There are many different types of psychotherapy. Some of these approaches, such as CBT, IPT, and psychodynamic therapy, have amassed substantial evidence for the efficacy of these approaches in the treatment of specific disorders. Most of these studies, unfortunately, have been conducted on individuals who are mostly displaying symptoms associated with a specific psychological disorder. Participants in these studies are selected based on strict inclusion-exclusion criteria (i.e., criteria about who gets into the study).

The reality is that many clients seeking services do not present with just one discernible disorder. In fact, some will have co-occurring psychological disorders (i.e., different types of psychological issues, such as depression, social anxiety, generalized anxiety, personality traits); while others will have multiple additional issues to contend with, including different types of relational, existential and meaning issues, grief and interpersonal problems that wreak havoc and create complexity in their work and personal lives. It’s vital that your clinician has familiarity with more than one treatment approach to be able to address your specific issues; otherwise, treatment will be limited to the practitioner’s preferred modality. For example, if you go to someone who only knows CBT, you are going to run into difficulties if you are needing to explore and grow by addressing complex emotional experiences (i.e., grief, defensive and more primary emotional experiences and needs), or want to understand the origins of your issues and work through a family of origin or relational matters (e.g., complex childhood trauma and attachment-oriented issues), self-esteem deficits and issues, or wanting to deal with complex existential issues of meaning and purpose. There is a wealth of knowledge from other treatment modalities for these particular areas of inquiry.

Clinicians at CFIR can provide you with first-line treatment options in addressing your concerns. Clinicians at CFIR are able to work with you at the level of symptom reduction by using a wide range of CBT approaches to learn new skills to alleviate your distress, while also delving deeper into the origins of this distress—either through accessing and exploring deeper feelings and emotions associated with your distress, or working through earlier painful experiences related to your childhood and adolescence. Delving deeper into the origins of your symptoms involves using more experiential and psychodynamic treatment approaches. For example, psychodynamic approaches help you to gain insight into how you have become a person who is anxious or depressed in the way that you are. The approach considers your unique experience in the world by exploring how earlier experiences may have affected how you think, feel, react, act, behave, and relate to your self and others in the world. Your relationship with your therapist becomes a vehicle of change in this approach. Ultimately, this awareness and your relationship to your therapist empowers you to make significant changes by looking at your current sense of self and relationships. With support from your clinician, the learning and insights gained in integrative therapy can become the springboard of new action in the world using behavioural strategies. 

Integrative therapists at CFIR typically have you undergo an assessment to understand your issues’ earlier origins while working with you in the ‘here and now’ to reduce your distress and resolve your difficulties. Our therapists are also well-versed in multiple modalities to support you through a wide range of issues, including self-esteem, grief, existential and relational issues. We are also a one-stop setting for all of your psychological service needs with over 25 treatment services and 17 assessment services.

Dr. Dino Zuccarini, C.Psych. is a clinical psychologist, and the Co-Founder and Executive Director of the Centre for Interpersonal Relationships (CFIR). He has published book chapters and peer-reviewed journal articles on the subject of attachment, attachment injuries in couples, and attachment and sexuality. He has taught courses at the University of Ottawa in Interpersonal Relationships, Family Psychology, and Human Sexual Behaviour. He has a thriving clinical practice in which he treats individuals suffering from complex attachment-related trauma, difficult family of origin issues that have affected self and relationship development, depression and anxiety, personality disorders, sex and sexuality-related issues, and couple relationships. At CFIR, he also supports the professional development of counsellors, psychotherapists, and supervised practice psychologists by providing clinical supervision.

CFIR’s co-founder, Dr. Dino Zuccarini, C.Psych. and CFIR Associate, Natalie Charron, M.A., Psy.D. (Candidate), R.P. are set to facilitate Community Clinical Supervision for Adults & Couples. Topics will include:

1st Part – 1 hour (Facilitated by Dr. Dino Zuccarini, C.Psych.)

Looking to deepen your understanding of psychodynamic and experiential approaches and their use for your clients? Trying to figure out how to integrate cognitive, behavioural, experiential, and relational interventions in your work? Using an integrative approach, Dr. Dino Zuccarini, C.Psych. will support you to formulate a case conceptualization for your clients, and guide you in treatment planning and interventions. CBT, EFT, and psychodynamic/psychoanalytic conceptualizations will be provided for individual and couple therapy in the treatment of depression, anxiety, personality, and sexual disorders. He offers a framework on how to integrate treatments based on the client’s current level of functioning and the in-session relational space.

2nd Part – 1 hour (Facilitated by Natalie Charron, M.A. Psy.D. (Candidate), R.P.)

