By: Garri Hovhannisyan

What typically brings a client to a therapy room is not a problem that they just had last week but problems they’ve been having time and again, trapped in a cycle of repetition with no apparent way out.

It’s important to consider the situational factors that shape our problems into what we experience them to be. It’s also important to understand some of the subtle ways in which we, ourselves, might be contributing to the very cycles of distress we come to experience as already “there,” as part of the world we are in.

Consider, for instance, the case of the “lonely extravert” who has a strong need to be with and around others but whose demanding work schedule does not permit much time for socialization. Consider, alternatively, the introverted counterpart who remains unphased by the fewer opportunities to socialize and is able to go about business as usual. Consider, next, the person whose feelings of self-esteem and self-worth have been deeply affected because their high agreeableness has predisposed them to being taken advantage of by those far less concerned with the feelings of others. Finally, consider the disagreeable individual who is far less bothered by moments of social tension and conflict, and who does not come to view instances of this sort as reflecting deep faults with one’s own self.

These brief vignettes are meant to illustrate how we sometimes come to suffer in repeated ways because certain needs that are associated with our unique traits aren’t being met by the contexts we are in; and that, moreover, those who possess traits that are different than ours simply do not suffer in the same ways because they do not share our needs.

In my research (some of which can be found here and here), I’ve been studying the relationship between people’s personality traits and the pervasive patterns of distress they succumb to in their daily lives, patterns they are repeatedly having to suffer but ultimately hoping to escape.

My work draws on the Big Five theory of personality, one of the most widely researched and esteemed theories in all of psychology for predicting human behaviour. As the name suggests, the Big Five describes personality along five major traits or dimensions: Conscientiousness, Agreeableness, Neuroticism, Openness, and Extraversion (an easy way to remember these traits is with the acronym CANOE or OCEAN). At the bottom of this page, you can find a table of basic definitions of what each trait says about a person’s general style of behaviour. If you are feeling especially curious, you can even complete the Big Five test for free by following this link. Completing this test takes about 25-35 minutes (a simplified 10-minute version can be found here) and gives you an opportunity to learn about how you compare to others who have taken the same test.

There is no one-size-fits-all formula for guaranteeing a pathway out of suffering of the kind that I have discussed here (i.e., repetitious cycles of distress). Rather, solutions have to be carefully individualized to fit the unique needs and personality profiles of the individual. Having a basic understanding of your personality traits and dispositions can therefore give you a good sense of what kinds of things you might “need” psychologically to better orient yourself toward your situation, a process that is often helpfully leveraged with the expertise of a therapist.

Indeed, learning about your personality traits has the potential to enrich your sense of what counts as “psychological oxygen” for you and offer you clues on ways you can proactively bring important aspects of your Self to fuller realization in the world.

BIG-5 TRAIT	TRAIT DESCRIPTION
Conscientiousness	High scorers tend to live in the future and structure their time around tight schedules and rules for completing long-term tasks
	Low scorers tend to be more concerned with life as it can be lived in the present moment
Agreeableness	High scorers tend to be polite and compassionate, regarding others’ thoughts, feelings, and points of view as more important than their own
	Low scorers tend to place their own thoughts, feelings, and point of view in centrestage even if doing might cause conflict
Neuroticism	High scorers tend to be more sensitive to negative emotions like anxiety, anger, or depression, and perceive the world as a place of hostility and threat
	Low scorers tend to experience less negative emotion and see the world as relatively habitable and safe to their personal projects and concerns
Openness	High scorers tend to be more imaginative, artistic, and curious, inhabiting the world of images and ideas and enjoying intellectual conversations
	Low scorers tend to be more concrete in their cognitive style and conventionally minded in their approach to learning and navigating ideas
Extraversion	High scorers tend to be enthusiastic, gregarious, and assertive, quite opportunistically minded and especially enjoy being around other people
	Low scorers can be rather indifferent to opportunities to socialize and to be moved to action through feelings of enthusiasm or excitement

Garri Hovhannisyan, M.A., R.P. (Qualifying) is a clinical psychology resident at the Centre for Interpersonal Relationships where he provides psychological services to adults and couples. His approach is integrative as it draws on existential, psychodynamic, humanistic, and cognitive-behavioural perspectives. His dissertation research studies the relationship between people’s traits and their patterns of distress and seeks to develop novel uses of the Big Five theory of personality in the clinical context.

