We’ve all experienced this: trying to focus on a work task, school essay, or work meeting – but you simply cannotfocus on what you’re doing. 

“Why can’t I just focus on this? What am I doing wrong?” you might wonder.

Often emotions, and particularly anxiety or stress, are the main culprits (Pacheco-Unguetti, Acosta, Callejas, & Lupiáñez, 2010). We evolved to be able to shift attention in response to external and internal factors – for example, by internally narrowing your focus on a conversation, or an external occurrence, like a loud noise, capturing your attention – to navigate the world. This usually works to our advantage by focusing on important and relevant things. However, this can also hinder our objective if our attention is hijacked by something seemingly irrelevant or unknown. For instance, you may have a tight deadline for a high stakes work report that is inducing anxiety, and despite needing to finish it, the stress around it can prevent you from engaging as much as you want. And it may be happening unconsciously.

So, what can be done about this?

Awareness: The first step is to notice a potential a problem and identify it. If you can rule out factors like fatigue, then stress may be the issue. Reflect on potential sources of stress, whether it’s the task, other things happening in your life at the same time, or some context for the task (e.g., being previously criticized for the work task).

Self-soothe: Rather than brute-forcing yourself to complete the task, try stepping away for a few minutes to self-soothe. This can include deep breathing, meditation, a short enjoyable activity, etc. Try to avoid simple distractions, like social media, because while they provide momentary relief, they don’t actively reduce distress.

Neuropsychological evaluation: If you continue to find yourself struggling to focus your attention, you may consider a neuropsychological assessment to disentangle potential neurodevelopmental conditions–such as ADHD–and emotional factors that could impact your attention and productivity (Mueller, Hong, Shepard, & Moore, 2017). CFIR provides both neuropsychological and psychological assessments, either in-person or virtually, as well as follow-up psychotherapeutic support.

References

Pacheco-Unguetti, A. P., Acosta, A., Callejas, A., & Lupiáñez, J. (2010). Attention and Anxiety: Different Attentional Functioning Under State and Trait Anxiety. Psychological Science, 21(2), 298-304. 

Mueller, A., Hong, D.A., Shepard, S., & Moore, T. (2017). Linking ADHD to the Neural Circuitry of Attention. Trends in Cognitive Sciences, 21(6), 474-488.

Dr. Peter Egeto, R.P., C.Psych is a psychologist and neuropsychologist at the Centre for Interpersonal Relationships. He provides psychological treatment, as well as psychological and neuropsychological assessments for adult clients with a range of issues, including mood, anxiety, trauma, interpersonal relationships, personality, attention deficit/hyperactivity disorder, autism spectrum disorder, acquired brain injury, and neurological conditions. In treatment, he practices primarily with an integrative therapeutic approach and draws on multiple strategies, including cognitive-behavioural, emotion-focused, interpersonal, and psychodynamic therapies.

Has anyone ever told you to “just take a walk outside to clear your head” or “go out and get some fresh air; it will make you feel better!”?  Recommendations to “get outside” when we are feeling overwhelmed or stressed are quite common, and oftentimes when we accept this advice, it works! Have you ever wondered why this might be the case? 

The diverse sights and sounds afforded by natural environments such as natural or urban forests draw our attention away the everyday commotion of our lives, allowing us to relax our bodies and effortlessly turn our curiosity and attention to the beauty of the world surrounding us. 

Research has been conducted that supports the psychological and emotional benefits of nature experience. Going for a walk in a natural or urban forest or simply sitting and breathing in the fresh air is a simple and effective way to reduce physical expressions of stress and anxiety, reduce rumination and improve mood as well as increase capacities for attention and cognitive functioning. 

Finding ways, even if only for a few minutes, to integrate nature experience into your daily life may provide additional support to your healing journey and overall well-being.  

