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.

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.”

It’s no surprise that 2020 was a challenging year — with the pandemic bringing anxiety, grief, burnout, and financial strain to the masses, not to mention other stress-inducing events. Now that we’ve entered Winter 2021, we are currently experiencing a new challenge: navigating the pandemic’s effects at a time that is already difficult for many people. With pandemic fatigue, shorter and colder days, and social isolation, it’s safe to say that this winter hasn’t been an easy season to date for many people. Despite this challenging time, the good news is that we can do things to help us prepare for and cope with the transition into winter. 

Learn to enjoy the outdoors

Nothing is worse than experiencing months of winter when you hate winter. The antidote? Find ways to engage with the outdoors. The cold is an apparent reason why people struggle with winter. I’ve found it’s easier to bear with preparation — investing in warm and comfortable winter wear is a helpful first step, and a hot beverage in hand can make things more relaxing. Taking up a winter sport or activity can also make the outdoors more fun. Why not try sledding with the family on the weekend, try cross country skiing, or try to see the beauty in wintery nature by going for a walk? Trying different activities can also bring variety to your life, which is sometimes lost when we ‘hunker down’ during the pandemic.

Exercise 

With the winter months bringing in higher rates of depression and seasonal affective disorder, finding ways to cope is an essential step in their treatment. While exercise may not be a solution to these disorders, research has shown physical activity to be as effective in treating mild to moderate depression as medication (O’Neal, Dunn & Martinsen, 2000). Winter is when many people want to stay inside watching movies on the couch, and engaging in exercise might feel like a chore. The key is finding an activity you like and ways to make it the most comfortable choice. The best exercise is the one you’ll do, and often, it’s easiest to engage in an activity when it’s a part of your routine (like brushing your teeth). Experiment with a time of day that works best for you. Many people feel most motivated in the morning, and engaging in health behaviours early on in the day can snowball into more health behaviours as your day continues.

Try a little Hygge

‘Hygge’ (pronounced: “hoo – guh”) is an integral part of the Danish lifestyle, encompassing coziness, warmth, and wellbeing through enjoying simple pleasures in everyday life. Though Denmark is known for having intense winters, the hygge lifestyle is a custom that has contributed to making the country amongst the world’s happiest. So how do you incorporate more hygge in your life this winter? Light candles, snuggle under warm blankets, gather some good books, enjoy comforting foods, fit in some quality time to connect with loved ones – what sorts of things will you try? 

Schedule regular social time

Ever find that it’s becoming increasingly more comfortable to be socially isolated during the pandemic? These social distancing regulations make it challenging to spend time with our loved ones in the same way we once did. Many of us can become inclined to isolate; but, isolation can make winter especially difficult considering a time when depressive disorders are most common. Scheduling weekly video calls or socially distanced walks with loved ones helps manage the effects of social isolation. 

Be kind to yourself

When times get rough, it can be tempting to look for someone to blame — and we often direct it to ourselves. While many of us are our own worst critics and often criticize ourselves for instigating change, we may promote the opposite. How can any of us have a positive relationship with ourselves, feel motivated to complete work, or begin a healthier lifestyle if we unceasingly criticize, condemn, nitpick, or hate ourselves? We often speak to ourselves in a way that we wouldn’t talk to our worst enemy–so why say them to the person we’re supposed to have the most connected, intimate relationship with — ourselves? When you’re in the self-critical headspace, try talking to yourself as if you were your own best friend. What would they say? Would they be judgmental or provide a balanced view of the situation? Would they tell you all of the things you’re doing poorly, or would they highlight the positive and how for you’ve come? Would they provide further criticism, or would they soothe the wounds you’ve created for yourself? Remember, all you are ever doing is the best you can, at this moment in time, with the resources you have. That’s the best anyone can ever ask for, given the circumstances!

