hispanic-Americans are higher than rates amongst Caucasians. Although it is possible that there are certain conditions within these ethnic groups which may result in higher rates, it may also be possible that ADHD assessment instruments are misleading or invalid for certain ethnic groups (Reid, 1998). Reid points out, however, that socioeconomic status was not taken into account for his study (1998). Therefore, it is possible that the differences in ADHD rates between ethnic groups may have been influenced by socioeconomic status (Reid, 1998). According to Russell, ADHD rates are often higher in those from lower socioeconomic status (Russell, 2015).
ADHD rates in Thailand appear to be somewhat lower than in Western cultures; however, studies on ADHD in Thailand are very limited. Barkley, et al. reported that ADHD rates are lower in Thailand due to cultural factors which train children to speak quietly in public and encourage obedience to authority figures (1987). Although is some truth to this, this would not necessarily identify children with ADHD, Inattentive type (since these children are rarely disruptive).
Studies have shown that the prevalence of ADHD varies widely across cultures, with a worldwide prevalence estimated to range between 2.2% and 17.8% (Skounti, Philalithis,& Galanakis, 2007). However, this variability in the rates of ADHD could possibly be explained by the reality that the perception of ADHD can vary across cultures (Bussing, et al., 1998). Furthermore, “whether individuals and communities perceive the behaviors associated with ADHD as problematic depends on a given culture’s acceptance of the problem behaviors associated with ADHD and their occurrence in children (Al Azaam, 2011).”
According to one study, Korean culture view symptoms of ADHD in children as a failure of teachers and parents. Therefore, Koreans may fail to recognize symptoms of ADHD as a disorder, but rather blames themselves—viewing themselves as inadequate parents or teachers. As such, parents and/or teachers are often reluctant to seek out assistance for dealing with children with ADHD (such as from psychologists and counselors) out of fear of being judged negatively by other family members or colleagues (Hong, 2008). Indeed, Singh states that ADHD is poorly understood in Korea, combined with a culture which places blame on parents and educators, it is logical that rates of ADHD reported in Korea would be lower when compared to other countries. However, in fact, lower rates of ADHD in Korea may be the result of perception rather than actual lower rates (2008).
ADHD rates in Thailand may be lower due to multiple reasons. For example, there may be less awareness amongst Thai society of ADHD as a disorder, leading Thai people to regard symptoms of ADHD as either normal child or adolescent behavior or as behavior that is willingly disruptive. Additionally, children and adolescents who display such behaviors may be regarded as “stubborn,” “bad,” or “stupid.” That is, children with ADHD in Thailand may be mislabeled rather than slotted for treatment, leading only to the appearance of lower rates instead of actual lower rates.
On the other hand, it is possible that there are in fact lower rates of ADHD in Thailand due to certain factors, such as culture and/or family upbringing. Indeed, culture has a strong influence on the expression of various mental disorders. However, it is also possible that perceptions of what constitutes ADHD or awareness of ADHD in Thailand gives the appearance of lower ADHD rates. Culture, perception, and actual pathology interact—leading to what is reported as ADHD rates in any given society.
Thus, to completely understand how to identify and treat ADHD, it must be studied from within a cultural perspective. Research suggests that ―culturally-relevant factors, like beliefs and values regarding child behavior, impact the way members of various ethnic and cultural groups view and respond to problematic behavior in children (Al-Azzam, 2011).
The focus of the present research is to examine rates and perceptions of ADHD in Thailand in order to gain a clear picture of ADHD in Thailand. One way to examine how culture may influence rates of ADHD is to examine parental and educators’ perceptions of what should be deemed normal problematic behavior or behavior resulting from pathology.
There is ever increasing evidence that links a healthy diet to psychological wellbeing. Recent research has found that a high-fat diet is linked to higher rates in anxiety and depression. What’s more, research indicates that unhealthy diets can lead to brain changes which may persist for months even after a healthy diet has been started.
Mental health professionals are advocating for diets low in sugars and fats as a cost-effective method for improving mental wellbeing, especially when it comes to treating anxiety and depression. In Bangkok, Thailand there is a wide variety of culinary options. Indeed, Thailand is well known for its diverse cuisine.