Jimenez MP, DeVille NV, Elliott EG, Schiff JE, Wilt GE, Hart JE, James P. Associations between Nature Exposure and Health: A Review of the Evidence. Int J Environ Res Public Health. 2021 Apr 30;18(9):4790. doi: 10.3390/ijerph18094790. PMID: 33946197; PMCID: PMC8125471.

Dr. Jennifer Bradley, PhD, C.Psych is a psychologist at CFIR. She works with individuals experiencing a wide range of psychological and relational difficulties including life transitions, anxiety and stress, trauma, depression, mood and grief, interpersonal difficulties, and issues related to self-esteem. Dr. Bradley is an integrative therapist with a particular interest in existential and relational approaches to psychotherapy. In her academic and research work, Dr. Bradley studies how spending time outdoors and our relationship with the natural worlds supports psychological health and well-being.

In the part 1 of this blog, we discussed intolerance of uncertainty, and how it presents and works within anxiety. Now let’s discuss how to manage and change this intolerance of uncertainty. 

Chances are that if you identify with being intolerant of uncertainty, that over time you have developed habits in your life that either help you avoid uncertain situations, or strive to achieve as much certainty as possible. But these methods are not effective, since uncertainty is an unavoidable part of life. Awareness and acknowledgement of the problem is not enough to change our relationship with uncertainty; Action is required to truly change those deep-rooted beliefs and thoughts about uncertainty mentioned in part 1. This action is reflected through the Cognitive-Behavioural Therapy technique of Behavioural Experiments, and/or exposures (Hebert & Dugas, 2019).

For example, take the common parenting/coaching technique used on young children who were afraid of getting hit by the ball in baseball, where the parent intentionally throws the ball at the child. Once the child has faced their fear of getting hit with the ball, they have objective evidence that helps them learn: 1) whether the feared outcome was as bad as they anticipated, and 2) whether they could cope with the feared outcome. This is how action helps us gather evidence to re-evaluate our beliefs and assumptions, and form new, more adaptive ones.

If I were tolerant of uncertainty, how would I act?

This question forms the basis of behavioural experiments and exposures directly targeting intolerance of uncertainty. But behavioural experiments are developed in a more intentional and systematic way than unpredictably being hit by a baseball and finding out that it wasn’t that bad afterwards. Behavioural experiments take exposure exercises one step further by not only requiring you to face situations that involve uncertainty (i.e., eating at a new restaurant), but facing uncertain situations in order to test specific beliefs about uncertainty (i.e., “Uncertainty will lead to disappointment and regret.”) (Hebert & Dugas, 2019).

Working with a CBT therapist will help you practice behavioural experiments that are effective and therapeutic, via empirically supported treatment. They will help you identify unhelpful or negative beliefs about uncertainty that drive your intolerance and symptoms of anxiety, develop a list of uncertain situations you either avoid altogether or seek out certainty around, and successfully conduct behavioural experiments or exposures that directly target and challenge your specific beliefs about uncertainty. 

Reference:

 Hebert, E. A., & Dugas, M. J. (2019). Behavioral experiments for intolerance of uncertainty: Challenging the unknown in the treatment of generalized anxiety disorder. Cognitive and Behavioral Practice, 26(2), 421-436.

Erin Tatarnic, R.P. is a registered psychotherapist at the Centre for Interpersonal Relationships (CFIR). She provides psychotherapy to individual adults experiencing a range of mental health difficulties including anxiety and anxiety-related disorders, obsessive-compulsive concerns, depression, relationship difficulties, and coping with neurodiversity differences. Erin works from a client-centred approach using a cognitive-behavioural framework (CBT), while also integrating therapeutic techniques from emotion-focused therapy (EFT) and mindfulness-based cognitive therapy.

