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

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

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

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

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

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.

As we move through winter and the COVID-19 pandemic, it is vital to make your mental and physical well-being one of your most important priorities. Dr. Lila Z. Hakim, C. Psych. (Registered Psychologist and Centre Director at CFIR Toronto), offers a few helpful tips below to start feeling good: 

Nourish Your Body

Many of us experience cravings for certain foods throughout the winter season, and our bodies develop a yen for carbohydrates. Carbohydrates are directly linked to the neurotransmitter serotonin production, an emotion regulator that helps you feel emotionally stable, less anxious, calmer, more focused, and energetic.

When that 3 p.m. craving for a savoury or sweet snack hits, it’s your body’s way of self-medicating, seeking to improve your mood by boosting your serotonin levels. Listen to your body and give yourself that much-needed serotonin lift.

Instead of calorie-dense, sugary pieces of bread and sweets that offer a quick mood-boost and then a crash, consider healthier alternatives such as fruits, nuts, and yogurt.

Get Active!

Physical activity increases the calming neurotransmitter serotonin and increases dopamine, the emotion and pleasure neurotransmitter, and endorphins, your pain-relief, and pleasure neurotransmitters. Incorporating movement into your day (climbing stairs, going for a walk, etc.) gives your body the activity it needs to keep your mood up throughout the day.

Make Sleep a Priority

Sleeping excessively (or hibernating) is customary in the winter and is often a reaction to the cold. Still, for some, ongoing insomnia or difficulties falling or staying asleep create challenges that can lead to the blues. Provide yourself with a space at home that includes comforting objects (such as a warm blanket, beautiful items, etc.) to calm your stress hormones. Aim to get precisely the amount of sleep you need to feel fully rested and ask a professional if you are unsure about how much rest is the ideal amount.

Do Things that Light You Up

Find activities in your life that give you a sense of pleasure and meaning, involving curiosity, exploration, and interest¬–this could be collecting or building things, researching something you love like travelling, or discovering creative ways to connect other people. Artistic endeavours, like making and listening to great music, are also great options. Pleasure, curiosity, exploration, and interest all stimulate dopamine, making you feel exhilarated and alive!

(**Note: If you are experiencing continual depression symptoms, it is important to seek attention from a physician or mental health professional.)

Presenteeism, an attendance behavior defined as going to work while our health is not optimal, is a phenomenon more and more recognized and known to impact workers and their organizations negatively. For example, we now know presenteeism generates significant productivity and financial losses and is associated with various health difficulties, such as burnout, depression, anxiety, and chronic pain (more details on the impacts of presenteeism are presented in Part 1 of this article).

The global pandemic has changed the professional reality: most workers are now forced to work from home, organizational restructuring and layoffs are more prevalent, and maintaining a work-life balance is even more challenging. In that context, it may be even more difficult for individuals to take the day off work when they need to – putting them and their organization at higher risk of experiencing the harmful consequences of presenteeism.

The good news is that we know organizations, managers, and workers alike can prevent and intervene to limit the impacts of presenteeism and promote well-being and productivity in the workplace. Here are a few points to consider to help you and others face this reality.

Recommendations for individuals

• One of the best tools we can use to prevent health difficulties associated with presenteeism is to be aware of our signals. Our body typically tells us when we need to slow down and take a break – we just need to respect it more. If you are experiencing difficulties with concentration, motivation, low energy, higher stress levels, and physical aches, it may be time to take some time off work to recharge your battery.

Checking in with yourself to see how you are doing psychologically and physically can help you decide if it could be a good idea to take time for yourself or slow down your work pace. Even taking a half-day for yourself or respecting your work-breaks can have a significant impact.

• Asserting your limits and expressing your needs to your colleagues and managers can also help manage your workload more effectively and help you manage your energy.

• Being present for work can be a positive source of self-accomplishment and social support. Continuing to connect with colleagues and friends, and practicing self-care activities, can help meeting those needs when you are off work.

