Year: 2019

“Psychology Works” Fact Sheet: Female Sexual Dysfunction

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Most women have questions or experience some concerns about their sexuality at some point in their lives. Information on sexuality can be easily accessed via books and a variety of online and social media resources. However, it is difficult at times to separate advice-touting articles from the fact that sexuality is a highly individual experience depending on an array of factors including values and attitudes, previous sexual experiences, overall physical and mental health, and the relational influences. Psychologists can assist women in their exploration of questions or concerns regarding sexuality and psychologists with the relevant training can provide evidence-based treatments for sexual dysfunction.

Female sexual dysfunctions

Desire

  • Lack of sexual desire
  • Desire discrepancy with partner
  • Aversion to sexual activity

Arousal

  • Difficulties with physical and/or subjective sexual arousal
  • Difficulties lubricating
  • Difficulties sustaining arousal

Orgasm

  • Difficulties experiencing orgasm

Pain

  • Pain with sexual activity
  • Difficulties with vaginal penetration (anxiety, muscle tension)

Lack of sexual satisfaction and pleasure

How common are sexual dysfunction?

Research studies in the U.S. and Europe estimate that 1 out of 3 women live with sexual difficulties. Most of these women are very distressed about their problems with sexual function and satisfaction, and about the effects the sexual problem may have on their relationship. The most frequently reported problem is lack of interest in sex. This is followed by experiencing pain and/or anxiety with sexual activity, difficulties experiencing orgasm, difficulties with sexual arousal, and not finding sex pleasurable or satisfying.

At different stages in a woman’s life, challenges can result in temporary sexual difficulties. For example, a pregnant woman may experience a decrease in her desire for sexual activity and experience difficulties with vaginal lubrication post-partum. A woman busy with child and/or elder care may find it difficult to feel desire for sexuality. Women who are experiencing physical or mental health problems may observe changes in their sexuality. With age, women may also observe changes but, with the exception of vaginal lubrication difficulties, the number of women who experience sexual dysfunction does not increase with age. Temporary sexual difficulties do not always result in personal or interpersonal distress and self-care and transitioning life’s challenges may result in the remission of sexual problems. However, lack of accurate sex information and negative evaluations from the self or partner may result in more lasting problems and increased distress. Psychologists are well-positioned to assist women in their path to sexual well-being in concordance with the woman’s psychological needs, values, and motivations.

What causes sexual dysfunction?

Female sexual dysfunction can have one or many causes. These may include physical conditions such as illness, hormonal imbalances, or reactions to medication. Psychological factors that may be involved in the development of sexual difficulties include a history of abuse, a woman’s beliefs about sexuality, the way in which she communicates about sexuality, the way she feels about how she looks, and her mood. A woman’s sexuality may also be affected by her life situation, stress, tiredness, or pregnancy, and a growing family. Difficulties within her relationship with her partner can affect the couple’s sexual relationship. Culture and religion also influence women’s attitudes towards their sexuality.

How can psychologists help?

Psychological treatment of sexual dysfunction usually starts with a careful assessment of the history and circumstance of sexual problems. The psychologist may also ask questions about the woman’s sexual and relationship history, and her overall physical and emotional health. Treatment for sexual dysfunction can involve other health care providers such as gynecologists or pelvic floor physical therapists. Specific psychological treatments vary somewhat depending on the sexual dysfunction and the treatment orientation of the psychologist. In general, psychologists who treat sexual dysfunctions, provide a supportive, non-judgmental atmosphere and provide accurate information about sexuality. They tailor treatments to particular life circumstances, needs, and overall personal values of the woman. Cognitive-behavioural therapy (CBT) is the most frequently used and best established short-term psychological treatment for sexual dysfunction.  In CBT, a woman works with the therapist to identify and change problematic feelings, thoughts, and behaviours that interfere with pleasurable sexual expression. This is done during weekly or bi-weekly sessions with the psychologist, and through the use of at-home exercises. Increasingly, mindfulness interventions are included in CBT interventions or used as a stand-alone intervention. Mindfulness has been shown to be particularly effective with sexual interest and arousal difficulties, problems of pain and anxiety with intercourse, and health-related sexual problems (e.g., cancer).

How do I obtain help from a psychologist for a sexual concern?

Talking about private, sexual feelings is not an easy, but essential first step! Many women suffer in silence with their problems for a long time. As a result, problems can worsen and distress increases. She may question her love for her partner, and her ability to sustain the relationship. If she is single, she may question her ability to start a new relationship. It is important to take the time to attend to one’s sexual health and seek advice, the earlier the better. Women seeking sex therapy will be surprised how facilitative psychologists can be in talking about sexuality in a comfortable and safe manner – and just talking about one’s questions, concerns, and distress are a good step in the right direction. It may be beneficial for a partner to participate in sex therapy. However, if not possible, it is still possible for her to benefit from sex therapy. Not all psychologists are trained to offer psychological treatment of sexual dysfunctions. When contacting a psychologist for a first appointment, it is important to ask about their professional expertise and experience.

Where do I go for more information?

Here are some examples of websites and books that provide more information about sexuality and female sexual dysfunctions:

 

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, go to https://cpa.ca/public/whatisapsychologist/ptassociations/ .

You can also find Canadian providers of sex therapy on the following website: https://sstarnet.org/find-a-therapist/?s2-s=canada

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Elke Reissing, a Faculty Member in the Clinical Psychology Program at the University of Ottawa, Ottawa, Ontario.

Revised: October 2019

 

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

“Psychology Works” Fact Sheet: Pediatric Palliative Care

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What is Pediatric Palliative Care?

Pediatric palliative care is an active and comprehensive care approach embracing physical, emotional, social, and spiritual well-being.  It focuses on enhancing the quality of life for a child or adolescent and their entire family throughout the course of a life-limiting or life-threatening illness.  Life-limiting or life-threatening illnesses can be broadly divided into four categories: diagnoses which are life-threatening in nature and curative treatments may or may not be effective (e.g., cancer), diseases with a high likelihood of premature death (e.g., cystic fibrosis), chronic progressive illnesses without a cure (e.g., Batten disease), and diseases that are irreversible but non-progressive which have complications likely to lead to premature death (e.g., severe cerebral palsy). Different from end-of-life care and hospice services, pediatric palliative care is a more broad-ranging service which can be accessed from the time a child receives a relevant diagnosis.  It can therefore be utilized throughout a child or adolescent’s life journey including alongside curative or life-prolonging approaches as well as with end-of-life care or hospice should a condition progress and death become imminent.

Palliative care is often provided through an interdisciplinary team which may include a number of professionals such as physicians, nurse practitioners, social workers, pharmacists, and psychologists. This approach can help to mitigate gaps in care while addressing a number of symptoms common for children and adolescents with life-limiting and life-threatening illnesses. Supports may be related (and are not limited) to: effective communication, psychological well-being, spiritual care, decision making, comprehensive pain and symptom control, and grief and bereavement support.

What is Psychology’s Role in Pediatric Palliative Care?