Seek professional help

Life isn’t simple, especially during a pandemic. Admitting that we need help can sometimes feel complicated. But no matter where you’re at in your life journey, you’re never broken — just stuck. Seeking professional help can be an excellent way to maintain your wellbeing and get support during your most trying times.  Consider contacting the Centre for Interpersonal Relationships (CFIR) if you are seeking therapy services. CFIR is a collective of over 70 clinicians who provide various treatment and assessment services and work with clients of all ages, life stages, cultural, sexual, gender, and romantic orientations. Free consultation and reduced fee options are available, making our services an affordable and accessible option for your therapeutic needs. We hope to be a part of your support network!

References

O’Neal, H. A., Dunn, A. L., & Martinsen, E. W. (2000). Depression and exercise. International Journal of Sport Psychology.

Carolyn Streich, BMus, B.A. is a counsellor at Centre for Interpersonal Relationships working under the clinical supervision of Tracie Lee, R.P. (Registered Psychotherapist). She currently holds a B.A. in Psychology (Honours), and is in her final year of her Masters in Counselling Psychology program (M.Ed) at University of Ottawa.

Reesa Packard, R.P., Ph.D. (Associate at CFIR – Ottawa) was on the airwaves with 1310News’ Sam Laprade! The two shared an engaging discussion about managing mental health throughout the pandemic and beyond. This conversation is one you don’t want want to miss.

To learn more about how clinicians at CFIR can help you online or by phone, go to www.cfir.ca

The COVID-19 pandemic has had, and continues to have, a significant impact on us as individuals and as a society, on a worldwide scale. There have been significant changes to our daily experiences in the context of lockdowns, self-isolation, and physical distancing. As humans, we are inherently social creatures, and in the context of this pandemic, we have lost access to the typical ways in which we meet our social needs. This pandemic has significantly changed our lives and can cause (variable and/or persistent) acute stress and chronic stress responses.

The pandemic as an “acute stress”

Initially, the onset of the pandemic can be considered to be an acute stress in terms of the way it impacted us and our ability to cope; regarding the impact on ourselves and our nervous systems, an acute stress response is one that activates the sympathetic nervous system or “fight or flight response.” This response is often referred to as “anxiety,” which can be more episodic in nature as our nervous system responds to a threat the environment and then we subsequently seek safety and can return to a state of ease. As such, the anxiety system is meant to switch on and off as a response to immediate threats in the environment. 

In regard to the pandemic, especially the initial onset, we perceive the presence of immediate danger and our nervous systems respond as if there is an immediate stress or risk of danger. In many ways, the pandemic provides a legitimate increased risk of danger in relation to the risk of infection and the consequences of that infection. As such, when responding to an acute stressor, our nervous systems respond with hypervigilance (i.e., scanning the environment for danger), muscle tension (in order to spring the action), worry/preoccupation (as a way to analyze the environment in hopes to keep us safe), as well as other sympathetic nervous system responses, such as increased heart rate and changes in breathing rate.

The pandemic as a “chronic stress”

In the wake of a prolonged period of an acute stress reaction, a stressor can become chronic. There are many stressors that can become chronic, such as work stress, interpersonal relationship issues, financial strain, and the prolonged fear of infection (i.e., pandemic), to name a few. For the context of this article, I believe there to be a difference between acute stress, referred to above as “anxiety,” and chronic stress, which I refer to as “stress,” but this is a matter of labels and diction.

When a stressor becomes chronic, it impacts the mind and body in a more profound manner as it continues to tax resources in a way that was not intended. During periods of chronic stress, stress hormones are continuously released in the body, perpetuating a fight or flight response. In the face of persistent sympathetic nervous system activation, we experience chronic muscle tension and soreness (e.g., in the shoulders, neck, jaw), disrupted sleep patterns, disrupted eating habits, significant fatigue or lack of energy, decline in cognitive function (e.g., poor attention/concentration), increased irritability, becoming easily overwhelmed, and feeling depressed. Other indicators of chronic stress include G.I. distress/digestive issues, chronic pain, headaches, poor immune system function (e.g., frequent infections/colds), and decreased libido. Over time, we begin to lose the capacity to engage more effectively in other parts of our life (that we previously enjoyed) as the chronic stressor takes up most, or all, of our physical and mental resources. Our lives become narrow in terms of activities where we confront/face the chronic stressor and resort to recovery actions; without awareness of our coping repertoire and the short and long term impacts of these actions, we often engage in “maladaptive” coping strategies that provide immediate relief of the stress response, such as escaping/disconnecting (e.g., excessive sleep, excessive use of TV or video games, zoning out), numbing (e.g., substance use, less health food habits and choices), and avoidance (i.e., not engaging in activities that provoke any level of distress). As maladpative coping of the chronic stressor persists, our lives may become more and more limited.

