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).

As we all navigate through the uncertain time of COVID-19, frontline workers face a set of particularly unique challenges. What follows is a list of ways that frontline workers are being affected by COVID-19, with some suggested coping techniques. It is my hope that, in creating this list, frontline workers will feel better understood and validated, while those not on the frontline may learn how to better offer their support. 

Isolated from Family/Friends

Being isolated from loved ones is perhaps one of the most challenging aspects frontline workers face. During a time when they may need it most, they may not be able to receive the same love and support from their family that they usually would. Keep in mind that, although frontline workers may have to or choose to isolate themselves from family physically, it doesn’t mean that they have to isolate themselves emotionally. 

Be creative – read bedtime stories over the phone or prop up a phone or tablet with video chat for dinner time. It might still be possible to meet in person, but with a degree of separation like a glass door or window. Also, activities like walks might remain an option, so long as there is physical distancing. Even short, positive, love-affirming texts throughout the day can make a world of difference. 

Direct Interaction with the Disease

Imagine a poisonous snake is living somewhere in your home. Every time you open the refrigerator to get food or hop into bed, you risk being bit. This is the reality that frontline workers are facing. Every person that they interact with and every surface they touch is a risk of contracting this disease. Their stress response is heightened for every moment of their day as they are at risk and may feel they can’t let their guard down. 

Frontline workers may benefit from practicing short-term stress-reduction techniques throughout their day, such as grounding or breathing exercises, as well as practicing long-term techniques like meditation, exercise, or therapy outside of work. Continue to take precautions as necessary to help minimize risk. 

Generally Chaotic Work Environments & Long Hours

Whether its hospitals at capacity or grocery stores swarmed with people, frontline workers are generally working in a chaotic environment at this time. Furthermore, working long hours can also be draining, regardless of the type of work. Imagine being used to going for an evening walk and now suddenly having to be able to run a marathon. The demand for frontline workers continues to grow as confirmed cases of COVID-19 increase, and as there is a need to cover shifts for those that are out sick.  

Try different relaxation techniques before and after shifts and, if possible, create a sanctuary or safe space at work in order to have a place to calm down or take a break quickly. Frontline workers are providing an essential service and are helping their community – use that as a basis to create meaning and satisfaction from work and to help maintain a positive attitude. 

Lack of Equipment/Resources

Some workplaces have been extremely aggressive in trying to keep their workers safe. For example, grocery stores are sanitizing carts, have put up a plastic divider between customers and cashiers, and not accepting paper money. Despite best efforts, however, many places are experiencing a shortage of personal protective equipment (PPE), such as face masks. This significantly changes how frontline workers interact with people and how they do their jobs, and it can also lead to a general sense of uneasiness or not feeling safe. Furthermore, the added layer of PPE also affects the patient relationship by way of creating an extra barrier. 

Just today, Prime Minister Trudeau has pledged $2B to buy personal protective equipment, in which Canadian companies are being enlisted to provide critical medical supplies like ventilators, surgical masks, and test kits. Until then, however, continue to focus on things that can be controlled rather than dwelling on things that can’t, and continue to remain positive and practice self-affirmations. Don’t repress worry or stress, however, but give proper times to process and handle those concerns. 

Increased Risk for Mental Health Issues

Many frontline workers are reporting an increase in depressive symptoms, anxiety, insomnia, distress, and trauma-related disorders. Through direct contact with patients, as well as through vicarious trauma of other frontline workers’ experiences with COVID-19, and witnessing illness and death around them all the time, frontline healthcare workers are at significant risk of developing post-traumatic stress disorder, as well as increased suicidal thoughts and/or behaviors. Some could also turn to unhealthy coping mechanisms and even addiction to help get them through this time of overwhelming anxiety, confusion, instability, and loss. Despite these growing mental health concerns, many still have to continue working and treating the ill. 

It is important to remember that there can also be post-traumatic growth, not just distress during these times. There are important resiliency factors that could help buffer against developing any of the above-mentioned mental health disorders. These factors include, but are not limited to: not avoiding the situation and self-disclosure of distress or trauma to loved ones; having social support available to you and being connected with others (practicing safe physical distancing); spirituality, or having a sense of community or belonging; having an identity as a survivor, and finding hope and optimism wherever you can; helping others, and finding a positive meaning in the trauma.