The journey with a life-limiting or life-threatening illness is long, complex, and challenging for the child or adolescent as well as their families. The stress or trauma of the situation can have many impacts on one’s well-being such as increased tension, strained relationships, and increased emotional vulnerability. Psychologists can help address a number of child or adolescent and family needs and goals, ultimately aiming to improve the quality of life of children and adolescents with a life-limiting or life-threatening condition and their families. For example, they may help children and adolescents and their families with:

  • Promoting coping skills and adjustment to a diagnosis and related emotions
  • Treatment of co-occurring mood and anxiety disorders
  • Supporting children and adolescents and families in a more structured way to problem solve and make difficult decisions
  • Talking to children and adolescents and families about death and related beliefs and wishes
  • Managing pain (e.g., through imagery or relaxation techniques)
  • Parenting guidance and education related to parenting a child or adolescent with a life-limiting or life-threatening condition or parenting siblings
  • Preparing for the child or adolescent’s death (e.g., anticipatory grief, completing meaningful activities related to their loved one)
  • Coping with loss, grief, bereavement for parents and siblings

 

In these situations, psychologists use a variety of therapies such as:

  • Cognitive and behavioural therapy which may help to challenge or alter maladaptive patterns of thinking and behaving, promote healthy and adaptive ways of thinking and behaving, and foster effective coping strategies
  • Relaxation therapies which may help to reduce arousal and improve sleep
  • Interpersonal therapy which may help individuals examine and better cope with relational difficulties
  • Existential therapy which may assist the individual to explore their sense of being-in-the-world, increase their self-awareness, and find meaning in their life

 

The therapeutic approach used will vary depending on the individual person, family and their needs or goals.

Developmental Considerations in Pediatric Palliative Care

Children and adolescents are in a process of physical, emotional, cognitive, and spiritual development. Depending on their developmental stage, they have different skills and different emotional, physical, and developmental needs. A child or adolescent’s cognitive development and age can also impact their understanding of concepts such as their illness, prognosis, emotional experiences, and death. It is therefore important to recognize the unique issues and needs arising within the context of palliative care of children and adolescents.

  • Children and adolescents communicate differently and depending on their stage of development, have a different understanding of illness, death and dying. A child or adolescent’s concept of illness and dying continues to evolve over time and is influenced by many factors (e.g., religious, cultural beliefs, patterns of coping, disease experience, previous experience with loss or death, emotions associated with grief).
  • Children and adolescents are members of many communities, including families, neighbourhoods, and schools. Their continuing role in these communities should be incorporated into their life journey despite their condition. For example, school is an integral part of their lives and it is essential they have ongoing opportunities to participate in normative academic and social interactions with their peers.
  • Children and adolescents are often less able to advocate for themselves and often rely on family members to make decisions on their behalf.

 

Where do I go for more information?

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, go to https://cpa.ca/public/whatisapsychologist/PTassociations/.

 

This fact sheet has been prepared for the Canadian Psychological Association by Lara M. Genik, MA; Danielle Cataudella, Psy. D., C. Psych; and Cathy Maan, Ph.D., C. Psych.

Revised: October 2019

 

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

“Psychology Works” Fact Sheet: Pediatric Oncology

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Cancer in Childhood and Adolescence

Compared to cancer in adults, cancer in children and adolescents (hereby referred to as ‘childhood cancer’) usually grow in different types of body tissues, result from unknown causes, and tend to grow rapidly and aggressively, and are more responsive to therapy (Pizzo & Poplak, 2010). The three most common types of childhood cancers are leukemia (cancer of the blood), CNS-related cancers (e.g., brain tumours), and lymphomas (cancers in the lymphatic system). Although childhood cancer is a relatively rare, the number of children diagnosed yearly appears to be rising by about 1% each year (Health Canada, 2017). Efforts to treat cancer continue to be an important focus of research, with the five year survival rate for all childhood cancers combined now reaching 81.5% (Health Canada, 2017).

With increasing rates of survival, there has been a parallel increase in our appreciation for the impact that childhood cancers and their treatments can have long after treatments ends. The risk of these ‘late effects’ depends on the type and amount of treatment received; however, research suggests that more than 60% of childhood cancer survivors will experience at least one chronic condition while about 30% will experience severe or life-threatening conditions (Health Canada, 2017). Late effects can include: growth impairment, infertility, damage to major organs (e.g., heart, kidney, lungs, central nervous system), neurocognitive impairments (e.g., learning disabilities, difficulty with memory, processing speed, attention) and secondary cancers (Health Canada, 2017). Not surprisingly, these effects can further impact other areas of individual and family functioning such as social relationships, academic success, employment, and daily living.

Cancer Treatments and Supports

Childhood cancers can be treated with a combination of treatments, chosen based on the type and stage of cancer. More traditional medical treatment for childhood cancers can include chemotherapy, radiation, surgery and bone marrow and stem cell transplants; however, new and innovative approaches to treating childhood cancer continue to be explored.

Most children with cancer in Canada and the United States are treated at a university affiliated children’s center that is a member of the Children’s Oncology Group (COG). Being treated in these centers offers the advantage of a team of specialists who know the differences between adult and childhood cancers, as well as the unique needs of children with cancer and their families. This team usually includes pediatric oncologists, surgeons, radiation oncologists, pathologists, pediatric oncology nurses, and nurse practitioners. These centers also have psychologists, social workers, child life specialists, nutritionists, rehabilitation and physical therapists, and educators who can support and educate the entire family. Palliative care supports may also address physical, psychological, emotional and social areas of need. It is important to also acknowledge that beyond the aforementioned treatments, a number of additional treatments and supports may also be provided or sought out by families. For example, complementary and alternative medicine approaches such as herbal remedies, diet and nutrition interventions, faith-healing, homeopathy, mind-body therapies, and massage therapy may be used.

For childhood cancer survivors, continued supports and treatments for identified late effects may continue to be a critical component of their lives. Formal childhood cancer survivorship clinics (e.g., ‘after care clinics’) have been established to (a) promote health and health education, and (b) monitor survivors at regular intervals for potential late effects so they can be both identified and treated as early as possible.

How can psychology help?

Cancer diagnoses create many changes and challenges for children, adolescents, and their families. For example, they may have difficulty adjusting to the illness and experience a number of stressors related to the illness (e.g., frequent medical appointments and hospitalizations, side effects, maintaining complex care regimens, inconsistent school attendance, the need to make difficult decisions, approaching the end of life). Many factors (e.g., age, developmental level, personality, normal coping style, support system, previous life experiences) can affect how one copes with the current crisis and early adaptive adjustment is associated with adjustment over time. Successful coping provides relief from both short and long-term stress and leads to adjustment and adaptation. When other life stressors such as death, loss of a job, moving, marital problems, divorce, emotional problems, or substance abuse exist in a family prior to the child’s cancer diagnosis, coping difficulties that negatively impact daily functioning may arise.

