Coping with Acute, Chronic, & Pandemic Stress

Coping with acute stress

Note: The sympathetic nervous system is the part of the nervous system that is responsible for activating the fight or flight response (i.e., acute stress response) and preparing the body for the necessary activity to protect itself from actual or perceived danger. The parasympathetic nervous system is the part of the nervous system that is responsible for recuperation and is important in feeling safe and calm.

There are many strategies we can learn and strengthen to help us tolerate and reduce the intensity of acute distress. It is important to note that we do not want to make the emotion “go away” as this will likely initiate less adaptive coping strategies, such as repression, denial, avoidance, and escape distraction. When coping with a distressing emotion, I encourage people to learn to tolerate some level of that emotion (i.e., within a “window of tolerance”), while also engaging in and using strategies to help reduce the intensity of that emotion. It is important to keep in mind that learning to tolerate emotion is a valuable skill and through practicing distress/emotional tolerance, we allow the emotion to rise and fall and, ultimately, run its natural course; while tolerating the emotion, we can “listen” to the emotion as it provides valuable information about what might be happening in the environment. Also, it is important to remember that all emotions are temporary

The following are a few examples of strategies that can be used to help reduce the intensity of a distressing emotion and bring it to a level that is tolerable; the goal of the following strategies is to help reduce nervous system activation (i.e., sympathetic nervous system) and increase parasympathetic nervous system function:

  1. Intense exercise: 3-5 minutes (or more) of intense exercise (i.e., enough to elevate your heart rate) will help to burn off anxious or distressing/unpleasant energy which is pent up and activating the sympathetic nervous system. This will help the body to regulate (allowing for the onset of the parasympathetic nervous system).
  2. Recovery-oriented relaxation strategies: there are a variety of activities and strategies that can be used within this domain and I encourage you to think about activities that help you experience a sense of ease and relaxation. Furthermore, encourage you to reflect on experiences that’ll allow your body to experience muscle relaxation to help reduce pent-up muscle tension.
  • Progressive muscle relaxation: this strategy uses repetitive tension and release movements in various muscle groups to help reduce muscle construction patterns induce muscle relaxation.
  • Diaphragmatic breathing: at any point when we are experiencing an unpleasant or distressing emotion, I encourage people to take stock of their breathing an attempt to slow their breathing down using deep, diaphragmatic breathing techniques. In doing so, feedback loops to our brain provide information and indicate that we are calmer and safer than the brain is interpreting. Deep breathing by itself may not be enough to reduce the intensity of the emotion we are experiencing, especially if the emotion is 8-10/10, with 10 being more intense. I encourage people to include deep breathing while using another strategy.
  • The “dive” technique: I use and recommend a modification of this strategy, which includes using a Ziploc bag full of cold water and is placed over the eyes, including the undereye area. There is a nerve that runs underneath the eye that, when cold, activates the parasympathetic nervous system.
  • Listen to calming music: Our nervous systems are acutely attuned to sounds from the environment. When we intentionally play music that is calming, we are providing a message to our nervous system that we are safe.
  • Use heat to induce muscle relaxation: Acute and chronic stress responses involve muscle tension. Using heat will facilitate muscle tension release and relaxation, in turn, sending information to the brain that you are relaxed and safe.

3. Mindfulness: The regular and intentional practice of mindfulness meditation can help develop our cognitive resources of attention allocation in order to more swiftly let go of distressing thoughts and sensations. As well, mindfulness helps create greater awareness of our bodies and minds (i.e., flow of consciousness). As we expand our intentional practice of mindfulness exercises into our greater daily experience, we allow ourselves to become more present in each moment, letting go of past and future thoughts and feelings, and creating “space” for in-the-moment experiences of cultivating contentment, joy, and ease.

Tip:  Finding it difficult to find time to engage in the above? Or single strategies not as effective as you would like? Try “doubling” or “tripling” up on the above strategies to send multiple signals to the brain that the body is calm/relax and safe. I encourage you to add deep breathing to all activity!  

Coping with chronic stress

There are many ways to cope with acute stress and chronic stress that can be applied at various times in our lives when acute and chronic stressors are present. I often encourage people to first take stock of their “foundations.” 

The Five Pillars to Wellbeing

  1. Sleep
  2. Nutrition
  3. Exercise/Movement
  4. Enjoyable activities (that bring you a sense of contentment, joy, and ease)
  5. Social connection 

By taking stock of these five “pillars,” we can start to make small, manageable changes to our foundation, which in turn, will provide us with ample physical and mental resources to facilitate our ability to cope with acute and chronic stress. It is important to note that during times of chronic stress, we often experience destabilization related to one or more of the above pillars; as well, when we get “busy,” we often reallocate time away from the above activities, which further perpetuates and exacerbates the impact of the chronic stress/distress. As such, I strongly encourage people to dedicate time (i.e., create “protected time”) each and every day to ensure maintenance of the above pillars.

Coping with Pandemic Stress

  1. Use gentle avoidance. Often psychologists help people to limit their use of avoidance as this is often driven by anxiety and leads us to be unable to engage in activities that he might otherwise enjoy. However, in some contexts, such as this pandemic, I encourage people to practice gentle avoidance regarding some aspects of activity and knowledge consumption.
  • Limit media consumption: The key here is to find reliable sources of information where you can stay informed about the procedures and guidelines to keep you safe. Additional information beyond this may contribute to and perpetuate anxiety.
  • Avoid discussing events: Although it can be helpful at times to discuss the pandemic and associated changes with friends and family, people can get swept into “anxiety spirals,” which worsen the acute/chronic stress impact and can maintain anxiety beyond the conversation. Also, misinformation can be shared, and in the context of high anxiety, it is easier to believe misinformation and become more fearful or paranoid. 
  • Keep things in perspective: Speaking with reliable sources can help us keep information in perspective and help to abate and let go of anxiety-driven thoughts/beliefs (e.g., catastrophizing). Remember, if people are bringing up topics of conversation regarding the pandemic that provoke intense feelings of anxiety/distress in you, it is ok to set boundaries and ask the person to not bring up said conversations with you.

2. Stay connected. Remember, we are social creatures and we thrive off of social connection, regardless of our place on the introversion/extroversion scale; the difference here is the frequency and intensity of social connection. Although phone and video connections do not provide the same sense of connection as in-person connection, it is important to stay connected to friends and family. Isolation, especially if living alone, can become very dangerous to our mental wellbeing. Without external sources of support, emotion-driven thoughts/beliefs can take hold and we start to believe them more strongly. 

  • Keep things in perspective: Speaking with reliable sources can help us keep information in perspective and help to abate and let go of anxiety-driven thoughts/beliefs (e.g., catastrophizing). Remember, if people are bringing up topics of conversation regarding the pandemic that provoke intense feelings of anxiety/distress in you, it is ok to set boundaries and ask the person to not bring up said conversations with you.
  • Use social connection as a source of adaptive distraction: Talk about topics that bring you contentment, joy, and ease! Share information about books/literature, movies/TV shows, and/or other hobbies and enjoyable activities. You may even wish to reminisce by sharing fond memories.
  • Remember that life will go on: It is important to acknowledge/validate that the pandemic and associated changes is difficult; however, because we cannot control the pandemic, it is not helpful to wallow or become preoccupied with the difficulty. Remind yourself and your family/friends that life will continue and try to anchor yourself to something hopeful in the future (e.g., a trip, a goal, an activity).

3. Movement/Exercise: Whatever the type of movement, try to incorporate some form of movement on a daily basis, whether it be walking, stretching, or a formal workout routine. Our bodies are meant to move and, as a result of self-isolation protocols, we are not moving as much as we have before. 

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. 

The Individual Impact of Pandemic Stress

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. 

Finding Work-Life Balance While Working At Home

More and more, organizations are adapting their work modalities and environments, and therefore changing their employees’ experiences. Telework is increasingly encouraged in the current workplace, mainly to facilitate a better work-life balance for workers and optimize their levels of productivity. However, the working-from-home scenario of the past is much different than our new pandemic reality, where full-time telework is imposed. 

Various factors can complicate working from home. These factors may include dealing with more distractions, having to care for kids (or other members of the family), technological issues, feeling disconnected from a team, or not having access to specific resources we usually have in the workplace. For many individuals, these factors add up to one significant challenge: finding and maintaining a sustainable balance between their work and personal life. Here are a few tips that can help set a healthy integration of your work and personal spheres:

  • Create a designated workspace: If you have the space in your home, organizing a work station that allows you to have all the tools you need to do your work, is ergonomically friendly, and is not too close to main distractions is worth it. It can be as simple as reorganizing furniture or adding a separating curtain around your desk.
  • Establish a flexible routine: Maintaining your typical routine might work best for you. If you are used to getting up, showering, eating breakfast, and walking to work, why not do the same steps before starting your workday at home? Keeping up with your usual routine will also ease the transition of returning to your workplace. However, if you find your regular routine does not match with your new reality at home, being flexible and creative with your schedule could help you find a work-life balance that fits better for you. For example, you may want to adjust your work hours to moments of the day when you feel most productive, or less likely to be distracted by familial obligations. 
  • Connect with colleagues: One of the positive benefits of being physically at work is connecting with colleagues in-person, celebrating successes together, and finding social support. Maintaining regular contact with your team is not only helpful for your work but can also be a great morale booster.
  • Keep house chores for after work hours: You don’t need to take care of your to-do list at all times because you are at home all day. If you get overwhelmed with everything that you need to do with work and home responsibilities, separating the two can be very helpful.
  • Take breaks: Personal and social breaks are essential, even when you are at home. Although many teleworkers usually would make time for a break while at the office, they won’t allow time to have one during work-at-home hours. Taking a walk, doing some stretches, calling a friend, eating lunch outside, or taking a coffee break will help to maintain focus and productivity, and a general sense of well-being.
  • Avoid working after work hours: You don’t need to work more because you’re working from home. Maintaining clear boundaries with your work will help you to find a better balance.
  • Communicate your needs to other members in your home: Signaling your needs and limits to other individuals living with you will help to maintain your work-life balance. It is ok to express your requirements – this will also allow others to respect your boundaries and express their own. 
  • Adjust expectations: It’s important to remember to adjust our self-imposed pressures and expectations. Given the current global climate, it may very well be impossible to be as productive as you wish you could be, and it is reasonable to experience lower motivation and higher levels of stress. Be kind to yourself, as your self-judgment is probably hurting more than it is helping. 

Full-time telework certainly has its perks, but maintaining a satisfying work-life balance can be demanding as well. If this new reality continues to be challenging and causing emotional distress, don’t hesitate to reach out for support. Clinicians at CFIR are here to help you identify strategies that will improve your day-to-day work and life routine, and better manage the difficulties you are experiencing. 

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).

A Psychologist’s Tips to Mentally Cope with COVID-19

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:

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.

Whole-Person Self-Care for the Holiday Period

by: Reesa Packard, M.A., Ph.D., R.P.

The dawn of a new holiday period is upon us once again; as the cool air sets in, the decorations are mounted, and typically, the to-do lists begin to grow… The holidays can be ripe with joy and celebration, but they can also be a time of stress. Being pulled out of our regular routines, eating more indulgent food, spending more money, being more immersed in the mixed experiences of family time, etc. can add up to create a holiday period that is harder than we hoped it would be. 

Whether there are specific stressors awaiting you this holiday period or you simply want to make the most of it, whole-person self-care can help you get there. So, what exactly is self-care? Self-care has its roots in 1950s medical communities, where it was learned that patients’ taking their own actions to care for themselves physically, spiritually, psychologically and emotionally was essential to their healing, health, and wellbeing. Now, decades later, the concept of self-care has been picked up by mainstream society. On social media, #selfcare now seems to depict a culture of luxurious consumerism and self-indulgence, but that is only part of its story. 

So, then what is whole-person self-care? While some versions of self-care can focus on a specific task that might help you feel better in one specific way, whole-person self-care is more like an attitude of overall self-reflection, and of building self-awareness, so that you can honour many different parts of yourself at once and care for your ‘entire self’. In this way, self-care is not only about taking a quick break or reveling in indulgences—self-care is about developing yourself, and your life, in a way that makes those breaks and indulgences less necessary to begin with. 

So, how can whole-person self-care help you this holiday season? You can use it as inspiration to get you thinking about questions like: “What is happening right now, how well is this working for me, and why?” “What is really important to me, out of all of this?” “How am I really doing?:” “How are my physical, spiritual, psychological and emotional parts doing right now?” “How are my relational, occupational, and financial parts doing right now?” “What do I want right now, what do I need right now, and how might those be different?”… These questions are the type that can lead you to become more self-aware, and as you build this self-awareness, you can have more clarity about the ways in which you might act to help yourself. 

Give yourself the best holiday gift this season, by connecting with yourself in the present! Try out some of the self-care strategies below: 

  • Physical: move your body or take rest, eat some nutrient-dense foods, quench your thirst, stretch your muscles, breathe deeply; 
  • Spiritual: immerse in a moment of silence, (re)discover some nature, attune deeply to yourself and others, contemplate some higher power or higher-order, seek experiences of awe and wonderment;
  • Psychological: build gratitude by naming what you are grateful for, emphasize relationships that fuel, and de-emphasize those that drain, ground yourself by scanning and taking in the details of the room and space around you; 
  • Emotional: practice feeling feelings as they arise, practice taking small breaks from feelings when they feel too intense, notice bodily sensations associated with feelings, try to fathom perspectives different than your own.

Professionals at CFIR can help you learn about and practice whole-person self-care. Contact us to inquire more and to begin or continue on your journey toward making yourself and your mental health a priority.

Reesa Packard is an Associate at CFIR. She has a doctoral degree from the Saint Paul School of Psychotherapy & Spirituality and works in private practice as a registered psychotherapist. She works with clients hoping to develop a more integrated sense of self as a means to well-being and meaningful, lasting transformation. Reesa is currently building a new service at CFIR called ‘The Integral Self’, which offers a place for clients to receive support and guidance in their advanced self-development, including spiritual and body-based growth. Reesa is also involved in the teaching and supervision of psychotherapists-in-training and advanced knowledge through research in her specialty fields.

Five Warning Signs of Burnout and How to Manage Them

We all experience stressful situations in our lives, whether they occur at work, school, or in our personal lives. While experiencing stress is completely normal, if this stress has started to seriously impact any aspect of your life it may be a sign of burnout. Burnout is a state of emotional, physical, and mental exhaustion caused by excessive or prolonged stress. 

Burnout can occur to anyone who is working or living in a consistently stressful environment. It can slowly creep up because the early warning signs may be innocuous. Some common warning signs of burnout include the following: 

  • Feeling more tired than usual, or having difficulty sleeping
  • Having difficulty concentrating 
  • Increased agitation or irritability 
  • Loss of enjoyment in things you used to enjoy 
  • Poor work performance 

If you are experiencing any of these symptoms of burnout, here are some tips to help you manage: 

  • Take care of your physical health: sometimes we can forget about eating properly, exercising, and sleeping when we are feeling burnt-out. Taking care of our physical health can also boost our mood. 
  • Self-Care: take some time out of your schedule to do activities that make you happy. It can be as simple as taking a bath, talking to a good friend, or making yourself a nice meal. 
  • Set Boundaries: whether at work or in your personal life, it is important to set boundaries with those around you to make sure you are not giving too much of yourself. 
  • Talk to someone: whether it’s a friend, co-worker, family member, or professional, talking to someone you trust about what you’re feeling can help to reduce feelings of isolation and loneliness associated with burnout.

These strategies can help reduce the symptoms of burnout. However, if you feel the symptoms you’re experiencing have been going on for an extended period of time or feel uncontrollable, it might be time to seek professional help. At CFIR, we can help you understand where your burnout is coming from and support you in developing healthy coping and self-care strategies.

Natalie Alexov, B.Sc. is a counsellor at the Centre for Interpersonal Relationships (CFIR) under the supervision of Dr. Aleks Milosevic, C.Psych., and a Masters of Education with a concentration in Counselling Psychology at the University of Ottawa. She supports individual clients to overcome a broad range of difficulties including depression, anxiety and stress, the impact of traumatic experiences, and relationship problems.

‘Tis the (Exam) Season!

by: Dr. Marisa Murray, C.Psych. (Supervised Practice)

You’ve prepared for weeks. Or maybe you haven’t? Your social life–at this point, is non-existent! Whether you’ve studied to the brink of reciting the material in your sleep or if your total exam prep has consisted of overnight cramming, when exam day arrives, the same thing often happens. Thoughts of uncertainty begin to kick in, leaving you feeling overwhelmed and anxious.

It’s natural to feel some butterflies in your stomach before an exam. It’s similar to the way you might feel before playing in the big game, performing on stage, or engaging in public speaking. Pre-exam jitters can be channeled to help motivate us to perform at our best. This is known as a helpful kind of anxiety. It helps us view the exam as an exciting challenge!

It’s the unhelpful kind of anxiety–the one that causes us to fear the exam, to have difficulty concentrating, to second guess ourselves or to have physical symptoms, like a headache or a racing heart–that interferes with our performance.

With exam season fast approaching, here are some helpful tips for managing your pre-exam anxiety: 

  1. Use your time effectively: No matter how hard you try, it can feel like there is ‘never enough time’ around exam season. Fine-tuning your time-management skills can include: using a calendar or a checklist to set goals, avoiding potential distractions (e.g., phone, your guilty pleasure on television) during study time, and keeping a consistent yet flexible study routine while rewarding yourself for meeting your study goals.
  2. Engage in self-care: Take care of yourself to manage your stress levels. Getting a good night’s sleep, taking breaks (typically ones that allow for stretching, moving around, replenishing food and water intake), engaging in social interactions, and/or practicing a relaxation activity are examples of how you can release some of the pre-exam stress. Just as you schedule your study time, schedule time for yourself!
  3. Develop a study plan: Consider putting together a realistic study plan that allows for flexibility. In developing your study plan, figure out which exams require more prep time. Also, try to factor in some wiggle room for potential obstacles that might interfere with the study plan (e.g., coming down with the flu!). Most importantly, figure out what helps you reach your optimal studying – do you study better alone? Or do you better achieve your studying goals in a group setting? Do you like to study in the comfort of your own home? Or do you prefer the silence of the library? Do you learn better visually? Auditorily? What time of day do you retain information best? Try to answer these questions and incorporate the answers into your study plan.
  4. Monitor your negative thoughts: Telling yourself, “I’m going to fail this exam,” can be very convincing to the powerful mind and, yes, exacerbate anxiety! Keep in mind that there will be questions you know and others you don’t. You cannot learn everything! Try to view your upcoming exam as a new experience. Perhaps the midterm didn’t go as well as you wanted – this is a new exam. Work on convincing your mind that you will “try your best.”
  5. Make use of available resources: Many schools offer workshops and presentations related to stress management, test-taking strategies, and time-management. Look into what’s available on campus. Also, make use of your professors’ and teaching assistants’ office hours to get a better grasp on challenging course material. Finally, consider reaching out to a mental health professional for assistance in managing unhelpful exam anxiety.


Dr. Marisa Murray, C.Psych. (Supervised Practice) is a psychologist in supervised practice at the Centre for Interpersonal Relationships (CFIR) in Toronto, Canada, under the supervision of Dr. Cassandra Pasiak, C.Psych. Dr. Murray supports children, adolescents, and adults with psychological treatment and assessment services, including psychoeducational assessments and treatment for eating disorders and body image-related issues.

10 Tips for Managing Holiday Stress in 15 Minutes or Less

by: Dr. Tracy Dalgleish, C. Psych.

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

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

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

Stress and the Brain

by: Ali Goldfield, M.A.

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

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

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

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

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

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

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

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