An interesting phenomenon that appears to be occurring during the pandemic is that many individuals report experiencing, sometimes extreme, fluctuations in their well-being, functioning, and emotion regulation/mood. People report this experience as functioning “ok” and being able to meet the demands have their daily life and some of the additional goals they may set for themselves for a few days, and sometimes without notice, the same person might report a significant reduction in their ability to meet these demands for a few days. During these “down days,” the person will likely experience the above-mentioned symptoms a facing a chronic stressor. Following a period of these down days, the person will return to an “ok” level of functioning -and the cycle continues, perhaps with longer periods of down days as the pandemic chronic stress endures.

Chronic stress – an analogy regarding coping

When speaking with clients about the impact of chronic stress, I like to use the analogy of a bucket, which I refer to as “the coping bucket.” When stressors appear in our life, as they do on a daily basis to varying degrees, it is as if liquid is filling our bucket; the larger the stressor, the greater the flow and quantity of the liquid. Once the liquid reaches the top of the bucket (i.e., our upper threshold for our ability to cope with the stress), we start to experience more severe symptoms, such as “breakdowns,” feeling overwhelmed, anger outbursts, emotional dysregulation, etc. 

In order for us to regulate the amount of liquid in the bucket, we need to find ways to release liquid from the bucket, and in the context of this analogy, I imagine spouts at the bottom of the bucket that can pour liquid out; these spouts are our adaptive coping (i.e., helpful) strategies. Similar to the flow speed and quantity of liquid entering the bucket, the spouts differ in terms of how quickly and how much stress they release. For example, in the context of the pandemic, the spouts that previously released greater amounts of liquid likely release less liquid currently because we strategy has been modified to fit within pandemic guidelines. A prime example of this is the way in which we connect socially during the pandemic; many people remark that there is something “different” about connecting virtually rather than connecting in person and that it does not meet our need for connection to the same degree as before.

It is important to note that, at certain points in our lives (depending on the surrounding context of our life), what may have been an adaptive and helpful coping strategy might actually become a source of stress and “add” to the bucket. Part of developing our ability to cope with the variable stressors of life is to pay attention to what our mind and body needsin a given moment and what will best serve the purpose of reducing the liquid (i.e., stress) from the bucket. For example, exercise is generally an adaptive coping strategy to burn off distressed energy; however, when we are feeling rundown and significantly fatigued, exercise may exacerbate this and push us closer to burnout.

If you are having difficulty coping with acute, chronic, or pandemic stress, I encourage you to reach out to a professional (psychologist or psychotherapist) who can assist you in developing and strengthening your coping skill repertoire, as well as address other contributing factors to the maintenance of your symptoms.

Dr. W. Rylie Moore, C.Psych., is a clinical psychologist & neuropsychologist at CFIR’s Toronto location and he has published academic articles in peer-reviewed journals and book chapters. As a requested presenter at numerous national and international academic conferences, Dr. Moore has spoken on topics related to gender dysphoria, LGBT2QA advocacy, psychological assessment, executive functions (cognitive abilities that could be described as the CEO of the brain), stuttering, and bilingualism. In his therapy practice, he works with clients to understand what is happening for them in its larger context, including past experiences and their social world. 