Pediatric clinical psychology is specialized area of practice that focuses on addressing the psychological aspects of illness, injury, and the promotion of health behaviors in children, adolescents, and families in a pediatric health setting (i.e., called health and rehabilitation psychology).  Pediatric psychologists have a strong and growing presence in childhood cancer programs, and play an important role throughout the entire process of a child or adolescent’s experience with cancer, including:

  • at the initial time of diagnosis;
  • throughout treatment;
  • at the end of treatment;
  • after treatment ends;
  • at times of relapse;
  • at the end of life.

Specifically, pediatric psychologists use evidence-based approaches to:

  • Assess and treat behavioural, cognitive, and emotional problems associated with pediatric cancer diagnosis (e.g., adjustment), cancer-related treatment (e.g., procedural distress, pain, worry, feelings of sadness), during after care for cancer survivors, and at end-of-life (e.g., bereavement counselling) for children, adolescents, and their families.
  • Conduct specialized neuropsychological assessments to evaluate and monitor how cancer and related treatments affect one’s cognitive functioning and related academic, social, and vocational functioning. Results from these assessments can provide an understanding of the child or adolescent’s learning needs and related recommendations.
  • Consult with school staff or others in the community and assist with school participation and reintegration. For example, children and adolescents may need help transitioning back to school, educating other students and staff about cancer.
  • Collaborate with other health care providers and team members to provide appropriate and coordinated care to children, adolescents, and their families. For example, psychologists might help to develop strategies to improve medication adherence if other members of the medical team are having difficulty with this.
  • Assist in structured ways with problem solving and making difficult decisions. For example, psychologists may help parents to make difficult decisions related to their child’s cancer treatments approaches.
  • Conduct research related to the individual and family impact of childhood cancer and develop evidence-based interventions to ameliorate difficulties.

Where do I go for more information?

More information on pediatric oncology, interventions, follow-up, coping, and more can be found through the Children’s Oncology Group (COG):  https://www.childrensoncologygroup.org/. Provincial websites and resources such as Ontario’s ‘POGO’ (Pediatric Oncology Group of Ontario) may also be helpful resources.

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, go to https://cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Lara M. Genik, MA; Danielle Cataudella, Psy. D., C. Psych; and Cathy Maan, Ph.D., C. Psych.

Revised: October 2019

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

“Psychology Works” Fact Sheet: Alcoholism

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What is alcohol use disorder?

Most of us drink alcohol. A large survey showed that about 78% of Canadians drank alcohol in the previous year, 21% exceeded low-risk consumption guidelines and about 6% drank heavily at least once a month (five or more drinks per occasion for men and 4 or more drinks per occasion for women).

Many people who misuse alcohol have occasional problems in their lives because of alcohol such as social/family, health, legal, or financial difficulties. Some people experience so many problems because of their drinking that they can be considered to have an Alcohol Use Disorder.

Alcohol use disorder occurs when there are ongoing negative consequences from drinking. For people with alcohol use disorder their drinking commonly results in significant distress and problems functioning in their daily life. Alcohol use disorder ranges from mild to severe, but anyone who is experiencing problems from their alcohol use should seek help to avoid the problem escalating.

In a recent survey of Canadians, approximately 18 % of the population met the criteria for some level of alcohol use disorder with the prevalence being higher for men than for women.

What are the symptoms of alcohol use disorder?

The number of symptoms a person meets is used to determine the severity of the disorder. Those who experience 6 or more of the symptoms below are considered to have a severe alcohol use disorder. However, a person who is experiencing any of these symptoms may benefit from professional help.

Alcohol is often taken in larger amounts or over a longer period of time than was intended.

  • There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
  • Craving, or a strong desire or urge to use alcohol.
  • Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
  • A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  • Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  • Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  • Recurrent alcohol use in situations in which it is physically hazardous.
  • Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
  • Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or b) A markedly diminished effect with continued use of the same amount of alcohol.
  • Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Is alcoholism a disease?

Some experts believe alcohol use disorder is a medical disease that cannot be cured, just like diabetes. This is known as the medical model. They believe that people with alcohol use disorder have no control over their alcohol use and that their disease can only be managed by avoiding alcohol altogether.

Other experts argue that alcohol use disorder is a psychological disorder rather than a disease. They do not believe that alcoholism is an incurable disease. Experts from this perspective believe that people attempting to recover from alcohol disorders can choose to stop drinking altogether or can learn to drink moderately instead.

Who is at risk for developing alcohol use disorder?

If a person has a biological parent with alcohol use disorder, that person is at increased risk. Children may also learn patterns of heavy drinking from their parents.

Those in cultures or social groups where heavy drinking is accepted (e.g., those working in bars) are at increased risk. Also people’s attitudes and beliefs are important (e.g., believing alcohol has lots of positive effects). However, it is still very difficult to predict precisely who will develop alcohol use disorder.

What psychological approaches are used to treat alcohol use disorder?

The best known treatment for alcohol use disorder is Alcoholics Anonymous (AA). The AA approach is consistent with the medical model and includes a strong spiritual component. Abstinence (no drinking at all) is the treatment goal. Research has shown AA is effective for those who stick with it. One of its strengths is peer support and encouragement. However, AA has high dropout rates.

Two common psychological treatments have similar effectiveness to AA.

Cognitive Behavioural Therapy (CBT) helps a client change his/her drinking as well as their risky attitudes and beliefs. The goal of CBT can be either no drinking or moderate/controlled drinking (i.e., harm-reduction). CBT helps the client identify his/her own unique high-risk situations for heavy drinking. Then, they develop plans and skills that are alternatives to heavy drinking in these situations.

CBT also increases the client’s confidence about his/her ability to resist heavy drinking. Because alcohol abuse/dependence has high rates of return to heavy drinking, CBT often includes relapse-prevention.

Motivational Interviewing (MI) is another effective psychological treatment. MI is based on the fact that people with alcohol problems are at different stages of readiness to change their drinking.

Some are completely ready and simply need help to change. Others are thinking of changing but are not quite ready. Still others are not even considering changing or deny they have a problem.

MI helps clients move to a stage where they are more ready to change their alcohol use. For example, the therapist might encourage the client to really examine the pros and cons of continuing versus changing their current drinking patterns.

Severely dependent clients may be treated in a detoxification program in the initial stages to provide medical supervision of withdrawal from alcohol. Detoxification can precede treatments such as CBT, MI and AA.

There are also medications that may help people quit drinking. However, they only work while people take them, and they can cause side effects. Thus, MI and CBT are seen by some as safer, or as producing longer-lasting benefits than medications. Sometimes psychological interventions are used with medications to maximize benefits. For people who have problems with their alcohol use they should consult with their doctor to find out what the best treatment approach is for them.

Where do I go for more information?

More information regarding alcohol abuse and dependence can be found at the website of the Centre for Addiction and Mental Health at http://www.camh.net and the website of the Canadian Centre on Substance Abuse at http://www.ccsa.ca.

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology go to http://cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Drs. S.H. Stewart and Cheryl D. Birch, Dalhousie University.