Need a space to process your experiences as a therapist? Want to learn more about retaining clients? Interested in learning how to use the moment-to-moment processes you observe in-session and to intervene in deeper ways with your clients? Using an integrative approach, Natalie Charron, M.A. Psy.D. (Candidate), R.P. provides a safe space for clinicians of all backgrounds to learn how to systematically analyze the countertransference and transference processes in the therapeutic context. She also proposes how to use this understanding of process to inform and generate more profound interventions with clients. In this group you will learn how to observe yourself, your clients and the relationship you are creating together to improve your guidance along their path of healing.

Supervision Format and Requirements

• Supervision will be held once per month for two (2) hours and consist of two (2) parts.
• A supervision contract will be required to be a member of a supervision group.

For Further Information Contact: ZuccariniCharronSupervision@cfir.ca

Meet the Clinical Supervisors:

Dr. Dino Zuccarini, C.Psych.

Dr. Zuccarini, C.Psych. is a clinical psychologist and co-founder of the Centre for Interpersonal Relationships (CFIR). CFIR was established a decade ago to provide clinicians with an interest in integrative therapy a space to creatively explore the integration of psychotherapy systems. He has published peer-reviewed journal articles and book chapters on the topics of attachment injuries in couples, attachment and sex, LGBTQ couples therapies, and the integration of EFT and sex therapy. His practice focuses on the treatment of trauma, personality disorders, sex therapy and couple therapy, as well as depression and anxiety. He has been trained in various psychotherapy systems, including EFT, CBT and psychodynamic therapy.  He is currently investigating the relationship between psychoanalytic constructs and DSM-5 disorders to understand the deeper developmental underpinnings of disorders.

Natalie Charron, M.A., Psy.D (Candidate), R.P.

Ms. Charron has been a registered psychotherapist since 2014, and an Associate at CFIR since 2015.  She is currently completing a Doctorate in Clinical psychology and specialized in trauma, complex trauma and personality disorders. She has been trained as an integrative practitioner and combines psychodynamic with Mindfulness based CBT, interpersonal, and experiential models in her work as a clinician. She has conducted research on various topics including Narcissistic Pathology and published in peer reviewed journals on topics related to, identity, LGBTQ and spirituality. She is currently completing her Doctoral research on complex trauma and post-traumatic growth in childhood sexual abuse.

“I just need to get over it and not let it bother me” or “I don’t think talking about this will help” are responses I often hear in my clinical work. Such reactions are often from men who have, or are currently experiencing emotional and psychological hardships. Challenges can range from concerns such as work-related stress, relational difficulties, trauma, anxiety, and depression. Another source of mental health stress for men (often less noticeable) is trying to maintain societal expectations and stereotypes of what it means to be masculine. Such harmful stereotypes often depict men as never being vulnerable, not acting or behaving in emotional ways, and solving their problems independently. This perspective can often begin in childhood when children are told “boys don’t cry,” and the ongoing societal pressure for men to remain ‘strong’ and not admit they are struggling.

Due to such beliefs and ideas, men are much less likely to seek support or treatment. This reasoning may help explain why men have lower rates of diagnosed depression; however, suicide rates are three to four times higher in men compared to women. Knowing this, how do we help men reach out for support?

Firstly, we need to be aware of the signs of mental health difficulties. Men and women may experience the same mental health conditions at various times, although men might show different signs and symptoms. Rather than seeking treatment for a specific condition such as depression, men are more likely to engage in maladaptive coping behaviours including turning to alcohol or drug use. Depression in men can also be characterized through anger and irritability in addition to expressions of sadness. Knowing how men might show signs of mental illness and the associated risk factors is required to seek or encourage support.

Secondly, it is crucial to be aware of the harmful stereotypes associated with the idea of masculinity, which serves as a barrier for men in seeking help. As human beings of all genders, we experience emotions, which at times might be complex and challenging to organize and make sense of on our own. Expressing emotion or vulnerability does not equate to weakness. As humans, we are a social species, and we thrive collectively. Discussing our difficulties with others and having a support system help to provide a sense of relief and understanding.

Lastly, it is essential to remember that you are not alone. If you are struggling emotionally yourself or are concerned about someone, know that you are not alone in experiencing such difficulties, and you do not bear the load in silence. Whether its offering support to someone by listening, talking to a family member or friend, or reaching out to a therapist who you can build a non-judgemental and trustworthy relationship with, knowing you are not alone is a vital step in finding support.

Edgar Prudco is a therapist at the Centre for Interpersonal Relationships (Toronto) and works under the supervision of Meg Aston-Lebold. Edgar is completing his Masters degree in Clinical Psychology at the Adler Graduate Professional School. He supports individual adults and couples to deal with difficulties related to emotion (e.g., depression, anxiety, anger), the effects of trauma, loss & grief, conflict resolution, and relationship functioning.