2020 has been far from the easiest year so far. The global pandemic imposed quarantine and social distancing, loneliness, loss of job and financial security, complexified family-work balance, increased levels of stress and mood fluctuations, winter weather in late April…

Meanwhile, our regular life stressors continue to persist. We may be dealing with illness, grief, conflicts, separation, or difficult life transitions. It can be quite challenging to hold all of this at the same time or to maintain our usual upbeat attitude and optimism.

These kinds of considerations often contribute to our negative thought cycles, where everything seems unmanageable, our cynical world views are confirmed, and we experience feelings of despair and frustration. Below are a few ways to soothe those negative loops and help regulate the underlying vulnerable emotions:

• Turn up the volume of our self-compassionate voice: Judging ourselves for not feeling well or not being our usual self is only aggravating our negative thought cycles. Instead, let’s be more validating regarding our feelings, needs, and limits, and remember that what we are feeling is normal and is a shared human experience.
• Limit exposure to news and social media: Being informed of the evolution of the pandemic, its impacts, and social measures recommended by our governments is important. However, a continual barrage of negative news and information has its toll on our mental state. I recommend allocating a specific amount of time during the day to read on the pandemic, and then moving on to more enjoyable content. 
• Reframing our thoughts: Being aware of our negative thoughts that contribute to lower mood and heightened anxiety helps to reframe them and identify authentic needs more effectively. “I am cut off from everyone” could be reframed as “I am feeling lonely today, which contributes to my sadness – I may call my friends today to feel more connected.” “This nightmare will never end” could be reframed as, “I am afraid of what is to come, which contributes to my anxiety – I will practice breathing exercises and talk about this with my partner.” 
• Practice self-care: We tend to forget to do what makes us feel good when we need it the most. Let’s put a pause on our daily autopilot routine and perform activities or small gestures to take care of ourselves. 
• Connect with the current positives around us: Even though the present times are very challenging, we continue to be surrounded by positive moments and kind actions. Try to glean hope from the various ways people are working together to mitigate the pandemic. Witness the support given to front-line health workers, and observe how the environment is benefiting from humans slowing down. Notice how strangers are saying hello to each other on the streets, or experience how being at home and connecting with loved ones is reminding us of what’s truly important to us.

We are going through this together, and we are required to take it one day at a time, but sometimes things can feel overwhelming. If the negative thought cycles are too challenging to cope with or are causing significant emotional distress, it is ok to ask for help from our social support system or mental health professionals. CFIR is here to help, and continues to offer teletherapy and reduced-cost services. 

Dr.Karine Côté, D.Psy., C.Psych. is a psychologist at the Centre for Interpersonal Relationships (CFIR). Dr. Côté provides psychological services to individual adults and couples experiencing a wide range of psychological and relationship difficulties related to mood and anxiety disorders, trauma, eating disorders, sleep disruptions, and interpersonal betrayal. She works from a humanistic approach and integrates therapeutic techniques from gestalt and object relations psychotherapies, emotion-focused therapy (EFT), and cognitive-behavioral therapy (CBT).

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

Isolated from Family/Friends

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

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

Direct Interaction with the Disease

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

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

Generally Chaotic Work Environments & Long Hours

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

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

Lack of Equipment/Resources

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

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

Increased Risk for Mental Health Issues

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

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

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

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

Last week there were crowds of people amassed at grocery stores; carts full of bottled water and toilet paper, and shelves left barren. Now, businesses are closing their doors, while many are near empty as people begin to self-isolate and avoid crowds. Some people are now out of work, and they’re worried about how to make ends meet. It’s hard to ignore the impact that COVID-19 has had on Canada, and around the world. Amid so much panic and uncertainty, what can we do, and how can we cope? 

Some of the most important things we need to remember are to stay calm, be prepared, and stay informed. It’s entirely understandable for everyone to have concerns or anxiety surrounding a growing global pandemic. In particular, individuals with pre-existing mental health conditions may be more prone to experiencing these symptoms. While stress and anxiety are seemingly at an all-time high, there are some strategies and techniques that can help as we navigate through this period. 