Although the Thai typical diet, is seemingly healthier than the average Western diet, there are many unhealthy options in Thai food, as well. In particular, desserts and drinks high which are very high in sugar are prevalent in Thailand. In addition, the consumption of fast food in Thailand has escalated dramatically, especially in urban areas, such as Bangkok. Indeed, obesity rates are on the rise in Thailand.
A study release December 2017 reports that children who consume more fruits and vegetables had better self-esteem and fewer psychological problems, regardless of socioeconomic background or body weight. The research points that emotions influence eating and vice versa. Therefore, parents who wish to have their children develop optimally, both physically and mentally, should keep in the mind the importance of healthy nutrition.
A diet high in lean protein, such as fish, appeared to impact mental health positively. It is assumed that omega-3 fatty acids play a major role in this develop.
People who have a predisposition for anxiety and depression or other mental health problems must consider healthy nutrition as part of plan to manage their mental health. In addition to other ways to improve mental health, such as adequate exercise, sleep, medications, avoiding drug and alcohol abuse, as well as seeing a counselor or mental health professional, and working on self-defeating thoughts, the importance of consuming healthy food is becoming more and more evident.
Indeed, improving mental health takes a multi-prong approach. More often than not, there is not one thing or magic bullet that will cure a mental health disorder. Rather than looking for a cure, people should think in terms of managing their mental health. If they learn how to manage their mental health appropriately, the disorder may eventually go into remission.
To have lived abroad, is to have seen the world through the lens of another. Indeed, traveling abroad often broadens your horizons and allows you to see the world through another’s perspective. Expats living abroad often find that they have changed or evolved in many ways that prove beneficial to their lives—careers, life satisfaction, and happiness, in general.
When you live or travel abroad, you learn to adapt to new situations. In fact, it is pretty much impossible not to adapt. Things that you may have found highly inconvenient in your first few weeks abroad often are not a problem after a few months. This is because you have adapted. To not adapt would mean to continue to sit in the problem rather than the solution. Psychologically healthy people tend to seek solutions rather than problems. In other words, they engage in adaptive thinking.
There are many psychological benefits to adaptive thinking. Studies suggest being adaptable may actually improve brain functioning, as it forces us to think and behave differently according to any given situation. This is the essence of learning. Furthermore, improvements in brain functioning will lead to better short-term and long-term memory and may help to delay the onset of cognitive disorders, such as dementia and Alzheimer’s. Although there are many products on the market, such as mind puzzle games, which attempt to challenge our brains in order to keep them sharp and encourage adaptive thinking, when you live and travel abroad you are forced to engage in adaptive thinking every day until it actually becomes a part of who you are.
In addition to the cognitive benefits, living and traveling abroad can also allow you to develop a more flexible personality. For example, when living and traveling abroad things may not always go exactly as you planned. Sometimes, you have to accept certain realities you cannot change about how things are done within a certain culture and just learn to go with the flow. Learning to do this is psychologically beneficial, as well. People with less rigid personalities tend to report greater happiness and satisfaction in life. If you allow yourself to have a more flexible personality, most likely you won’t experience stress as intensely as people who are rigid. High levels of stress are often linked to real diseases, such as hypertension and depression. Therefore, being more flexible may in fact lead to a longer and healthier life. When living and traveling abroad, you have to learn to go with the flow, because if you don’t bend little, you might just break.
Of course, some people may find it more difficult than others to adapt abroad due to their particular life circumstances, such as profession, family matters, or previous experience abroad. If you think that you are taking longer than normal to get over culture shock and you are experiencing abnormal levels of stress, anxiety, or depression, it may be worth consulting with a counselor or psychologist to help you break out of your rut.
In my opinion, traveling and living abroad makes you a better person, overall. It opens your mind to other ways of life and forces you to realize that your way of doing things may not be the only way. Likewise, you may come to realize that other cultures may even have some better practices or traditions, aspects of which you can adopt in to tour own way of life. On the other hand, living abroad may allow you to come to appreciate aspects of your native culture which you had previously taken for granted.
Although appreciating parts of your native culture can elicit positive thought s and feelings, focusing only on what is better about your native culture or constantly comparing your native culture with the culture in which you are living, can limit your own personal growth and be psychologically unhealthy, as well. Psychologically healthy people choose to focus on how they can improve themselves or the lives of others in any given situation, rather than on how their surrounding bring them down.
