In this blog series, we will define health psychology, explore the relationship between mental and physical health, and provide tools to help cope with the impacts of chronic illness.

Health psychology is the study of biological, psychological, and socio-environmental processes that impact physical health and illness. The field places great emphasis on examining the bidirectional relationship between mental and physical health. Chronic illness refers to illnesses or conditions that are of long duration and generally slow progression (WHO, 2018). Common chronic illnesses include heart disease, diabetes, cancer, asthma, arthritis, autoimmune disorders, and neuromuscular disorders. Research shows that individuals with chronic illness are more likely to experience mental health issues including anxiety and depression. But did you know the reverse is also true? Individuals with mental illness are more likely to experience chronic illness. Research shows that individuals with anxiety, depression, and trauma experience higher rates of chronic illness. We will discuss the pathways underlying the relationship between mental and physical illness in the second part of this blog series.

Chronic illnesses can impact our lives deeply and can make us feel alone. In health psychology, we support clients throughout their health journey from the onset of symptoms, to advocating for themselves within healthcare, receiving a new diagnosis, coping with physical limitations or loss of independence, navigating impacts on identity and relationships, and adjusting way of life and plans for the future. We also help clients modify health behaviours such as appetite, exercise, alcohol/substance use, and address barriers to treatment that may be contributing to or worsening physical symptoms.

Health psychology providers utilize a biopsychosocial approach, that aims to recognize the biological, psychological, and social factors contributing to or worsening health issues. Treatment approaches may include: Cognitive-Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Mindfulness-based techniques.

If you or a loved one are facing health challenges, please know we are here to support you.

Dr. Megan Dann, C.Psych. (Supervised Practice) is a Clinical and Health Psychologist nearing the end of supervised prac8ce. She is currently supervised by Dr. Lila Hakim, C.Psych. and Dr. Natalina Salmaso, C.Psych. She provides assessment and treatment services for adults and couples. Dr. Megan Dann, C.Psych. (Supervised Practice) utilizes a holistic, biopsychosocial, integrative and trauma-informed approach to help clients with a wide range of issues including: depression, anxiety, trauma, sleep difficulties, alcohol/substance use, chronic illness and pain.

References

Andrasik, F., Goodie, J. L., & Peterson, A. L. (Eds.). (2015). Biopsychosocial assessment in clinical health psychology. The Guilford Press.

Bobo, W. V., Grossardt. B. R., Virani, S., St Sauver, J.L., Boyd, C. M., Rocca, W. A. Association of

Depression and Anxiety with the Accumulation of Chronic Conditions. JAMA Netw Open. 2022 May 2;5(5):e229817. doi: 10.1001/jamanetworkopen.2022.9817. PMID: 35499825; PMCID: PMC9062691.

Herrera, P.A., Campos-Romero, S., Szabo, W., Marenez, P., Guajardo, V., Rojas, G. Understanding the Relationship between Depression and Chronic Diseases Such as Diabetes and Hypertension:

A Grounded Theory Study. Int. J. Environ. Res. Public Health 2021, 18, 12130.

hgps://doi.org/10.3390/ijerph182212130

National Institute of Mental Health. 2024. Understanding the Link between chronic disease and depression. NIH Publica7on No. 24-MH-9018.

hgps://www.nimh.nih.gov/health/publications/chronic–illness–mental–health#part_6118

World Health Organization [WHO]. (2018). World health statistics 2018: monitoring health for the SDGs, sustainable development goals. Geneva, Switzerland: WHO Press. 

Dual Process Model Blog Post

PART 1

Grieving the loss of a loved one can leave us feeling lost, disconcerted and searching for a roadmap through an incredibly difficult time. Many of us may be familiar with the Five Stages of Grief by Elizabeth Kübler-Ross (1973), in which a grieving person moves from denial, to anger, bargaining and depression, finally arriving at acceptance. However, few of us fit neatly into a linear journey. Navigating a world changed by loss takes time, patience, self-compassion and more than a little allowance for things to fall apart and be put back together.

