WADING THROUGH YOUR MENTAL HEALTH TREATMENT OPTIONS—CONSIDERING YOUR NEXT STEPS TOWARD BRIGHTER, CALMER DAYS

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.”

The Challenges of Being Assertive and Setting Boundaries for Pleasers and Self-Sacrificers

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.

Self-Harm – It’s More Than You Think

What is Non-Suicidal Self Injury?

Non-suicidal self-injury (NSSI), commonly described as self-harm, involves deliberate acts (such as cutting) that directly damage the body but occur without suicidal intent. Typically, when we think of NSSI we think of individuals who cut, burn, punch, or pinch themselves. In the psychological literature, these behaviours are referred to as direct NSSI. In an ideal setting, individuals who engage in self-harm behaviours either independently seek out psychological support in the form of therapy, or are noticed to be engaging in self-harm by individuals close to them and are encouraged to seek help at that time.

Indirect NSSI

However, individuals can also engage in other self-harm behaviours that are not as clearly noticed by others, since the methods of self-harm do not directly lead to bodily damage. These behaviours are termed indirect NSSI. 

‘Indirect’ methods of NSSI can include:

  • Involvement in abusive relationships
  • Substance abuse
  • Risky or reckless behaviour (e.g., reckless driving, bar fights, unsafe sexual practices)
  • Intentionally putting one’s body into physical danger (e.g., ‘daredevil’ acts)
  • Disordered eating behaviour

Since these activities are not often identified as self-injury, and can even be missed as warning signs by therapists, hospitals, and primary care physicians, it is crucial to notice problematic behaviours before their severity increases.

Men and Self-Harm

For a variety of reasons, individuals who identify as male are more likely to engage in indirect self-harm than those who identify as female (St. Germain & Hooley, 2012; Hooley & St. Germain, 2014). One such reason that has been proposed is that behaviors that have often been labeled as traditionally male expressions of anger and frustration sometimes contain indirect forms of NSSI (e.g., punching walls, picking fights with others, overconsumption of drugs and alcohol; Green & Jakupcak, 2016). Adherence to these traditional male gender norms is also associated with difficulties articulating thoughts and feelings, which can further increase an individual’s risk of engaging in self-harm (Levant et al., 2003). As a result, some men might not readily identify the intentionality behind some of the harmful actions described above.

Finding Help

Psychologists and therapists at CFIR are able to diagnose and guide the treatment related to direct and indirect self-harm for all individuals. We provide support to children, adolescents, adults, couples, and families who themselves struggle with self-harm, or have loved ones who do. We help clients establish solid networks of physical and emotional care and support. We also provide specific psychological treatment for individuals who self-harm, supporting them through the cascading negative emotions that may precede or accompany instances of self-harm.

Dr. Brent Mulrooney, C.Psych. is a psychologist in supervised practice at CFIR (Toronto). He has substantial interest and treatment experience in the realm of family functioning and relationships, anxiety and mood disorders, work and school success, addictions, violence (especially violence in the home), trauma, and gender identity and sexuality. Brent holds a PhD in School and Clinical Child Psychology from the University of Toronto, as well as a Masters degree in Applied Social Psychology from Memorial University of Newfoundland.

10 Tips for Managing Holiday Stress in 15 Minutes or Less

by: Dr. Tracy Dalgleish, C. Psych.

Holidays bring us a lot of joy. But the increased demands and events at this time of year can also bring us a lot of stress. We tend to say that we are ‘too busy’ to tackle stress and instead of trying to manage it, we push ourselves to get through each day. Come January, many clients end up in my office burnt out. Managing your stress does not have to take hours each day. Just a few short minutes each day can help you not only cope during this busy time, but also prevent burn out down the road.
Here are ten tips that take less than 15 minutes each day to help you manage stress.