Having lived abroad makes you a member of a very small club. If you have lived abroad for any significant amount of time, you may begin to think of your expat life as routine or the norm. However, a very small percentage of the world’s population has ever had the opportunity to live abroad. A recent UN survey estimated that only about three percent of the world’s population currently lives abroad. Once you have lived abroad, you’ll never be the same again. If you embrace all the challenges expat life brings, you will surely undergo a great deal of personal growth and fulfillment.
Eric Mason is the director of lighthouse human services in Bangkok where he provide general counseling, substance abuse counseling, and mental health counseling. He has degrees in psychology, international studies, counseling, and is a licensed professional counselor. A native of the United States, Eric has lived abroad in Germany, Japan, and Thailand. He can be reached at firstname.lastname@example.org.
Counseling and Psychological Services in Bangkok, Thailand
Treatment of ADHD
There are a variety of approaches which are effective in the treatment of ADHD. These approaches include pharmacological, psychological, behavioral treatments, psychosocial, and academic. Often, parent training to teach parents how to manage children with ADHD is recommended, as well. Often a combination of all of the aforementioned approaches is the most effective method to ensure the best treatment outcomes.
Pharmacological treatments includes the use of stimulant medications, such as Ritalin, Dexedrine, Concerta, Adderall, and Metadate. Modafinil a stimulant medication used for the treatment of narcolepsy is sometimes used “off label” for ADHD. Stimulant medications appear to be the most effective medications for treating ADHD.
Other non-stimulant medications used to treat ADHD include anti-depressants, such as Wellbutrin and imipramine. A non-stimulant and non-antidepressant medication which has proven effective in treating ADHD is called Strattera. In addition, a blood pressure medication, known as Hypodine, has shown some effectiveness in improving ADHD symptoms. However, this medication is usually used in combination with one of the stimulant medications mentioned above.
Although the medications above are quite different in many ways (from stimulants to antidepressants to blood pressure medications), they share in common one way in which they affect the brain that provides relief from symptoms of ADHD—namely, stimulating or activating the frontal lobes of the brain. Other than having this in common, these medications affect the various neurotransmitters in the brain differently. For example, stimulants tend to have a greater effect on dopamine, while the non-stimulant medications increase norepinephrine levels. Both of these neurotransmitters have a stimulating effect on the brain which is why these medications are believed to reduce symptoms of ADHD. It is believe that the aforementioned blood pressure medication works by increasing blood flow to the frontal lobes, leading to an improvement in ADHD symptoms.
One of the most comprehensive studies of ADHD revealed that medications alone may be effective in reducing ADHD symptoms. That is, medications without the use of other treatment approaches, such as psychological or behavioral interventions, significantly reduce the symptoms of ADHD in 80% of people with ADHD, according to the study mentioned above. Although medications are often effective in reducing symptoms of ADHD, due to the complex nature of ADHD, it is advisable to combine treatment approaches, nevertheless. For example, the complexities of ADHD are evident as it pertains to the challenges those with ADHD face, such as poor school performance, emotional difficulties, social isolation, other mental disorders, as well family discord and parenting skill needs.
Although psychological treatments, such as psychotherapy and counseling, typically are not recommended as a standalone treatment for ADHD, they may be very effective in treating some aspects for ADHD, especially when incorporated as part of a comprehensive treatment approach. Psychotherapy may be used to address other concerns that may arise indirectly from ADHD, such as family conflict and poor self-esteem, as well as other disorders which may co-occur alongside ADHD (e.g., depression and anxiety disorders). Furthermore, psychologists and counselors often employ cognitive strategies, such as collaborative problem-solving techniques to address negative thoughts and perceptions which may be exacerbating ADHD and/or symptoms of other mental disorders.
Behavioral treatments are an essential part of a comprehensive approach to treating ADHD, as behavioral treatments are designed to reduce problematic behaviors associated with ADHD.
Behavioral approaches include positive reinforcement, token economies, and response-cost programs. In general, effective behavioral plans for symptoms of ADHD have the following common features: increased structure and support, reinforcement of appropriate behaviors, an immediate response, and a focus on rewards. Systematic behavior modification programs can help manage behaviors, particularly oppositional behaviors (Connors, 2009).