As the possibility of business and recreation gradually reopening becomes more of an imminent reality, many of us will face the opportunity to step out into the outside world again, into closer contact with other live (not-virtual) human beings, for the first time in months. 

Despite many social media narratives that celebrate this possibility, the actual emotions we might face as such opportunities become realities might be a lot more complex than that.

When COVID-19 initially hit, we fell suddenly and unexpectedly into a full-blown crisis. As with any onset of crisis, it is common and even likely to feel emotions like anxiety, worry, panic, overwhelm, and fear.

And as long as we continue to live in this crisis, especially as food, work & income, and housing remain uncertain for so many, we can expect these emotions of anxiety, worry, panic, overwhelm and fear to stay present. 

Everything inside of us is mobilizing—body and mind—to meet these threats that we face, and to survive them. 

Now that we are a couple of months into the pandemic, I am seeing some clients in my psychotherapy practice who are beginning to enter into the next phase of emotions. Since we’ve now had some time to start absorbing a bit of the new reality, and certainly, as we anticipate returning to work, the main emotions we are feeling are expected to shift. Increasingly, I anticipate seeing more people with emotions like depression, chronic boredom & under-stimulation, frustration, hopelessness, helplessness, and despair.

As we continue to take in more of what we have been experiencing, we are going to feel more of the weight of it all, and at times that weight is likely to feel quite heavy. 

So, what can you do to support yourself through these current and upcoming emotional experiences? For me and the way that I practice psychotherapy, the answer comes back to ‘connection.’ 

Firstly, it is essential to maintain—or build—connection to yourself. Once or twice per day, for 15 or 30 or 60 seconds at a time, stop and check-in with yourself. Notice what is happening in your thoughts and feelings, and even in your body. Notice your breath, notice your bodily sensations, and check in on them at various moments and throughout the following days because they are likely to fluctuate. 

Self-monitoring, in this manner, can help you to feel grounded in yourself and your experiences. It can also help you to identify when you need help—and this leads to a second point: we also need to be maintaining connection to others. 

If you find yourself struggling or feeling unwell, try to reach out. Of course, you can always reach out to a psychotherapist, and you can also reach out to a close friend or family member who might intently listen to you, or else might help you problem solve, depending on what you need. 

You can also try going for a walk to give your thoughts some space, or write them out, or even audio record them for yourself. In any of these cases, reaching beyond yourself to outwardly express what you are thinking and feeling can help you release some emotional burden, and so can help you to feel a little better. 

Secondly, as you are reaching out to others, do not forget that you can probably assist others, too; there can be a mutual exchange of support. Sometimes all someone might want is to be heard, and even in times when we feel we have nothing left to give, just existing next to someone alongside their experiences can bring great relief. The relief is mutual, as we benefit from a dose of feel-good chemicals in the brain when we connect with and help others. 

One final thought on emotions in this next stage of the pandemic: sometimes we can forget that it is absolutely possible to feel many different things, including stress and hopelessness, and even gratitude, or any other mix of emotions, all at the same time. These feelings can co-exist together.

If we can hold on to this thought, maybe we can make even just a tiny bit more space for the feelings of connection and groundedness. 

Take good care.

Reesa Packard, M.A., Ph.D., R.P. is an Associate and registered psychotherapist at CFIR (Ottawa). She has a doctoral degree from the Saint Paul School of Psychotherapy & Spirituality and works in private practice as a registered psychotherapist. She works with clients hoping to develop a more integrated sense of self as a means to well-being and meaningful, lasting transformation. Reesa is also involved in the teaching and supervision of psychotherapists-in-training and advanced knowledge through research in her specialty fields.

It’s been a strange time. There are daily news updates regarding the current pandemic; still, it’s uncertain how long we’ll be required to stay home. Some of us have found this period at home to be calming, while others have found it to be monotonous. The change of pace has left us with time to spend with (and learn more about) our selves. Here are a few things you may wish to explore:

Do Things You Enjoy: When life gets busy, we may start to neglect aspects of ourselves to make time for things that seem even more essential. During this time, allow yourself to reconnect with the things that bring you joy (e.g., art, music, writing, etc.). Reignite those passions and take note of how they affect your wellbeing. 

Unplug: The ongoing dissemination of news can become overwhelming. It is okay to allow yourself a chance to step away and take a breath. Instead of tending to something that may exacerbate feelings of anxiety and being out of control, shift your focus to what can be controlled-you. Do the things that bring you peace of mind (e.g., yoga, reading, cooking, etc.) 