Revised: September 2019

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

“Psychology Works” Fact Sheet: Grief in Adults

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Bereavement is the state of loss when a loved loved one such as a parent, child, spouse, or close friend has died. Grief refers to the psychological reaction to the bereavement. Grief can occur due to various losses:

  • Spousal death: Under the age of 55 about 1% of adults are widows, but by age 85 the majority of people are widowed. Spousal death after decades of marriage can be an enormous shock and adjustment.
  • Anticipatory grief: When a spouse is experiencing a debilitating illness like Alzheimer’s or is admitted to a personal care home, grief may occur prior to the physical death. This is sometimes referred to as “anticipatory grief” but is in many ways is a full grief. At the same time that one is experiencing “caregiver stress” for taking care of a debilitated spouse, one is also grieving the loss of the marital companionship and affection.
  • Death of a child: Death of a young child can be an emotionally painful parental experience. We all find the death of a child disturbing. Health care workers such as physicians and nurses working in pediatrics can experience significant grief distress when witnessing the deaths of their young patients. About one in ten of older people over the age of 65 will experience the death of one of their adult-aged children, a loss that can significantly deplete the family support network as they age.
  • Cumulative bereavement: This refers to the reality that older adults will experience a number of losses of family and friends, often very close together. As we age, our social network can grow smaller and smaller as friends die, and we need to be able to re-build it, sometimes over and over again. Maintaining and rebuilding social networks is one of the essential tasks required for successful aging.
  • Pets: Research shows that the death of a family pet can result in significant grief.

Many life changes can possibly also trigger an adjustment reaction similar to a grief response, including loss of health (amputations), retirement and loss of career identity, divorce.

While many aspects of this discussion of grief can apply to younger adults and children, much of our understanding of grief comes from the psychological study of middle aged and elderly bereavement, especially death of a spouse.

What is grief?

Grief is normal. Grief, especially for the death of a child, has been observed in many intelligent social animals such as dolphins and elephants. Creating social bonds and attachments is necessary for the survival and well-being of many species. When that bond is severed, grief is a normal reaction.

When death occurs for a person who has been a constant companion and with whom we have had a close emotional attachment, many changes in our life must be assimilated. Over many years of a close relationship, our self-concept can become defined by the relationship and this identity now must be reshaped. C S Lewis, the author of the well-known Narnia books, wrote of his own experience: “grief comes from the frustration of so many impulses that had become habitual.” Lewis observed in himself that many daily thoughts, feelings, and actions focused on the loved one as their object, “but now there’s an impassable frontierpost across it.”

Patterns of grief reactions

What is the normal intensity and length of grief? Are there stages or phases to this experience? There are many different reactions to grief and no one single pattern that fits most people.

About 30% or more, one in three people, experience a relatively mild distress in response to the death of a spouse, are able to quickly accept the loss of a loved one and resume normal activities. These people do not typically experience a delayed grief, and have good health outcomes. On the other hand about 30% experience waves of high distress. And another 30% or so falls in between these extremes and experience a moderate distress. Another 10% of people appear to experience a slightly delayed grief about 6 months after the bereavement. These estimates are approximate as different studies have found slightly different results.

The idea that grief occurs in stages is a common one, and was implied by Charles Darwin in 1872: “after the mind has suffered from an acute paroxysm of grief, and the cause still continues, we fall into a state of low spirits; or we may be utterly cast down and dejected.”  Some people experience an initial stage of shock or numbness, followed by a period about 3 months after the death of an increased depressed mood and yearning for the loved one. Generally, as acceptance of the death increases towards the end of the first year, the yearning, sadness, and anger gradually diminishes.

The experience of grief

The normal grief response can be very intense. For the 30% who experience an intense grief, symptoms may include waves of sadness, sleeplessness, fatigue, poor concentration, and loss of appetite. There will be a strong yearning for the lost loved one. Death of a close life partner may lead to sensing the presence of the dead spouse, such as briefly hearing their voice; this is very common and can last for over a year. Many people find hearing the voice of a spouse or dreaming of the spouse reassuring if they are aware that it is normal.

An intense grief experience may closely resemble the symptoms of a depression. Indeed, grief can be more intense than a depression. DSM-5, the diagnostic manual of the American Psychiatric Association, indicates that a careful clinical judgement by a professional is sometimes required to differentiate a normal intense grief from a depression.  DSM-5 suggests that grief can be differentiated from depression in that grief comes in waves of emotion, whereas in a clinical depression the mood is more constantly negative. In grief, the individual usually maintains a positive self-esteem and the focus of the grief experience is specific to the loss of a loved one, whereas depression includes a much broader negative view of the self.

How long does grief last?

How long is grief expected to last? There is no straightforward answer to this question. The answer varies by person, circumstance and culture. We are not meant to forget the deceased loved one, and memories of that person may be painful for years to come. Increasingly, grief experts suggest that a sense of a “continuing bond” and relationship with the deceased is quite normal and healthy. The resolution of grief does not mean forgetting the deceased person, or lessening our affection for them. But one is expected to resume normal activities.

Many events during the first year can be difficult such as the first family dinner, first birthday, first wedding anniversary, first major religious holiday, or first anniversary of the death. After the first anniversary of the death, the intensity of grief reactions has typically subsided with the individual having returned to everyday activities and normal daily mood. However, even after many years, brief waves of grief may still occur, especially at anniversaries.

When is prolonged grief considered a problem?

At the time of the bereavement, most grief reactions of varying intensities, even intense reactions, are generally considered normal. Grief is typically only considered a mental health issue if it becomes excessively prolonged. About 7% of people experience a prolonged high level of grief.

In a prolonged or “complicated” grief, the individual stops making progress in recovering from the bereavement stress and remains overly focused on past memories for many months and years. In a prolonged complicated grief, the individual continues to yearn for the deceased and remains withdrawn from resuming normal social activities. Everyday thoughts and memories of the deceased continue to be accompanied by severe emotional spells. There may be pervasive feelings of numbness towards others, loneliness, emptiness, meaninglessness, regret, and difficulty acknowledging the death. There may be a continuing avoidance of places that are reminders of the deceased person including family gatherings, social groups, the church where both attended, medical facilities, and other funerals. Some degree of these symptoms may occur from time to time in most grieving people; it is only when these prolonged symptoms are excessive and interfere with normal everyday functioning that the grief is seen as problematic.

A prolonged grief may depend on many factors. Grief may be complicated by the circumstances of the death, such as being unexpected, accidental, by suicide, or after a difficult and painful illness. Death of one’s child at any age is difficult to accept. Life factors may contribute to the development of a complicated grief, such as a lack of support from family and friends. The personality style of the grieving person can also lead to complicated grief. For example, if the individual has been overly dependent on the now-deceased spouse or parent, the grief process may be more difficult or prolonged.