The problem with expecting a linear journey through grief is that we may perceive ourselves as grieving incorrectly or regressing when a good day is followed by a bad day. The Dual Process Model of Coping with Bereavement (DPM) by Margaret Stroebe and Henk Schut (2010) offers a different approach to grief. The DPM suggests that those who are grieving face two major types of stressors: loss-oriented stressors and restoration-oriented stressors. Loss-orientation involves “grief work”, which includes feeling sorrow, anger, and yearning for your loved one, as well as thinking about the loss or the event. Restoration-orientation involves life necessities such as practical day-to-day tasks like working, shopping or cleaning, as well as taking on new roles and responsibilities after the loss, and periods when you might be temporarily distracted from the loss altogether. As we grieve, we move back and forth between loss-oriented and restoration-oriented stressors.

Art therapy can provide support while navigating the complex and non-linear journey of grief. Through creative expression, we can explore complex feelings that may be difficult to verbalize, allowing space to confront and process loss in a safe environment. Art therapy focuses on the process of creative expression rather than the final product, so you do not need to be an artist to benefit from it.

In the second part of this blog, I describe a simple sewing exercise I use to introduce clients to the DPM.

PART 2

In part one of this blog, we were introduced to the Dual Process Model of Coping with Bereavement (DPM) developed by Margaret Stroebe and Henk Schut (2010). This model illustrates how those who are grieving move back and forth between two types of stressors: loss-oriented stressors, which involve processing grief, and restoration-oriented stressors, which focus on present-day life and changing roles. In part two, I will introduce you to an art therapy activity designed to help grieving clients engage with this process. This meditative sewing exercise requires simple stitches made into fabric using just a piece of fabric, some thread, and a sewing needle of any size. In this exercise, the rise of the needle represents moments spent confronting restoration-oriented stressors, while the fall of the needle symbolizes the time dedicated to facing loss-oriented stressors.

I ask my client to make their first stitch and, if it is comfortable, to match their breath with the rise and fall of the needle. As they bring the needle up through the fabric, I invite them to focus on something in the present – perhaps a task at work or school that needs their attention. Then, when they lower the needle, we shift focus to their grief, allowing any emotions that arise – be it sadness, anger, or something else – to surface.

Throughout the process, I help them acknowledge the present moments as the needle rises, such as new responsibilities they’ve take on. When it lowers, I provide space for them to explore feelings relating to grief or reflect on the story of their loss. I guide them at their own pace, continuing until they feel ready to conclude the exercise.

As we examine stitches we’ve created, I highlight how they may not be perfectly even, reflecting the non-linear nature of grief. Just as our journey through grief is not always linear, the time spent facing loss-oriented and restoration-oriented stressors is not always equal. Navigating grief is a deeply personal experience that involves moving between these two types of stressors. Each person must move through grief at their own pace, allowing space to work through emotions and build a new sense of personal meaning. The DPM offers a valuable framework for understanding this dynamic, while art therapy can provide a creative outlet for processing complex emotions. Ultimately, it is in embracing the ebb and flow of the process that we begin to stitch together a tapestry of healing and resilience.

If you or someone you know is coping with loss, our team is here to support you on this journey.

Stephanie Myles, DTATI, RP(Q), is registered psychotherapist (qualifying) and a professional art therapist. She offers in-person and online psychotherapy and art therapy services to adult individuals experiencing grief, loss, depression, anxiety, or a history of childhood trauma.

Kübler-Ross, E. (1973). On death and dying. Routledge.

Stroebe, M., & Schut, H. (2010). The dual process model of coping with bereavement: A decade on. OMEGA – Journal of Death and Dying, 61(4). 273-289.

When it comes to mental health, one important but often overlooked area is the connection between neurodiversity and eating disorders. Neurodiversity covers a range of conditions, particularly ADHD (Attention Deficit Hyperactivity Disorder) and Autism Spectrum Disorder (ASD). Neurodivergent individuals often face unique challenges in their daily lives—and food and eating habits are no exception.