Frontline workers should know that they are valued and appreciated for all that they are doing and sacrificing for the better of their community. I am offering pro bono services (1-5 sessions) for frontline healthcare workers in Ontario (through the Ontario COVID-19 Mental Health Network), and reduced cost services for other frontline workers. Please reach out if you need support – we are all in this together. 

Dr. Brianna Jaris, C.Psych. is a clinical psychologist at CFIR. She has extensive experience in psychological assessment and diagnosis and the treatment of a wide range of psychological issues, including trauma, depression, anxiety. She is currently the head of CFIR’s Trauma and PTSD service. 

Today, I scooped myself a bowl of ice cream. This is no different from countless other times I’ve done the same thing, save for one fact: I didn’t add chocolate chips. Now, let me back up for a second. I’ve been putting chocolate chips in my ice cream since I was a small boy. (somewhere out there in internet land, there is a mention of me eating too much ice cream-it’s true!).

Vanilla ice cream? Add some chocolate chips. Chocolate? Add chocolate chips. Cookie dough brownie with fudge? You guessed it, that’s going to get some chocolate chips too. So why didn’t I add them tonight? The answer: the global pandemic.

By now, I’m sure we’re all sick of reading about and talking about and hearing about the COVID-19 pandemic. So, I won’t belabour that. However, one side effect of the situation is that it’s caused almost all of us to re-think our routines. I didn’t add chocolate chips because when I went to grab another package at the grocery store earlier this week, they were all out (we really do seem to modulate our emotions with baked goods). That made me change a tiny part of my daily routine in a way I haven’t done for probably 20 years.

I’m betting that you, dear reader, might have had something similar happen to you in your week. Maybe you made that meal that you’ve been planning on for months. Maybe you cleaned the baseboards. Maybe you finally reached out and actually called your mother, or your grandmother (or their male counterparts!). Whatever it was, I’m betting that it felt weird at first, but that you felt better after doing it.

See, massive societal changes don’t just change things on the macro (read: big picture) level; they change on the micro, too.

Brent Mulrooney, M.A.S.P. | Therapist

See, massive societal changes don’t just change things on the macro (read: big picture) level; they change it on the micro, too. For 20 years, I have consistently thought that ice cream just wasn’t right without chocolate chips, so I consistently added them to every bowl I’ve ever eaten. Today, because of a situation entirely out of my control, I changed my habit. But here’s the thing: I liked it better. I tried it and I liked it better.

That got me to thinking. How often do we recognize that there’s something happening in our lives that just doesn’t sit right with us? Maybe you don’t call your friends because you think you’re going to bother them? Maybe you want to say hello to someone in an elevator, but you get shy because you’ve never done it before and …don’t weird people do that? (I say hello quite often, so make of that what you will). Maybe you want to start going to the gym, but you haven’t found the right day, or the right time, or the right gym outfit.

Yet, when we actually try something new, those tales we tell ourselves don’t often hold water. Sometimes they’re just not true. Sometimes, the ice cream is better without the chocolate chips.

Looking to start a journey towards change and your life? Mental health professionals at CFIR can help you navigate where you’re coming from and support you in developing healthy strategies to build an emotionally healthy future.

Brent Mulrooney, Ph.D., is a therapist at the Centre for Interpersonal Relationships. He works with individuals and families to improve mood, anxiety, relationships, work, and school. He also works to alleviate problems associated with substance use, learning difficulties (including ADHD and Learning Disabilities), bullying, trauma, violence, grief and loss, transitions in life, self-esteem, gender identity, sexuality, and intimate relationships.

During times of crisis and panic, many people can feel as though their current mental health issues are on overdrive. Everyday activities that were once employed to help alleviate depression and anxiety, such as face-to-face encounters and related activities, have been put on pause in light of social distancing measures and self-isolation. Stress and uncertainty surrounding COVID-19 have many feeling overwhelmed by potential financial, social, and health implications. With the additional strain on our mental health, some of us may feel like we’re regressing into old habits that we deem as ‘unhealthy.’ These practices may include excessive drinking, emotional eating, insomnia or oversleeping, and even over-exercising. It’s easy to start turning to old behaviours.  

There are countless social media posts about ways to achieve new goals, and become uber-productive now that we ‘have the time’; this can intensify feelings of isolation in our struggles. With social distancing in play, it’s even more important to stay connected and share what might be challenging for you right now, because chances are, others are struggling too. 