By Cherisse Doobay MSc.

One of the first things I ask people about when they start working with me is their nutrition – why would a therapist do that? There is a strong connection between the food we eat and our mood. The relationship between diet and mood is complex, and the specific effects of different food on mood can vary from person to person. However, research has shown that certain dietary patterns and nutrients can have a significant impact on our mental health, most notably depression and anxiety symptoms. 

One important factor is the balance of nutrients in our diet. A diet that is high in fruits, vegetables, whole grains, and lean proteins, and low in processed and sugary foods, is generally considered to be healthy and can have a positive effect on mood. These types of foods provide the body with the necessary nutrients it needs to function properly, including essential vitamins, minerals, and antioxidants. On the other hand, a diet high in processed and sugary foods can lead to fluctuations in blood sugar levels and contribute to feelings of irritability, fatigue, and low mood. 

Another factor that can affect mood is the presence of certain nutrients in the diet. For example, omega-3 fatty acids, which are found in fatty fish and certain plant-based sources, have been shown to have a positive effect on mood and cognitive function. Similarly, vitamin B12, which is found in animal products, has been linked to improved mood and cognitive function.

In addition to the types and balance of nutrients in our diet, the overall quality of our diet can also have an impact on our mood. Research has shown that following a healthy, balanced diet can lead to improved mood and cognitive function, while a diet high in unhealthy foods can have the opposite effect.

It is important to remember that the relationship between nutrition and mood is complex, and the specific effects of different foods on mood can vary from person to person. However, following a healthy, balanced diet and getting adequate nutrients can have a positive impact on mood and overall well-being. So, the next time you’re feeling down, grab a broccoli crown! 

Cherisse is an integrative therapist and cognitive nutrition practitioner with a specialty in addictions for 17 years. She works with individuals, couples, and families to address a multitude of issues such as relationships, stress, depression, anxiety, trauma, depression, anxiety, and addictions. 

1. Harvard Medical School (February 15, 2021) “Food and Mood: Is there a connection?” https://www.health.harvard.edu/mind-and-mood/food-and-mood-is-there-a-connection

2. Firth, J, Gangswisch, J., Borsini, A., Wooton, R, Mayer.E. (November 9, 2020) “Food and mood: how do diet and nutrition affect mental wellbeing?” https://www.bmj.com/content/369/bmj.m2382

When we get angry or are in heightened conflict, we lose the ability to think complexly. This process is commonly referred to as the fight-flight-freeze response, which is the body’s automatic, built-in system designed to protect us from threat or danger. The fight-flight-freeze response developed early in human evolution and continues to impact our psychology today. While this response was helpful when we were running away from predators as early human beings, it’s less helpful when we are having complex interactions with our partner. It’s important for all couples to recognize when they are angry, as this can trigger their flight-fight-freeze response. Taking a break is one-way couples can reduce this response and be better able to navigate complex discussions.

Remember: Breaks will not solve every problem, but they should help you think more clearly about the ones that do occur.

Try your best!

Joshua Peters is a Clinical Psychology Doctoral Resident and Registered Psychotherapist (RP) with the Centre for Interpersonal Relationships, Ottawa. Over the past decade, he has presented at several notable conferences, including the Guelph Sexuality Conference, the National 2SLGBTQ+ Service Providers Summit, and the Community-Based Research Centre’s Atlantic Regional Forum. Joshua also regularly contributes to online, radio, and television news stories for the CBC, Global News, the Toronto Star, and other organizations. In his clinical practice, he is particularly interested in providing psychotherapy, mental health research, and advocacy for the 2SLGBTQ+ community — especially for those from rural and other marginalized backgrounds. Joshua has obtained a specialization in Psychology at the University of Ottawa, a Master of Arts in Counselling at Saint Paul University, and is currently completing his final year in the Doctorate in Clinical Psychology at the University of Prince Edward Island under the supervision of Dr. Aleks Milosevic and Dr. Lila Hakim. 