Reminisce: It’s not uncommon to want to press ‘pause’ sometimes during fast-paced times. If you have some extra time now, reconnect with who you are, and how far you’ve come, whether it’s looking at old pictures or looking at mementos; allow yourself to look back on special memories. Reconnect with the forgotten parts of yourself and reflect on how they affect your wellbeing. If distressing feelings or thoughts arise, it may be an indication for you to reach out for support.

Re-Evaluate: With the opportunity to disconnect from ‘auto-piloting’ through life, we may start to evaluate our thoughts and feelings concerning our experiences in the present. Allow yourself to acknowledge this information. Sometimes, we may need to re-evaluate what is working and what is not working in our lives and how it’s affecting our wellbeing.

Social isolation can be a confusing and anxiety-provoking state to be in, but it may also teach you a lot about yourself. Taking the time to reflect on who we are, how far we’ve come, and where we would like to head in life can be a compelling experience. Therapists at Centre for Interpersonal Relationships can help you process different aspects of your identity during this time. We are currently offering virtual sessions that you can connect to from the safety and comfort of your home. Click here to learn more. 

Nereah Felix, B.A. is a registered psychotherapist (Qualifying) at Centre for Interpersonal Relationships (CFIR) in Ottawa and is under the supervision of Dr. Dino Zuccarini, C.Psych and Dr. Natalina Salmaso, C. Psych. The clients who come to see her are provided with an authentic, non-judgmental, safe, and supportive environment to share their experiences and improve their wellbeing. Nereah is currently enrolled in the Master of Arts in Counselling Psychology at the University of Ottawa.

Coping with acute stress

Note: The sympathetic nervous system is the part of the nervous system that is responsible for activating the fight or flight response (i.e., acute stress response) and preparing the body for the necessary activity to protect itself from actual or perceived danger. The parasympathetic nervous system is the part of the nervous system that is responsible for recuperation and is important in feeling safe and calm.

There are many strategies we can learn and strengthen to help us tolerate and reduce the intensity of acute distress. It is important to note that we do not want to make the emotion “go away” as this will likely initiate less adaptive coping strategies, such as repression, denial, avoidance, and escape distraction. When coping with a distressing emotion, I encourage people to learn to tolerate some level of that emotion (i.e., within a “window of tolerance”), while also engaging in and using strategies to help reduce the intensity of that emotion. It is important to keep in mind that learning to tolerate emotion is a valuable skill and through practicing distress/emotional tolerance, we allow the emotion to rise and fall and, ultimately, run its natural course; while tolerating the emotion, we can “listen” to the emotion as it provides valuable information about what might be happening in the environment. Also, it is important to remember that all emotions are temporary. 

The following are a few examples of strategies that can be used to help reduce the intensity of a distressing emotion and bring it to a level that is tolerable; the goal of the following strategies is to help reduce nervous system activation (i.e., sympathetic nervous system) and increase parasympathetic nervous system function:

1. Intense exercise: 3-5 minutes (or more) of intense exercise (i.e., enough to elevate your heart rate) will help to burn off anxious or distressing/unpleasant energy which is pent up and activating the sympathetic nervous system. This will help the body to regulate (allowing for the onset of the parasympathetic nervous system).
2. Recovery-oriented relaxation strategies: there are a variety of activities and strategies that can be used within this domain and I encourage you to think about activities that help you experience a sense of ease and relaxation. Furthermore, encourage you to reflect on experiences that’ll allow your body to experience muscle relaxation to help reduce pent-up muscle tension.

• Progressive muscle relaxation: this strategy uses repetitive tension and release movements in various muscle groups to help reduce muscle construction patterns induce muscle relaxation.

• Diaphragmatic breathing: at any point when we are experiencing an unpleasant or distressing emotion, I encourage people to take stock of their breathing an attempt to slow their breathing down using deep, diaphragmatic breathing techniques. In doing so, feedback loops to our brain provide information and indicate that we are calmer and safer than the brain is interpreting. Deep breathing by itself may not be enough to reduce the intensity of the emotion we are experiencing, especially if the emotion is 8-10/10, with 10 being more intense. I encourage people to include deep breathing while using another strategy.

• The “dive” technique: I use and recommend a modification of this strategy, which includes using a Ziploc bag full of cold water and is placed over the eyes, including the undereye area. There is a nerve that runs underneath the eye that, when cold, activates the parasympathetic nervous system.

• Listen to calming music: Our nervous systems are acutely attuned to sounds from the environment. When we intentionally play music that is calming, we are providing a message to our nervous system that we are safe.

• Use heat to induce muscle relaxation: Acute and chronic stress responses involve muscle tension. Using heat will facilitate muscle tension release and relaxation, in turn, sending information to the brain that you are relaxed and safe.