Yes, you read that right. Not gluten-, not dairy-, but an Intolerance of Uncertainty, which is a key driver within anxiety (Koerner & Dugas, 2006). When one has a medical allergy, they experience very strong physical reactions when exposed to even a small trace of the substance they’re allergic to. Intolerance of uncertainty is like a psychological allergy, where even a miniscule amount of uncertainty in a situation, creates negative and uncomfortable effects, such as excessive worrying and physical symptoms of anxiety. No matter how unlikely an outcome is, such as being in a plane crash, unless one can achieve 100% certainty of the outcome, it will be worried about. This intolerance of uncertainty can go as far as those with anxiety even preferring a negative outcome to their problem, over an uncertain one (Hello, self-sabotage!). 

So what are some telltale signs that you have an intolerance of uncertainty?

No, not hives, anaphylactic shock, or swelling. Some of the most common ways those with anxiety may act in the face of uncertainty include:

• Avoiding doing uncertain things altogether
  • Avoiding investing in therapy because it’s uncertain what the outcome will be or how the experience will feel
• Making up obstacles or excuses to not do things
  •  “I know exercise would be good for me, but what if I end up injuring myself?”
• Procrastinating
  • Avoiding asking a friend for a favour because you’re uncertain of how they’ll respond
• Having difficulty delegating tasks or trusting others
  • Doing all the chores yourself because you can’t be certain that your partner will do it “right”
• Seeking excessive information before making decisions or acting
  • Researching several different options of blenders from several different stores before buying one 
• Seeking reassurance from others
  • Asking multiple people in your life for advice or reassurance about the same problem, or asking them to decide for you

Intolerance of uncertainty is due to unhelpful beliefs held about uncertainty: That it is dangerous, that we cannot cope with it, and that it must be avoided at all costs (Koerner & Dugas, 2006). However, operating under those beliefs only strengthens the adverse reaction to uncertainty, shrinks your comfort zone, and exhausts you from constantly trying to achieve certainty in a world where it’s impossible to not come across uncertainty in some way or another. Read on for part 2 of how to face uncertainty if you identify as uncertainty-intolerant.

Reference:

 Koerner, N., & Dugas, M. J. (2006). A cognitive model of generalized anxiety disorder: The role of intolerance of uncertainty. Worry and its psychological disorders: Theory, assessment and treatment, 201-216.Erin Tatarnic, R.P. is a registered psychotherapist at the Centre for Interpersonal Relationships (CFIR). She provides psychotherapy to individual adults experiencing a range of mental health difficulties including anxiety and anxiety-related disorders, obsessive-compulsive concerns, depression, relationship difficulties, and coping with neurodiversity differences. Erin works from a client-centred approach using a cognitive-behavioural framework (CBT), while also integrating therapeutic techniques from emotion-focused therapy (EFT) and mindfulness-based cognitive therapy.

It may come as no surprise to any parent to hear that anxiety is the number one mental health difficulty children and adolescents face today. There are a myriad of different factors that contribute to the stress that children and adolescents experience, such as school, social, and familial expectations. Youth can be excellent at hiding their anxious symptoms not only from their parents but even from themselves! Some symptoms are easier to see while others take a keener eye to spot and may take more effort to uncover. 

Look for Physical Signs…

• Tenseness
• Jitteriness
• Restlessness
• Fidgeting
• Sweating
• Complaining of aches and pains (e.g., stomach, chest, or head aches)
• Trouble breathing

It’s important to remember that any of these physical signs of anxiety can occur during everyday events. Any one of these occurring on their own, or with others, can be felt by every person at one point or another for both positive and negative experiences. When these physical signs occur frequently and are consistently displayed before or during a specific situation, there is likely something anxiety provoking about that situation. 

… And Subtle Signs

Less easy to notice are actions, behaviours, and thoughts that can fly under the radar. Notice what it is your child is doing and when they are doing it. Are they often late to leave for school? Do they procrastinate on difficult subjects but not on easier ones? Do they check things repeatedly, like locked doors, before doing something else? It’s just as important to notice what your child is not doing. Are they not studying, doing homework, going out with friends, or attending extra-curricular activities? Refusal to do something can be a subtle way to avoid situations that provoke anxiety. If you suspect your child is experiencing anxiety, talk to them about it to better understand what they are thinking. Listening to what they say and understanding their perspective can help uncover what they are worried about. Anxiety can grow when left unchecked and your child needs your support to cope with it. 

