The Profound Impact of Cancer: Posttraumatic Stress and Posttraumatic Growth

Cancer can completely upend your life and the lives of those who love you. It not only affects you physically, but also has profound emotional and psychological consequences for everyone involved. From the moment you receive the diagnosis to the often challenging or even excruciating medical treatments, cancer brings a whirlwind of difficulties that can lead to symptoms of posttraumatic stress. People living with cancer may have symptoms of post-traumatic stress at any point from diagnosis through treatment, after treatment is complete, or during recurrence. This can range from experiencing irritability, hypervigilance, and sleep disturbances, to loss of interest in life and feeling detached from oneself or reality.  

In simple terms, the trauma of cancer can greatly reduce your ability to handle and cope with stress and emotions, narrowing your “window of tolerance.” Within this window of tolerance, we usually feel safe, calm, and capable of effectively managing stress and emotions. However, cancer pushes us to our limits, often causing this window to shrink. It becomes much more challenging to find that sense of safety and calmness in the face of overwhelming stress. 

However, survivors of cancer also often report experiencing posttraumatic growth (PTG) after their journey. PTG refers to the positive psychological changes that can occur in people following the experience of a traumatic event or significant life crisis. PTG can include improved relationships, new possibilities for life, a greater appreciation for life, increased personal strength, and spiritual development. 

PTG coexists with personal distress and does not diminish the emotional impact of traumatic events or the amount of work that it takes to achieve it. It is not a universal or inevitable outcome for all people who experience trauma, but by working with a mental health practitioner, you can work towards achieving PTG. Embracing the potential for posttraumatic growth means embracing the opportunity to discover new paths and possibilities that may have never been considered before. It means finding a deeper appreciation for what life has to offer and a renewed sense of purpose. 

Cancer-related post-traumatic stress. National Cancer Institute. (n.d.).  

Jim, H. S., & Jacobsen, P. B. (2008). Posttraumatic stress and posttraumatic growth in cancer survivorship: A Review. The Cancer Journal, 14(6), 414–419.  

Tedeschi, R.G. & Calhoun, L. (2004). Posttraumatic Growth: A New Perspective on Psychotraumatology. 21(4). 

Laura McKinney, B.A., is a therapy and assessment practicum student working under the supervision of Dr. Lila Hakim, C. Psych., currently completing her master’s in psychology. Alongside her placement at CFIR, Laura is training as a therapist at Princess Margaret Cancer Centre, where she is working with individuals living with cancer. As a practicum student, Laura offers therapy at a discounted rate. Please check out her profile on the Toronto team page on the CFIR website for more information.

Mind-Body-Wellness Sessions (Episode 1): Integration of the Mind & Body

We love it when great insights come together! Tracie Lee, (registered psychotherapist at Centre for Interpersonal Relationships – Ottawa) and Stephanie Karlovits, (founder and CEO of EPIC Fitness + Lifestyle) recently recorded a 3-part mini-series called ‘Mind-Body-Wellness Sessions.’ The series explores ways to make psychological and physical wellbeing a priority in our day to day living, and why it matters.

In episode 1, Tracie and Stephanie discuss why it’s often essential to integrate the mind and body, especially during challenging times. Check it out!

Going to Work While Being Sick – Not Always the Best Policy

For many of us, work represents a significant part of our lives. Not only do we spend half of our time at work, but we also tend to invest personal resources and efforts to accomplish our professional responsibilities, develop meaningful relationships with colleagues, and construct our sense of identity on what we do.

In the past few decades, organizational and management research has focused on the impacts of absenteeism and implement measures to prevent it, such as rewarding satisfactory attendance and reinforcing policies to justify absences. Combined with a social context that values performance and being seen positively by peers, these measures can influence employees’ decisions to go to work or not. In return, another attendance behavior has been a subject of interest more recently: presenteeism

Defined as going to work while being sick, presenteeism is now known to be a widespread phenomenon among workers. It is estimated that more than 60% of employees report having worked while their health was not optimal, having different impacts for organizations and their members. 