How long is too long? There is much debate and controversy as to the length of grief that should be required as the minimum to consider a prolonged grief as warranting a mental health diagnosis. The World Health Organization (ICD-11) uses a diagnostic category of Prolonged Grief Disorder which can be considered at a minimum of 6 months following the bereavement. Prolonged Grief Disorder is conceptualized within ICD-11 as a stress disorder, similar to an Adjustment Disorder. The American Psychiatric Association’s DSM-5 proposes a similar diagnostic category of Persistent Complex Bereavement Disorder, which is considered only after 12 months post bereavement. These different recommended minimums for a prolonged grief disorder need to be viewed as arbitrary. Expecting an adjustment to a severe grief reaction of at least 12 months post bereavement more closely matches the normal course of grief. There are many varying circumstances, and a great variety of grief reactions.

When and how is pronged complicated grief treated?

Grief is a normal response.  Grief is not an illness and usually does not require medication or psychological treatment unless safety issues emerge. Treatment of grief should be approached with caution. It is not necessarily desirable to eliminate grief, which is part of a normal emotional adjustment to the death of a lifelong partner or loved one.

Preventative approaches immediately following the death have not received evidence of a lasting effectiveness. Early grief interventions such as bereavement groups can provide useful social support and reassurance if conducted carefully, but appear to have only a temporary positive effect and little evidence of long-lasting benefit. Bereavement groups may potentially be harmful if they convey to the individual that their grief is unhealthy, or undermine the person’s normal coping by forcing onto them an intense emotional grief focusing.

Psychological interventions are best reserved for a prolonged complicated grief. When psychological intervention is provided to a prolonged grief, at least 6 months following the bereavement, there is evidence of moderate but lasting benefit. For prolonged grief there is also some evidence of greater benefit using an individual format rather than group interventions.

Cognitive-behavioural therapy (CBT), cognitive processing therapy, interpersonal psychotherapy, brief psychodynamic or other effective psychotherapies can be used to help the person engage in activities and think about and understand the impact of the loss. Some individuals may need to work through some of the complicating aspects of their relationship to the deceased. Regret resolution can be important. For example, it may be useful to revisit past relationship hurts and forgive past faults, regrets, anger, and guilt.

Cognitive behavioral interventions are used to help people gradually return to their daily routines.  An important component of a psychological treatment for traumatic aspects of grief is to help the individual to return to situations they are avoiding because of the fear of the distressing memories. Continued avoidance of these situations increases the sensitization to grief emotions, whereas only by entering these situations does the excessive distress gradually dissipate. Cognitive behavioural strategies to overcome avoidance have been shown to be more effective than supportive counseling.

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, go to https://cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Lorne Sexton, Psychology Program Site Manager at St. Boniface General Hospital, Winnipeg Regional Health Authority, and Associate Professor, Department of Clinical Health Psychology, University of Manitoba.

Revised: September 2019

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“Psychology Works” Fact Sheet: Irritable Bowel Syndrome

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What is irritable bowel syndrome?

Symptoms of Irritable Bowel Syndrome (IBS) include pain or discomfort in the lower abdomen (below the belly button area) and changes in bowel habit that involve frequent, urgent diarrhea or constipation. Bloating is another common symptom. IBS is a medical disorder of the lower ‘gut’ (the small and large intestine) which is one part of the gastrointestinal (GI) tract.

It is understood to be a problem of the functioning of the gut. It is thought to occur because of communication problems between the brain and the gut. Research suggests that people with IBS experience abnormal gut motility (changes in the rate of contractions of the gut muscles) and enhanced visceral sensitivity (an increased sensitivity to gas or sensations from routine activities that occur in the bowel).

It is not clearly understood what causes IBS. For some people it begins in childhood with a ‘sensitive stomach’ that develops into more intense symptoms as an adult; for others, the GI problems start suddenly during a period of stress or persist after an infection in the bowel. IBS is diagnosed based on the presence of the symptoms described above in combination with the absence of other ‘red flag’ symptoms (such as weight loss or bleeding).

IBS is very common. It is estimated to affect up to one in five Canadians. It often starts in young adulthood and occurs much more frequently in women than men. It is the second most common reason for missing work and is one of the most common reasons that people visit their doctor. In Canada, IBS has been estimated to cost over $350 million in direct and over $1 billion in indirect health care and productivity costs each year.

While the impact on society is quite significant, IBS can be very challenging for the individual. Pain, cramping or urgent trips to the washroom may interfere with work and home activities. The bloating, gas and urgency can be embarrassing, so people often suffer in silence.

Many people think certain foods must be the culprit but there is no evidence to support the idea that IBS is related to food allergies or food sensitivity. Once IBS develops, however, the bowel is over-reactive to or easily triggered by a variety of things including diet, stress, emotional state, and even hormone fluctuations.

Stress does not cause IBS, but it does appear to play a particularly important role in triggering IBS symptoms, likely because of the close communication via nerves and chemical pathways between the brain and the gut. In fact, two-thirds of healthy individuals without IBS report GI symptoms of pain or bowel upset in response to stress and the numbers are even higher for people with IBS.

Research suggests that both ‘acute stressors’ such as deadlines, exams, job interviews, or conflict with others as well as ‘chronic stressors’ such as financial concerns, time pressures, or family issues can aggravate the gut.

Can psychology help?

Absolutely. For those with milder IBS symptoms, use of over-the-counter medications and changes in lifestyle that ensure more regular eating and sleep routines, a healthier diet with increased fibre and water intake, as well as more regular aerobic exercise are usually sufficient to provide some relief.

However, for those with moderate to severe symptoms, medical and psychological treatments are recommended. These treatments usually target specific symptoms (like pain, diarrhea, or constipation) or aim to decrease the triggers (such as stress) that aggravate the symptoms.

Conventional medical treatment has included fibre supplements, antispasmodics, gut motility agents, and medications that act on biochemicals such as serotonin in the GI tract and central nervous system. At this point, reviews of the effectiveness of the medication treatments have concluded that they are helpful for small subsets of people with IBS, but have been disappointing overall in their impact. For the most up-to-date information on medication treatments as they apply to your situation, you are encouraged to discuss the use of these medications with your family doctor.

Several specific psychological treatments have been found to be effective in providing relief of IBS symptoms as well as reducing the distress and coping difficulties that often occur when dealing with a chronic illness. These psychological therapies focus on ways to decrease stress and cope differently so that the stress does not ‘go to the gut’.

What psychological treatments are effective??

Four approaches have been carefully evaluated over the past number of years and have been found to be of benefit. These treatments are provided by professionals trained in psychological interventions for health problems.

Relaxation training teaches ways to relax the body and mind.

Cognitive Behavioural Therapy (CBT) incorporates a number of steps aimed at changing behaviour to improve health and coping. It often involves providing information to ensure a better understanding of the illness (to help with fears and worries), teaching strategies to change thinking patterns that can contribute to strong emotional and physical reactions, teaching skills to deal with challenging or stressful situations that can trigger the gut, and goal setting to establish optimal health habits. CBT typically includes relaxation training.

Hypnotherapy uses mental imagery and hypnosis instruction to specifically reduce gut sensations and develop a state of calmness and relaxation.

Brief Dynamic Therapy focuses on significant personal relationships. The emphasis is on identifying and dealing with challenging interpersonal situations and interpersonal stressors that can trigger the gut.