Massimo Di Domenico, M.A., is a therapist working under the supervision of Dr. Nalini Iype, C.Psych. and is also working towards the completion of his PhD in Clinical Developmental Psychology. He provides both treatment and assessment services to individuals of all ages – children, adolescents, and adults. Working with an integrative framework, he treats those suffering from depression and anxiety, difficulties in social relationships, and concerns related to parenting and family dynamics. For those seeking answers on how they, or their child, learn or work best, he also provides assessment services for learning disorders and ADHD.

Major life transitions can occur at any stage in life. Whether it is starting university or college and living on your own for the first time, starting a new job, becoming a parent, or experiencing a death or loss of a loved one, life transitions can evoke many complex feelings. When we experience a big life-altering change, we are often faced with many unknowns and a sense of unpredictability regarding our future. Confronting the unknown and uncertain can evoke feelings of stress, worry, fear, self-doubt, grief, and depressive experiences. While these feelings are normal when faced with a major life change, they can still feel intense and overwhelming. To support yourself or loved ones during a time of major life transition, it is important to remember to: 

1. Acknowledge and validate your feelings—Sometimes our emotions can feel so overwhelming and intense because we don’t yet know why or what we are experiencing. Acknowledging that a life transition is likely to evoke strong emotions and finding new and healthy ways to identify and validate your feelings can help you navigate change. 

2. Accept the inevitability of change— We are constantly changing, growing, and evolving in our lives and relationships. Change can be difficult and overwhelming, but it can also provide an opportunity for self-growth and development. Through experiencing change, we can discover new possibilities and parts of ourselves, which can be exciting and motivating!

3. Reach Out and Connect—Sometimes experiencing a major change in your life can feel lonely and isolating. Connecting with loved ones, members of your community, or others who may be experiencing a similar life change can help you to navigate this difficult time. Engaging in psychotherapy can be another way to address any difficulties that you are facing because of a major life change. In the process of psychotherapy, you can learn new ways to navigate difficult emotions, and develop a deeper understanding and meaning about what this major life change means to you. 

If you are experiencing a major life transition, and wanting to better understand and navigate your experience, CFIR has counsellors, psychotherapists and psychologists who are available to support you!

Jennifer Bradley, M. A. is a Registered Psychotherapist (Qualifying) at CFIR. She works with individuals experiencing a wide range of psychological and relational difficulties including life transitions, anxiety and stress, trauma, depression, mood and grief, interpersonal difficulties, and issues related to self-esteem. Jennifer is an integrative therapist with a particular interest in existential, relational, and psychodynamic approaches to psychotherapy. 

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

By: Dr. Peter Egeto, C.Psych (Supervised Practice)

Everyone has this thought run through their head when they’re having trouble focusing on a work task, school assignment, or other commitment. It is a very frustrating obstacle, so why can’t we just focus?

Attention is the first, and crucial step to apply our thinking power to a task. Without it, we’re unable to learn, problem solve, or think clearly. There are lots of reasons why our attention can be challenged. 

Anxiety often takes attention away from the task at hand. Evolutionarily, anxiety developed partly to help us survive by looking for threats in the environment. Although your project deadline may not be a life or death “threat,” the emotion still kicks in and draws your attention away from the work you’re trying to do.

Alternately, some people’s brains develop differently, and have trouble controlling their attention. This is referred to as attention deficit/hyperactivity disorder (ADHD). People with ADHD have great difficulty focusing because they are easily distracted by other thoughts or things in their surroundings. It can feel like your head is a vortex of racing thoughts, which can make a simple task frustrating or daunting.

How can I focus better? 

