By June Cheong
These days, the field of psychotherapy has greatly expanded and people are spoilt for choice when it comes to dealing with matters of the heart and mind.
Mind Your Body delves into five of its branches - cognitive behavioural therapy (CBT), positive psychology, emotional freedom techniques (EFT), hypnotherapy and neurolinguistic programming (NLP) - and investigates how and why they work.
While CBT is part of mainstream medical practice, the other four are perceived as fringe therapies.
Dr Adrian Wang, a consultant psychiatrist at Gleneagles Medical Centre, said: 'There's no magic bullet for problems like a broken heart or alcoholism.
'The psychiatrist or therapist has to tailor the treatment to the patient's need and his level of receptivity.'
He added: 'Methods like hypnotherapy are considered to be on the fringe of psychotherapy but that doesn't mean they're fluff.
'They can be useful to kickstart change within a patient.'
Indeed, that was the case for 31-year-old teacher Usha R.
She started going for weekly EFT sessions in July last year.
'I was going through a tough time at work and in my personal life and I tried EFT for a month,' she said.
'I found that I lost my temper much less. Before, when I got angry in class, I'd scold and shout at the students who were misbehaving.
'Now, I just excuse myself, go to the washroom and do EFT there.'
Using EFT techniques, she was able to work through her issues to rebuild her self-esteem and confidence. She moved out of her parents' home to live on her own and now teaches in a new school.
She said: 'Having learnt to manage my emotions and my past, I felt more empowered to make changes in my life so as to be more in control.
'Previously, there was fear in me. I'm much happier than before.'
1: Cognitive behaviour therapy
What you think and feel affects how you behave.
That, essentially, is what cognitive behavioural therapy (CBT) is about.
Dr Matthew Woo, the deputy head and principal clinical psychologist at the Institute of Mental Health, said: 'CBT is a key feature of many clinical courses in psychology around the world and every course worth its salt would include either components of CBT or feature CBT as the mainstay of the course.
'If you shift your thinking and emotions, you can shift your behaviour.'
CBT works by breaking problems into smaller components, which can be analysed in terms of how they are connected and how helpful they are to the patient's well-being.
A problem can be dissected into a situation and the thoughts, emotions, physical feelings and actions that follow.
For example, if a person thinks that others do not like him because he is fat, he can pause and rationalise that it may be due to other factors like his anti-social tendencies instead of his weight.
When we are distressed, we are more likely to jump to conclusions and to interpret situations in unhelpful and hurtful ways.
CBT helps to break us out of this vicious circle of negative thinking, feelings and behaviour. It allows us to have a clear overview of a situation and its resultant feelings, emotions, thoughts and behaviour.
This broad perspective empowers us to make a positive choice for ourselves and to work out a way of tackling the problem.
CBT has been shown to be of help with problems like anxiety, depression, panic, phobias, stress, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis.
Consultant psychiatrist Adrian Wang of Gleneagles Medical Centre said: 'CBT definitely works. Research has proven that it is as effective as medication in cases of mild to moderate depression.
'It helps patients create permanent change in their lives.'
2: Positive psychology
American novelist Edith Wharton once said if only we would stop trying to be happy, we could have a pretty good time.
Fast forward to the 21st century and happiness is still an elusive goal.
It is also the main theme of positive psychology - said by its disciples to be the scientific study of the strengths and virtues that enable people and communities to thrive.
Pioneered by American psychologist Martin E. P. Seligman, positive psychology turns mainstream psychology on its head by concentrating on uncovering what goes right in life instead of focusing on diseases and ailments.
Mr Stephen Lew, a hypno-psychotherapist from the Positive Psychology Center, said: 'Positive psychology focuses on human strengths and sees human goodness as real, credible and measurable.
'It is interested in building the best things in life.'
The field seeks to understand positive emotions like being hopeful about the future; positive traits like courage and creativity; and positive strengths like justice and tolerance.
It can be applied in daily life through a variety of methods like keeping a journal of things one is grateful for, staying optimistic, learning to be more self-aware and honing one's characteristic strengths.
Mr Lew said: 'Applying positive psychology in your life is like installing an anti-virus software. Things change and sometimes your belief systems need updating.'
He added that positive psychology has to be learnt and is not innate in everyone.
He said: 'There is no quick fix for happiness. You have to work at it every day.'
However, Dr Matthew Woo, the deputy head and principal clinical psychologist in the department of psychology at the Institute of Mental Health Singapore, said: 'I think there's some basis of truth in positive psychology, especially for people who are in the group I will describe as the 'wellness population'.
'These are people who already have the skills to deal with life's problems but want to enhance their resilience. It is promising in the sense that the evidence base surrounding positive psychology is growing, albeit slowly and steadily.'
Meanwhile, its practitioners insist their field can help deal with depression and relationship and self-esteem issues.
Mr Lew said: 'Positive psychology helps in terms of influencing people's lifestyle and modifying their behaviour and thought processes.'
3: Emotional freedom techniques
Emotional freedom techniques, or EFT, is often dubbed 'emotional acupuncture'.
EFT was developed by Gary Craig, a Stanford engineering graduate and an ordained minister at the Universal Church of God in southern California. A non-denominational church, it embraces all religions.
The method uses principles of traditional Chinese medicine and purportedly manipulates the body's energy field by tapping on key meridian points while the mind is focused on a psychological issue.
Ms Lena Chen, a holistic therapist who practises the method, said: 'EFT frees up blockages in the body's energy pathways, hence allowing the body to heal itself of negative emotions and physical symptoms.'
EFT can be done with a trained practitioner who has undergone a course in EFT either here or abroad, or by oneself.
It has been used to address issues like phobias, relationship problems, chronic body pain, post-traumatic stress disorder and anxiety.