Cognitive behavioural therapy is the most commonly available type of psychological treatment for IBS in Canada and the United States. Evaluation studies have shown that psychological treatments can lead to greater improvement than the usual medical treatment. As well, the psychological therapies have long lasting effects months to years after treatment was completed.

Medication treatments, in contrast, tend to cease to have an effect when patients stop taking the medicine. Some research suggests that the amount of improvement relates in part to the effort and time the individual contributes to working with the strategies.

Where do I go for more information?

For more information about irritable bowel syndrome and steps you can take based on these psychological therapies:

  • Breaking the bonds of irritable bowel syndrome: A psychological approach to regaining control of your life. (2000) Barbara Bolen. New Harbinger Publications Inc.
  • IBS Relief: A complete approach to managing irritable bowel syndrome. 2nd edition (2006) Dawn Burstall, T. Michael Vallis, Geoffrey Turnbull. John Wiley & Sons Inc.
  • Controlling IBS the drug-free way. A 10-step plan for symptom relief. (2007) Jeffrey Lackner. Stewart Tabori & Chang.

For general information about IBS and similar gastrointestinal disorders please visit the International Foundation for Functional Gastrointestinal Disorders at http://www.iffgd.org.

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, click https://cpa.ca/public/whatisapsychologist/PTassociations/.

 

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Lesley Graff, Associate Professor with the Department of Clinical Health Psychology, Faculty of Medicine, University of Manitoba and staff psychologist at Health Sciences Centre, Winnipeg, Manitoba. Dr. Graff’s clinical work and research is primarily in the area of chronic pain, stress, and gastrointestinal disorders.

Revised: September, 2019

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

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“Psychology Works” Fact Sheet: End Of Life

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Psychological Distress and Coping with Serious Incurable Illness

When people become seriously ill, they are often immersed in an intense process of medical testing and treatments. They may be overwhelmed with navigating a complex health pathway and unfamiliar medical language.

Understandably, this unfamiliar illness pathway affects different parts of people’s physical, emotional, social, and spiritual lives. It can have a profound psychological impact. For example, medical testing may be a time of real worry, as one prepares for the possibility that the illness is very serious. After diagnosis, there may be a period of shock, as well as anxiety, fear, and for some, anger.

Medical treatments may bring about troubling side effects, perhaps with no certainty of a cure. People may experience several changes over time that increases psychological stress. These include declining physical function, changes in family and social roles, increasing dependence on the health-care system, and the potential threat of death.

People use different coping strategies during these stressful times. Coping styles may range from trying to avoid reminders of the illness to thinking about it all the time.

People who adopt more active coping strategies, such as seeking support from others, constructive problem-solving, and finding positive meaning, tend to show the best adjustment.

Most people who are told that they have an incurable illness experience some periods of anxiety, sadness, and grief. As their health declines, they may experience many emotions, in anticipation of their own death. These can all be considered part of a normal coping process, albeit a very difficult one.

For many seriously ill people, however, these emotions can become quite overwhelming. For example, it has been estimated that about 1 out of 4 people with incurable cancer will develop depression or anxiety disorders.

These problems are important to recognize and treat, as they are very distressing. They also make it more difficult to manage physical symptoms and to face the wide range of concerns involved in preparing for the end of life.

Occasional, passing wishes for death are relatively common among individuals who are living with incurable illnesses. For some, requests for end-of-life measures are consistent, and are associated with physical and emotional suffering.

For some, considering a hastened death in a hypothetical way, might be comforting if the symptoms of their illness become unbearable. For others, dying brings about a great level of despair, and psychological support can help manage this despair. Some, who are ready for death, have prepared themselves for it as best they are able, and are ready to discuss end of life options with their medical team. Medical options for end of life could include ceasing treatment, do not resuscitate orders, or Medical Assistance in Dying, which became legal in Canada in 2016.

Quality Health Care at the End of Life

What do people want from the health-care system at this stage? First and foremost, patients say that they want adequate treatment for their pain and other symptoms.

They want to take part in treatment decisions to maintain a sense of control and to be treated as a ‘whole person’ by professionals. Most people want truthful information, given in a way that is respectful of their hopes and fears.

They also want to be prepared for their own death, having achieved a sense of completion in their lives.

They want their families to have a decreased burden of care. Wherever possible, they would like to resolve any conflicts and be able to say goodbye, hoping that their families and other significant relationships will be okay.

How can Psychologists Help?

The care of people with serious incurable illness is complex. It often requires contributions from several different kinds of health professionals working together in a team, each bringing special skills. Psychologists can be involved in the following ways:

Stress Management

Different types of relaxation therapies may help people calm down, sleep better, and separate themselves from the stress of physical symptoms.

Problem-Solving

People with incurable illness have issues with declining health. They also have practical concerns, such as managing finances, keeping their households running, and supporting others who also must cope. Some psychological interventions involve help in setting priorities, breaking problems down into manageable parts, and finding solutions.

Counselling Support

Counselling can provide people with a non-judgmental, confidential relationship. They can speak openly about any personal issues that may be troubling them. These may include fear, anger, and guilt, as well as distress around changes in appearance or function, or concerns about family members.

Family Therapy

Families handle stress in different ways. For some, there may be a history of conflict. Others may have a general style of avoiding the expression of deep emotion. Within a family, members may not all come to a place of acceptance of a person’s illness at the same time. Family therapy could help all members face their challenges together by opening genuine communication.

Psychotherapy

Different types of psychotherapy can be helpful for people with incurable illness.

Supportive-expressive psychotherapy encourages people to express and explore their deep-seated worries and concerns. It helps them identify personal ways of dealing with illness and acknowledges efforts to live meaningfully in the time remaining. This is often done in a support-group format with other people with incurable illness.

Cognitive-behavioural psychotherapy helps people to be realistic in their judgement of situations. It challenges them to think differently when their negative thoughts start to become a major cause of distress. It also encourages people to stay engaged in pleasurable activities as long as they are able. Achieving small goals can contribute to an ongoing sense of fulfillment.

Supportive therapy. In addition to supportive-expressive and cognitive-behavioural psychotherapy, there are other supportive approaches that can be helpful.

Meaning-centered therapy: The view of a ‘good death’ is very personal and can vary from one person to the next. For some people, a ‘good death’ means that symptoms are well controlled and that important psychological, social, and spiritual concerns have been addressed at the end of life.

People want to feel that their lives have made a difference. They want to know that they have touched others in meaningful ways, and that they will leave a legacy that lasts beyond their physical presence.

Hope-focused therapy enables people to identify and enhance hope in their lives, without denying the reality of the severity of their illness. Different strategies can be used to help with recalling special memories, leaving a legacy, finding positive viewpoints, dealing with uncertainty, maintaining hopeful relationships, and motivating people to find meaning in life.

Creative Arts

The creative arts can be used to help people share their emotions, find meaning in their suffering, and create a legacy, when words are not enough.