Psychosocial treatments essentially aim to improve the social skills of those with ADHD, especially with peers. Although most people with ADHD do not lack social skills, they may fail to apply appropriate social skills at the appropriate time. Psychosocial treatments tend to rely on cognitive and behavioral method to teach better social skills to those with ADHD. Additionally, social skills training may include practical tips, such as teaching the person with ADHD to pay attention to socials cues (e.g., body language, social context, or tone of voice), not just what the words that people use to communicate. Unfortunately, children and adolescents with ADHD may become socially isolated which, in turn, may lead to other issues, such as depression or substance abuse (Conners, 2009). Therefore, psychosocial treatments and social skills training are an important part of a comprehensive approach to the treatment of ADHD.
Academic interventions are designed to improve the odds of school success for those with ADHD. These interventions tend to practical solutions and involve teachers, school counselors, and parents—ensuring all those involved with the student with ADHD are on the same page and working together help the student by “evening the playing field.”
Academic interventions include specific recommendations for change. Modified instruction (e.g., increased hands-on), specialized instructions, and specific skill instruction (e.g., organization, time management) are all forms of academic intervention that can be very effective for youth ADHD (Conners, 2009).
Academic interventions are essential in improving organizational skills by practical applications, such as encouraging the student to use separate folders for each school subject, having teachers place the student’s homework in a specified homework folder each (which parents can check daily), explicit and step-by-step instructions, testing accommodations (such as allowing more time), as well assignment modifications (such as allowing the student to divide large assignment into multiple smaller assignments which would equate to the original assignment). These interventions are not intended to make school assignments and tests easier for students with ADHD, but rather serve to allow the student time to develop the necessary skills to cope with ADHD while also ensuring that the students receives an equal education to those without ADHD. In addition, these interventions may serve to prevent the student from becoming overly discouraged by school which, in turn, limits the probability of the student developing other problems, such as low self-esteem or depressive disorders (Conners, 2009).
Although medication alone may be effective in treating ADHD, a comprehensive assessment should be completed in order to decide the best treatment approach.
Thank you for choosing me as your counselor or consultant. This form is meant to inform you about my credentials and background, as well as to ensure that you understand our professional relationship.
I earned a MS in Addiction and Mental Health Clinical Counseling in 2009 from East Carolina University. In addition, I have a MA in International and Cultural Studies, as well as BA’s in Psychology and German. I am currently completing a PhD in Counseling Psychology at Assumption University in Bangkok. I have completed all course work for the PhD and passed the qualifying exams. I am in the process of completing the dissertation.
I am a Certified a Rehabilitation Counselor (CRC #00110985), a Licensed Clinical Addictions Specialist (LCAS #1661), a Licensed Professional Counselor (LPC #7660), an Internationally Certified Advanced Drug and Alcohol Counselor (ICAADC #206201), and a Full Member of the Singapore Psychological Society (MSPS). My licensures are verifiable at the following websites: www.ncsappb.org and www.ncblpc.org I have worked in the mental health and addiction filed for about 10 years.
Counseling Services Offered and Theoretical Approaches
People can make better decisions if they have enough information and understanding about how counseling works. Here are some aspects of counseling as I perceive and practice them:
Counseling requires your active involvement, including efforts to change any self-defeating thoughts, feelings, and behaviors. You will be asked to work both in and out of counseling sessions. There are no instant, painless, or passive cures. In short, there are no “magic pills.” Instead, you will work on improving yourself through homework assignments and other therapeutic techniques. Most likely, you will be asked to work on improving stress management, belief systems, relationships, and your general lifestyle, if counseling is to be successful. Change may be relatively easy at times; however, more often change will take much effort, time, and persistence. It is not uncommon that some psychological and behavior patterns have been reinforced for 20 to 30 years and will not change with insight alone. These entrenched behavior patterns and ways of thinking will usually require much focused time and effort.
It is important that you are upfront about the reasons you have sought out counseling. Although counselors and psychologists may possess a great amount of insight into the human mind, they are not mind readers. Issues that people may have a hard time talking about include sexuality, infidelity, abuse, and drug addiction. Most mental health professionals with any amount of experience will not be caught off guard by any of these issues. In short, no topics are off limits and please feel free to discuss any of your concerns.