For individuals with ADHD and ASD, factors like sensory sensitivities, difficulties with executive functioning (like planning and organization), and social communication challenges can heavily influence their relationship with food (Cobbaert et al., 2024). For example, some may find certain textures or tastes unbearable, leading to restrictive eating patterns. Others may struggle with impulsivity or emotional regulation, which can sometimes lead to episodes of binge eating (Cobbaert et al., 2024). Additionally, neurodivergent individuals often have a natural tendency toward routines, which can sometimes show up as strict food rules or eating rituals, making disordered eating habits harder to manage (Cobbaert et al., 2024).

Despite the clear links, the overlap between neurodiversity and eating disorders hasn’t received much attention in healthcare. However, research is revealing that neurodivergent individuals tend to have a harder time with eating disorder treatment than neurotypical individuals (Babb et al., 2022; Svedlund et al., 2017). That’s why it’s so important for mental health professionals to understand the specific challenges that neurodivergent people face with food and to offer treatment options that are tailored to their needs.

Effective therapy needs to address both neurodivergence and eating habits holistically. For example, treatment might need to consider sensory sensitivities or adjust communication methods to better connect with neurodivergent clients. When therapy is personalized like this, it’s more likely to help individuals build healthier relationships with food and with themselves.

Breaking the stigma around neurodiversity and eating issues is essential. Everyone deserves a safe, understanding space to explore their relationship with food and body image. Finding a therapist who truly understands the connection between neurodivergence and disordered eating can be transformative, offering support that respects both your individuality and your journey.

If you’re dealing with the dual challenges of neurodiversity and disordered eating, know there’s help tailored to your experience. Therapy can provide tools for self-acceptance and empower you to build a healthier relationship with food and yourself.

REFERENCES

Babb, C., Brede, J., Jones, C. R., Serpell, L., Mandy, W., & Fox, J. (2022). A comparison of the eating disorder service experiences of autistic and non‐autistic women in the UK. European Eating Disorders Review, 30(5), 616-627.

Cobbaert, L., Rose, A., Elwyn, R., Silverstein, S., Schweizer, K., Thomas, E., & Miskovic-Wheatley, J. (2024). Neurodivergence, intersectionality, and eating disorders: a lived experience-led narrative review. PsyArXiv Preprints, 14.

Svedlund, N. E., Norring, C., Ginsberg, Y., & von Hausswolff-Juhlin, Y. (2017). Symptoms of attention deficit hyperactivity disorder (ADHD) among adult eating disorder patients. BMC psychiatry, 17, 1-9.

Loreana La Civita (B.A.Hons) is a Registered Psychotherapist (Qualifying) at the Centre for Interpersonal Relationships (CFIR) working under the clinical supervision of Dr. Jean Kim (C.Psych). Loreana provides psychological services to adolescents and adults and has a special interest in treating individuals with eating disorders, body image concerns, neurodiversity (e.g., ADHD, ASD, OCD) and trauma. Using an integrative approach that combines therapeutic modalities such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Emotion-Focused Therapy (EFT), Loreana is passionate about providing tailored support to neurodivergent individuals on their journey toward healing and self-acceptance.

“Know thyself” has been a key existential invitation from Grecque philosophers and different psychological, religious and spiritual practices have contributed to shaping the concept of self-observation as a way to support this quest.

To understand the power of self-observation, it is important to mention awareness (or lack of) and patterns in the way individuals connect to themselves, others and the world around. Sometimes, it could feel like there is a loop or a sense of repetition in human experiences that it is difficult to break. However, observing oneself can help in loosening the grip of these loops while making room for curiosity, openness and learning. 

In the development of the concept, different contributions have tried to break self-observation down to make it understandable. For some, it is about studying oneself and perhaps failing, at the beginning, because it takes time to create space for self-observation in people’s internal experience. The study of the self requires gathering data by observing, without judgement; then, some understanding begins to emerge about patterns of thought, emotions and body sensations. 

