Conquering Stress: Make It Fun!

By Dr. Douglas Kong

If you’re in a quandary about which book to pick in the library or bookshop to read on ‘Stress’, this slim volume by Dr Douglas Kong has to be your choice.

It begins with ‘Stress sucks!’ and ends with ‘Make stress fun for yourself!’ In between are chapters on neuroscience, nutrition, fitness, social support and of course psychotherapy which is the forte of the author.

From his more than 40 years as a doctor, psychiatrist and psychotherapist, he enlivens this book with brief case studies of his vast experience. If you read between the lines, you will realise that his approach is person-centred and he advises on diet, food and exercise. Although trained in psychodynamic psychotherapy, Dr Kong is not dogmatic and advocates other techniques including cognitive behavioural therapy, mindfulness practice and Jacobson’s progressive muscle relaxation. In short his approach in stress management is personal and integrative – this is the psychotherapeutic zeitgeist of the 21st century.

Because the 21st century is also the Asian century, in the next edition of ‘Conquering stress’ the author may wish to include more references from research in Asia. In understanding and coping with our stress, we may want to heed the advice of the 6th century Chinese philosopher, Lao Tzu: Knowing others is wisdom, knowing the self is enlightenment.

Kua Ee Heok
Tan Geok Yin Professor of Psychiatry and Neuroscience,
Senior Consultant Psychiatrist, Department of Psychological Medicine,
National University of Singapore

• Language: English
• Publisher: Partridge Publishing Singapore
• Release date: Sep 20, 2019
• ISBN: 9781543753882

Dr. Douglas Kong

Dr Douglas Kong is a retired psychiatrist who specialized in psychoanalytic psychotherapy and stress management. As a clinician he used psychological techniques complemented by medical treatment to help his patients to recover completely. Dr Kong now helps normal people to achieve more in their lives as a Performance Coach.

Book preview

Copyright © 2019 by DR DOUGLAS KONG.

Library of Congress Control Number:      2019913458

ISBN:      Softcover         978-1-5437-5387-5

                eBook              978-1-5437-5388-2

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the author except in the case of brief quotations embodied in critical articles and reviews.

The information provided in this book is provided for educational and informational purposes. No responsibility can be taken for any results or outcomes resulting from the use of this material. While every attempt has been made to provide information that is both accurate and effective, the author does not assume any responsibility for the accuracy or use/misuse of the information. This book and the advice contained herein does not constitute a psychiatric diagnosis or purport to be psychiatric treatment. You should seek the professional advice of the relevant medical or psychological professional should you be concerned about the medical or psychological symptoms you are having. If you are already consulting a psychiatrist or other professional for your stress, you are advised that you should not discontinue or modify your treatment without professional supervision and advice.

While the stories within the book are based on true histories from patients who have seen me, they are nonetheless fictitious as significant details have been changed to alter them substantially though not the gist of it. Any resemblance to any living persons, alive or dead, is purely coincidental and merely reflects the fact that the conditions described in this book are relatively common and frequently seen.

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

www.partridgepublishing.com/singapore

CONTENTS

Dedication

Preface

1    Introduction

2    What is Stress?

3    The Neuroscience of Stress

4    Reducing Stress

5    Health, Nutrition, and Fitness

6    Social Support

7    Closing Thoughts

Appendix A    List of Screening Instruments

Appendix B    Relaxation Techniques

References

To my wife, Margaret Choy Wan, and to my beloved children, Adeline and Terence

PREFACE

This book has been many years in the writing. I have worked in this area of stress for many years. My first introduction to this topic was when I was training in the UK in the late seventies and early eighties. I was introduced to the meetings of the Royal Society of Medicine in London where talks and presentations on psychosomatic medicine were presented. There, I was introduced to stress.

The model that most influenced me was one where stress was filtered through a series of lenses. On coming back home to Singapore as I planned for the stress management workshops with my then-partner Dr PC Ang, I simplified it to three lenses and called it the psycho-socio-biological model, basically a descriptive term for the ‘holistic’ concept. Together, we managed to present these workshops to several corporations, MNCs, and local statutory boards. They were well received because of the practical approach we adopted.