I utilize an eclectic counseling approach, which is a mix of different approaches. Mostly, I rely on Person-Centered Therapy, Motivational Interviewing, Cognitive-Behavioral Therapy, Solution Focused Therapy, and Narrative Therapy. These are all well established, researched, and respected therapies.
I provide counseling services to adolescents and adults with general mental health concerns, rehabilitation needs, substance use disorders or addictions, relationship problems, vocational concerns, as well as those in need of general supportive counseling.
In addition, I am qualified to administer various types of psychological tests for assessment and diagnostics purposes. For example, this includes comprehensive assessments for ADHD and/or other psychological disorders, as well as to assess overall functioning in general.
Mental health counseling and therapy can involve both benefits and risks. Potential benefits include becoming free from self-defeating, and self-destructive behaviors, developing more satisfying relationships with other people, becoming happier, and living a healthier lifestyle. Risks may include experiencing uncomfortable feelings or difficulties with friends and family members during the counseling and/or rehabilitation process. Personal growth often involves change. Sometimes changing the way we usually function or relate to others involves considerable stress. Major life changes like divorce and changing jobs or careers, although stressful in the short-term, may be the conclusion you arrive at as a result of professional counseling in order to actualize your long-tem mental health or career potential. For example, an outcome of counseling may not be to keep a dysfunctional marriage together at all costs. Sometimes it is in the best interests of both spouses and other family members to separate.
When people enter into counseling, they may receive a diagnosis when appropriate. Diagnoses are not meant to be judgmental or to reflect upon you, negatively. They are simply a short-hand method clinicians use to describe a group of symptoms that one may be experiencing.
I regard the information you share with me with the greatest respect. I want us to be as clear as possible about how this information will be handled. Generally, I will not tell anyone what you tell me. The privacy and confidentiality of our conservations and my records will be held confidentially according to my profession’s ethical standards in all but a few circumstances. These circumstances are as follows: (1) If I believe you intend to harm yourself or another person; (2) If I believe a child or elderly person has been or may be abused or neglected; (3) In rare circumstances, a judge may order professional counselors to release information. (4) I may share information with my supervisor (for clinical advice); however, your name will not be associated with such information. I will ask your permission and ask you to sign a consent form before any information is released. Otherwise, I will not tell anyone anything about your treatment, diagnosis, history, or even that you are a client, without your full knowledge and, usually, a signed “Release of Information Form.”
Explanations of Dual Relationships
Although our sessions may be very intimate psychologically, it is important to remember that we have a professional relationship rather than a social one. Our contact will be limited to sessions you arrange with me. Please do not invite me to social gatherings, offer me gifts, or ask me to relate to you in any other way than the professional context of our counseling sessions. You will be best served while I am seeing you for counseling and therapy if our relationship stays strictly professional and if our sessions concentrate exclusively on your concerns. You will learn a great deal about me as we work together during your counseling experience. However, it is important to remember that you are experiencing me in my professional role.
Length of Sessions
I assure that my services will be rendered in a professional manner consistent with accepted ethical standards. Sessions are 60 to 75 minutes in duration. If you are unable to keep an appointment, please call to cancel or reschedule at least 24 hours in advance. Please note that it is impossible to guarantee any specific results regarding your counseling goals. Often, counseling and treatment goals change with increased understanding. Your counseling, treatment, or rehabilitation goals will likely be modified throughout the counseling process. However, counseling and rehabilitation goals will always be your goals. Together we will work to achieve the best possible results for you.
Individual sessions are 3000 Baht for a session and 7500 Baht for three sessions (if you pay in advance for three sessions). There is no charge for an initial consultation by phone or email. The costs of psychological assessments vary. Please contact me for details. Please notify me 24 hours in advance if you are unable to attend an appointment. Failure to do so will result in 1000 Baht fee for each missed appointment. Please note that prepaid sessions expire after eight weeks. Please make use of your prepaid sessions within that time period.
If you are dissatisfied with any aspect of our work, please inform me immediately. This will make our work together more efficient and effective.
If you have any questions, feel free to ask. Please sign and date this form.