  1. Go for a 15-minute brisk walk. It could be around the building during a break, or around the block when you get home.
  2. Take ten, slow, intentional breaths. Breathe in through your nose counting to six, and exhale slowly through your nose counting to six. Try this while taking a shower, or standing in line at a store.
  3. Notice five things. Whether you are sitting in your office, in traffic, or watching your children play, say to yourself, ‘I notice the license plate in front of me,’ ‘I notice the red book on my shelf,’ or ‘I notice the colour of the lights.’
  4. 5-4-3-2-1 with your senses. Notice five things with your sense of sight (see previous). Notice four things with your sense of touch – the roughness of the chair you are sitting on, the smooth edge of the table, the warmth of your coffee cup. Notice three things you hear – the hum of the computer, a car buzzing by, a door opening. Notice two things with your sense of taste (e.g., the taste of toothpaste left in your mouth after brushing your teeth) and smell (e.g., the smell of fresh air). Take one deep breath in through the nose and slowly out through the nose.
  5. Talk to a friend, lover, or co-worker. Sharing with a significant other about what is contributing to your stress can help you problem solve or work through your emotions.
  6. Listen to music. It can be soothing to listen to music that puts you in a good mood.
  7. Try a guided relaxation or mindfulness exercise. I recommend this “Leaves on the Stream” exercise on YouTube. You can also download the app Head Space and get ten free short exercises to try each day.
  8. Let go of unhelpful thoughts. We all have them – the thoughts of worry, the thoughts of “what if,” the thoughts of the worst-case scenario, or predicting the future. First acknowledge that you are having these unhelpful thoughts, then try letting go of your thoughts and focusing on what you are doing in the moment.
  9. Stretch. We could learn a lot from watching a dog or cat. Every time they move, they stretch! Try lifting your arms over your head with a breath in, and as you let the breath out bringing your arms back down.
  10. Make a list. Writing out your to-do items can help unload the mental energy of trying to remember everything you want to get done. Try breaking items down into small, achievable tasks, and prioritizing items.

Finally, if stress becomes too difficult to manage, reach out for help. Trained psychologists and therapists are available at CFIR to help you manage stress, depression, and anxiety.

What’s Anxiety and How Is It Related to Stress?

by: Dr. Lila Z. Hakim, C.Psych.

Mood and anxiety disorders are among the most common types of mental disorders in Canada and have been shown to have a major impact on the daily lives of those affected.

SOURCE: Mood and anxiety disorders in Canada | canada.ca

Anxiety tends to be accompanied by a wide range of physical and psychological symptoms. Individuals experiencing anxiety may have physical complaints such as shortness of breath, heart palpitations, sweating profusely, or feeling dizzy. Chronic fearful arousal can interfere with sleep, concentration, and attention, and affect overall functioning. These physical symptoms are often accompanied by negative and self-critical thoughts about oneself, catastrophic fears, and thoughts of terrible things happening to oneself or loved ones. Some individuals will engage in certain behaviours (e.g., checking, counting, handwashing), or avoid certain places or social situations to deal with their anxiety.  Anxiety can manifest in different ways — individuals can struggle with different types of anxiety, including agoraphobia, generalized anxiety, panic, social anxiety, and specific phobias.

Anxiety may be rooted in difficult early or present-day life situations. For some of us, early childhood experiences in which we lacked appropriate and sufficient nurturance and support may have resulted in a vulnerable sense of self that is prone to anxiety in everyday life. For others, challenging, negative life experiences with family, friends, peers, and relationship partners may have undermined our safety and security in such a way that our confidence in our selves and others has been drastically altered.

Deep self-vulnerability may emerge when the unprocessed emotions and unmet needs associated with these past and present-day life events are not addressed. As a result of these experiences, we begin to think about, or emotionally react to our selves, others, and the world, in ways that constrict us from being able to move freely in the world or create relationships with others. We can begin to overly anticipate danger, or bad things happening to us, and engage in behaviours to cope with the anxiety. These behaviours then stop us from participating fully in life and become a further source of distress.
Sometimes stress, particularly when long-lasting, can overwhelm us and result in us feeling anxious. Some individuals have stress for days before tests, public speaking, or appointments, which impairs their ability to cope with life’s daily tasks. Their functioning becomes significantly diminished and our anxiety response to life increases. Being able to manage stress increases our sense of confidence, and improves the quality of our lives, and reduces our anxiety.