Life Review

Through thoughtful discussion and life review, people can be helped to conduct a “summing up,” find meaning in the experience, and reflect on the important contributions that they have made in their lives.

Dignity therapy: One type of life review is Dignity Therapy. This interview approach may be used to help people identify and come to terms with their life accomplishments. It can also be used to create a legacy document for sharing words of wisdom and special memories.

End of Life Decision Making

Physicians or nurse practitioners provide treatment options and conduct the assessment for eligibility for Medical Assistance in Dying. Psychologists can work with individuals and/or families to work through the thinking, emotions, and possible social (e.g., burden, isolation) concerns of those who are contemplating end of life treatment options.

Where do I go for more information?

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, go to https://cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet was originally prepared for the Canadian Psychological Association in cooperation with the Canadian Coalition on Seniors Mental Health by Dr. Keith Wilson. At the time of the original publication, Dr. Wilson was a staff psychologist at the Rehabilitation Centre of the Ottawa Hospital and Associate Professor of Medicine and Psychology at the University of Ottawa.

This fact sheet was first updated by Dr. Cheryl Nekolaichuk, who is a registered psychologist with the Palliative Institute, Covenant Health, and Professor, Division of Palliative Care Medicine, University of Alberta, Edmonton, Alberta, and again in 2021, by Dr. Kerri Ritchie, Psychologist, Professional Practice Coordinator, Training – Psychology, The Ottawa Hospital.

Revised: December 2021

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
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“Psychology Works” Fact Sheet: Autism Spectrum Disorder

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What is Autism Spectrum Disorder (ASD)?

Autism spectrum disorder (ASD) is a neurological (brain-based) disorder that affects the development of social and communication abilities, as well as other aspects of behaviour, in characteristic ways. The term “autism spectrum disorder” (ASD) reflects the current view that the impact of ASD on learning and  behaviour can range from relatively mild to severe in any or all of these areas of development. For example, the pattern of social and behavioural differences that defines ASD can co-exist with all levels of intellect, although a substantial minority of people with ASD also have an intellectual disability. People with ASD face challenges in understanding and relating to other people in typical reciprocal ways. For example, although interested in social interactions and relationships someone with ASD may lack a natural grasp of some interpersonal skills, such as the ability to take another person’s point of view. Language difficulties with may make it harder for some people with ASD to express their ideas, or to understand others’ complex spoken ideas. However, even when language skills are strong, other differences in communication may affect social situations. For example, a person with ASD might have difficulty beginning a conversation or keeping one going in a fluent, two-sided manner. People with ASD also tend to have inflexible patterns of thinking and behaviour. For example, their interests and activities may be narrow, unusual, and /or more intense than those of their peers. In some individuals with ASD, unusual sensory responses may include over- and/or under-reaction to lights, sounds, touch, tastes, odours, or pain. Long-term outcomes vary widely for persons with ASD. Some individuals attain academic and vocational success, as well as independent living, especially as our communities become more accepting of social differences. Vulnerability to mental health difficulties such as anxiety and depression remains an issue for many of these otherwise able adults with ASD.

Research shows that ASD is a genetic disorder, but the specific causes are not yet known. The risk of developing ASD is increased for children born to families who already have a diagnosed family member, and more boys /men than girls / women are affected by ASD (although ASD is also less often diagnosed accurately in girls and women).  ASD is a life-long condition that is usually recognized in more severe forms by age 2 or 3 years – often at this age because the child is not yet speaking and shows limited interest in people. However, more subtle signs of ASD may not be recognized until much later, often when the child enters school and their differences from their peers become more obvious.

How is ASD diagnosed?

ASD is diagnosed by an experienced clinician (usually a clinical child psychologist or a specialist physician) based on patterns of behaviour. There is no medical test for ASD. The diagnosis is made by gathering in-depth information from parents and others about specific aspects of the individual’s development and behaviour, and by making systematic direct observations of behaviour — both what the person does that may be atypical, and doesn’t do that would be expected of a typically developing individual at that age or level of development.

With earlier recognition in young children and a better understanding of both milder and more severe forms in people of all ages, the diagnosis of ASD is becoming far more common. A recent Canadian estimate suggests that at least 1 in every 66 children is affected (Public Health Agency of Canada, 2018). The impact of ASD varies, but can be overwhelming for some families, as well as for the health, education and community services that support them. Many communities are trying to keep pace with the increasing need for ASD services.

What do we do about ASD? Can Psychology help?

Outcomes for many people with ASD are far more positive than in past decades. Advances in psychological research have improved our understanding of the fundamental developmental differences as well as the challenges faced by people with ASD. Psychologists have contributed to improved methods of recognizing, assessing, and treating ASD. Psychological assessment of children’s ability profiles – areas of relative strength and weakness – as well as evaluation of both ASD symptoms and co-occurring conditions – can guide the development of appropriate programs for children with ASD. Treatments based on psychological principles are at the leading edge of autism intervention.

Early intensive intervention based on the scientifically derived principles of learning (Applied Behaviour Analysis, or ABA) can help children with ASD when used within an individualized treatment program. Key areas for intervention usually include language / communication and social skills, daily living skills, self-regulation or coping skills, and family support. A variety of other psychological / behavioural interventions may be integrated with ABA-based techniques to meet an individual’s needs. These include incidental teaching and other strategies (such as pivotal response treatment) that capitalize on teaching opportunities in the home and community.  Structured teaching approaches emphasize organizing the person’s environment (schedules, materials and settings) to optimize learning and functioning. Peer-mediated interventions, in which other children are taught effective ways to interact with a child with ASD, can promote more positive social opportunities. For older and more able individuals with ASD, cognitive-behavioural therapy (CBT) strategies can be modified to help manage the anxiety that is common in ASD. CBT involves teaching individuals how to change the way they think, and to use systematic relaxation techniques, in the specific situations that provoke anxiety. Emotion regulation strategies may also be taught using modified CBT methods. Evidence –based treatment for the mental health needs of adults with ASD may be particularly hard to find. Psychologists and other mental health professionals who understand ASD can modify existing programs to customize treatment when ASD-specific services are lacking. Vocational supports such as job coaching and appropriate recreational opportunities may also be beneficial for many people with ASD.

Where can I get more information?

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial, and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, please visit:  http://www.cpa.ca/public/whatisapsychologist/PTassociations

This fact sheet has been prepared for the Canadian Psychological Association by Isabel M. Smith, PhD. Dr. Smith is a registered Clinical Psychologist, Professor and Joan and Jack Craig Chair in Autism Research , Departments of Pediatrics and Psychology & Neuroscience, Dalhousie University. Dr. Smith’s work at the Autism Research Centre at the IWK Health Centre in Halifax NS is focused on children and adolescents with ASD and their families.


July 2019

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

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“Psychology Works” Fact Sheet: Arthritis

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What is arthritis?

Arthritis is a general term that refers to diseases that involve inflammation of the joints. In all, there are more than 100 different forms of arthritis that range from mild forms such as tendonitis or bursitis to systemic chronic diseases such as rheumatoid arthritis, psoriatic arthritis, lupus erythematosus, gout and scleroderma.