Impacts of presenteeism for organizations

By reducing employees’ efficiency, presenteeism also generates productivity losses for organizations, which are estimated to be higher than those produced by absenteeism. It is estimated that presenteeism costs, on average, $255 annually per employee of a single organization, and its productivity losses can cost between $150 – $180 billion dollars per year (Goetzel et al., 2004; Hemp, 2004). Some authors argue that organizational culture and policies that promote presence at work can then have the impact of developing presenteeism, and therefore, is very costly.

Impacts of presenteeism for employees

Presenteeism represents a risk factor for workers’ physical and mental health. 

  • Going to work while being sick can put others at risk by contributing to the transmission of infectious diseases. 
  • This attendance behavior has been associated with different health difficulties, such as burnout, depression, anxiety, and chronic pain.
  • Presenteeism is also associated with the worsening of physical and psychological symptoms, and by delaying the recovery process, it can eventually lead to more absences.
  • Not respecting our need to stay at home and to take care of our health can also impact our productivity or sense of accomplishment at work, and therefore leading to a diminished sense of work engagement and job satisfaction.

In summary, even though absences from work can hurt an organization, going to work while being ill also can provoke real consequences for both the organization and its employees. It is, therefore, important to recognize signs of suboptimal health and to promote self-care in and outside the workplace. Psychotherapy can be a great place to start to learn how to identify our warning signs, how to assert our needs, and develop acceptance of our limits – and then optimize your health!

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).


Goetzel, R. Z., Long, S. R., Ozminkowski, R. J., Hawkins, K., Wang, S., & Lynch, W. (2004). Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers. Journal of Occupational and Environmental Medicine, 46(4), 398-412.

Going to work while being sick – not always the best policy (part 1)Hemp, P. (2004). Presenteeism: At work—But out of it. Harvard Business Review, 82, 49-58. Retrieved on

Five Easy Tips to Improve Your Sleep Quality

by: Dr. Karine Côté, D.Psy., C.Psych. 

Do you have a hard time falling asleep? Do you wake up frequently during the night? Do you tend to wake up too early? Do you feel like your sleep is never really restful? You are definitely not alone! According to the American Academy of Sleep Medicine, about 30% of adults experience occasional insomnia, and 10% of the population suffers from chronic insomnia. 

The impacts of sleep difficulties on our psychological and physical functioning are diverse. They can include mood fluctuations, increased stress and irritability, problems with concentration and motivation, low energy and fatigue, an upset stomach, and muscle tension and headaches. Fortunately, there are strategies that can help improve your sleep quality. 

1. Practice sleep hygiene

Limit coffee, tea, and sugar intake after 3 PM. Eat your dinner and exercise at least two hours before your bedtime. Your bedroom should be comfortable and quiet, and try to limit looking at electronics, screens, and alarm clocks while in bed.

2. Implement a sleep routine

Maintaining a consistent routine throughout the week is vital. Ideally, your bedtime and wake-up time should be the same every day, even on weekends! 

3. Limit time spent in bed to sleeping

Time spent in bed should be reserved for sleeping (and romantic activities) only. Activities such as watching TV or reading in bed can contribute to your sleep difficulties. It is, therefore, more beneficial to engage in these activities in a comfortable space outside of your room and go to bed only when feeling sleepy. 

4. No napping

It is often tough to resist napping when we feel tired. However, to give you the best chance of sleeping during the night, eliminating any length of napping is essential.

5. Regulate your anxiety

Our sleep difficulties are often related to anxious thoughts that are hard to control. Writing them down before bedtime can help release anxious feelings, while also being reassured that your thoughts are not forgotten in the morning!