3. Mindfulness: The regular and intentional practice of mindfulness meditation can help develop our cognitive resources of attention allocation in order to more swiftly let go of distressing thoughts and sensations. As well, mindfulness helps create greater awareness of our bodies and minds (i.e., flow of consciousness). As we expand our intentional practice of mindfulness exercises into our greater daily experience, we allow ourselves to become more present in each moment, letting go of past and future thoughts and feelings, and creating “space” for in-the-moment experiences of cultivating contentment, joy, and ease.

Tip:  Finding it difficult to find time to engage in the above? Or single strategies not as effective as you would like? Try “doubling” or “tripling” up on the above strategies to send multiple signals to the brain that the body is calm/relax and safe. I encourage you to add deep breathing to all activity!  

Coping with chronic stress

There are many ways to cope with acute stress and chronic stress that can be applied at various times in our lives when acute and chronic stressors are present. I often encourage people to first take stock of their “foundations.” 

The Five Pillars to Wellbeing

1. Sleep
2. Nutrition
3. Exercise/Movement
4. Enjoyable activities (that bring you a sense of contentment, joy, and ease)
5. Social connection 

By taking stock of these five “pillars,” we can start to make small, manageable changes to our foundation, which in turn, will provide us with ample physical and mental resources to facilitate our ability to cope with acute and chronic stress. It is important to note that during times of chronic stress, we often experience destabilization related to one or more of the above pillars; as well, when we get “busy,” we often reallocate time away from the above activities, which further perpetuates and exacerbates the impact of the chronic stress/distress. As such, I strongly encourage people to dedicate time (i.e., create “protected time”) each and every day to ensure maintenance of the above pillars.

Coping with Pandemic Stress

1. Use gentle avoidance. Often psychologists help people to limit their use of avoidance as this is often driven by anxiety and leads us to be unable to engage in activities that he might otherwise enjoy. However, in some contexts, such as this pandemic, I encourage people to practice gentle avoidance regarding some aspects of activity and knowledge consumption.

• Limit media consumption: The key here is to find reliable sources of information where you can stay informed about the procedures and guidelines to keep you safe. Additional information beyond this may contribute to and perpetuate anxiety.

• Avoid discussing events: Although it can be helpful at times to discuss the pandemic and associated changes with friends and family, people can get swept into “anxiety spirals,” which worsen the acute/chronic stress impact and can maintain anxiety beyond the conversation. Also, misinformation can be shared, and in the context of high anxiety, it is easier to believe misinformation and become more fearful or paranoid. 

• Keep things in perspective: Speaking with reliable sources can help us keep information in perspective and help to abate and let go of anxiety-driven thoughts/beliefs (e.g., catastrophizing). Remember, if people are bringing up topics of conversation regarding the pandemic that provoke intense feelings of anxiety/distress in you, it is ok to set boundaries and ask the person to not bring up said conversations with you.

2. Stay connected. Remember, we are social creatures and we thrive off of social connection, regardless of our place on the introversion/extroversion scale; the difference here is the frequency and intensity of social connection. Although phone and video connections do not provide the same sense of connection as in-person connection, it is important to stay connected to friends and family. Isolation, especially if living alone, can become very dangerous to our mental wellbeing. Without external sources of support, emotion-driven thoughts/beliefs can take hold and we start to believe them more strongly. 

• Keep things in perspective: Speaking with reliable sources can help us keep information in perspective and help to abate and let go of anxiety-driven thoughts/beliefs (e.g., catastrophizing). Remember, if people are bringing up topics of conversation regarding the pandemic that provoke intense feelings of anxiety/distress in you, it is ok to set boundaries and ask the person to not bring up said conversations with you.

• Use social connection as a source of adaptive distraction: Talk about topics that bring you contentment, joy, and ease! Share information about books/literature, movies/TV shows, and/or other hobbies and enjoyable activities. You may even wish to reminisce by sharing fond memories.

• Remember that life will go on: It is important to acknowledge/validate that the pandemic and associated changes is difficult; however, because we cannot control the pandemic, it is not helpful to wallow or become preoccupied with the difficulty. Remind yourself and your family/friends that life will continue and try to anchor yourself to something hopeful in the future (e.g., a trip, a goal, an activity).

3. Movement/Exercise: Whatever the type of movement, try to incorporate some form of movement on a daily basis, whether it be walking, stretching, or a formal workout routine. Our bodies are meant to move and, as a result of self-isolation protocols, we are not moving as much as we have before. 

If you are having difficulty coping with acute, chronic, or pandemic stress, I encourage you to reach out to a professional (psychologist or psychotherapist) who can assist you in developing and strengthening your coping skill repertoire, as well as address other contributing factors to the maintenance of your symptoms. 