Work stress can also undermine our sense of emotional and physical well-being, and as a result, bring about chronic anxious feelings. Burnout can result from long-term stressors that are unresolved. Being able to cope with work stress is essential to prevent burnout. Work stress and exhaustion are caused by multiple factors that require attention to ensure we are creating a good quality of life in our work lives. Work stress and burnout can have a long-lasting impact on our sense of selves and our relationships when not addressed. When we are overly stressed and experiencing burnout, life’s smallest tasks can bring about anxious feelings. 

The Anxiety, Stress & Obsessive-Compulsive Service at CFIR offers clients a comprehensive assessment and diagnosis of your anxiety issues to facilitate appropriate treatment planning. We employ short-term and long-term, scientifically-validated interventions to address the specific type of anxiety you are experiencing. Cognitive-behavioural, psychodynamic, and experiential approaches are employed to help you resolve issues related to anxiety or stress.

Read more about our Anxiety, Stress & Obsessive-Compulsive Treatment Service.

Stress and the Brain

by: Ali Goldfield, M.A.

We all have stress in our daily lives. So much so that we often think nothing of running from place to place, eating on the go, and juggling work and family life. You have probably already heard that stress can wreak havoc with our immune systems, our sleep patterns and our ability to enjoy the things we used to, but did you know that stress can actually affect the size of your brain? 

Researchers know that trauma can significantly affect brain structure but one study done by researchers at Yale University now shows that everyday stressors, like a divorce, job loss, the death of a loved one or a serious illness can also affect our brain in the same way that one traumatic event can. These cumulative stressors, it seems, can lead to shrinkage in our brains, reducing the volume of grey matter and lowering our ability to further cope with adversity and may even lead to self-destructive behaviours such as addiction, overeating and depression. 

Past studies have shown that the stress response involves a brain region known as the amygdala, which sends out signals alerting us to any kind of threat. This results in the release of hormones, including cortisol, which prepare us for the flight or fight response to fend off the threat. Prolonged exposure to cortisol can cause brain neurons to shrink and it also interferes with their ability to send and receive information efficiently. This is just another piece of the puzzle in how prolonged stress can impair our ability to think and act in creative, flexible and healthy ways.

And it’s not only about stress shrinking our brains. In another study from Yale University, researchers compared the genetic makeup of donated brain tissue from deceased humans with and without major depression. Scientists found that only the depressed patients’ brain tissues showed activation of a particular genetic transcription factor, or “switch” that basically stops the genes from communicating. This lack of communication leads to a loss of brain mass in the prefrontal cortex. The scientists hypothesized that in the depressed patients’ brain, prolonged stress exposure led to disruption of brain systems. The depressed brains appeared to have more limited and fragmented information processing abilities. This finding may explain the pattern of repetitive negative thinking that depressed people exhibit. It’s as if their brains get stuck in a negative groove of self-criticism and pessimism. They are unable to envision more positive outcomes or more compassionate interpretations of their actions.

While the evidence is not conclusive, it makes a pretty good argument that stress and mental health issues that lead to stress do kill off our brain cells through the damaging effects of cortisol and through the disruption of the genes that facilitate neuronal connections. This shrinkage affects our cognitive abilities, our focus and our ability to concentrate. Since much in our lives is beyond our control, how can we prevent this type of cumulative stress from affecting our ability to deal with what life throws at us? 

The most important thing to remember is that the brain is plastic, meaning that there are ways to reverse the negative impact of stress on the brain. With the right tools and techniques, like meditation, exercise, proper diet (think Omega-3s), yoga and by maintaining strong social and emotional relationships, we can, in fact, counterbalance the damaging effects of stress and stop our brains from shrinking.