Consistently practicing these strategies will give you the best chance to overcome your sleep difficulties. However, if these tips do not work and insomnia persists, don’t be discouraged! Cognitive-behavioral therapy (CBT) offered in psychotherapy can help you regulate your sleep and provide beneficial effects that last well beyond the end of treatment. Don’t hesitate to reach out to Centre for Interpersonal Relationships for support – it is time to prioritize your sleep and regain restful nights! 

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).

How Health Psychologists at CFIR Can Help You

Health psychologists at CFIR can help you to cope with a wide range of health concerns.  

Chronic Illness:

Individuals experiencing chronic illnesses, such as diabetes, HIV, hypertension, and irritable bowel syndrome (IBS), suffer from debilitating physical symptoms that influence how they function in everyday life. Management of these medical conditions requires medication and lifestyle modifications. A psychologist can support individuals to adapt to the lifestyle changes necessary to manage chronic illness, including adhering to treatment regimens as well as dealing with the psychological and emotional aspects of the debilitating side effects of treatment or the disease itself. Often overlooked is the importance of our mental and emotional well-being in dealing with a chronic illness. Depression and anxiety can emerge as we adapt to our new medical realities. Our psychological and emotional functioning can exacerbate or worsen our experience of a chronic, manageable illness.

Life-Threatening Illness:

Individuals experiencing life-threatening illnesses experience physical health issues associated with the disease process and treatment that can influence their emotional well-being and psychological functioning. Being calm and relaxed and maintaining a positive sense of emotional well-being during medical treatments, while challenging, can buffer clients from the distress associated with medical procedures and hospitalizations. Making sense of, and coping with, the adverse emotional reactions related to uncertainty can alleviate our emotional distress during these problematic life moments. Adapting to treatment regimens and medical appointments can create emotional distress. Treatments can also affect our psychological functioning, which alters our sense of self and the world around us. Anxiety and depression can also grow out of the uncertainties of our medical circumstances.

Terminal Illness: 

Facing a terminal illness precipitates a wide range of emotional reactions, including fear, anger, sadness, and grief. Moving toward acceptance is an internal journey. The disease process and treatment of the disease can bring about debilitating side-effects, and can also affect our emotional and mental health status, and our psychological functioning. Making sense of our circumstances and lives, and dealing with the emotions associated with a terminal diagnosis can be overwhelming.

Smoking Cessation, Weight Concerns, Healthier Lifestyle: 

Whether you’re looking to quit smoking, lose a few pounds, or make healthier lifestyle choices, there are several stages one goes through to change behaviours. Whether contemplating change or actively attempting to change, maintaining healthy practices requires us to be attentive and mindful to the self and environmental triggers that stimulate us to engage in these behaviours. Learning how to manage healthy behaviours, including adopting new coping strategies to address underlying stress and emotions, is an essential component of behavioural change. When motivation to change an unhealthy behaviour wanes, deeper issues associated with self-esteem, self-worth, trauma, and abuse may also be present. Sometimes unhealthy behaviours serve as a source of soothing the self and dealing with difficult emotions from our past and present-day life. 

How We Help You:

You don’t have to be alone while struggling with the physical and psychological aspects of your condition. A health psychologist at CFIR can meet with you for a free consultation to help you better understand how he or she may support you through your journey with a health-related or lifestyle adaption. We offer clients comprehensive assessment and psychological treatment to address the psychological aspects of managing chronic, life-threatening or terminal illnesses or promoting healthy behaviours. Clinical and health psychologists at CFIR work with clients to treat a wide range of psychological issues that may emerge as we encounter challenges in our efforts to manage our physical health concerns or face life-threatening or terminal illnesses. We provide you with knowledge and emotional support to diminish your sense of isolation and to assuage distress associated with fear and hopelessness as you face challenges related to health and illness. Regarding lifestyle adaptations, we can help you manage these stages of change, deal with underlying self and relationship, or past traumatic issues, and help you to find more adaptive coping mechanisms to allow you to live the healthier life you desire.

Read more about our Neuropsychology, Rehabilitation & Health Psychology Treatment Service.