Like any other skill, this could be learned through trial and error. One way to support this effort is by directing the attention towards what the person wishes to observe while having the attention also on oneself (the observer). This could look like watching, without judgement, a silent film in which the spectator is the main character but without getting lost in the movie, able to watch while remembering who is watching and how.

Myriam Hernandez M.A., R.P., is a psychotherapist at the Centre for Interpersonal Relationships (CFIR). Myriam provides psychotherapy to adults and couples experiencing a wide range of challenges including interpersonal relationships, anxiety or depression, loss and grief.  She works using an integrative approach that draws from different theories and interventions to conceptualize cases and develop treatment plans tailored to the needs of each client. 

We feel bodily signals often. Sometimes they indicate a need: to get warmer or cooler; to eat; to rest. Sometimes we get signals that lead us to believe that something is different in our bodies and we need to have that checked out in case it is a physical illness or condition. 

Often it is a psychological signal expressed through our body: tension in our jaws or in other muscles; an unsettled stomach; stuttering; a headache and many others. Of course one should rule out physical causes first. But many times we have checked with a physician and there is nothing wrong, it is repetitive and we have the feeling that it is related to something. We tend to call it with different names: “my anxiety”; “my symptom”.

Our attitudes towards these signals may vary from person to person and from time to time. We might tend to ignore them and sometimes they go away or they increase in strength and we have no alternative than to acknowledge them. At times we might get angry at the symptoms for showing up or at ourselves for having allowed them to come in and bother us. Some people might have, often unknowingly, caring attitudes towards the symptoms: “giving food“ to the stomach to calm the acidity; “caressing” the tense muscle; “trying to reason” with the headache that “now it is not the best moment to show up”. 

In general the psychological symptoms we have been discussing are signals from our body telling us that we are not doing what we want; that we are attempting to lie to ourselves; or that we are doing what we do not want to do. 

If we could take these symptoms at that level, that is, a warning, we could stop for a second and realize that it would be for our benefit to listen to them. The symptoms are signaling to us that we are entering a situation that we dislike. Sometimes we could change what we are doing but even when we cannot, there is a large difference between doing something that we do not like and doing something and trying to convince ourselves that we do like it. 

One might find it difficult at times to listen to the message of some of our symptoms. This might be because listening to them would imply changes we do not want to face or because we might need to admit that we are in the wrong path and we do not want to accept that. It might even be frightening to think about getting rid of the symptoms and realizing that most of our decisions for the future depend on us. Oftentimes, after starting to pay attention to their symptoms, people stop seeing them as “enemies” and see them as an opportunity to improve their quality of life. 

The decision to change is ours. 

David Mibashan holds a Ph.D. in Clinical Psychology from the University of Ottawa. For almost 40 years he has worked, as a Registered Psychologist, with people who felt depressed, anxious, at the verge of burn out or just not satisfied with some aspects of their life. Together with his clients, he has dealt with traumas, grief, giftedness, disabilities, immigration issues, among others. He utilizes a Humanistic / Existential approach integrating elements of Psychodrama, Gestalt and Systemic approaches. He works in English, French and Spanish.

How long does a psychotherapy take? How many different stages will it have? The answer depends on several variables: the therapist; the client; the type of therapy.

As a psychotherapist, I think of layers. The first one is to know why the person is coming right now, that is, what motivated her or him to ask for a session. Usually, my first question is “What brings you here?” or “What ails?” I then listen. Sometimes it is specific words, like anxiety or depression. At times it is an example of the situation they are experiencing. In other cases, the client is flooded with emotion and cannot speak.

I want to know what bothers them. I try to understand what they are going through and how it feels from their perspective. I reflect what I perceived to the client, concentrating on their feelings. I convey that with simple words, the ones that do not mask things.

At this point I may want to know since when the person has been feeling the issues they have described. Sometimes the answer is forever; sometimes it’s something more specific.
We delve then into the layer of discerning whether there are repeated patterns concerning their sufferings and/or what triggers them. I ask about their history, starting as far back as they can remember.

Therapy for me is what goes on between session and session: the emotions and ideas that clients experience. Those are the main bricks of psychotherapy.