Remember…this is not an easy time. It’s okay if you are not okay right now, and most importantly, you are not alone in this.

• Be kind to yourself. Some days are going to be better than others, both in mood and motivation. Remind yourself that these are hard times, and everyone has moments of struggling in both similar and different ways. 
• If you do engage in old habits, try to see this as a signal of emotional pain and a need for something that stimulates or soothes you. Try different types of care and activities until you find something that meets your emotional needs.
• Try moving your body regularly, and walk outside (even across the street or around the block) once a day. This practice can help, especially when you feel restless or have low energy.
• Build motivation by making a daily routine and planning things to look forward to in your week, but try not to look too far into the future. There is an ending to all of this, even if it feels far away at the moment. 
• Be realistic. You don’t have to finish a novel or establish a side business by the end of the pandemic. For example, finding a new hobby or activity that you enjoy (even if you’re “bad” at it) is good enough. 
• Connect! Strike a balance between scheduling virtual hangouts, phone calls, or facetime dates, and spontaneously connecting with others throughout your week. When you start to feel lonely and disconnected, call a friend or family member. 
• Disconnect from social media and news intermittently. Many of us are glued to our phones, scrolling through Instagram or Facebook, and catching up on a constant stream of COVID-19 articles. Set boundaries and limits with these things and try to give yourself some breaks in your day to connect to yourself and your needs.  
• Breathe. It may seem simple, but it has a profound impact on our nervous systems. In moments where you feel overwhelmed with anxiety and fear, take a few deep breaths and remind yourself that this will pass.  

If you feel alone and overwhelmed, clinicians at CFIR are ready to offer support. Psychologists, psychotherapists, and counsellors from CFIR Ottawa and Toronto are providing secure, confidential therapy online or by phone. 

Whitney Reinhart, R.P. (Qualifying) is a qualifying registered psychotherapist, at the Centre for Interpersonal Relationships (CFIR) in Toronto. She supports adult and couple clients with a wide range of difficulties related to depression, anxiety, traumatic experiences, and interpersonal conflict.

Almost two years ago, the worst thing in the world happened: my precious, loving, silly, joyful, brilliant, freshly two-year-old son was unexpectedly diagnosed with cancer. Despite putting him through every treatment available, nine months after that, he suddenly began to decline, and one day, he came to die in my arms. 

For the past two years, I have been living every parent’s absolute worst nightmare, every single moment of every single day. 

And yet, for the past two years, I have also maintained a thriving psychotherapy practice; expanded my skills and hobbies and personal culture; developed a deeper practice of self-compassion; cultivated a stronger sense of connection with others both close and far and across different life domains; and immersed in a strong sense of meaning and purpose, more than I could have ever imagined at any point in my life before losing my son… 

This era that the world has been ushered into so suddenly and most unexpectedly, by the novel coronavirus and COVID-19, reminds me in so many important ways of the life of a cancer parent:

• One day, you and I each woke up to a whole new world. Nothing was as we expected it to be anymore. All of the mainstays of our day-to-day lives, everything we had come to count and rely on, everything that made us feel like our normal selves—our daily routines, our goods and services, our relationships with others, all the sights and sounds we had grown accustomed to—had seemingly ceased to exist. Our sense of normality, sense of safety and security, hopes and dreams for the future—all of these and more were shaken to their very core, one day, oh-so-unexpectedly. And this new world had no roadmap. We felt lost and disoriented and scared.
• As we took in the intensity and severity of what was happening around us, we lost the luxury of ever forgetting, even for a second, how fragile life really is. Without a moment’s notice, everything can change, even for the worst, despite our best efforts and wishful thinking. Our shared experiences, like confinement to our homes, financial strain, social isolation, perceived scarcity, and a sense of helplessness, all combine to worsen the impacts of the situation further, while also failing to make it better. 
• We learned, in an undeniable way, once and for all, that we are all vulnerable—that even we are impermanent.

When our basic sense of normal is so shaken up—when we understand that we are vulnerable to this disease, that it can get and take us or our loved ones, or at least, our financial means and other things that mean so much to us, this is such a massive weight that becomes piled onto our shoulders. 

“…even when the worst thing imaginable happens, we can still be okay.”

Reesa Packard, M.A., Ph.D., R.P. 

Notice that in calm times, to feel free and peaceful and relatively unburdened, the fragility of life and our inherent vulnerability is not always at the forefront of our thoughts—it simply cannot be. To feel okay enough in the present moment, we cannot also be so terribly consumed with what might happen in the next moment, or tomorrow, or next month or year.