Over the years, I did research in stress, including stress in children; attended to stress-related psychiatric diagnoses; joined the then Society of Behavioral Medicine, USA; got interested in PTSD and traumatic stress, and learnt hypnosis and later EMDR to treat PTSD and so on.

It was an eventful career that was rich in experiences and insights. I certainly like those rich experiences and insights to be passed on. At that time, having not written anything more than an article, I got a ghost writer to do it. Though well written, somehow the work did not cohere; so it was kept under wraps.

As I thought about the topic again, I realised I had to rewrite the entire book to bring it more up-to-date and to infuse it with relevant material within a coherent framework. I found this framework in a re-interpretation of my earlier model after becoming acquainted with the work of the Lazarus and the Chicago group on stress.

My thanks to my previous group practice, Ang & Kong clinics, that allowed me to test and develop my ideas especially in the subsidiary Centre for Effective Living Pte Ltd, which basically worked out these ideas I had developed over the years. Also, my thanks to my colleagues who were with me in the Association for Group and Individual Psychotherapy that allowed me the platform and the sounding board to test out theory and practical application.

So armed with the numerous case histories of real patients whom I had helped and who have taught me a lot about life and stress, here it is. This book follows on from my earlier book, Conquering Panic Attacks, which basically sums up my approach to helping people: help them to help themselves.

Where they cannot help themselves, then use everything we have and teach them skills, make available resources in themselves, in the social network, and in the community. The goal? That everyone may have a self-fulfilled life, living the life that they choose and one that, in spite of the constraints of reality, makes them happy and connected to one another.

I invite you to read it, enjoy it, and make it real in your life!

1

Introduction

‘Stress sucks!’

This was the response of a millennial young man when I asked him for his views on stress and stress management. He explained that amongst his friends, stress was associated with an inability to perform; hence, they rather not talked about it. It would be a topic of conversation when someone had succumbed to the effect of stress and became depressed, for example. It would be even more tragic when someone amongst them would lose his mind or, worse, his job.

But the unfortunate truth is that a lot of people are likely to be affected by stress, especially those in the workplace. (I use workplace in a generic sense to include those who are self-employed.) Nowadays, the work environment is highly competitive; and as a result, you find that you must work hard to maintain your position or to advance in your career. This stress comes from various sources. It can come from your superiors, those you serve, and their demands on you. There is always more to do in the limited time that you have. You may very likely bring the work home or work longer hours to fulfil the demand of your superiors whose requirements seem to be never ending. That is enough to give a lot of people who work stress! If you feel this way, you are certainly not alone.

But if this is not enough, stress also comes from colleagues (competitors for those self-employed) where competition for rewards and promotion can sometimes create difficulties in working together, leading to friction in relationships. This kind of stress has a social dimension as well, as colleagues who are ambitious may lobby others for support and alienate others towards you. More insidious will be the kind of manipulation that goes on when he (includes she) began to play office politics to isolate you and to promote himself forward amongst your superiors and peers. And if you are the kind of person who will respond in kind, sometimes the pressure that piles on you includes a measure of social isolation, which does make it hard to cope because social support is actually one of your main resources for reducing stress. A few hope to bury their head in the sand by deliberately isolating themselves. If you are one of those who do so, know that while you can avoid the stress in the short term, in the long term, you may be forced to resign or be terminated if those who seek to manipulate you have their way. And that may be more traumatic psychologically.

An entrepreneur, while free from the office politics of an organization or company, nonetheless has to face the stress of keeping up with his competitors, cultivating networking relationships for the purpose of meeting the need to get prospects and customers, and keeping these customers satisfied so he could get sufficiently remunerated for whatever he sells. It is equally stressful.

Of course, as the stress level mounts, you will need relief. So it is that many people find ways to reduce the stress, to chill off so to speak. If you just have a simple notion of stress, probably that will be enough. Indeed, for many people, stress management is all about finding the right way to relax so that you don’t have to live with high stress levels for long periods.

But this need to relax and reduce our stress belies a more important truth, and that is stress has a deleterious effect on your lives. Stress, if unchecked, can give rise to stress symptoms, which, as it gets increasingly severe due to unrelenting level of high stress, would result in actual harm to your physical health as well as to your mental health.