• At times, we need to adjust our self-imposed ideals and expectations. Life is full of stressors and transitions, so, understandably, we cannot always be present at work or as productive as we want to. We are not robots, and sometimes we need to accept that we have limits and needs.

Recommendations for organizations and managers

• Too often, promoting wellness and productivity clashes instead of being an integrated message within the work culture. However, from a clinical point of view, well-being and productivity go hand in hand. If we proactively respect needs and limits and take concrete actions to maintain a healthy work-life balance, we will be more productive at work and in our personal lives.

Offering sick-days to employees does not seem to be enough. Changing implicit messages that reward being present at work at all costs, training managers on the risks of presenteeism, and recommending concrete behaviors that promote well-being are all avenues that can limit presenteeism and its negative impacts.

• Managers are often in a privileged position to see members of their team struggling with workload, feeling unwell, lacking motivation, etc. Having open discussions regarding a need for taking time off work, reducing or reassigning tasks, and implementing a more reasonable work routine, can help prevent the negative impacts of presenteeism.

• Supervision and management mean many different things, and it also includes modeling. Suppose directors and managers themselves respect their own boundaries, promote well-being and healthy work-life balance, and encourage taking advantage of sick and personal days. In that case, their team members will be even more likely to practice the same behaviors.

Taking time off work is not the only solution to prevent presenteeism. Taking care of ourselves and others and promoting healthy boundaries and a work culture that does not exclusively care about productivity can positively impact employees and organizations alike.

If you recognize a more pronounced difficulty to manage psychological or physical symptoms within yourself or colleagues, starting psychotherapy can also be an option. CFIR’s professionals are here to support individuals and organizations to promote wellness in the workplace.

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).

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

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. 

Were you already feeling lonely before physical distancing became mandated? Now in response to the novel Coronavirus Pandemic, The World Health Organization (WHO) recommends “physical distancing” as it is vital to slowing the spread of COVID-19. It is difficult to fully grasp the idea of limiting physical human connection as it is essential for promoting wellness in our lives. But we are being told this vital connection could potentially harm us. 

But I Was Already Lonely…

Unfortunately, COVID-19 is not the only public health concern we should be worrying about as we start to see the countering effects of social isolation and loneliness. According to new research by Statistics Canada, the number of people living alone in Canada more than doubled over the last 35 years. Also, there is some evidence that individuals who live alone are more likely to report social isolation or loneliness than those who live with others. For many of us, especially those who live alone, being deprived of social connection for an uncertain amount of time could exacerbate current feelings of loneliness and other mental or physical illnesses.

We were already living through an epidemic of loneliness, even before the Coronavirus pandemic started. Those who are lonely do not choose to be isolated. Loneliness can be defined as the subjective feeling of being alone and not connected to others, which can still occur when in the company of other people. Those who experience loneliness tend to have higher levels of cortisol, which is an indicator of stress. An accumulation of this stress hormone can suppress your immune system when exposed to pathogens.

Stay Physically Apart But Stick Together

Being told to stay away from one another physically is the opposite of our innate response as humans to seek out and support one another during stress to maximize survival. Humans have lived in groups for thousands of years for this reason.

The new term “social distancing” was intended to stop or slow the spread of the Coronavirus by limiting the number of people you come in contact with while keeping a physical distance from one another. But more recently, The WHO says efforts taken to slow the spread of the Coronavirus should instead encourage strengthening social ties while maintaining that physical distancing. The new term “physical distancing” emphasizes the need to be physically apart, but socially we still need to work together. 

Why is Social Connectedness so Important?

There are decades of research that support the importance of social connection and love and belonging. According to Abraham Maslow, humans possess an innate desire for a sense of belonging and acceptance. These needs are met through pleasing and fulfilling relationships with others.