Dr. W. Rylie Moore, C.Psych., is a clinical psychologist & neuropsychologist at CFIR’s Toronto location and he has published academic articles in peer-reviewed journals and book chapters. As a requested presenter at numerous national and international academic conferences, Dr. Moore has spoken on topics related to gender dysphoria, LGBT2QA advocacy, psychological assessment, executive functions (cognitive abilities that could be described as the CEO of the brain), stuttering, and bilingualism. In his therapy practice, he works with clients to understand what is happening for them in its larger context, including past experiences and their social world. 

Reesa Packard, R.P., Ph.D. (Associate at CFIR – Ottawa) was on the airwaves with 1310News’ Sam Laprade! The two shared an engaging discussion about managing mental health throughout the pandemic and beyond. This conversation is one you don’t want want to miss.

To learn more about how clinicians at CFIR can help you online or by phone, go to www.cfir.ca

The COVID-19 pandemic has had, and continues to have, a significant impact on us as individuals and as a society, on a worldwide scale. There have been significant changes to our daily experiences in the context of lockdowns, self-isolation, and physical distancing. As humans, we are inherently social creatures, and in the context of this pandemic, we have lost access to the typical ways in which we meet our social needs. This pandemic has significantly changed our lives and can cause (variable and/or persistent) acute stress and chronic stress responses.

The pandemic as an “acute stress”

Initially, the onset of the pandemic can be considered to be an acute stress in terms of the way it impacted us and our ability to cope; regarding the impact on ourselves and our nervous systems, an acute stress response is one that activates the sympathetic nervous system or “fight or flight response.” This response is often referred to as “anxiety,” which can be more episodic in nature as our nervous system responds to a threat the environment and then we subsequently seek safety and can return to a state of ease. As such, the anxiety system is meant to switch on and off as a response to immediate threats in the environment. 

In regard to the pandemic, especially the initial onset, we perceive the presence of immediate danger and our nervous systems respond as if there is an immediate stress or risk of danger. In many ways, the pandemic provides a legitimate increased risk of danger in relation to the risk of infection and the consequences of that infection. As such, when responding to an acute stressor, our nervous systems respond with hypervigilance (i.e., scanning the environment for danger), muscle tension (in order to spring the action), worry/preoccupation (as a way to analyze the environment in hopes to keep us safe), as well as other sympathetic nervous system responses, such as increased heart rate and changes in breathing rate.

The pandemic as a “chronic stress”

In the wake of a prolonged period of an acute stress reaction, a stressor can become chronic. There are many stressors that can become chronic, such as work stress, interpersonal relationship issues, financial strain, and the prolonged fear of infection (i.e., pandemic), to name a few. For the context of this article, I believe there to be a difference between acute stress, referred to above as “anxiety,” and chronic stress, which I refer to as “stress,” but this is a matter of labels and diction.

When a stressor becomes chronic, it impacts the mind and body in a more profound manner as it continues to tax resources in a way that was not intended. During periods of chronic stress, stress hormones are continuously released in the body, perpetuating a fight or flight response. In the face of persistent sympathetic nervous system activation, we experience chronic muscle tension and soreness (e.g., in the shoulders, neck, jaw), disrupted sleep patterns, disrupted eating habits, significant fatigue or lack of energy, decline in cognitive function (e.g., poor attention/concentration), increased irritability, becoming easily overwhelmed, and feeling depressed. Other indicators of chronic stress include G.I. distress/digestive issues, chronic pain, headaches, poor immune system function (e.g., frequent infections/colds), and decreased libido. Over time, we begin to lose the capacity to engage more effectively in other parts of our life (that we previously enjoyed) as the chronic stressor takes up most, or all, of our physical and mental resources. Our lives become narrow in terms of activities where we confront/face the chronic stressor and resort to recovery actions; without awareness of our coping repertoire and the short and long term impacts of these actions, we often engage in “maladaptive” coping strategies that provide immediate relief of the stress response, such as escaping/disconnecting (e.g., excessive sleep, excessive use of TV or video games, zoning out), numbing (e.g., substance use, less health food habits and choices), and avoidance (i.e., not engaging in activities that provoke any level of distress). As maladpative coping of the chronic stressor persists, our lives may become more and more limited.

An interesting phenomenon that appears to be occurring during the pandemic is that many individuals report experiencing, sometimes extreme, fluctuations in their well-being, functioning, and emotion regulation/mood. People report this experience as functioning “ok” and being able to meet the demands have their daily life and some of the additional goals they may set for themselves for a few days, and sometimes without notice, the same person might report a significant reduction in their ability to meet these demands for a few days. During these “down days,” the person will likely experience the above-mentioned symptoms a facing a chronic stressor. Following a period of these down days, the person will return to an “ok” level of functioning -and the cycle continues, perhaps with longer periods of down days as the pandemic chronic stress endures.

