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Prime and Primary

Here’s a fact. 1 in 7 people had mental health issues in 2016. The number of people with problems in mental wellness is expected to have increased in 2022.

According to the Singapore Mental Health Study in 2016, one in seven people experienced a mood, anxiety, or alcohol use disorder in their lifetime. The study found that “…the majority of people (i.e. more than three-quarters) with a mental disorder in their lifetime did not seek any professional help.

To me, the fear of being stigmatised and prejudiced most likely prevented people to come forward and look for treatment.

According to the COVID-19 Mental Wellness Taskforce Report by Singapore’s Ministry of Health, depression, anxiety, and stress were significant mental health issues faced during the pandemic.

Based on these data and trends, it is believed that the ratio of “1 in 7” (14.28%) is gradually increasing since the start of the pandemic. This also means that there are even more people who are suffering in silence, unwilling, or even do not have the abilities or resources to request any professional help!

Derail and Overturn

I am glad that an ex-client of mine, Mr P (name changed for client confidentiality) dared to be treated by a mental health professional.

Mr P was in his early 40s, single, living alone, and leading an affluent lifestyle. He was a “high flyer” in his career, which involved frequent overseas trips to visit customers.

However, Mr P’s “glamourous and smooth journey in life” was disrupted after a particular overseas business trip, where his flight had to endure a series of severe air turbulence. That horrific experience made him recognise his unfinished business and his life’s purpose. These realisations created much fear of his own mortality.

As a result, Mr P became overly anxious when driving a car, riding a bicycle, walking beside or crossing a busy road, entering a long tunnel, using an overhead bridge, elevator and escalator etc. It was through sheer willpower that he managed his emotional disturbances and fears when flying for work. Even so, he actively reduced as many overseas business flights as possible.

Such a high level of apprehension affected Mr P’s quality of life negatively, for more than a few months. He experienced frequent physical fatigue (even though he exercised moderately), insomnia, irritation, and difficulty concentrating.

Mr P only went to consult his family doctor after having persistent headaches and unexplainable body aches. But the clinic could not pinpoint the cause of his physical ailments even after medical examinations at a hospital.

Then, Mr P’s family doctor suggested he seek psychotherapy treatment as the doctor believed that his issues were predominantly psychological in nature.

After a couple of therapy sessions with me, I referred Mr P to obtain an official diagnosis from a psychologist. The psychologist’s report affirmed my preliminary assessment that he was experiencing a Generalized Anxiety Disorder, concerning his prolonged, constant and uncontrollable chronic disruptive worry, fear, and apprehension.

Self-Transformation Process

With the confirmed diagnosis, I customised a treatment programme for Mr P, using a Bio-Psycho-Social Model.


The prime therapeutic goal was to reduce Mr P’s anxiety symptoms, through specific skills and tools such as progressive muscle relaxation, physical anchoring and grounding processes, positive coping mechanism, problem-solving procedures etc.

Mr P was encouraged to eat healthily, ensure sufficient sleep and rest routines, reduced or stopped the consumption of alcohol and caffeinated beverages, and smoking.


Addressing Mr P’s negative thought patterns and distortions through Cognitive Therapy and Behaviour Therapy was another primary therapeutic goal. These therapies linked and explained to him how he had perceived and interpreted his safety and security illogically and inappropriately. His regular inputs on the daily homework and assignments also analysed and mitigated his behaviours and reactions in the situations that contributed to and triggered his anxiety.

Additional techniques such as emotional stabilisation, mindfulness and visualisation processes, stress management etc shared with Mr P reinforced and supplemented the “cognitive construction” as well.


It was important for Mr P to reconnect with others, especially his loved ones. Losing his father (and the family’s sole income) unexpectedly during his childhood, Mr P developed a strong desire to gain wealth to improve his family’s financial situation – in particular, to provide well for his mother. After all, he was the only child and he felt the responsibility to do so. His mother’s mental state and physical wellness were the main contributors to his fear towards death, if he were to pass on before his mother.

However, in the quest for financial success, he spent little time with his mother. Even so, he was reminded that his mother who lived separately with two domestic helpers looking after her then, could still be his emotional pillar.

As for finding a life partner, a series of bitter betrayals made him give up the idea of settling down and trusting anyone.

It was that fateful flight that jarred him to wonder about his life purpose(s) – “Who am I, if I were stripped of all these labels and materialistic possessions?”

The Three Rings

Only when Mr P’s anxiety symptoms reduced considerably and his resilience strengthened did I turn to another essential therapeutic goal of our sessions – the purpose of life.

I used my own framework on life engagementsThe Three Rings, to lead and guide him in this area:

The First Ring: Self-Engaged

This is the most imperative engagement one has to build up. Imagine if we are not even able to accept ourselves fully and engage ourselves meaningfully.

We spent much time, energy and resources in processing Mr P’s painful past. Using some self-assessment practices, he was prompted to discover himself and recover from the past.

As Jim Loehr puts it, “To be fully engaged, we must be physically energized, emotionally connected, mentally focused and spiritually aligned with a purpose beyond our immediate self-interest.” This understanding facilitated Mr P to have a reflective insight, “My First Lover” is always himself, as the prime and primary pursuit first.

The Second Ring: Engage Others

None of us is a real superman or superwoman, as we are perfectly imperfect. We could and should accept “It’s OK not to be OK”, and it is absolutely fine for us to solicit aid from others from time to time.

I appreciate what Vera Nazarian proposed, “Sometimes, reaching out and taking someone’s hand is the beginning of a journey. At other times, it is allowing another to take yours”.

To Mr P, asking for help was a sign of weakness. It was understandable, as such a disposition had been his defence mechanism, whilst he kept hunting for monetary accomplishments in life.

It took me much time to prove and convince Mr P that it was not degrading for us to request assistance from others when needed. He finally realised that he did require someone to support him to regulate his frequent and intense anxiety episodes. During the process, his dignity and pride were well respected and upkept by me as his professional therapist. Thus, it was reasonable and acceptable for him to engage others, if things were beyond his control and influence.

The Third Ring: To Be Engaged

As you grow older, you will discover that you have two hands, one for helping yourself, the other for helping others”, highlighted by Audrey Hepburn.

After a breakthrough of having Mr P admitting that he did need support from others, he was led to see how he could in turn lend a hand to others.

We ran through the strengths, talents and availability that Mr P possessed and matched them with the volunteering opportunities at SG Cares. Shortly after, Mr P was engaged actively by different charitable organisations for his expertise in marketing management in terms of designing and driving some donation campaigns, action plans etc.

These days, Mr P is living with his mother, and still consistently practising the skills and tools in managing his anxiety, and enthusiastically offering his knowledge and time in assisting others voluntarily. The noteworthy applications of “Self-Engaged”, “Engage Others”, and “To Be Engaged”, of The Three Rings, continue to foster his self-actualisation which he had been looking for!

I cheated on my fears, broke up with my doubts, got engaged to my faith, and now I’m marrying my dreams. Soon I will be holding hands with Destiny. Eddie A. Rios

Note: As this article is mainly catered to general members of the public, the case conceptualisation, intervention formulation, discussion and terminologies used are deliberately simplified and presented for an easy reading, comprehension and relevancy.

This article is written based on Krish Phua's greatest aspiration to be a mind healer, facilitating his clients to cultivate and explore "Inside Mind Insights" for improving their Wellness, Wholeness and Wiseness.

Other articles of Krish Phua:


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