Tag: anxiety

Your mental health contributes to your longevity

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Does your mental health and  emotional health contribute to living a long happy life?

Most of us know some of the elements that contribute to our physical health and potential longevity such as maintaining healthy weight, managing your cholesterol, regular exercise, and preventative checking for cancers.

Emotional health and physical health are closely intertwined in ways that mainstream medicine is starting to recognise. Part of being healthy will require good emotional mental health.

Making positive choices can contribute to greater longevity, and more enjoyment in life. Conversely, some choices, and conditions unfortunately can take time away, and make time harder for us.

In this article we look at those conditions and behaviours that can give us more time, and also take time from us. We don’t control exactly how much time we have on earth, but we can have some power on our time we have, and how enjoyable that time is.

Losing time – conditions that compromise our ability to live long, fruitful lives.

Our emotional health, and threats to our emotional health, can compromise our longevity. Whilst a psychiatric condition such as stress, depression, anxiety, may have developed because of your circumstances, they are not your fault. However dealing with those conditions becomes your responsibility.

Psychiatric disorders

Serious mental illnesses such as psychosis, bipolar disorder, schizophrenia can leave individuals more prone to suicide, and also more likely to being placed in situations where their physical safety may be compromised. Whilst these conditions are usually quite rare, compared to depression and anxiety, illnesses such a bipolar or schizophrenia disorder appear in about 0.5 of most countries populations [3]. In Hong Kong, documentation of these disorders is not current, but reports as recent as 2017, detail that requests for psychiatric services continues to grow from 187,000 requests in 2011-2012 to 220,000 cases in 2015-2016 [2]. And these numbers predate the COVID pandemic.  The COVID pandemic may have exacerbated negative mental health situations for many people in Hong Kong,

The presence of a serious psychiatric disorder adds to the individual, and their family’s’ experience of stress and depression. Additionally, it is difficult to medically treat these conditions so people who are hospitalised may possibly be over medicated, and many of these medications can cause harm to the individual (whilst they are also calming them). Balancing the benefit/cost of psychiatric medications is a complicated situation.

Depression

We use the term “depression” so flippantly we often forget that being depressed for some people is a long term, severe illness which robs them of all enjoyment, and sometimes leads individuals to thoughts of death. Depression affects about 3% of the population of Hong Kong [2].

Unfortunately, around 1000 people choose to take their lives in Hong Kong every year (1) . All of these deaths are tragedies. Its worth noting that, on average, 20% of the suicides in Hong Kong are people over the age of 65 years of age, and about 13% are individuals under 24 years of age. We need to take depression in individuals seriously and provide comprehensive treatment, especially for these more vulnerable populations.

Depression can lead to a fast death, but it can also contribute to a slow death. For individuals with persistent and severe depression some of the aspects of their depressive experience will affect their physical health to the extent that this can influence their physical health and possibly length of life, even in the absence of suicidal ideation or tendencies.

Such behaviours include lethargy, especially long periods, in bed, poor eating habits (both too much and too little) and the impact of poor self-care and hygiene. These are common elements of depression and maintain depression, and have negative impact on blood pressure, metabolism, movement and overall physical health.

People who are persistently depressed need help. The condition of depression is corrosive and controlling over the thought patterns of those trapped in this situation. Some depressed people seem think that they will wake up one day and be motivated to feel better. They are simply waiting for motivation to “kick in”. This is not what happens. Recovery from depression takes work under expert guidance.

Treatment of depression can involve medication, talk therapy, and behavioural interventions. If you  have been feeling any of the following symptoms for more than a few weeks, I urge you to contact a counsellor or GP to discuss treatment options.

Symptoms of depression:

  • Persistent sad, anxious, or “empty” feeling mood
  • Irritability
  • Feelings of hopelessness or pessimism
  • Excessive fatigue
  • Loss of interest or pleasure in hobbies and activities
  • Difficulty sleeping, early morning awakening, or oversleeping
  • Changes in appetite or weight
  • Perpetual feelings of guilt, worthlessness, or helplessness
  • Difficulty focusing, remembering, and inability to make decisions
  • Somatic aches or pains, – headaches, cramps, or digestive problems without a clear physical cause
  • Feeling physically heavy and moving more slowly
  • Thoughts of death or suicide, or even just wishing to not be alive anymore.