From the beginning of our lives, we are wired to connect. This fact is evident from our early days as a newborn. When an infant cries, oxytocin is released. The cry serves as a signal for the mother to bond with their child. Also, there is evidence that this bonding hormone is released when we engage in positive social interactions.

Here are some ways to engage in positive social interactions while halting the spread of COVID-19 and turn social distancing into distant socializing:

Be in Nature – Cultivates interconnectedness of others and reminds us that we are just a small part of the greater whole. 

• Go for a walk at least once a day – each person you pass say hello and smile at them
• Go for a hike or bike ride

Use Technology in Socially Healthy Ways Set reminders to connect with others 

• Social Technology Connections 
  • Use Facetime, Zoom, House Party or Marco Polo 
• Watch Netflix in Party Mode stream together with a chat function at Netflixparty.com
• Virtual Exercise Classes

Media and News Exposure

• Limit exposure to media related to COVID-19 ten minutes in the morning and ten at night 
• Use consistent and credible news sources for your information 

Slow Down and Reflect

• Create a new normal at home with structure and consistency 
• Reflect on a past positive event 
• Look at old pictures or videos- by seeing, hearing, or thinking of loved ones can recreate old attachment bonds. 
• Embrace little connections; they can be meaningful
• Comfort food – reminds us of being safe and cared for 

Be Present and Mindful

• Engage in interactions requiring eye contact with both people and pets 
• Pet and play with your furry companion

Help Yourself and Others

• Talk about your feelings of loneliness with others. It may not rid you of your loneliness entirely but lets you know you are not alone in that feeling.
• Give support to others – helping others will help them, but it makes us feel connected as well, which can help us see our shared humanness. We are all in this together.

The correlation between social connection and overall health is clear. Social interaction and connectedness can be used as treatment and prevention for feelings of loneliness and isolation.

At this point, it is safe to say that connecting with others during this period of isolation and using technology in socially healthy ways can increase pleasure and continue to release the oxytocin we need to thrive and survive. This can, in turn, reduce stress and increase happiness. Physical distancing may protect us from the Coronavirus, but it may deprive us of our innate need for social connectedness and belonging.

When we are isolated from others with limited social connection and deprived of oxytocin, life can feel cold and empty. For many, loneliness and even depression follow. Right now, our clinicians at CFIR are offering secure video and teletherapy sessions to new and existing clients. Please feel free to reach out if you would like to connect for a confidential therapy session from the comfort of your own home.

Laura Moore, B.Sc. (Honours) is a therapist at the Centre For Interpersonal Relationships (CFIR) in Toronto. She is completing her Masters degree in Clinical Psychology at the Adler Graduate Professional School in Toronto. Laura works with adults and couples in therapy, to support them to overcome challenges related to depression, stress, grief and loss, trauma, and relationship conflicts. Her current research focuses on cultivating spousal attunement following traumatic experiences.

Blog 3 in a 3 Part Series on the Developmental Roots of Anxiety and Depression: Linking Narcissism to Depression and Anxiety

Healthy narcissism is important for us to achieve our goals and cope with the inevitable disappointments and failures we all face in our lives. The word “narcissism” usually conjures up negative images of a very entitled, attention-seeking, arrogant individual. Narcissism, however, can come in both healthy and unhealthy forms. It can even be considered synonymous with self-esteem and we know that healthy self-esteem is critical to your wellbeing and optimal functioning.

We are all born with an innate sense of the potency and vigour we possess to develop our own self through self-expression, the pursuit and fulfillment of our authentic needs, and setting and achieving our goals to thrive. We all need a healthy investment in our own self – to feel that we are significant, valuable, worthwhile, and deserving enough to take and receive what we need for our self. We must love our self enough to pursue our own self-interests and entitlements while maintaining our relationships with others. Without healthy narcissism, we may not feel potent or strong enough, or we may not have enough vigour and vitality to meet our needs and pursue our goals. We are not able to feel excited, proud, and joyful in our achievements, nor fulfilled and satisfied in the pursuit of our self and relational needs. We may not feel sufficiently entitled to assert our self with others. We may not feel worthy enough to pursue our fair share of the rewards of our work, or to request that our needs be met in our relationships.