Chronic stress – an analogy regarding coping

When speaking with clients about the impact of chronic stress, I like to use the analogy of a bucket, which I refer to as “the coping bucket.” When stressors appear in our life, as they do on a daily basis to varying degrees, it is as if liquid is filling our bucket; the larger the stressor, the greater the flow and quantity of the liquid. Once the liquid reaches the top of the bucket (i.e., our upper threshold for our ability to cope with the stress), we start to experience more severe symptoms, such as “breakdowns,” feeling overwhelmed, anger outbursts, emotional dysregulation, etc. 

In order for us to regulate the amount of liquid in the bucket, we need to find ways to release liquid from the bucket, and in the context of this analogy, I imagine spouts at the bottom of the bucket that can pour liquid out; these spouts are our adaptive coping (i.e., helpful) strategies. Similar to the flow speed and quantity of liquid entering the bucket, the spouts differ in terms of how quickly and how much stress they release. For example, in the context of the pandemic, the spouts that previously released greater amounts of liquid likely release less liquid currently because we strategy has been modified to fit within pandemic guidelines. A prime example of this is the way in which we connect socially during the pandemic; many people remark that there is something “different” about connecting virtually rather than connecting in person and that it does not meet our need for connection to the same degree as before.

It is important to note that, at certain points in our lives (depending on the surrounding context of our life), what may have been an adaptive and helpful coping strategy might actually become a source of stress and “add” to the bucket. Part of developing our ability to cope with the variable stressors of life is to pay attention to what our mind and body needsin a given moment and what will best serve the purpose of reducing the liquid (i.e., stress) from the bucket. For example, exercise is generally an adaptive coping strategy to burn off distressed energy; however, when we are feeling rundown and significantly fatigued, exercise may exacerbate this and push us closer to burnout.

If you are having difficulty coping with acute, chronic, or pandemic stress, I encourage you to reach out to a professional (psychologist or psychotherapist) who can assist you in developing and strengthening your coping skill repertoire, as well as address other contributing factors to the maintenance of your symptoms.

Dr. W. Rylie Moore, C.Psych., is a clinical psychologist & neuropsychologist at CFIR’s Toronto location and he has published academic articles in peer-reviewed journals and book chapters. As a requested presenter at numerous national and international academic conferences, Dr. Moore has spoken on topics related to gender dysphoria, LGBT2QA advocacy, psychological assessment, executive functions (cognitive abilities that could be described as the CEO of the brain), stuttering, and bilingualism. In his therapy practice, he works with clients to understand what is happening for them in its larger context, including past experiences and their social world. 

More and more, organizations are adapting their work modalities and environments, and therefore changing their employees’ experiences. Telework is increasingly encouraged in the current workplace, mainly to facilitate a better work-life balance for workers and optimize their levels of productivity. However, the working-from-home scenario of the past is much different than our new pandemic reality, where full-time telework is imposed. 

Various factors can complicate working from home. These factors may include dealing with more distractions, having to care for kids (or other members of the family), technological issues, feeling disconnected from a team, or not having access to specific resources we usually have in the workplace. For many individuals, these factors add up to one significant challenge: finding and maintaining a sustainable balance between their work and personal life. Here are a few tips that can help set a healthy integration of your work and personal spheres:

• Create a designated workspace: If you have the space in your home, organizing a work station that allows you to have all the tools you need to do your work, is ergonomically friendly, and is not too close to main distractions is worth it. It can be as simple as reorganizing furniture or adding a separating curtain around your desk.
• Establish a flexible routine: Maintaining your typical routine might work best for you. If you are used to getting up, showering, eating breakfast, and walking to work, why not do the same steps before starting your workday at home? Keeping up with your usual routine will also ease the transition of returning to your workplace. However, if you find your regular routine does not match with your new reality at home, being flexible and creative with your schedule could help you find a work-life balance that fits better for you. For example, you may want to adjust your work hours to moments of the day when you feel most productive, or less likely to be distracted by familial obligations. 
• Connect with colleagues: One of the positive benefits of being physically at work is connecting with colleagues in-person, celebrating successes together, and finding social support. Maintaining regular contact with your team is not only helpful for your work but can also be a great morale booster.
• Keep house chores for after work hours: You don’t need to take care of your to-do list at all times because you are at home all day. If you get overwhelmed with everything that you need to do with work and home responsibilities, separating the two can be very helpful.
• Take breaks: Personal and social breaks are essential, even when you are at home. Although many teleworkers usually would make time for a break while at the office, they won’t allow time to have one during work-at-home hours. Taking a walk, doing some stretches, calling a friend, eating lunch outside, or taking a coffee break will help to maintain focus and productivity, and a general sense of well-being.
• Avoid working after work hours: You don’t need to work more because you’re working from home. Maintaining clear boundaries with your work will help you to find a better balance.
• Communicate your needs to other members in your home: Signaling your needs and limits to other individuals living with you will help to maintain your work-life balance. It is ok to express your requirements – this will also allow others to respect your boundaries and express their own. 
• Adjust expectations: It’s important to remember to adjust our self-imposed pressures and expectations. Given the current global climate, it may very well be impossible to be as productive as you wish you could be, and it is reasonable to experience lower motivation and higher levels of stress. Be kind to yourself, as your self-judgment is probably hurting more than it is helping. 