Stress

Being stressed is a emotional mental health challenge that may affect your longevity and the quality of enjoyment you experience. Being stressed can place undue stress on your heart. Stressful events can be sudden stressful life events such as seeing an accident or the death of a loved one. Sometimes stress is more chronic, an accumulation and persistence of stressful events such as relationship split up, moving house, and a stressful job. A common assessment of stress, Holmes-Rahe-Stress-inventory [4] can help you check if your experience of stress is at such a level that it is likely that you will start experiencing challenges to your physical health.

Unfortunately, those under excessive stress can doubling impact on their physical health through associated compromising lifestyle choices, such a avoidance of exercise, poor diet, poor sleep and self-medication through pills or substances. All of these behaviours make the experience of stress worse, and also threaten the physical health of a person.


Substance addictions

Alcohol, nicotine, cocaine, stimulates, beta blockers – all of these can be dangerous to our physical health. Introducing dangerous levels of toxins into our bodies on a regular basis, can affect the way our body processes these toxins. Additionally, addiction itself, to behaviours and substances traps us in a cycle of shame that can lead to depression.  Taking a break from alcohol and other addictive substances can be, literally, lifesaving for many people.

Adding time – choices that can extend life, and the enjoyment of it.

Good help.

Individuals can have a propensity to think to muddle through when they are anxious, stressed or depressed. Something about your lifestyle, thinking processes, or stress levels, is quite possibly prohibiting you from seeing stressful situations realistically. An expert, outside of yourself, can help you see that situation in the way that helps you better process what what has happened, and what can be done. Sometimes individuals who feel down, are stressed, or are self-medicating need to vent, sometimes they need to change.

Consider counselling. Ask your counsellor how they see your current life situation and what you, as a team, can do to alter how you have been feeling. If your counsellor can’t answer this question for you, you are completely entitled, even encouraged, to talk to another counsellor. Counsellor – patient chemistry is an important predictor of positive outcomes.

Dial down your reactivity

Some people are like simmering pots of anger. It doesn’t take much for those pots to boil over. Does this describe you?

Emotional health is the consequence of being able to regulate your emotions. Peter Attia in his masterpiece book on longevity, Outlive, writes, “90% of male rage is helplessness masquerading as frustration”. If you are quick to anger, tears or frustration, you may benefit from working on emotional regulation.

Regulating your emotion requires an attention to the triggers, forces and thoughts that drive your reactions to circumstances. In counselling we unpack your reactions to dissect what you really experienced and believed about a situation and explore how the lessons you have learnt from your past, and the fears that you have about your future, intersect at the way you choose to react. If you feel as if your emotions are out of control, or can’t even feel emotions any more, counselling is for you.

Adopt flexible perspectives

We can all get trapped in our thought patterns and many times we do not look at situations as flexibly as we could. Cognitive filters are thinking errors that make us look at situations from certain perspectives. We grow into using cognitive filters as a means to, we believe, efficiently assess situations. However filters can become problematic and can make us less happy.  

For example, we often compare the worst of ourselves to the best of others. When people compare themselves to other people often, they are often misguided in their assessment of both how “lucky/successful” the other person is, as well as a “how unlucky/unsuccessful” we are. When we enter a situation from a rigid black vs white perspectives we tend to think that only one party can be correct, whilst the other must be wrong. Actually, many situations are much more nuanced that we first appreciate and sometimes focusing on you vs someone else means everyone loses.

Change your thinking – change your life.

Read our attached blog to read more about cognitive filters. Change your thinking – change your life.

In order to overcome cognitive filters we need to capture, review and re-frame our perspectives. In therapy we use cognitive flexibility exercises in order to help clients re-frame their experience in ways that helps them become less reactive, and calmer.

Working to develop more flexible thoughts around situations can help you build a different set of responses to situations. The next time you find yourself reacting problematically to a situation consider some of the questions outlined below. These are some of the questions I use when working with clients on their cognitive flexibility.

Embracing age as a gift

Positive age beliefs serve as a barrier against stress. Being accepting or positive about growing older can affect how contented you are as you grow older. Fixating on your age, negative self talk that  you are “over it” of “old and frumpy” will make you feel bad. Think about your self-dialogue as a meal that you consume. If you only feed yourself negative commentary, how can you expect to feel good?

Connect to protect

A million little things – how we build great friendships and protect against loneliness.

The central tenet of Waldinger and Schulz’s 2023 book, The good life: Lessons from the world’s longest scientific study of happiness, is that good relationships, keep us healthier and happier. Good relationships, friendships and romantic relationships, protect us about the impact of negative events in our lives. Negative events are going to happen. No one completely avoids emotional hardships, what gets us through is the quality of our relationships.