As therapy continues, the agenda will be jointly set at the beginning of every session. I’m very interested in knowing what the client experienced after the first sessions, what connections they made, what they felt. At this point I might have questions: I want to see parallelisms between the concerns that brought the clients to therapy and things that happened in the past, thus opening a new layer: Did the symptoms serve any purpose? Many times, during childhood, we utilize any mechanism that will help us tolerate or survive difficult situations and as strange as those mechanisms might sound in adult life, for a child those are life savers. However, sometimes carrying those coping mechanisms into adulthood does not lead them to achieve the things that they want (peace of mind, balanced self-esteem, knowing that they are moving forward in life).

Here starts another layer in the therapeutic work. By this time we have both rolled up our sleeves and we are working together in this. This stage might take many sessions and there is progress: clients are working on themselves; they start to make changes; they like therapy and many times there is pain involved. I believe that the pain of facing the music is less damaging and less hurtful than the pain of trying to avoid the music, something that we excel at.

So here we are and we make more connections, another layer. If we could solve one issue we can now look back at our lives and try to solve other issues or to revisit periods of our life that were not as good, understanding and coming to peace with that.

At this stage many clients will want to end therapy; we are probably anywhere from 8 to 30 sessions into the process and as I explained in other articles it generally isn’t me who decides when the end of the therapy occurs, but it is the client. Some clients want to continue until they feel certain that they can go on their own or there are no other issues to resolve. Some clients prefer to stop at that point and a few clients come back a few years later when something else flared up or just to look at specific things. Clients learn how to use the tools and they can face new situations and find the way to resolve most of the new issues.

David Mibashan holds a Ph.D. in Clinical Psychology from the University of Ottawa. For almost 40 years he has worked, as a Registered Psychologist, with people who felt depressed, anxious, at the verge of burn out or just not satisfied with some aspects of their life. Together with his clients, he has dealt with traumas, grief, giftedness, disabilities, immigration issues, among others. He utilizes a Humanistic / Existential approach integrating elements of Psychodrama, Gestalt and Systemic approaches. He works in English, French and Spanish.

Natalie Guenette, M.A., R.P.

What does it mean to be in a healthy relationship? Many elements are important in a relationship, such as open communication and reciprocity. The Ontario Psychological Association suggests that “when our relationships are strong, we’re more resilient in the face of stress and hardship. But when our relationships are fraught, we are more likely to experience anxiety, depression and maladaptive coping behaviours” (The psychology of relationships: Connections for better well-being, 2023). 

The Crisis and Trauma Research Institute (CTRI) identifies 5 elements to a healthy relationship. Let’s explore them.

1. Respect
2. Boundaries
3. Sharing of power
4. Guidelines on conflict management
5. Adaptability and flexibility

Respect

In relationships, respect is about allowing each member to be as they are. It is about accepting their personality, individuality, unique opinions, thoughts and feelings and recognizing that everyone has a right to express themselves. Respect is about holding space for differences to exist; despite the discomfort this can create in you. 

Boundaries

Boundaries in relationships are about identifying your limits in order to have your needs met. Individual boundaries are set and communicated with one another. In relationships where children are involved, their needs are prioritized and boundaries are set to protect them from adult challenges and conflicts. 

Sharing of power

This means that everyone involved in the relationship can co-exist and that there is space for everyone to openly and freely share their thoughts, feelings, and opinions without fear of consequences. It is important to consider individuals’ ages in relationships (i.e.: it is OK and normal that parents/adults make more decisions and have more responsibilities than children. This does not mean, however, that children’s wants and needs are not considered). The risks for relationships to become unhealthy are increased when there is an imbalance of power.

Guidelines on conflict management

The fourth element is about having rules on how conflicts will be managed. Conflicts are stressful and can trigger uncomfortable emotions. For this reason, having a structure for conflict management can help navigate the discomfort that conflicts may elicit in you and other member(s) of the relationship. In addition, because we all respond differently to stressful situations, it is important to discuss openly about the best ways to handle conflicts for everyone involved (e.g.: having a code word that reminds you to take a step back; taking a 10-minute break when the conversation is escalating before going back to it; etc.). 