Read more about our Anxiety, Stress & Obsessive-Compulsive Treatment Service.

What is Mindfulness?

by: Tatijana Busic, PhD. Candidate

Welcome to our blog on mindfulness. This is the first in a series of upcoming blogs in which we’ll introduce you to the concept of mindfulness and talk about the incredible benefits of this simple, yet, powerful way of living! 

In this first blog, we’ll define mindfulness and talk about some important distinctions between mindfulness and meditation. In our second blog, we’ll explore the psychological and physical benefits of a simple mindfulness practice in everyday life. In our third blog, we’ll talk about how mindfulness can be used to enrich and deepen your relationships at home, school and work. Finally, we’ll tie things up by introducing you to some very basic tools and strategies that you can start practicing, as well as, share some helpful resources. So let’s begin!

To start, lets talk about what mindfulness actually is. Some folks may think of mindfulness as meditation, and this can be scary! Rightly so! We might imagine spiritual gurus spending years of their life practicing and honing the powerful skill of meditation. Although these two concepts are closely related, there are some important differences.

Similarities: The beginning stages of learning mindfulness and meditation are virtually identical. We are learning how to do two very important tasks – How to consciously relax and how to consciously direct our attentional processes. Essentially, we’re learning how to relax our bodies and control where and how our mind wanders.  

Differences: Basically, meditation stems from Buddhist philosophy and spiritualties that derive from ancient monastic traditions. Learning how to meditate involves learning the values, beliefs and traditions that are embedded within various traditions. Mindfulness, on the other hand, emerged from the discipline of psychology, scientific research and modern day language and culture. Learning to be mindful, doesn’t necessarily involve learning the practice or values of monastic traditions. In many ways, mindfulness is far more applicable to our complex, modern society and therefore, a lot easier and faster to learn. 

Some other differences include:

  • In meditation we sit still – In mindfulness we can be engaged in any task.
  • Meditation takes time. Mindfulness can be switched on at any time.
  • In meditation we focus inward on the body. Mindfulness involves thoughts, feelings, actions and any state of mind!

So, what is mindfulness, exactly?

Mindfulness has become a key focus in psychological and educational research and practice since the 1980’s. Our busy, modern-day lifestyles have steered our minds and bodies toward a constant state of frenzy. We’re always doing – multi-tasking, multi-thinking and multi-moving!

It’s like the autopilot switch in our brain has been turned on permanently. At times this kind of intensity is great! We need it to get a job done while under high pressure. However, when chronically activated, over time, our brains and our bodies become hungry for, addicted to constant stimulation. We may find it hard to switch off or we may become uncomfortable when things are quiet. At other times, we may miss the beauty that surrounds us. Have you ever been on vacation or even just walking through an autumn kissed park and found yourself worrying about other things? Things you have no control over in that moment? Have you found yourself unable to take-in the serenity?  Notice it, feel it and reap the rewards from it? 

Put simply, mindfulness is about slowing down our stimulus-bound attentional processes and taking the time to consciously, with self awareness, choose what we pay attention to vs. automatically responding to whatever is going on around us. 

Like any skill, learning how to live a more mindful life, takes time and practice – about 100-200 repetitions or three months to consolidate this new and wonderful practice in your brain, your mind and your body. 

In the next blog, we’ll talk about the physical and psychological benefits of mindfulness. And explain how and why this practice can help alleviate psychological issues such as anxiety and depression.  How it helps us sleep better, feel better and see our selves and the world around us in a different and healthier way.

Stay tuned!

Read more about our Anxiety, Stress & Obsessive-Compulsive Treatment Service.

Perfectionism vs. Healthy Striving

by: Dr. Marie-Pierre Fontaine-Paquet, Psy.D., C.Psych.

In this post, we will define perfectionism vs. healthy striving, describe when perfectionism is a problem, and we’ll offer strategies for overcoming perfectionism. 