Do you have the relationships you want, or infact need in your life? If not, what can you do to build new and better friendships. Our blog on friendships may help you on this matter.

You can take charge of your future. You don’t have to wait for your mood to improve to engage in change. And you can feel differently, exist differently, and live better (and longer)

About the author. Angela Watkins was named Hong Kong’s best therapist. Angela works with adults and teens to help them build better lives – including relationship recovery, building positive self esteem, overcoming depression, quietening anxiety, getting stuff done, and recovery from trauma. To contact Angela for therapy email Angelaw@reddoor.hk

If you want to read more on the topic of longevity consider reading some of these books:

Attia, P (2023). Outlive: The science and art of longevity. Harmony Books. New York

Gratton, L & Scott, A. (2016) The 100-year life: Living and working the in age of longevity. Bloombury. London.

Greger, M. & Stone, G. (2015). How not to die. Flatiron books.

Levy, B. (2022) Breaking the age code: How your beliefs about aging determine how long and well you live. Harper Collins. Sydney.

Ni, M (2006) Secrets of Longevity

Waldinger, R. & Schulz, M. (2023). The good life: Lessons from the world’s longest scientific study of happiness. Simon & Schuster. New York.

Anxiety Attacks – Emergency responses

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Living with anxiety feels as if you are inhabited by a monster constantly whispering about your fears, insecurities and your worthlessness, your inevitable failures and the catastrophes which you can’t avoid and are probably creating. It is estimated that 13-14% of people in Europe [1] live with anxiety. One symptom is anxiety attacks. Some people only realise that they have been suffering from anxiety when they experience such an attack.

An anxiety attack differs from a panic attack. It is usually a response to a stressor – often a thought or feeling or specific dread. People feel apprehensive and full of fear. Their hearts may race and they may feel short of breath. Often people feel out of control and may become extremely tearful. A panic attack may include some of these symptoms, but usually occurs without a clear stressor. Both can be terribly frightening. If you experience anxiety attacks it is important that you are prepared with an emergency response.

Here are my favourite techniques to respond when anxiety attacks.

Try this exercise when you feel anxious.

Breathing exercises – Listen to the pattern of your breath when you are anxious. It can give you a clue as to how best to respond to your anxiety. If you are hyperventilating – taking fast, shallow breaths, feeling faint, and fearing that you can’t catch your breath, try to breath into a paper bag. Breathing in and out using a paper bag will recycle air, returning carbon dioxide to the body, which will naturally make the breath deeper and slower. Do this for a minute. If you don’t feel better, try again for another minute.

If you are not hyperventilating, you can use the calming breath technique. Breathing exercises such as those used in yoga classes are effective in reducing anxiety. One simple exercise I use with clients uses counting inward and outward breaths to calm the mind. Simply breathe slowly in through your nose for a count of 4, then breathe out of your mouth for a count of 4. Repeat. Then breathe in through your nose for a count of 4, and out of your mouth for a count of 6. Repeat. Then breathe in through your nose for a count of 4, then breathe out of your mouth for a count of 8. Repeat. Check to see if you feel better. If you don’t, repeat the exercise again, concentrating on the sensation of your breath.

Distraction exercises. Distraction exercises help your parasympathetic nervous system override an anxious reaction. By simply refocusing your energy to elements of your environment and allowing your underlying operating system to return to homeostatic (ie regular) breathing.

Use your senses to help calm your breathing

The most commonly used therapeutic technique asks the client to engage their senses to distract their busy minds. Identifying a number of items you can see, smell, hear, touch and taste can help you reset your body. Imagine 5 things you can see, then 4 things you can hear, then 3 things you can smell, then 2 things you can touch, and 1 thing you can taste. Then monitor your breathing again. Has it become less panicked?

Since we work with a number of teens and children at RED DOOR we also use the RAINBOW technique, often with our proprietary rainbow fidget toy, to help teens achieve quick calm. One can perform this technique without the fidget toy. Simply you count objects in your near vicinity which are specific colours. You can count the number of objects, or a specified number of objects that are red, orange, yellow, green, blue and black.

Distraction and can also be created with some physical “reset” activities such as repeatedly snapping an elastic band against the wrist or performing sets of 10 jumping jacks.