Luckily, there are ways to optimize your attention. Completing a neuropsychological assessment is a good way to tease apart whether your attention is hindered by anxiety, or potentially ADHD. It can also offer solutions tailored to your unique issues. Anxiety management strategies can free up your attention, while ADHD can be managed with medication, therapy, or both. 

Each year, millions of Canadians suffer from mild to debilitating bouts of depression and anxiety. “It’s so hard to figure out what next steps to take when your attention, concentration, emotional distress and basic sense of vitality are so affected by declining mental health” says Dr. Lila Z. Hakim, C.Psych, Centre Director at the Centre for Interpersonal Relationships in both downtown Ottawa and Toronto.

Figuring out your next steps isn’t so easy. Clients are often overwhelmed by the numerous choices and decisions that have to be made about treatment possibilities and who might be the appropriate mental health professional to help them.

Decades of research on depression and anxiety point to biological, attachment, developmental, childhood trauma, socio-cultural context, environment, emotional, cognitive, behavioural, personality and interpersonal factors as possible precipitators of symptoms. What’s causing you to be depressed and anxious can be complex to sort through.

“CFIR mental health clinicians employ a biopsychosocial model to understand and capture a broad picture of the factors that may be affecting your well-being. It’s not always so simple that there is only a sole factor underlying your symptoms—sometimes many factors have to be considered to address the different layers underlying a person’s distress” cautions Dr. Hakim, C.Psych., “and it’s important to find a practitioner that can understand your depression and anxiety in complex ways. For example, sometimes it’s not just about changing thoughts and how you are thinking about a situation.”

Choices and decisions also have to be made about treatment —medication and/or psychological treatment and what type of psychotherapy might be best for you. Adding to the burden of decision-making is the recent advent of computerized psychological treatments—where treatment involves minimal contact with a care provider. Dr. Hakim, C.Psych. offers several suggestions to help you wade through these complex waters.

“It’s always important to have a general physical health exam to rule out physical causes for your depression and anxiety. Your physician can help you with decisions about which medication might be best for you, and there’s even testing you can have done that can inform you about which medications might have lesser side effects for you. Physicians have different levels of training in mental health treatment and do provide medication options. You might want to also seek out a professional trained as a mental health practitioner along with your visit to your doctor”, according to Dr. Hakim, C.Psych.

Whether you decide to take medication or engage in psychotherapy as a first line treatment approach will depend on you. Numerous research studies, however, have been conducted to guide clients on this subject. Dr. Hakim, C.Psych provides insights from these studies; “Research shows that psychotherapy is effective for mild to moderate symptoms, and a combination of both medication and psychotherapy might be the way to go for individuals with severe and debilitating symptoms. Medication increases neurotransmitters in your brain and can make you feel better, and adding psychotherapy to the mix improves outcomes because the other possible factors underlying your depression and anxiety symptoms still have to be addressed.”

When it comes to choosing what type of psychotherapy might be right for you, clients have further complex decisions in front of them. Dr. Hakim, C.Psych. provides further guidance to help you sort through these decisions. “Some mental health care professionals provide clients with support to change the way they think about situations, or provide skills and strategies to deal with distress and symptoms (e.g., Cognitive-Behavioural Therapy). These types of approaches try to help the client to feel better by managing symptoms, yet there are often many potential factors underlying anxiety and depression. Other mental health care professionals will work with your past and present-day experiences to help you gain awareness and insight into your emotions, self and relationship patterns, self-protection and defences that interfere with healthy functioning. These approaches help you to find more adaptive responses to everyday life but requires a deeper exploration of and engagement with the individual’s emotions, self and past experiences (e.g., Psychodynamic Therapy).”