Defining Perfectionism 

Wishing to do things well and having high standards is often adaptive and can help you to pursue and achieve your goals in life. This healthy striving can be contrasted with perfectionism, which is a felt need to do things perfectly and to regard anything short of perfection as unacceptable. To help clarify the distinction between healthy striving and perfectionism, here are some characteristics of each one.

Characteristics of Healthy Striving:

  • Striving for high but achievable standards that result in feelings of satisfaction and increased self-esteem
  • Motivated by enjoyment of the process, enthusiasm, enjoyment of what you do, and desire for success and mastery
  • Efforts (not just results) give you satisfaction and a feeling of accomplishment
  • Self-esteem is not based on accomplishments and performance
  • Rewarding self or others for good performance
  • Seeing mistakes as opportunities for growth and learning
  • Bouncing back quickly from failure or disappointment

Characteristics of Perfectionism:

  • Repeatedly setting goals for yourself that are beyond reach and reason and not being satisfied by anything less than perfection
  • Motivated by fear of failure, obligation or duty
  • Driven to be the best, but unable to enjoy accomplishments
  • Feeling that your sense of self-worth and acceptance is based on accomplishments and performance
  • Criticism and judgment of self or others
  • Seeing mistakes as evidence of unworthiness
  • Becoming depressed when faced with failure or disappointment

When is Perfectionism a Problem?

Like many things, perfectionism can be viewed as a problem when it interferes with a person’s wellbeing and happiness, relationships, or functioning at school or work. This is not always easy to know. If you struggle with perfectionism, the high standards you hold for yourself or others may be so long-standing and ingrained that they may even be unconscious and outside of your awareness. You may have a self-critical internal voice that constantly judges and berates you for not being “______” enough (fill in the blank: smart, hardworking, rational, strong, attractive, thin, sexy… and the list goes on), but you may be more aware of ensuing feelings of guilt, shame, sadness, inadequacy, anxiety, helplessness and hopelessness. You may also be aware of feelings of anger, frustration and resentment when others fail to live up to your expectations, and perhaps this has caused difficulties in your relationships.

Perfectionistic thoughts and behaviours can place an individual at higher risk for depression (see blog ‘Depression: How Your Thinking Can Lead to the ‘Blues’’) and anxiety. Research shows that perfectionism is associated with several psychological problems, such as depression, anxiety, worry about being judged by other people, excessive anger, body image and eating disorder problems, and obsessive-compulsive behaviours.

Strategies for Overcoming Perfectionism

Building Awareness:

The first step to change is to first build awareness of what it is that you want to change. Since perfectionistic thoughts and behaviours can be automatic and unconscious, this may not be an easy task! One way of identifying perfectionistic thoughts is to notice situations in which you experience emotions such as anxiety, sadness, anger, frustration or shame, and to reflect on thoughts and interpretations that may be contributing to these feelings. You can also pay attention to situations in which you find yourself engaging in  perfectionistic behaviours (e.g., checking and rechecking your work, spending too much time cleaning, excessive organizing and list making, difficulty making decisions, procrastinating, exercising excessively to stay thin, etc.), and notice what you may be thinking and feeling in these situations.

Evaluating Your Standards

Here are some questions to consider when evaluating whether your standards are serving you well or whether you might benefit from challenging or altering them:

  1. The excessiveness of the standard (e.g., Can this goal be met?)
  2. The accuracy of the belief (e.g., Is it true that this standard must be met?)
  3. The costs and benefits of imposing the standard (e.g., Does it help me to have the belief or standard?)
  4. The flexibility of the standard or belief (e.g., Am I able to adjust my standards and change my beliefs when necessary?).

If you determine that a particular standard cannot be met or that the costs of having a particular standard or rule outweighs the benefits, you may want to consider loosening your standards for that particular issue. If you are unsure, you may consider asking the opinion of a friend or loved one whom you trust.