Adaptability and flexibility

The fifth and final element to a healthy relationship is about being adaptable and flexible to trying new ways of working through stressful situations together. It is also about wanting to work as a team towards a collective goal, such as having a healthy relationship.

If you or someone you know is experiencing challenges in their relationships, know that CFIR-CPRI has many clinicians available to help you reinforce your skills to improve your relationships. 

References: 

Coburn, S.C. (2021). Family Violence [Workshop]. Crisis and Trauma Research Institute.

The psychology of relationships: Connections for better well-being. Ontario Psychological Association – The Psychology of Relationships: Connections for Better Well-Being. (2023, December 21). https://www.psych.on.ca/Public/Blog/2023/the-psychology-of-relationships

Natalie Guenette, M.A., R.P. is a Registered Psychotherapist at the Centre for Interpersonal Relationships (CFIR). She provides online and in-person individual psychotherapy services to adults in both French and English. Natalie offers services to individuals experiencing a wide range of difficulties related to interpersonal relationships, anxiety, depression, self-esteem, trauma, and substance use. She works from humanistic and psychodynamic approaches and integrates a variety of therapeutic interventions from emotion-focused therapy (EFT) and cognitive-behavioral therapy (CBT). 

Perfectionism is often lauded as a desirable trait in the professional world, but it can also be a double-edged sword. While striving for excellence is commendable, an obsession with perfection can hinder career growth and lead to burnout. Here’s how professionals can let go of perfectionism and prioritize more meaningful career development and skills.

Set Realistic Goals

Instead of aiming for perfection, set achievable and realistic goals. Break larger projects into smaller, manageable tasks and focus on making consistent progress. This approach not only reduces stress but also allows for flexibility and continuous improvement.

Embrace a Growth Mindset

Adopting a growth mindset means understanding that skills and intelligence can be developed through dedication and hard work. Embrace challenges, persist in the face of setbacks, and view effort as a path to mastery. This mindset shifts the focus from perfect outcomes to personal and professional growth.

Prioritize Essential Skills

Identify the skills that are most critical for your career development. These might include leadership, communication, strategic thinking, or technical expertise. Invest your time and energy in honing these skills rather than getting bogged down by the minutiae of perfectionism.

Learn from Mistakes

Mistakes are inevitable and valuable learning opportunities. Instead of fearing errors, use them as feedback to improve your performance. Analyze what went wrong, understand why, and think about how you can do better next time. This approach fosters resilience and continuous improvement.

Delegate and Collaborate

Perfectionists often struggle with delegation, fearing that others won’t meet their high standards. However, collaboration is essential for career growth. Trust your team, delegate tasks, and focus on the bigger picture. This not only alleviates your workload but also fosters a collaborative and innovative work environment.

Practice Self-Compassion

Be kind to yourself. Acknowledge that everyone makes mistakes, and that perfection is an unrealistic standard. Practicing self-compassion reduces the anxiety associated with perfectionism and promotes a healthier work-life balance.

Focus on Impact

Shift your focus from perfect execution to the impact of your work. Consider how your contributions benefit your team, organization, or clients. Prioritizing impact over perfection can lead to more meaningful and fulfilling work.

Seek Feedback

Regular feedback is crucial for professional growth. Instead of fearing criticism, seek constructive feedback from peers, mentors, and supervisors. Use this feedback to refine your skills and improve your performance.

Celebrate Progress

Acknowledge and celebrate your achievements, no matter how small. Recognizing progress boosts motivation and reinforces the importance of continuous improvement over perfection.

Conclusion

Letting go of perfectionism is a journey, not a destination. By setting realistic goals, embracing a growth mindset, prioritizing essential skills, and focusing on impact, professionals can reduce stress, enhance their productivity, and achieve meaningful career development. Remember, progress, not perfection, is the key to long-term success and fulfillment in your career. Working with a career coach can help you target your focus towards enhancing your core skills and minimizing your perfection reflex.