Some individuals may prefer to learn strategies to diminish symptoms and feel good without deeply understanding themselves by exploring their pasts and emotional reactions to every day life while others may want to understand themselves more profoundly. “The idea that our past influences our present-day experience is a commonly held notion in the field. The way we think and feel about ourselves, think and emotionally react and respond to others, and how we behave and relate to others in our present-day is highly influenced by our past experiences” according to Dr. Hakim, C.Psych. Her final word on this topic is “that finding a mental health clinician who can flexibly work with you and integrate different psychotherapy models might provide more opportunities to work on different factors underlying depression and anxiety symptoms.” This view of treatment is the basic philosophy that underlies the treatment approach offered by the over 75 mental health clinicians at Dr. Hakim, C.Psych.’s centre. They offer flexible treatment options to work with different factors underlying anxiety and depression, and can move between symptom and distress management to working with deeper underlying factors causing your distress.

Finally, Dr. Hakim, C.Psych. shares her perspective on computerized psychological treatment. ‘In Ontario, free computerized psychological treatment services are offered, which is good and I do refer my clients to these sites as an adjunct to the treatment I am providing. Computerized treatment isn’t for everyone and doesn’t necessarily capture the complex factors underlying a unique individuals struggles with depression and anxiety. Sitting alone in front of a computer with only intermittent meetings with a mental health care professional may not allow for the necessary support and treatment related to the numerous factors underlying symptoms. Depression and anxiety have attachment, developmental, emotional, personality and interpersonal factors that are difficult to address on a computer.”

Many people struggle with being assertive or setting boundaries. The prospect of setting limits or asserting that your needs be met can provoke anxiety as this may require some form of aggression or expression of anger on your behalf. Aggression and anger – in proper measure – can help clearly signal to others what you’re willing to tolerate and is implicated in your capacity to take up space when it’s appropriate.

Some people disavow their aggressive drives – because of conditioning within the family or the broader cultural surround – as they fear that it may negatively affect how others see them or even how they see themselves. However, disclaiming anger or aggressive drives when it may be needed doesn’t mean that these parts of you vanish; instead, it accumulates within, and it may eventually be experienced as resentment and bitterness toward others and the world. Indeed, many clients I see who attempt to preserve relationships by disavowing their need to set boundaries or assert themselves, swiftly cut people out of their lives. Or they displace their anger onto “safe” relationships that are ultimately not the source of their frustration. Others may direct their anger inward, which mutates into a nasty self-critic that sometimes ends in them physically hitting themselves in frustration.

Another common outcome for people-pleasers or non-asserters is burnout. Habitually prioritizing others’ needs over one’s own is untenable and may lead to exhaustion and symptoms of depression. During burnout, their identity as someone useful and helpful is compromised, making their dominant ways of maintaining closeness and connection unavailable to them. This experience can further exacerbate distress, as people in this situation often feel unable to communicate their needs to others – the language to do so may elude them.

Therapy can help people like the ones described above to understand the context of their people-pleasing habits. Everyone is born ready to assert their needs in the world. But, in a global sense, your experiences will shape your attitudes regarding whether being assertive is perceived as negative. Understanding how you went from being an infant who only knew how to need to someone who disavowed your needs can help reorient you to a more moderate space where you can set appropriate boundaries, and where a reciprocal exchange of needs with others is possible.

Mental health professionals at CFIR can also support you in addressing problems often associated with perfectionism, including anxiety, depression, anger, eating disorders and relationship problems.  Contact us to inquire more and to begin or continue on your journey toward making yourself and your mental health a priority.

Dr. Sela Kleiman, C.Psych. (Supervised Practice) is a psychologist in supervised practice at CFIR’s Toronto office. He has provided clinical and assessment services in a variety of settings such as the Centre for Addiction and Mental Health, the McGill Psychoeducational and Counselling Clinic, and the Health and Wellness Centre within the University of Toronto. He has alsoI completed his Ph.D. in clinical and counselling psychology at the University of Toronto. In individual therapy, he help adults struggling with depression, anxiety, grief, as well as those trying to cope with the effects of past and/or current verbal, emotional, physical, and sexual abuse.