Meditation/Relaxation – Mediation, when practiced regularly, can help people reach a relaxed state more easily. Practice makes progress when it comes to mediation. If you are experiencing an anxiety attack, try to find somewhere to sit quietly or lie down. Then try progressive relaxation, also known as a body scan, which can be especially helpful. Progressive relaxation soothes as you tense and relax muscles – isolating and focusing exclusively on one group of muscles at a time. Begin with your toes, and work up through your muscles to your head, where you may focus on relaxing the muscles around your chin and eyes.  Guided progressive relaxations are available on Spotify, YouTube, and on CD.

Imagery – In the throes of an anxiety attack use your active imagination to help your de-stress. First, isolate the location within your body where you feel the greatest sensation of anxiety. Use imagery to help unwind and relax that spot. Cute, warm, and amusing imagery will be of the greatest help. If you feel tension in your shoulders imagine a collective of kittens massaging the knots away. If you feel butterflies in your stomach – imagine yourself in your stomach with them, asking each to settle on your arms and flutter no more. One client recently expressed her fear of butterflies, so, using imagery, we collected the butterflies and they turned into Golden Retriever puppies, ready for a cuddle.

This mantra might help with your negative self-concept

Mantras – Anxiety attacks are created by dreadful thoughts running through your mind. One way to settle these thoughts is to repeat a mantra. While there are mantras on the internet, you may benefit from one that you write specifically for yourself. The mantra should be full of words of kindness, understanding and love. The words “should” or “must” cannot be part of any mantra.

Centre yourself with art therapy techniques

While avoidance is not a long-term technique for managing anxiety, if you are ruminating or feeling a panic attack, distracting yourself with a change of scene or activity can help. Go for a walk, particularly in nature, to reset yourself. Try colouring, which I have detailed in a previous blog [https://reddoorhongkong.wordpress.com/2017/03/06/reasons-to-colour/ ], which involves both sides of the brain, stimulates creativity, and can help to calm the mind.   Even listening to some upbeat tunes at this time, get up and dance, just break the pattern of your anxiety for a moment to reset your emotional clock.

Talk to your anxiety – The long-term cognitive approach to anxiety is to create an internal dispute. Disputing your anxiety helps you reframe situations, see hope, and utilise self-compassion. If you experience anxiety ask yourself to challenge your view of the stressful situation – have you been overgeneralising, personalising, or catastrophizing? Is there an alternative way of looking at this issue? Sarah Wilson[2] , in her compendium of suggestions to utilise in one’s challenge with anxiety suggests an ancient adage, “ First make the beast beautiful”, meaning accept that your anxiety – it is something that originally may have been created to help you, but overtime has started to inappropriately misfire. When you make the anxiety beast beautiful you may say to yourself, “Thank you brain for alerting me to potential danger, but I know I am safe right now, you can go back to your guarding post”.  Developing the process of dispute is an area of action where a therapist can be of significant help. If you cannot create this dispute for yourself, utilise the resources of a counsellor. For more information see our post on this topic https://reddoorhongkong.wordpress.com/2020/09/07/talk-to-your-anxiety/

Prolonged anxiety is extremely challenging to your health. If you have been struggling with anxiety for a while please seek the help of a counsellor or a doctor. They may recommend a combination of therapy and even medication to help lessen your anxiety. There is no shame in needing help. Take charge of your future.

Everyday is a new day for you to thrive. Start gently, start now.

 #mentalhealth #mantra #mindfulness #anxiety #reddoorcounselling #selfhelp #anxietyattack #treatmentanxiety #women

Sources

1: Prevalence –

2004: The ESEMeD/MHEDEA 2000 Investigators,2004, Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

2011: https://www.theguardian.com/society/2011/sep/05/third-europeans-mental-disorder

2: Sarah Wilson, 2018, First we make the beast beautiful: A new journal through anxiety. Dey Street Books

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Angela Watkins is a psychologist and counsellor at RED DOOR Counselling in Hong Kong. Her current clinical work focuses on parenting. relationships, anxiety, OCD, career change, stress management and divorce.

Your mental health matters – protecting your mental health in a world experiencing a mental health crisis.

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Hong Kong’s mental health crisis has escalated dramatically since the COVID-19 pandemic, but alarmingly, troubling trends were already in motion. The World Health Organization now estimates over 1 billion people worldwide battle mental health conditions requiring support, underscoring an urgent global concern (WHO, 2025).