Erin Leslie, career coach at CFIR and founder of EQFootprints is a Career Strategist and Leadership coach who will enable any professional or team to achieve their career aspirations through personal development, training and coaching.

Erin practices one-on-one and team coaching with clients and mentees across all industries. Certified in EQ-i 2.0 assessments, Erin specializes in emotional intelligence practices and tools to support a stronger emotional quotient in the workplace. Her emotional intelligence acumen harvested through 25 years as a business career woman in tech; combined with a tailored coaching style she has the intuitive ability to uncover personal or environmental barriers and help identify new goals for your business audience. Helping professionals, teams and newcomers with all aspects of business negotiation, personal branding, networking and business culture is not only a vocation, it is her passion.

By Camille Garceau, B.Sc.

Suicide is the second leading cause of death in Canadian adolescents and young adults (Statistics Canada, 2022). In 2021, approximately 18% of Ontario students grades 7-12 reported seriously thinking about suicide in the past year (Boak, Elton-Marshall, & Hamilton, 2022). Tragically, suicide rates are 6 times higher in First Nations youth and 24 times higher in Inuit youth than in non-indigenous youth (Statistics Canada, 2019).

How do you know if your teen is at risk for suicide? Suicide is sometimes an impulsive act, and attempts can be difficult to predict. The strongest predictor of a future suicide attempt is a past suicide attempt; other risk factors include difficult life events, social isolation, past trauma, mental illness, debilitating physical illness, and availability of means (e.g. firearms) (Bilsen, 2018). Although there is no one way to accurately determine the likelihood of someone dying by suicide, there are several warning signs that are worth monitoring. These include threats to end one’s life, getting the means to end one’s life (e.g. firearm, pills), having a suicide plan, talking or writing about wanting to end one’s life, expressing hopelessness and/or a lack of purpose in life, dramatic changes in mood, reckless behaviour, sleep problems, and increased substance use (see youthsuicidewarningsigns.org). 

As a parent, you are likely (and understandably!) disturbed and frightened by the idea of your child being at risk for suicide. This may make you hesitant to discuss the topic with them. You may wonder: will talking about suicide with my child “put the idea in their head”? Could it make them more likely to attempt? These fears, although normal, are thankfully unfounded. It is a widespread misconception that talking to someone about suicide will induce or exacerbate suicidal thoughts or urges (Dazzi et al., 2014). In reality, asking your teen direct questions shows them that you want to hear about their experience — no matter how distressing — rather than hide your head in the sand. Examples include “Do you have suicidal thoughts?”, “How often do you think about suicide?”, and “Do you have a plan to kill yourself?”. By opening the dialogue in a clear, honest, and courageous manner, you invite your teen to respond in kind. 

Fearing that your teen could take their own life can be terrifying, overwhelming, and isolating. If this is your experience, do not delay in seeking mental health care from a qualified professional for both your teen and yourself. A therapist can help you manage your emotions and help you support your teen during this difficult time.

All Canadians can access the 24-7 Suicide Crisis Helpline by calling or texting 9-8-8.   

Camille Garceau, B.Sc., is a practicum student at the Centre for Interpersonal Relationships in Ottawa under the supervision of Dr. Nalini Iype, C. Psych. She is currently completing her doctoral degree in clinical psychology at the University of Ottawa. She works with adolescents and adults in both assessment and therapy contexts. 

References

Bilsen, J. (2018). Suicide and youth: Risk factors. Frontiers in Psychiatry, 9, 540. DOI: 10.3389/fpsyt.2018.00540

Boak, A., Elton-Marshall, T., & Hamilton, H. A. (2022). The well-being of Ontario students: Findings from the 2021 Ontario Student Drug Use and Health Survey (OSDUHS). Centre for Addiction and Mental Health. https://www.camh.ca/-/media/files/pdf—osduhs/2021-osduhs-report-pdf.pdf

Dazzi, T., Gribble, R., Wessely, S., & Fear. N. T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44, 3361–3363. DOI: 10.1017/S0033291714001299 