Full-time telework certainly has its perks, but maintaining a satisfying work-life balance can be demanding as well. If this new reality continues to be challenging and causing emotional distress, don’t hesitate to reach out for support. Clinicians at CFIR are here to help you identify strategies that will improve your day-to-day work and life routine, and better manage the difficulties you are experiencing. 

Dr. Karine Côté, D.Psy., C.Psych. is a psychologist at the Centre for Interpersonal Relationships (CFIR). Dr. Côté provides psychological services to individual adults and couples experiencing a wide range of psychological and relationship difficulties related to mood and anxiety disorders, trauma, eating disorders, sleep disruptions, and interpersonal betrayal. She works from a humanistic approach and integrates therapeutic techniques from gestalt and object relations psychotherapies, emotion-focused therapy (EFT), and cognitive-behavioral therapy (CBT).

2020 has been far from the easiest year so far. The global pandemic imposed quarantine and social distancing, loneliness, loss of job and financial security, complexified family-work balance, increased levels of stress and mood fluctuations, winter weather in late April…

Meanwhile, our regular life stressors continue to persist. We may be dealing with illness, grief, conflicts, separation, or difficult life transitions. It can be quite challenging to hold all of this at the same time or to maintain our usual upbeat attitude and optimism.

These kinds of considerations often contribute to our negative thought cycles, where everything seems unmanageable, our cynical world views are confirmed, and we experience feelings of despair and frustration. Below are a few ways to soothe those negative loops and help regulate the underlying vulnerable emotions:

• Turn up the volume of our self-compassionate voice: Judging ourselves for not feeling well or not being our usual self is only aggravating our negative thought cycles. Instead, let’s be more validating regarding our feelings, needs, and limits, and remember that what we are feeling is normal and is a shared human experience.
• Limit exposure to news and social media: Being informed of the evolution of the pandemic, its impacts, and social measures recommended by our governments is important. However, a continual barrage of negative news and information has its toll on our mental state. I recommend allocating a specific amount of time during the day to read on the pandemic, and then moving on to more enjoyable content. 
• Reframing our thoughts: Being aware of our negative thoughts that contribute to lower mood and heightened anxiety helps to reframe them and identify authentic needs more effectively. “I am cut off from everyone” could be reframed as “I am feeling lonely today, which contributes to my sadness – I may call my friends today to feel more connected.” “This nightmare will never end” could be reframed as, “I am afraid of what is to come, which contributes to my anxiety – I will practice breathing exercises and talk about this with my partner.” 
• Practice self-care: We tend to forget to do what makes us feel good when we need it the most. Let’s put a pause on our daily autopilot routine and perform activities or small gestures to take care of ourselves. 
• Connect with the current positives around us: Even though the present times are very challenging, we continue to be surrounded by positive moments and kind actions. Try to glean hope from the various ways people are working together to mitigate the pandemic. Witness the support given to front-line health workers, and observe how the environment is benefiting from humans slowing down. Notice how strangers are saying hello to each other on the streets, or experience how being at home and connecting with loved ones is reminding us of what’s truly important to us.

We are going through this together, and we are required to take it one day at a time, but sometimes things can feel overwhelming. If the negative thought cycles are too challenging to cope with or are causing significant emotional distress, it is ok to ask for help from our social support system or mental health professionals. CFIR is here to help, and continues to offer teletherapy and reduced-cost services. 

Dr.Karine Côté, D.Psy., C.Psych. is a psychologist at the Centre for Interpersonal Relationships (CFIR). Dr. Côté provides psychological services to individual adults and couples experiencing a wide range of psychological and relationship difficulties related to mood and anxiety disorders, trauma, eating disorders, sleep disruptions, and interpersonal betrayal. She works from a humanistic approach and integrates therapeutic techniques from gestalt and object relations psychotherapies, emotion-focused therapy (EFT), and cognitive-behavioral therapy (CBT).