Healthy self-esteem involves a sense of feeling competent and capable enough to achieve realistic life goals. Feelings of competency and ability come from our hard-earned efforts along with our innate sense of talents and intelligences. The more we are able to learn, achieve, and overcome life obstacles, the more confident and competent we feel as we deepen our sense that we can manage our lives effectively. Self-esteem also means developing a positive self-image that is congruent with the skills, talents, intelligences, and competencies that we possess, along with an acknowledgment of the realistic goals and achievements we have attained for ourselves. On the other hand, having an overly-inflated self-image – seeing ourselves as much greater than others see us or significantly overestimating what is possible for us – becomes problematic. Narcissism can become unhealthy when you come to believe that you deserve or are entitled to more, when in fact there is nothing real (i.e., achievements, goal-attainment, talents, skills, intelligences, contributions) to back up that entitlement.

With healthy narcissism, an increased sense of competency bolsters our capacity to face life challenges and enhance our resilience. Anxiety and depression are less likely when we have a realistic and positive self-image and we pursue realistic goals with the deep belief that “I can do it.” Healthy narcissism is important particularly in contexts in which we are facing adversity and require the stamina, resilience, and self-trust required to overcome life obstacles. We can tolerate adversity and failure much more when we have the self-esteem for it. At the same time, this healthy narcissism involves pursuing our self, but not at the expense of injuring others. Our capacity for empathy limits our narcissism within healthy ranges as our awareness of others’ feelings, needs, and rights puts a natural boundary on our ability to take excessively from others (i.e., their attention, admiration, recognition, and material items like money, property, etc.).

Some individuals go on to develop unhealthy self-esteem as a result of their early interactions with others. They will seek more than their fair share of rewards, recognition, and attention from others in their work and relationships without putting forward enough effort to justify it, or by inflating their sense of self-importance and significance. Unhealthy narcissism can develop out of different kinds of conditions. One of these conditions is when a child is overpraised and admired for something they did not initiate and something they did not put much effort into doing, such that they begin to expect or demand the same praise on an ongoing basis. Another condition is when a child is shamed, abandoned, rejected, and punished with great suffering and feelings of powerlessness that then result in fantasies and pursuit of greatness and fulfillment of self-impulses, desires, and needs at the expense of others. Individuals with unhealthy narcissism, or fragile self-esteem, are externally dependent on others to boost their self-esteem and good feelings about themselves. They can become anxious, aggressive, and depressed (i.e., hopeless, despairing) when the outside world does not validate them as competent or as great as they see themselves. Depression and anxiety ensue in those with poor self-esteem, as they lack the internal resilience and self-esteem to address their life problems.

Clinicians at CFIR can help individuals whose self-esteem is too externally dependent on others.  Psychodynamic and attachment-based treatments are provided to help you deal with the original suffering underlying unhealthy narcissism and to help you develop better internal self-esteem. We can help you develop more internal self-esteem while enhancing your connectedness with others. We can also help you build a greater sense of healthy confidence in your self by setting out and pursuing realistic life goals.

Dr. Dino Zuccarini, C.Psych. is CEO and co-founder of the CFIR. He has published book chapters and peer-reviewed journal articles on the subject of attachment, attachment injuries in couples, and attachment and sexuality. He has taught courses at the University of Ottawa in Interpersonal Relationships, Family Psychology, and Human Sexual Behaviour. He has a thriving clinical practice in which he treats individuals suffering from complex attachment-related trauma, difficult family of origin issues that have affected self and relationship development, depression and anxiety, personality disorders, sex and sexuality related issues, and couple relationships. At CFIR, he also supports the professional development of counsellors, psychotherapists, and supervised practice psychologists by providing clinical supervision.