Making Changes to Perfectionism:


Rather than being unwilling to accept anything less than perfection, remind yourself that no one is perfect nor do we need to be in order to be worthy, lovable and valuable as human beings. Think about what is good enough and possible in your current life situation rather than how things should be in order to be perfect. Work on developing self-compassion in place of harsh self-criticism and perfectionism, and more compassion for others. Coping statements like “It’s okay to make mistakes” and “Nobody’s perfect” can be helpful in challenging perfectionistic thinking. People who struggle with perfectionism tend to go to great pains to control many different aspects of their lives, including their own behavior, the behavior of other people, and the environment in which they live. Because you often cannot control or predict things that occur, it can be helpful to find ways to tolerate some degree of uncertainty and ambiguity in your life.


If perfectionism is a problem for you, chances are that the high standards you hold for yourself or others are long-standing and ingrained. The thought of giving up these standards may be very frightening for a number of reasons, and changing these long-standing patterns can be difficult. You may find that it is too difficult to overcome your perfectionism alone or with the help of your family and friends. A psychologist can help you better understand your perfectionism and the role it plays in your life, and support you in changing these long-standing patterns. A psychologist can also support you in addressing problems often associated with perfectionism, including anxiety, depression, anger, eating disorders and relationship problems.

This blog is based on some parts of the book: “When Perfect Isn’t Good Enough: Strategies for Coping with Perfectionism” by Antony & Swinson (1998)


Read more about our Anxiety, Stress & Obsessive-Compulsive Treatment Service.

Anxiety and Your Relationships

Written by Dr. Dino Zuccarini and Tatijana Busic

Welcome to our third blog on anxiety! Today, we’ll be sharing some interesting information about anxiety and your relationships to others, such as your partner and children.

Several decades ago a British psychiatrist, John Bowlby, developed attachment theory, which provides a framework to understand how we experience our self and others in our relationships. Attachment theory helps explain the anxiety we can experience in relationships.

Attachment theory suggests that as human beings we are biologically hard-wired to seek out others and to connect to them—emotionally, psychologically and physically. These connections provide nurturance, soothing, contact and comfort to help us ease distress in everyday life.  Attachment is from the ‘cradle to the grave’—-beginning with the soothing, non-verbal communications between a mother and child (e.g., comfort of a mother’s sound, smell and gaze to newborns) through to the nurturing, caring and intimate moments in our adult relationships with our partners (e.g., emotional, physical and sexual intimacy). Our experiences in these close relationships—from childhood and throughout our lives—play a role in determining something psychologists refer to as our attachment style.

When we have experiences in which our primary attachment figures (i.e., mother, father or whomever took care of us when we were younger) have been generally responsive to our feelings and needs growing up, we learn to be securely attached to others.  In these circumstances, we develop a positive sense of our self— we see ourselves as competent, worthwhile, and lovable. We are also more likely to see other people in a positive light— reliable, dependable, and trustworthy. Early attachment relationships are the primary mechanism for developing our capacity for healthy relationships with others. We learn how to tune into our own feelings and needs and express them to others. We also learn how to empathize with others — the ability to tune into what others are feeling and respond appropriately. We also discover how to create closeness with others, while being independent and tolerating distance from our loved ones. 

When we are raised in inconsistent environments — too much or not enough attention from our caregivers — then we might become anxiously attached to others.  An anxiously attached person may have a negative sense of self —and may see themselves as unlovable or unworthy of care — while continuing to hold out hope that others are trustworthy, reliable and will eventually respond to their connection needs.  An anxiously attached individual may experience fear about the availability of important people in their lives—they become preoccupied with how available their partner, friends or family members are to respond to their feelings and needs. These individuals may express a lot of emotional distress to communicate their feelings, needs and concerns to others, and at times, may come across as demanding in their efforts to solicit attention, care and support—this kind of anxious attachment can be overwhelming for others. 

When you are anxiously attached, you also tend to overly rely on your children and partner for reassurance, affirmation and validation.  You overly seek out others to reassure you and to soothe your anxiety about others not being available to you. You may need too much closeness and those around you might feel smothered. Your children and partner may get a sense that there is not a lot of room for them in the relationship — and stop sharing with you as a result — or they themselves might have to increase their expressions to been seen and heard. 