Imagine going about life with everything going relatively smoothly and then waking up the next day to find yourself suddenly feeling extremely low, highly irritable and overwhelmed by the simplest task. You almost feel like a completely different person, as if a switch was flicked and you’re no longer able to recognize yourself. And then, almost as suddenly as it began, a week or so later the switch is flipped back and you return to inhabiting your usual self. The transformation is as unnerving to you as it is to those close to you.

For people with premenstrual dysphoric disorder (PMDD), this is a very familiar reality that frequently occurs in the last two weeks of the menstrual cycle. Some of the most commonly reported symptoms include fatigue, bloating, depression, anxiety and irritability, along with other typical symptoms of premenstrual syndrome (PMS). But unlike PMS, symptoms of PMDD are severe enough to affect functioning in everyday life; they might interfere with one’s ability to work or study, or may cause problems in interpersonal relationships. It is believed to be caused by a sensitivity to fluctuating levels of hormones such as progesterone and estrogen that may in turn affect neurotransmitters in the brain that control things like mood and the stress response.

The recognition of PMDD as a distinct and diagnosable mental health disorder is not without controversy, since some believe that it pathologizes the normal experiences of women and people who menstruate. However, others cite the importance of distinguishing between normal PMS, which the majority of menstruating people experience, and PMDD, which affects only around 3-8% of those individuals. For many people in the latter group, it is helpful and empowering to find a label for their more severe PMS, as it can increase their understanding of their experiences and help them access treatment options.

If you think you might have PMDD, speaking to a medical or mental health professional can help you make sense of your experiences, rule out other diagnoses and offer treatment options that may include medications and psychotherapy. There are also a number of online resources such as support groups, websites and podcasts for those who live with PMDD that can help you feel less alone.

Esztella Vezer, M.A., is a Registered Psychotherapist (Qualifying) and is currently completing her clinical residency at CFIR as part of her doctoral degree in clinical psychology. She works with individuals and couples experiencing a wide range of issues, including depression, anxiety, trauma, low self-esteem and relationship difficulties. She also provides fertility counselling and sex therapy, and helps couples who are looking to renew or restore emotional, physical or sexual intimacy, or to repair ruptures related to emotional injuries and interpersonal conflicts. Esztella takes an integrative approach to psychotherapy, drawing on a number of modalities such as emotion-focused therapy (EFT), accelerated experiential dynamic psychotherapy (AEDP), cognitive-behavioural therapy (CBT), psychodynamic psychotherapy (PDT), acceptance and commitment therapy (ACT) and mindfulness-based therapies.

By Davey Chafe, MA, RP(Q)

Too often emotions are dismissed as weakness or as something that clouds our judgment from more “rational” thinking. However, emotions are very important for effective communication and give us vital information about our environments and the people within them. For example, if someone wrongs us or mistreats us and we become angry, it signals that we may need firmer boundaries with this person. In the same way, if we suffer a loss and feel sadness and grief, it may signal for closeness and support from people around us.

Over time, we learn how to listen to, and trust these emotional cues to help us navigate our worlds. However, if we experience traumatic events that we have difficulty coping with, it is not uncommon for people to develop negative changes in mood which can include distorted views of the self (e.g., self-blame and criticism), persistent negative emotional states (e.g., fear, horror, anger, guilt, or shame), feeling detached from others, and inability to experience positive emotions, such as happiness, satisfaction, or even loving feelings (American Psychiatric Association, 2022). These emotional disturbances can be present even without a diagnosis of PTSD or other trauma-related disorders. When this happens, people will often develop a negative relationship with their emotions, often leading to ignoring, avoiding, or no longer trusting their feelings.

Not feeling our emotions can lead to unhelpful coping strategies over time that allow us to “escape” the severe, negative emotions that can come with experiences of trauma. Unfortunately, avoiding these feelings can often result in new or worsening symptoms as our underlying emotions will look for new outlets. The energy from these emotions may manifest as symptoms such as anxiety, outbursts of anger, feeling low or depressed, dissociation, or substance use to avoid these negative feeling states. This is where therapy can help.