Grounding

Grounding is a technique that can help to focus on the present and pull away from challenging emotions. One method to practice grounding is to follow the 5-4-3-2-1 rule – identify five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. Helping your mind to focus on the present is an excellent way to calm down quickly. 

Positive Self-Talk

Positive self-dialogue helps identify negative thoughts and attitudes and works to turn them into positive ones. A positive mindset or outlook is better able to take on and tackle life’s challenges and help to mitigate stress and anxiety. 

Journaling

Writing in a journal is a great technique to help you collect and organize your thoughts. When things are so chaotic and uncertain, journaling can be a means of self-reflection, and a means to provide more clarity. Additionally, keeping a gratitude journal can be a great way of focusing on the positives and silver linings of this situation.

Exercise

The benefits of exercise extend beyond that of just physical. Physiologically, exercise helps to address your body’s stress responses by releasing “feel-good” endorphins, while, psychologically, it can boost self-confidence and take your mind off your worries. Some numerous programs and organizations are offering free video sessions for yoga and physical exercises so that you can stay healthy at home. 

Reach Out for Support

Don’t be afraid to reach out to friends or family to help provide comfort or support, however possible. Also, be sure to take advantage of community or government resources as available and as necessary. 

Meditation

Through meditation, we learn about our internal thoughts and emotions, safely explore them, and work to better cope and manage them. Meditation is a great technique to help regulate stress and anxiety. The Calm app is currently offering several free resources, from guided meditation to relaxation techniques, to music and sleep stories. 

Deep Breathing

Breathing exercises can offer simple techniques that can help overcome emotional strain. It can be used on its own or in tandem with other methods like grounding or meditation.

Stay Busy

By focusing on our behaviors and things we can accomplish during this time, we can stay productive and mindful. Making effective use of this time by learning a new skill or hobby, spending quality time with loved ones, getting our spaces organized, and focusing on self-improvement (all the things that we don’t normally have time for). When we get productive, we can increase our moods and decrease our stress and anxiety. Staying healthy by controlling what you can when things feel out of control. 

Make Our Spaces Cozy and Peaceful

During this time when we are all cooped up in our homes, it can begin to feel as though we are trapped in our environments. When we don’t want to spend times in our physical environments (e.g. messy, cramped, chaotic), we can increase negative thought patterns and turn to potentially unhealthy coping mechanisms (e.g. isolation, lashing out at others). Make your space inviting by keeping it clean and organized. Having a cozy place to curl up and watch a movie or read a book is essential. By making a relaxing environment, you will want to enjoy your time at home. You can use essential oils and diffusers, as well as calm lighting and soft blankets (or weighted blankets) to slow down your arousal response and reduce your stress levels. 

In addition to the anxiety-reducing techniques mentioned above, the Government of Canada website offer ways to help reduce and contain viruses like COVID-19 such as:

• Practice proper hand hygiene and coughing/sneezing etiquette

• Stay home if you are sick

• Reduce exposure to crowded places, whenever possible

• Avoid direct contact with individuals

• Stock up on essentials, but avoid panic buying

• Disinfect frequently touched objects like doorknobs or toys

• Get reliable information

• Communicate and make a plan

It’s completely normal to be concerned or experience stress and anxiety from the growing challenges we are facing from COVID-19, but it’s essential to stay calm, be prepared, and stay informed. Mental health professionals can work with you and develop ways to manage the stress and anxiety surrounding this global pandemic – it’s never too late to start. 

Clinicians at CFIR are offering secure video and teletherapy sessions during this time, to ensure continuity of care. Please reach out if you would like to have a safe, confidential therapy session from the comfort of your own home. 

For additional information and important updates related to COVID-19, please refer to the following links:

• https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html

• https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

• https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

Dr. Brianna Jaris, C.Psych. is a clinical psychologist at CFIR.  She has extensive experience in psychological assessment and diagnosis and the treatment of a wide range of psychological issues, including trauma, depression, anxiety.  She is currently the head of CFIR’s Trauma and PTSD service. You can visit www.cfir.ca to find out more about Dr. Jaris.