The burden is so heavy that we cannot sustain carrying it so much all of the time. Sometimes we have to put it away and change our focus to something else—ideally something uplifting, something that deeply soothes and nourishes, whatever that is for you (nature? connection with self or other? a sense of something bigger than yourself? something creative? something fun?). 

COVID-19 and its consequences are still going to be there when you return to thinking about it, and your time away will not change anything significant, so we can surely all afford a good, well-deserved, full break from it every now and then.  

The helplessness of all of this is a common theme that I am hearing people struggle with the most. We want to protect ourselves; we want to fix it, and we want to be safe. To this, I offer some food for thought:   

1. There is only so much that we can control. If we trouble ourselves with trying to control it all, all we end up with is despair. Learn, through credible sources, what we best understand for now as being some ways to protect yourself and your loved ones, and take these actions, and then speak to yourself directly to remind yourself: “I have done everything I can.” 
2. Because we cannot control everything, there will be things that upset or stress us, that we cannot directly do anything about. In moments when these feelings strike, try to embrace them, and try to embrace yourself as you experience them. Speak to yourself again, this time to remind yourself: “this is hard—really, really hard—and we have to get through it. This will come to be okay, somehow, someday. It will pass because nothing has ever lasted forever, so nor will this”. 
3. There is a harsh reality that none of us can truly ignore right now: even though we have done all we could, and coped as well as we could, sometimes, things still go wrong or not as planned. Sometimes all that we can do is not enough, and the worst happens anyway… And even as we work to accept this harsh reality, I am here to tell you—because I now absolutely know this to be true—that even when the worst thing imaginable happens, we can still be okay. We still get to wake up the next morning, coax ourselves out of bed, and choose to find or create the meaning and purpose that keeps us going. We can make it through, and we will make it through. 

Suffering is relative. Many of you have already survived so much. Some other hard thing you lived through before this might have already felt like “the hardest thing ever.” This, right now, may or may not be harder. 

Remember that you are strong and resourceful and have a lot, already inside of you that can help get you through this. You have come this far, and you will keep trekking forth. 

Remember that you are not alone and that we are globally in this together through our common humanity and shared experience. 

Remember that we can choose to approach this current crisis with the goal of simply trying to make the most it that we can while trying to minimize negative impacts as best we can. 

Remember that the brain and the body respond to the demands that we place on them. Whether or not you can imagine this, you can and will grow in incredible ways as you live this extreme experience that is capable of stretching you, far beyond the confines of your previous self that didn’t yet have to deal with all of this. 

Remember that we can and that we will. 

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.

With the outbreak of COVID-19, the whole world changed rapidly and drastically, which can invoke feelings of fear as well as uncertainty. A particularly crucial yet psychologically difficult element associated with COVID-19 is the worldwide efforts of socially distancing to limit the spread of the virus. As human beings, we have a fundamental need and drive for interpersonal connections and relationships. During social distancing, it can be common to feel loneliness and disconnection from others. However, with modern technology, we can build and nurture new and existing relationships that have evidence-based findings to improve our mental health and overall wellbeing. Healthy relationships are linked to reduced production of stress hormones such as cortisol, a greater sense of purpose, and healthy coping behaviours.

During times like this, it is crucial to utilize the psychological benefits of social relationships by:

• Scheduling times to connect via FaceTime, Skype, or virtual platforms. This activity can serve as a wonderful substitution for face to face interaction. 
• Sharing our thoughts, feelings, concerns, and experiences with friends and family. Doing so allows us to feel heard, understood, and increasingly connected to others.
• Create time for individual hobbies and self-care; however, include scheduled time for family activities such as game nights or think of some creative ideas on date nights you can create with your partner at home.
• Reconnecting with friends or relatives that we haven’t had much time or opportunity to connect with as frequently in the past.
• Keeping in touch with colleagues or employees during these uncertain times and offering support.

Clinicians at CFIR are offering confidential, secure video therapy or teletherapy therapy, which can help support you with maintaining social relationships during COVID-19 as well as working through feelings of loneliness, loss, or uncertainty, amongst others.

Edgar Prudcoi, B.A. is a therapist at the Centre for Interpersonal Relationships (CFIR) in Toronto and is near completion of 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 and grief, conflict resolution, and relationship functioning.