Ms Chen added that EFT has been shown to be highly effective in treating mild to moderate depression.
She said: 'It works especially well for reactive depression, which is when the depressive symptoms occur as a reaction to one or more specific events in the person's life, be it the loss of a job, the death of a loved one or a failed relationship.
'EFT gently peels away the layers of the problem, allowing the real issue to arise so that deep therapeutic work can be done, resulting in permanent healing.'
Asked if EFT works as claimed, Dr Matthew Woo, the deputy head and principal clinical psychologist in the department of psychology at the Institute of Mental Health, said: 'I don't think so. I'm sceptical. The evidence base showing that it works has not been built up enough.'
4: Hypnotherapy
Hypnosis conjures up the image of a showman on stage snapping his fingers - with the 'victim' singing, dancing or jumping at his bidding.
As entertainment, that may well be so. However, hypnosis can be used as a form of therapy too, hence the term hypnotherapy.
For starters, people may experience everyday hypnosis.
If you are engrossed in a TV programme or book, you would have experienced a mild state of hypnosis, said Ms Katherine Wong, the director of Hypnae Center at Camden Medical Centre. Another instance of everyday hypnosis is when you cannot recall the detailed moments of actually driving or commuting after you have arrived at your destination, Ms Wong added.
During hypnosis, the conscious mind becomes completely relaxed and the brain is brought to the theta state, which is akin to the stage between wakefulness and sleep.
The hypnotherapist guides the patient into a state of hypnosis through relaxation exercises and then feeds the patient with suggestions to help him make changes in his life.
Ms Wong said: 'When a person comes to see us, he is trapped in a condition he can't get out of. He needs us to help pull him out.'
Asked if undergoing hypnosis means giving up self-control or free will, Ms Nancy Ho, the director of Regional Hypnosis Center, said: 'We can't work on anyone who's not willing. The person must recognise he has a problem and want to change.'
When a person is under hypnosis, the body secretes dopamine, serotonin, melatonin, acetylcholine and other minor neurotransmitters.
This chemical cocktail induces the person to be more relaxed and calm.
Despite what is commonly believed, such a person is fully conscious and aware at all times. He usually experiences symptoms like heaviness of the body or a floating sensation and time distortion.
When he emerges from the hypnotic state, he usually feels relaxed, refreshed and more positive about himself and the world.
While reaching a stage of heightened suggestibility is important in hypnotherapy, the real work is in taking the patient to the root of his problem.
Ms Ho said: 'For example, in cases of insecurity or depression, we help the patient re-experience earlier instances of such feelings.
'We go back to the first time he experienced such negative emotions. Perhaps his mother left him alone at home when he was young and his young mind perceived it as abandonment, even if his mother returned later.
'After we find the root incident or cause, we help the patient recognise it and neutralise the negative emotion.'
Hypnotherapy can help with problems like smoking addiction, anxiety, stress, depression, self-esteem issues and relationship difficulties.
According to Ms Ho, those interested in becoming a certified hypnotherapist can travel to the United States for training or attend any course here conducted by an instructor who is certified by one of the following three boards: National Guild of Hypnotists, American Council of Hypnotist Examiners and International Medical and Dental Hypnotherapy Association.
Asked about the medical perspective of whether hypnotherapy really works, Dr Adrian Wang, a consultant psychiatrist at Gleneagles Medical Centre, said: 'It does work but people sometimes have unrealistic expectations that hypnotherapy will give them a quick fix.
'It helps patients to develop deep relaxation skills and think about solutions to their problems.'
Clearly, the nub of such fringe therapies is the durability of the positive change they claim to effect. The jury seems to be out here.
'While hypnoatherapy is a useful short-term tool, the main problem is how to sustain long-term change,' Dr Wang said.
5: Neurolinguistic programming
It is all in the mind, say practitioners of neurolinguistic programming (NLP). In a nutshell, we think, therefore we act - or are able to change our actions and behaviour.
This technique was developed in the 1970s by American author Richard Bandler and American linguist John Grinder.
The pair created a model of interpersonal communication which focused on the relationship between successful patterns of behaviour and the thoughts and emotions underlying them.
NLP is based on the work of three psychotherapists: Virginia Satir, well-known for her approach to family therapy; Fritz Perls, who founded Gestalt therapy; and Milton Erickson, who specialised in hypnotherapy.
Ms Lindley Craig, the founder of NLP training centre All In The Mind, said: 'You take in information through the five senses. Your brain runs programmes to process that information and deletes, generalises and distorts the information to make sense of the immense amount of data collected.
'Once the programmes have been run, there is an output, which is your behaviour and how you speak (both verbally and non-verbally). NLP helps to fix the programmes that aren't working and gives you new ones that do.'
Ms Janet Cropper, the managing partner of leadership development company NoLimits, said: 'The brain is an incredible organ that is growing, changing and developing every moment.
'Consciously and unconsciously, our thoughts and behaviour shape the neural pathways. With reinforcement of behaviour and modifying how we think, we can choose new, more empowering patterns of thought and behaviour that will become hardwired in us.'
NLP practitioners claim that it can be used in various situations, from weight management to treating depression to getting over traumatic events and phobias.
A practitioner, who has undergone a training course in NLP techniques, begins by assessing the patient's present state and finding out what his desired state and past and present influences are.
He then helps the patient work towards his desired state by 'scrambling' the patient's brain connections.
This is done through repeated exercises. For example, to help a patient overcome depression, an NLP coach may use 'breaking states', which is interrupting a person's current state of mind to allow him to clear out unhelpful thoughts and to re-adjust.
Asked if he thinks NLP works, Dr Matthew Woo, the deputy head and principal clinical psychologist at the Institute of Mental Health, said: 'NLP is not part of academic psychology. The efficacy evidence surrounding NLP is not robust.'
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