The hard part of this work is facing the feelings we have been avoiding, sometimes for years. If these feelings are not acknowledged and worked through, the emotional signals continue to go unheard, and we will continue to experience symptoms. Therapy can help by creating a safe place to begin unpacking and exploring these feelings through building safety and stability in our bodies and then learning to develop a relationship with our feelings again. As we process traumatic events and memories in a safe and productive way, it allows us to get back in touch with our bodies, our emotions, and the meaningful roles and relationships in our lives.

Davey Chafe, M.A., R.P. (Qualifying), is a Clinical Psychology Resident at CFIR in the final year of his PhD at York University and works with both individuals and couples in therapy. Throughout Davey’s clinical training, he has gained experience in a broad range of settings. He has worked with Emotion Focused Therapy for individuals and couples and Dialectical Behavioural Therapy for couples through York University, CBT for Mood and Anxiety at Brampton Civic Hospital, and with individuals and groups treating PTSD, mood disorders, and anxiety through community trauma initiatives. In addition to clinical work, Davey has been involved in psychotherapy research for over 10 years and has published in peer-reviewed journals and attended international conferences to present his clinical work. He is currently being supervised by Dr. Dino Zuccarini, C.Psych, Dr. Lila Hakim, C.Psych, and Dr. Aleks Milosevic, C.Psych.

REGULATING NERVOUS SYSTEM RESPONSES TO TRAUMA

Please see blog post: PART I: TRAUMA AND THE NERVOUS SYSTEM prior to reading this post

There are many different ways to regulate our nervous system. Body-based or somatic approaches are accessible and can create lasting changes to our feelings, thoughts, and behaviours. 

HYPERAROUSAL:

1. Hand on heart: 
   • place your hand on your heart and start to notice the gentle contact between your hand and your chest. Notice the weight of your hand on your chest.
   • Notice the temperature (e.g., warm or cold)
   • Notice any sensations (e.g., tingly, spacious, energized, airy)
   • Notice if the sensation starts to spread
   • Notice your breathing 
   • Deep breathing
2. Deep breathing:
   • Inhale for 4 counts; hold for 4 counts; exhale 8 counts
   • *try: inhaling through your noise and exhaling through your mouth (making an “O” shape with your mouth)
3. Belly breathing:
   • Place your hand on your belly
   • Inhale for 4 and actively expand your stomach
   • Hold for 4 
   • Exhale for 8 and collapse your stomach 

HYPORAROUSAL:

1. Posture change: 
   • Elongate your spine (*imaging your spine being pulled up to the top of your head)
   • Pull your shoulder back 
   • Gently push your chest out 
   • Take a few breaths here
2. Breathing:
   • Inhale for 8 counts; hold for 4 counts; exhale for 4 counts
3. Grounding through contact:
   • Stand up and notice your feet on the floor; elongate your spine and start to peddle your feet to apply more weight to one foot at a time; notice activation of muscles in your legs and glutes; bring attention to sensations (e.g., pressure, energized) and temperatures in your feet.  

Whitney Reinhart, M.A., R.P., is a psychotherapist who provides psychological services to adults and couples experiencing a wide range of issues, with a special interest and expertise in trauma and relationships. She uses a variety of trauma-informed approaches, including sensorimotor psychotherapy, somatic experiencing, and parts-based therapies.  

When we experience threat, our nervous system reacts in the best possible way for that situation, either by fight, flight, freeze, submit, or cry for help. When we experience threatening situations or traumas where we aren’t able to mobilize and run to safety or fight back, we will freeze or submit. In freeze, we feel stuck; there is an internal sense of danger and threat, but we are unable to move or act. In submit, we collapse; everything goes offline, our muscles become flaccid, and breathing decreases. 

When we have unresolved trauma (chronic or acute; attachment-based or threat to body), we can go throughout our lives reliving the trauma through our nervous system – often leaving us in a chronic state of hyperarousal (fight, flight, freeze, attach) or hypoarousal (submit). In chronic hyperarousal, our nervous system is geared up and activated. For example, we might find ourselves feeling irritable and on edge (fight), using substances for relief, distancing from relationships (flight), relying heavily on others, clinging to avoid abandonment (attach/cry for help), feeling frozen and/or experiencing panic attacks and flashbacks (freeze). In chronic hypoarousal, our nervous system is shut down and numbed out, and can result in us feeling depressed, ashamed, disconnected, unable to think, and passive.  