Locally, data from the Hong Kong Jockey Club Centre for Suicide Research and Prevention at the University of Hong Kong reveals a grim reality: suicide rates in Hong Kong have surged more than 22% since 2011, with suicide tragically the leading cause of death among those aged 15 to 24. A startling 1 in 4 youths in this age group face mental health challenges, with academic pressure topping their stressors, followed closely by work demands. Nearly 20% experienced suicidal thoughts within the past year (HKFP, 2023).

The workforce is also under immense psychological strain. An overwhelming 87% of Hong Kong employees report feeling stressed, with one in five describing this stress as unmanageable (Cigna 360 Hong Kong Well-being Survey, 2025). Work-related pressures, uncertain futures, and social isolation are key contributors, especially among young professionals and Gen Z, the most affected demographic facing elevated anxiety, depression, and burnout.

Mental health is far more than the absence of illness. The WHO defines it as a dynamic state of emotional, psychological, and social well-being that enables people to cope with everyday stresses and thrive. It exists on a continuum, shaped not only by challenges like job loss or divorce but also by positive transitions such as marriage.

Recognizing warning signs early is critical:

Physical symptoms like racing heart, fatigue, muscle pain, or sleep disturbances often signal unmanaged stress activating the body’s fight-or-flight response.

Emotionally, mood swings, irritability, persistent sadness, and feelings of hopelessness warn of deeper struggles.

Cognitive red flags include overthinking, poor concentration, and decision-making difficulties.

Socially, withdrawal, loneliness, and changes in interaction patterns indicate potential burnout.

The urgent takeaway: mental health demands deliberate, daily care. It’s essential to check in regularly with oneself—acknowledging feelings, understanding limits, and crafting protective strategies. Self-care isn’t indulgent; it’s vital. Simple habits like scheduling downtime, practicing mindfulness, engaging in positive self-talk, and nurturing sleep can fortify resilience.

Stress management is equally crucial—setting boundaries, saying no, breaking tasks into manageable chunks, and celebrating small victories help keep stress from becoming overwhelming. Lifestyle choices matter too: regular exercise, outdoor time, nutrition, hydration, and conscious digital detoxes bolster mental resilience.

Lastly, nobody should suffer in silence. Seeking support from trusted friends, family, support groups, and mental health professionals is a sign of strength, not weakness. Talking about struggles makes them more manageable—a truth captured by the saying, “What is shareable is bearable.”

Hong Kong’s mental health landscape not beyond hope. With awareness, proactive care, and compassion—for oneself and others—individuals can move from merely surviving to truly thriving in these challenging times.

The counsellors at Red Door are here to support you if you are not sure who to turn to or would value objective and unbiased guidance. Alternatively, below are a selection of resources and hotlines in Hong Kong to support you in starting a conversation. Please share this and help to raise visibility so that this information can reach more people.

Affordable, Compassionate Counselling with Trainee Counsellors at RED DOOR

Alcoholics Anonymous Hong Kong

https://www.aa-hk.org/

9073 6922

Emotional Support Hotline – The Samaritan Befrienders

2389 2223 – Mon-Fri 6.30-10pm (English)

2389 2222 – 24 hours (Cantonese)

Suicide Prevention Hotline – The Samaritans

2896 0000 – 24 hours (Multilingual support)

#worldmentalhealthday #mentalhealthawareness #mentalhealthsupport #mentalhealth #wellbeing #selfcare #stressmanagement #anxietyrelief #breakthestigma

About the author.

Contact the RED DOOR reception to set up an appointment with Tanya. reception@reddoor.hk

References

Cigna. (2023, November). 2022 Cigna 360 Global Well-Being Survey [Press release]. https://www.cigna.com.hk/iwov-resources/docs/en/about-cigna/news/2022-Cigna-360-Global-Well-Being-Survey-Reveals-9-in-10-in-Hong-Kong-are-Stressed-and-Burnt-Out-EN.pdf

Mok, L. (2023, May 12). Up to 25% of young Hongkongers have suffered from mental health disorders, HKU research reveals. Hong Kong Free Press. https://hongkongfp.com/2023/05/12/up-to-25-of-young-hongkongers-suffered-from-mental-disorders-hku-research-reveals/#:~:text=inHong%20Kong-,Up%20to%2025%25%20of%20young%20Hongkongers%20have%20suffered%20from%20mental,stress%20from%202019%20to%202022.

The Samaritan Befrienders Hong Kong. (2023). The Samaritan Befrienders Hong Kong 2022 annual report: Empowering the inner-self. https://sbhk.org.hk/wp-content/uploads/2023/07/2022-Annual-Report-2.pdf

World Health Organization. (2022). COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide