Winters are a hard time for so many of us – we can get stuck in routines, retreat more within the comfort of our homes, and perhaps most challenging, we find ourselves reflecting on ourselves and our relative contexts. In fact, this particular time of year is synonymous with seasonal affective disorder (SAD), an experience that is so common it has become a (uninvited) household name and guest. 

Mental health challenges tend to be more acutely challenging this time of year, as it becomes more difficult for us to maintain self-care routines, try to get adequate sleep, and feel well balanced – we tend to slip back into old habits, enter into more relational struggles with our loved ones, and generally feel less satisfied and resilient. Small stresses can take us down, and we find ourselves stuck with distressing thoughts, and uncomfortable emotions. What if it didn’t have to be that way?

Cognitive-Behavioural Therapy (CBT) is an evidence-based and often gold-standard approach anchored to client needs to address the unhelpful thinking and behavioural patterns that underly the challenging emotions that hold us back. 

How does it work? 

Work with a cognitive-behavioural therapist involves developing a treatment plan that is tailored to address a number of client goals. It is a short-term treatment that generally lasts between 8-24 sessions. CBT focuses on finding solutions, providing strategies and techniques to improve coping and reduce distress, designed to help clients challenge difficult thoughts and beliefs, and change problematic behaviours. A number of specific interventions have been developed stemming from a cognitive-behavioural perspective: Dialectical Behavioural Therapy (DBT), Exposure and Response Prevention (ERP), Mindfulness-Based Cognitive Therapy (MBCT), and Acceptance and Commitment Therapy (ACT). 

The CBT Clinic

On January 16^th, 2023, the Centre for Interpersonal Relationships (CFIR) opened its doors to The CBT Clinic. CFIR is poised to provide cognitive-behavioural therapy in a client-centered fashion, tailored to your specific needs. The CBT Clinic includes a large number of empathic and caring mental health professionals that can see clients virtually, and in-person at our sites in Ottawa and Toronto. 

Dr. Marc Bedard, C.Psych. is a psychologist and neuropsychologist at the Centre for Interpersonal Relationships (CFIR). Dr. Bedard provides psychological services to individual adults experiencing a wide range of psychological and relationship difficulties related to mood and anxiety disorders, trauma, eating disorders, sleep disruptions, and interpersonal betrayal. He works from a client-centered approach and integrates therapeutic techniques from object relations, ego, and self-psychology psychotherapies, emotion-focused therapy (EFT), and cognitive-behavioral therapy (CBT). He also provides neuropsychological assessment services to individuals with acquired brain injury, post-concussive difficulties, and to diagnose issues related to neurodivergence (e.g., Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder). Dr. Bedard is the Director of the Cognitive Behavioural Therapy Clinic (CBT-C) at CFIR. 

As the possibility of business and recreation gradually reopening becomes more of an imminent reality, many of us will face the opportunity to step out into the outside world again, into closer contact with other live (not-virtual) human beings, for the first time in months. 

Despite many social media narratives that celebrate this possibility, the actual emotions we might face as such opportunities become realities might be a lot more complex than that.

When COVID-19 initially hit, we fell suddenly and unexpectedly into a full-blown crisis. As with any onset of crisis, it is common and even likely to feel emotions like anxiety, worry, panic, overwhelm, and fear.

And as long as we continue to live in this crisis, especially as food, work & income, and housing remain uncertain for so many, we can expect these emotions of anxiety, worry, panic, overwhelm and fear to stay present. 

Everything inside of us is mobilizing—body and mind—to meet these threats that we face, and to survive them. 

Now that we are a couple of months into the pandemic, I am seeing some clients in my psychotherapy practice who are beginning to enter into the next phase of emotions. Since we’ve now had some time to start absorbing a bit of the new reality, and certainly, as we anticipate returning to work, the main emotions we are feeling are expected to shift. Increasingly, I anticipate seeing more people with emotions like depression, chronic boredom & under-stimulation, frustration, hopelessness, helplessness, and despair.

As we continue to take in more of what we have been experiencing, we are going to feel more of the weight of it all, and at times that weight is likely to feel quite heavy. 

So, what can you do to support yourself through these current and upcoming emotional experiences? For me and the way that I practice psychotherapy, the answer comes back to ‘connection.’ 

Firstly, it is essential to maintain—or build—connection to yourself. Once or twice per day, for 15 or 30 or 60 seconds at a time, stop and check-in with yourself. Notice what is happening in your thoughts and feelings, and even in your body. Notice your breath, notice your bodily sensations, and check in on them at various moments and throughout the following days because they are likely to fluctuate. 

Self-monitoring, in this manner, can help you to feel grounded in yourself and your experiences. It can also help you to identify when you need help—and this leads to a second point: we also need to be maintaining connection to others. 

If you find yourself struggling or feeling unwell, try to reach out. Of course, you can always reach out to a psychotherapist, and you can also reach out to a close friend or family member who might intently listen to you, or else might help you problem solve, depending on what you need. 

You can also try going for a walk to give your thoughts some space, or write them out, or even audio record them for yourself. In any of these cases, reaching beyond yourself to outwardly express what you are thinking and feeling can help you release some emotional burden, and so can help you to feel a little better. 

Secondly, as you are reaching out to others, do not forget that you can probably assist others, too; there can be a mutual exchange of support. Sometimes all someone might want is to be heard, and even in times when we feel we have nothing left to give, just existing next to someone alongside their experiences can bring great relief. The relief is mutual, as we benefit from a dose of feel-good chemicals in the brain when we connect with and help others. 

One final thought on emotions in this next stage of the pandemic: sometimes we can forget that it is absolutely possible to feel many different things, including stress and hopelessness, and even gratitude, or any other mix of emotions, all at the same time. These feelings can co-exist together.

If we can hold on to this thought, maybe we can make even just a tiny bit more space for the feelings of connection and groundedness. 

Take good care.

Reesa Packard, M.A., Ph.D., R.P. is an Associate and registered psychotherapist at CFIR (Ottawa). 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 also involved in the teaching and supervision of psychotherapists-in-training and advanced knowledge through research in her specialty fields.

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

The pandemic as an “acute stress”

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

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

The pandemic as a “chronic stress”

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

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

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

Chronic stress – an analogy regarding coping

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

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

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

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

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

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

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

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

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

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

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

During times of crisis and panic, many people can feel as though their current mental health issues are on overdrive. Everyday activities that were once employed to help alleviate depression and anxiety, such as face-to-face encounters and related activities, have been put on pause in light of social distancing measures and self-isolation. Stress and uncertainty surrounding COVID-19 have many feeling overwhelmed by potential financial, social, and health implications. With the additional strain on our mental health, some of us may feel like we’re regressing into old habits that we deem as ‘unhealthy.’ These practices may include excessive drinking, emotional eating, insomnia or oversleeping, and even over-exercising. It’s easy to start turning to old behaviours.  

There are countless social media posts about ways to achieve new goals, and become uber-productive now that we ‘have the time’; this can intensify feelings of isolation in our struggles. With social distancing in play, it’s even more important to stay connected and share what might be challenging for you right now, because chances are, others are struggling too. 

Remember…this is not an easy time. It’s okay if you are not okay right now, and most importantly, you are not alone in this.

• Be kind to yourself. Some days are going to be better than others, both in mood and motivation. Remind yourself that these are hard times, and everyone has moments of struggling in both similar and different ways. 
• If you do engage in old habits, try to see this as a signal of emotional pain and a need for something that stimulates or soothes you. Try different types of care and activities until you find something that meets your emotional needs.
• Try moving your body regularly, and walk outside (even across the street or around the block) once a day. This practice can help, especially when you feel restless or have low energy.
• Build motivation by making a daily routine and planning things to look forward to in your week, but try not to look too far into the future. There is an ending to all of this, even if it feels far away at the moment. 
• Be realistic. You don’t have to finish a novel or establish a side business by the end of the pandemic. For example, finding a new hobby or activity that you enjoy (even if you’re “bad” at it) is good enough. 
• Connect! Strike a balance between scheduling virtual hangouts, phone calls, or facetime dates, and spontaneously connecting with others throughout your week. When you start to feel lonely and disconnected, call a friend or family member. 
• Disconnect from social media and news intermittently. Many of us are glued to our phones, scrolling through Instagram or Facebook, and catching up on a constant stream of COVID-19 articles. Set boundaries and limits with these things and try to give yourself some breaks in your day to connect to yourself and your needs.  
• Breathe. It may seem simple, but it has a profound impact on our nervous systems. In moments where you feel overwhelmed with anxiety and fear, take a few deep breaths and remind yourself that this will pass.  

If you feel alone and overwhelmed, clinicians at CFIR are ready to offer support. Psychologists, psychotherapists, and counsellors from CFIR Ottawa and Toronto are providing secure, confidential therapy online or by phone. 

Whitney Reinhart, R.P. (Qualifying) is a qualifying registered psychotherapist, at the Centre for Interpersonal Relationships (CFIR) in Toronto. She supports adult and couple clients with a wide range of difficulties related to depression, anxiety, traumatic experiences, and interpersonal conflict.

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

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

Grounding

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

Positive Self-Talk

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

Journaling

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

Exercise

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

Reach Out for Support

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

Meditation

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

Deep Breathing

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

Stay Busy

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

Make Our Spaces Cozy and Peaceful

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

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

• Practice proper hand hygiene and coughing/sneezing etiquette

• Stay home if you are sick

• Reduce exposure to crowded places, whenever possible

• Avoid direct contact with individuals

• Stock up on essentials, but avoid panic buying

• Disinfect frequently touched objects like doorknobs or toys

• Get reliable information

• Communicate and make a plan

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

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

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

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

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

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

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

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.

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.

by: Dr. Brianna Jaris, C.Psych.

The holiday season is an incredibly stressful time for many people. There are some things that we may not be able to avoid – congested malls, traffic and travel, holiday gatherings and parties, buying gifts, etc… but, throughout it all, the best thing that we can do is to give ourselves the gift of self-care. Here are a few things that we can do to make the best out of this holiday season:

1) Make a plan – Be prepared by making a plan. For example, make a grocery list or plan out when you can do your holiday shopping. Having a plan is the first step in preventing the added stress of forgetting something or having to do things last minute. 

2) Be proactive – Don’t wait until the last minute to shop for groceries for a holiday dinner or shop for gifts. Getting things done ahead of time can give you a great sense of accomplishment and can help avoid the stress of overwhelming yourself with having to do too much at once. 

3) Be realistic – For example, plan for there to be traffic or for the shopping centres to be busy. Also, set a budget and don’t go overboard. It’s important to realize that you may not be able to do it all yourself, so don’t be afraid to enlist help if you need to as well.

4) Set up appropriate boundaries – Establish a timeline for visitation – don’t let guests overstay their welcome. Do certain topics of conversation need to be set as “off-limits”? Don’t forget that setting up healthy boundaries also means being able to say “no” to people or demands. Remember that in order to be healthy, sometimes you have to risk disappointing other people.

5) Build time in for yourself – The most important thing of all this holiday season is to take care of you. Take breaks and build in time to relax as necessary. Self-Care is the best gift you can give.

Stay ahead of stress this holiday season by sticking to a plan, recognizing your limits, and not letting others dictate your holiday. We all want to make the holiday season special for the ones we love, but don’t forget to take care of YOU this holiday season!

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.