Kumar, M. B., & Tjepkema, M. (2019, June 28). Suicide among First Nations people, Métis

and Inuit (2011-2016): Findings from the 2011 Canadian Census Health and Environment Cohort (CanCHEC). Statistics Canada. https://www150.statcan.gc.ca/n1/pub/99-011-x/99-011-x2019001-eng.htm

Statistics Canada. (2020). Leading causes of death, total population, by age group. https://doi.org/10.25318/1310039401-eng

Trauma occurs when the stress of a situation overcomes our ability to cope, and mindfulness can help us process this while better allowing us to regulate emotionally (Larsen et al., 2021). A key concept related to this is the idea of a window of tolerance (Siegel, 1999). Our window of tolerance is where we can still cope with what is happening, maintain regulation of our nervous system in a way that allows us to be grounded in the present, and behave in ways that serve our values and outcome goals. When dysregulated, we can move in two directions; towards a state of complete shutdown and disconnection with the world or towards an activated state of anxious thought and overwhelming fear that leads to a desire to fight or flee from a perceived threat. The state of shutdown can be seen in individuals who, when overwhelmed, move into feelings of hopelessness and helplessness and appear depressed or withdrawn from the world, unable to connect with others. When individuals move in the other direction, their anxiety propels them to attack others or run away from difficult situations to protect their sense of self and feeling of safety.

With mindfulness, we can identify the cues from our bodies and emotions to determine when we are about to move away from our window of tolerance. Mindfulness also provides various tools and strategies to help us move back toward the window of tolerance through awareness and non-judgment.

An example of a mindfulness-based practice I use with clients in a state of fight or flight is three-part yogic breath, in which awareness is drawn to feeling the rise of the lower, mid and upper regions of the abdomen as they expand. By placing the palms together with just the middle fingers touching while the others are separated, we can begin to notice if each of the regions of the abdomen is rising on the inhale. This awareness can foster a focus on the breath that can draw an individual back toward their window of tolerance. Over time, they can be encouraged to lengthen their exhalation relative to their inhalation, facilitating this movement from anxiety towards balance.

Conversely, when a client is moving towards emotional shutdown, mindfulness can be used to bring them back to their window of tolerance. A simple technique is to ask the client to allow their inhale to be slightly longer than their inhale. For those who find these overwhelming, gentle, rhythmic movements like gently rubbing a stone or rolling their shoulders up, back, and down continuously can help return the client’s basic level towards their window.

Mindfulness approaches can be integrated into any therapeutic modality but are integral to approaches such as mindfulness-based Cognitive Behavioural Therapy and Acceptance and Commitment Therapy. Our therapists at the CFIR can help you learn how to build mindfulness skills to process trauma and emotionally regulate it.

Mr. Jeffery Driscoll, B.SC., B.Ed., is a counsellor at the Centre for Interpersonal Relationships (CFIR) supervised by Dr. Ashwin Mehra, C.Psych, Psychologist. Mr. Driscoll is registered as both a teacher in Ontario and a yoga instructor and provides integrated therapy through a mindfulness lens to adults and seniors. Given his years of experience in yoga and education, he is skilled at helping individuals navigate life transitions or find greater career or relationship meaning and joy. He works with individuals who are experiencing a wide range of psychological, relationship and career difficulties relating to grief, life changes, aging, mood disorders, trauma, sexuality, sleep disturbances and interpersonal conflicts. He integrates mindfulness with Cognitive-behavioral therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavioural Therapy (DBT), Emotion-Focused Therapy (EFT), Existentialist, Systemic, Adlerian and Psycho-dynamic therapy.

Reference

Larsen KL, Stanley EA. Leaders’ Windows of Tolerance for Affect Arousal-and Their Effects on Political Decision-making During COVID-19. Front Psychol. 2021 Oct 26;12:749715. doi: 10.3389/fpsyg.2021.749715. PMID: 34764917; PMCID: PMC8575779.

Siegel, D. J. (1999). The developing mind: Toward a neurobiology of interpersonal experience. Guilford Press.