If you identify with some of these internal experiences, therapy is a great step for understanding your nervous system responses, what you had to do to stay safe, and how to regulate your nervous system. 

Stay tuned for Part II on regulating your nervous system.

Whitney Reinhart, M.A., R.P., is a psychotherapist who provides psychological services to adults and couples experiencing a wide range of issues, with a special interest and expertise in trauma and relationships. She uses a variety of trauma-informed approaches, including sensorimotor psychotherapy, somatic experiencing, and parts-based approaches. 

Imagine having to over-explain your experiences of discrimination to a therapist, just to have that very same experience invalidated. It’s as though what you’ve just shared did not happen. You’re left confused, feeling misunderstood, and questioning your reality. Perhaps feeling worse than before meeting your therapist, why would you even continue?  

This surprisingly common experience highlights the importance of cultural competence—the understanding and acceptance of norms other than your own. This requires more than simply following a checklist; it requires the ability to openly embrace different ways of being, which at times, you may disagree with. In Canada, there is a clear—and striking—underrepresentation of ethnic and sexual minorities in the mental health profession. What are, if any, the practical consequences of this, one may ask? 

The Ontario Health Study tells us that mental health services are consistently underutilized in minority communities. Interview-based research gives us some insight as to why. A common thread in these studies is that many individuals encounter varying forms of discrimination (i.e., both “microaggressions” and overt discrimination) from professionals and begin to feel like “therapy is not for them”.

Mental health does not discriminate—and as unfortunate as this is, the data suggests that your care provider may. While there is an active effort to understand and teach the ability to perceive and appreciate subtle differences in the cultural experiences of any given client, at times there simply may be no substitute for shared experience. 

Demographic factors are not the only thing to take into consideration when selecting a therapist, but clients should not be made to feel ashamed if they choose to do so. By and large, most clinicians offer free consultations. Meet with them. See what they are like. Be explicit with your concerns and ultimately, you make the decision if you feel understood—whether the therapist looks like you or not.

Ola Kuforiji, M.A., is a registered psychotherapist (qualifying) at the Centre for Interpersonal Relationships. He provides therapy with for individuals and couples (with a special interest in ethnocultural and sexual minorities) under the supervision of Dr. Lila Z. Hakim, C.Psych.

Complex post-traumatic stress disorder (C-PTSD) is a relatively new diagnosis for understanding how past events can impact our mental health in the present. If you’re struggling with difficult symptoms, you might have wondered if they could be due to complex trauma. 

Complex trauma involves experiencing a series of events of a threatening or horrific nature, where escape is difficult or impossible. These events overwhelm an individual’s capacity to control or cope with the stressor. They can occur in childhood or adulthood, and could include (but aren’t limited to):

• Domestic violence
• Physical abuse
• Sexual abuse, harassment, or assault
• Neglect or abandonment
• Racial, cultural, religious, gender, or sexual identity-based oppression and violence
• Bullying
• Kidnapping
• Torture
• Human trafficking
• Genocide and other forms of organized violence

Those with complex trauma develop post-traumatic symptoms such as flashbacks, avoiding reminders of the events, and feeling constantly “on edge” or hypervigilant. But due to the prolonged and pervasive nature of the trauma, those with complex trauma develop additional symptoms that are important to recognize.

The first is trouble with affect regulation. This means they might have trouble calming down after a stressor or have strong emotional reactions. On the other end of the scale, they may often feel emotionally numb, or not able to experience positive emotions such as joy. 

Secondly, individuals with complex trauma struggle with negative self-concept. This means they often have strong beliefs that they are worthless, or a failure. They might feel intense guilt or shame in relation to these beliefs.

Finally, individuals with complex trauma often have issues in relationships with others. They might have trouble sustaining relationships and feeling closeness to other people. They might have short, intense relationships, or avoid relationships altogether.

Complex trauma often occurs across generations (sometimes referred to as intergenerational trauma), due to a lack of resolution of previous traumas and prejudice and discrimination that results in the oppression of entire families and groups.

Always consult with an experienced mental health professional if you believe that you may have complex trauma or another condition. Regardless of the cause of your symptoms, there are many treatment options available that can help you achieve your goals and feel better. 