If we are raised in environments where others were harsh and rejecting, we may become avoidantly attached to others. This attachment style makes expressing needs or feelings really hard—the other person is viewed negatively as unreliable and undependable during a moment of need. Avoidantly attached people  experience significant amounts of anxiety as a result of the unavailability of their caregivers—however, their strategy is different than the anxiously avoidant—they learn how to avoid emotions to deal with emotional distress. 

When distressed, avoidantly attached individuals struggle to express their feelings and needs—and, dependency on others for care and support does not seem possible during these moments. When dealing with difficult life moments they dismiss their own and others’ emotions as a strategy to cope—expressing themselves feels risky and may subject them to painful rejection once more.  As a result of this strategy, children or partners may feel that you are unavailable or unable to tune into or attend to their emotional needs while you seek even more distance to avoid difficult feelings. Given these difficulties avoidantly attached individuals often over focus on tasks, rules and duties in their relationships—while struggling to understand others’ feelings and needs. This avoidance often results in significant others becoming anxious and distressed because they feel you are unavailable and unable to connect with them. 

Here are some tips on how to deal with attachment anxiety or avoidance in your relationships:  

For the anxiously attached:

  • If you are anxious and preoccupied in your relationships, start working on developing a greater sense of yourself — learn how to enjoy a good book, find a hobby, keep yourself busy with activities—as opposed to being overly preoccupied with your children and partner.
  • When you are worried about whether or not others are there for you, remember a time that you felt connected to others. Reframe how you think about the absence of loved ones. Try not to get overwhelmed by negative thoughts about their absence (e.g., I’m alone, I miss them), and focus on positive thoughts and feelings (e.g., I look forward—and feel excitement—thinking about my beloved returning home).
  • Try to notice when you may be seeking too much closeness or reassurance from others and try to slow this process down. Although you are feeling fearful or doubtful about whether those closest to you love you—the more you do this, the more they might push you away. Learn to recognize themental and physical cues of anxiety and learn to calm yourself prior to communicating to others.

For the avoidantly attached:

  • Notice what you are thinking and feeling in these situations. Practice giving your feelings and needs a label—What do you feel and need? Take a risk to express these feelings and needs to a close friend or your partner. 
  • Learn how to recognize and attune to others’ feelings and needs. If you are not sure, ask them what they need or how they feel. Remember that the more you distance in moments of distress (yours or others), the more distress you create in your relationships.
  • Recognize when you are distancing from yourself and others. Try to observe yourself inmoments of emotional discomfort and to catch yourself in this distancing strategy. 

A psychologist can help you assess your attachment style and its impact on important relationships (i.e., relationship with family, partner, children, friends and colleagues). After identifying your attachment style, a psychologist can help you to understand your own emotional reactions and needs and communicate to others more effectively. A psychologist can also help you learn how to respond to others’ feelings and needs so your relationships feel more secure and more satisfying. 

Read more about CFIR’s Anxiety, Stress & Obsessive-Compulsive Treatment Service.

Anxiety and You

by Dr. Dino Zuccarini and Tatijana Busic

Welcome to our second blog on anxiety. Today we’re going to talk about how anxiety affects your relationship to yourself.

We all experience anxiety at different times in our lives — sometimes more than others. When anxiety gets the better of us — or when our brain’s fight-flight-freeze response kicks in — it’s hard to slow down our mind and our thoughts, feelings and body can become very uncomfortable!

You’ll recall from our first blog, when anxiety is unhealthy it becomes tough to accurately assess threat or danger — when you can’t calm down enough, it’s difficult to reflect on your experiences in a healthy and adaptive way — and if the threat is real, feeling anxious can make it hard to plan how to deal with danger. It’s as though our mind becomes a rollercoaster with no brakes to slow things down — the rollercoaster feels out of control and going in one direction — and we can’t change direction easily. When this kind of anxiety kicks in, our relationship to our self becomes challenging. 