Hence, stress management by reducing stress levels by various relaxation and ‘chilling’ techniques is simply not enough. To do so, you are simply functioning reactively to the effects as if it is an afterthought. This shows a complete misunderstanding of the function of stress in your lives. Stress has been understood rightly by a lot of laypeople to be a fight-or-flight response. This avoidance reaction is not only a flight from stress but also a flight to safety. This implies that you—in fact, all of us—are looking for safety. If this is the case, then the stress reaction is meant to protect you. And if it is to protect you, you need to understand better how this comes about and if there are better ways of protecting yourself that gives you more benefits with as little as possible of the downside of stress, the stress symptoms, and the aftermath in disease, both physical and mental.

My personal opinion is that to focus purely on reducing stress in reaction to high stress levels by relaxation or any other means of stress reduction is to function at the lowest level of survival. In this book and a subsequent volume, I hope to teach you to more than relax and reduce stress. I want you to learn how you can understand the stress response and then to be able to be less reactive to stress. This will mean that you can tolerate a higher level of stress; and more importantly, you can bounce back from stress each time you are affected by it.

A more important result is that when you are reactive to stress, your ability to perform at your optimum is compromised. This means that your ability to function and be productive is reduced. So whatever you are doing, whether you work in a job, run your business, involve yourself in an academic study, perform a task to entertain or compete, care for loved ones, or volunteer at a helping agency, your ability to do what you are supposed to do is compromised when you are stressed. If we believed that as humans, we can find fulfilment in doing meaningful and productive tasks with an end in mind, then it would be the goal of stress management that we should be able to function at an optimal level in all that we are involved in, be it sports, performing arts, intellectual and cognitive tasks, social and domestic chores, and duties. That should be the purpose of stress management.

We now know that for us to be performing optimally most of the time, if not all of the time, there is a state of functioning that is finely balanced and involves several aspects including a state of mindfulness, presence, flow, concentration, focus, positivity, and pleasure in a social atmosphere of safety, social connectedness, and physical security. Stress management is multidimensional if it is truly able to enable you to function effectively.

Today, in our hypercompetitive world where you need to fulfil your individual objectives as well as the objectives of communities you belong to, you need to function best in the midst of competition or function in a way where creativity, innovation, and learning are facilitated. This last function is now called transformational in management theory. Currently, my writing on stress is organised to address this. In this volume, I shall explain our basic foundational ideas on stress. This will include more recent research findings on stress more consonant with our times.

I have spent two chapters discussing about our physical health (specifically exercise, nutrition, and behaviour changes) and social support. In my model of stress management, I called them stress buffers. Their presence makes stress easier to confront, tolerate, and ultimately overcome. Their presence also makes the individual able to derive greater joy and pleasure once they have reached the point where stress is transformed to pleasure. In a subsequent volume, I shall touch on our building resilience to stress and toughness, culminating in a discussion on psychological trauma. It should be noted that these two chapters are summaries of what we know about our physical health (note my term physical self-efficacy) and social support and are not intended to be an exhaustive treatment of these two important topics. For that, you are advised to look elsewhere.

Psychological trauma is increasingly becoming more pervasive in modern living. Such major trauma comes from various causes overtaking us as a community or communities of humans. What with political upheavals manifested in political and economic disruption, terrorist action and military conflict, as well as natural disasters as hurricanes, tsunamis, earthquakes, and so on. With everyday occurrences such as crimes, acts of violence, especially sexual violence, and accidents from modern-day conveniences like motor vehicle accidents and plane crashes, more and more people are being exposed to a greater frequency of major physical and psychological trauma.

Now it would appear that psychological trauma of such magnitude sensitises us to experience future stress acutely. Our threshold to stress is reduced, and our minds are weakened. Thankfully, there are techniques that can enable us to recover from such traumatic stress and to gain back the mental toughness or increase it so that we can endure stress better.

Lastly, a word on stress training, which is the strengthening of your mental toughness even for those who have not been exposed to major psychological trauma so that they can survive