Camille Labelle, BSci, is a therapist working at the Centre for Interpersonal Relationships (CFIR) under the supervision of Dr. Lila Hakim, C.Psych. They provide individual therapy to adults who have experienced single-incident or complex trauma or are seeking support for other mental health conditions such as anxiety or depression. They use an integrated approach including emotion-focused therapy (EFT) and cognitive behavioural therapy (CBT) to empower people to process their experiences, understand their reactions, and change their lives. 

References

Ford, J. D. & Courtois, C. A. (2020). Treating Complex Post-Traumatic Stress Disorders in Adults, 2nd ed: Scientific Foundations and Therapeutic Models. New York, NY: The Guilford Press. 

World Health Organization. (2019). International Statistical Classification of Diseases and Related Health Problems (11th ed). https://www.icd.who.int/  

As we enter the New Year, we are suddenly bombarded with advertisements pushing weight loss products and filling our minds with the idea that, in order to be our “best selves” this year, we must follow some new diet and exercise regimen. For many individuals—especially those struggling with eating disorders (ED)—this time of the year can make us particularly vulnerable to feelings of guilt and shame as we are faced with increased pressure to “undo” the indulgences of the holidays.

For individuals struggling with an ED, food-related guilt and body image shame is often dealt with through self-punishing behaviours; for example, following an overly restrictive diet and excessively exercising. On the other hand, some individuals cope with body image shame by hiding under baggy clothes in an effort to avoid painful feelings of guilt and shame. However, in my practice as a therapist, I’ve found that such self-punishing and avoidance behaviours are unsustainable and ultimately perpetuate the cycle of guilt and shame.

Instead, consider these three more sustainable tips for coping with post-holiday food guilt and body image shame, none of which involve dieting or pursuing weight loss:

1.   Don’t criticize yourself: Practice self-compassion and Radical Acceptance

Instead of beating yourself up, or running away from feelings of shame (literally or figuratively), try working towards greater self-compassion. Be gentle with yourself and be reminded that shame is a fleeting feeling, not an identity; just because you are feeling bad, does not mean you are bad. Another self-compassionate approach to dealing with shame is practicing Radical Acceptance, a skill used in Dialectical Behavioural Therapy (Dimeff & Linehan, 2001). Rather than ignoring, avoiding, or wishing the situation were different, accept things exactly as they are, including the painful emotions of shame and guilt. Radical Acceptance can help you regulate feelings such as anger, guilt, and shame by approaching them with kindness and self-understanding rather than self-judgment.

2.   Ask Yourself: Whose Shame is it Really?

When working with clients who struggle with body image shame, I often ask them to reflect on who their shame really belongs to. This question is meant to facilitate differentiation, the process of recognizing the extent to which one’s body image shame has been taken on as a result of someone else’s shame. This can help you detach from and “disown” feelings of shame by identifying that perhaps your shame does not belong solely to you. Differentiation can protect you from internalizing—and thus negatively reacting to—body shame-inducing comments made by others.

3.   Swap your “Clean Eating” Plan for a Social Media Cleanse

Research shows that exposure to media promoting the “thin ideal” or “athletic/muscular ideal” increases body image dissatisfaction and can also lead to negative emotions, depression, and disordered eating (Huang et al., 2021). We now have the ability to control what shows up on our timelines, so consider unfollowing any accounts that promote diet culture and start following body-positive or body-neutral content online. Doing so will ensure such shame-inducing content no longer appears on your feed or negatively impacts your well-being this year.

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 (e.g., Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, ARFID), body image concerns, neurodiversity (e.g., ADHD, ASD, OCD) and trauma. She integrates emotion-focused therapy (EFT), cognitive-behavioural therapy (CBT), and dialectical-behavioural therapy (DBT) informed techniques to support individuals struggling with concerns regarding eating, weight, and body image.  

SOURCES

Dimeff, L., & Linehan, M. M. (2001). Dialectical behavior therapy in a nutshell. The California Psychologist, 34(3), 10-13.

Huang, Q., Peng, W., & Ahn, S. (2021). When media become the mirror: A meta-analysis on media and body image. Media Psychology, 24(4), 437-489.