So today, we’re going to share with you some important information about how anxiety affects your relationship to yourself — we’re referring to how you think and feel about your self — body and mind. When the fight-flight-freeze response is in overdrive it affects how we think, feel and behave. We’re also going to offer you some practical tips to deal with anxiety — we hope to show you how psychology can help you slow down your mental motor. 

Anxiety causes us to get stuck on fearful, recurring negative and critical thoughts (e.g., overthinking about the past, excessive self-criticism and worry). You may become scared of what you’re feeling (e.g., intense anger, loneliness). Sometimes anxiety can cause us to become overly self-conscious about expressing ourselves or dreading certain sensations (e.g., pounding heart, sweating, flushing, muscle tension).  When this happens our mind and body tells us we aren’t safe! And we get stuck in a negative feedback loop — our negative, fearful recurring thoughts create more fearful sensations in our bodies, and our sensations indicate danger. This cycle continues to fuel our worry and negative thinking — this is the cycle of anxiety! When your mind and body are in overdrive like this and running on fear, you can’t stop this negative feedback loop — the capacity to reflect and respond appropriately to the threat becomes compromised. It’s as though, you can’t dislodge from the thoughts and sensations that crowd your mind.  There’s no inner peace, relaxation or safety. You become uncertain, self-doubting, and feel unease.

Eventually, anxiety can start to drive your entire world — it’s persistent! When you can’t slow down your motor — it’s hard to sit alone with yourself with all that bodily tension — you’ll have to do a lot of things to calm yourself down eventually. You try to discharge the tension (e.g., distract, exercise, run), you avoid people, places, and/or situations, you lose focus and get distracted, you do repetitive things to calm yourself, you get aggressive with others who you perceive as threatening, you don’t show up to work, school, and even go outdoors to keep yourself safe! Maybe you over or under eat, over or under work, procrastinate, drink alcohol too much, have too much sex or risky sex, use illegal substances — these behaviours are in response to too much anxiety related tension!  Or maybe you think about things you’ve said or done, mistakes you’ve made during the day, over and over again — trying to think about whether what you’ve done or said during the day will bring about bad things for you. Either way, it’s hard to feel good and confident about yourself when your world becomes more and more confined, and you feel like you’re losing control. 

The good news is that psychology can work for you by providing you with strategies to deal with your anxiety! Here are some tips to lower the physiological response of anxiety!

Slow down your motor! 

It’s important to deal with all the fear and stress-based negative arousal going on in your body. Learning how to do this gives you a sense of mastery over your own self and body. Here is a site to help you learn to breathe and relax so your muscle tension is not so overwhelming. http://www.helpguide.org/mental/stress_relief_meditation_yoga_relaxation.htm

Observe and let go of distressing thoughts and feelings! 

Learning how to observe and let go of negative thoughts and feelings also helps reduce distress. It is important that we learn how to stay in the present — not let the anxious brain get the better of us; by staying focused in the present (i.e., learning how to stay with our breath, and observe our thoughts, with some sense of detachment and focus on the present so we don’t jump too fast in anticipating bad things happening). Visit this site to learn how to be mindful, more present and aware, and let go of distressing thoughts. http://www.mindfulness-solution.com

Explore the ‘truthfulness’ of the negative and fearful thoughts!  

Ask yourself, how real is the danger I am anticipating? What evidence do I have that my fears will actually transpire? Is there any possibility that my fears won’t transpire? 

Mental health professionals at CFIR administer scientifically based treatments in the area of anxiety, and can offer you many more strategies to deal with your anxiety. We also can help you to address the underlying emotions, and patterns that are at the root of your anxiety.  Typically, it’s more difficult to get to these underlying emotions, needs and patterns — at the root of your anxious thoughts — on your own.

Read more about our Anxiety, Stress & Obsessive-Compulsive Treatment Service.

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