There are currently more than 4 million Canadians living with arthritis. Many of these are autoimmune disorders in which a person’s immune system attacks joints and other organs within the body. Osteoarthritis, the most common form of arthritis, is not autoimmune but tends to be age and injury related.  Although once thought to be a result of “wear and tear”, osteoarthritis is now defined in terms of the body’s failure to repair our joints.

It occurs as a result of damage to cartilage and the underlying bone.  Osteoarthritis affects about 1 in 6 Canadians. No drugs are available to change the course of this disease but if it is severe enough joint replacement surgery is often done.  Prior to joint replacement surgery, a number of more conservative strategies are tried, including weight management, exercise and medications.

On the other hand, rheumatoid arthritis and other forms of autoimmune arthritis are now treated with drugs that suppress the immune system. Early treatment with these medications leads to less joint damage and disability in the long run.  Sometimes these diseases may even go into remission as a result of these treatments.

How can psychology help?

Psychological adjustment to their illness can be a significant challenge for many people with arthritis. For example, about 20% of those with rheumatoid arthritis are clinically depressed.

This high rate of depression is perhaps not surprising when one considers the impact that the disease can have on a person’s ability to participate in life and the significant pain that often accompanies joint damage.

In addition, significant flare-ups of symptoms are common and unpredictable. These changes can influence the individual’s ability to work as well as family and social relationships.

We now know that people who: feel able to control their pain and adopt active coping strategies, have a sense of self-efficacy and feel less helpless, have less pain, less depression, and less disability.

Recent evidence also suggests that psychological functioning and mood are even linked to the disease process. For example, mortality rates are higher over time for those who have both rheumatoid arthritis and depression. Stressful events, particularly interpersonal stressors can increase symptoms of arthritis.

Psychologists have played the leading role in developing treatments that improve coping, decrease pain and decrease disability in persons with arthritis. Psychologists who work with arthritis patients are trained to understand these diseases, their psychological impact and the treatments that can help them adjust better.

Cognitive-behavioural therapy and other psychological treatments that help individuals cope with their disease are an important adjunct to medical treatments. Although it is best to prevent psychological problems in the first place, psychologist can also provide treatment for the depression, anxiety, relationship problems and pain that can occur.

Are psychological interventions effective?

Dozens of randomized controlled trials, the gold standard for evaluating health care interventions, have now been reported for psychological treatments in arthritis. These studies suggest that psychological treatments are effective in helping patients cope with their disease and reduce its impact.

Psychological treatments have enjoyed sufficient success that they have become an integral element of Arthritis Self-Management (ASMP) Programs that are sponsored by the Arthritis Society across Canada and have been adopted the world over.

Where do I go for more information?

The following websites provide useful information on arthritis care:

The Arthritis Society at http://www.arthritis.ca

Medline Plus at http://www.nlm.nih.gov/medlineplus/arthritis.html.

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, go to http://www.cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Warren Nielson, London, ON.

Revised: July 2019

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
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“Psychology Works” Fact Sheet: Eating Disorders

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What are eating disorders?

Eating disorders are serious illnesses comprised of physical and cognitive symptoms that can have profound consequences for an individual’s overall health and quality of life. The eating disorders include bulimia nervosa, anorexia nervosa, binge eating disorder, and other specified feeding and eating disorder. Eating disorders affect both men and women but are mostly diagnosed in women. They often develop during adolescence but may emerge at any point across the lifespan. Bulimia nervosa occurs in 1% to 3% and anorexia nervosa in 0.3% to 1% of Canadian women. It has also been reported that 3% of the population has binge eating disorder and impacts men and women at similar rates.  According to the Public Health Agency of Canada, approximately 3% of women will be affected by an eating disorder in their lifetime.

Bulimia nervosa is characterized by a cyclical pattern of bingeing and use of compensatory strategies. Bingeing means eating a large amount of food in a brief period and experiencing a sense of loss of control. Compensatory behaviours are strategies to get rid of unwanted calories and include self-induced vomiting, abuse of laxatives, diuretics, excessive exercise, and/or fasting. Individuals with bulimia also experience shape and weight as core determinants of self-esteem.

Anorexia nervosa is characterized by significant weight loss due to restriction of food intake, an extreme fear of gaining weight or becoming fat, feelings of ‘fatness’, and experience body shape and weight as a core determinant of self-esteem. Some individuals with anorexia nervosa also experience episodes of bingeing and/or use of compensatory behaviours.

Binge eating disorder is characterized by recurrent binge eating. It is differentiated from bulimia nervosa by the absence of compensatory behaviours. Individuals with binge eating disorder commonly report dieting between binge episodes.  This dieting behaviour is markedly different from the fasting/extreme dietary restriction frequently observed in bulimia nervosa.

Other specified feeding and eating disorder (OSFED) is a final category of the eating disorders that includes individuals who do not meet the full criteria of all the aforementioned feeding and eating disorders, yet still exhibit life interfering symptoms.

Feeding disorders

Feeding disorders also impair physical health and cognitive functioning but are disturbances to eating-related behaviours. The Feeding disorders include pica, rumination disorder, and avoidant/restrictive food intake disorder.

Pica is characterized by the persistent eating of non-nutritive food and non-food substances. Onset of pica is most commonly observed in childhood, however it may also develop in adolescence and adulthood. The ingestion of non-nutritive food is not related to weight control efforts, as in anorexia nervosa.

Rumination disorder is characterized by the repeated regurgitation of food that may be re-chewed, re-swallowed, or spit out. Rumination disorder occurs at all ages (3 months through adulthood).  The behaviour is not associated with a concern of body shape or weight control efforts.

Avoidant/restrictive food intake disorder (ARFID) is characterized by an aversive sensory experience of eating or the effects of eating, leading to a lack of interest or avoidance of food. Significant weight loss and/or nutritional deficiency are key features of ARFID.  Unlike anorexia nervosa, in ARFID the avoidance of food is not related to body shape and weight concerns.

What psychological approaches are used to treat the eating disorders?

Eating disorder behaviours typically occur when an underlying struggle (e.g., emotional, interpersonal, or life challenge) exceeds an individual’s capacity to cope. As such, despite severe health consequences, eating disorder behaviours can serve a valued function in the individual’s life; they may enhance self-esteem, be a means of communication, address a need for control, or provide a way to avoid painful emotions. As a result, ambivalence regarding change is common. It is therefore essential that the treatment approach explores the underpinnings of the illness and is matched to the individual’s readiness for change.

Treatment may be individual or group-based and can occur in outpatient or inpatient/residential settings. Effective ED treatments address motivational issues and provide skills that support behaviour change (i.e., weight gain, cessation of bingeing and purging). For instance, these therapies help patients examine the costs and benefits of change, explore the functional role of the ED, teach distress tolerance skills, and assertiveness training. Therapies that have received the greatest empirical support include Cognitive Behavioural Therapy (CBT), Interpersonal therapy (IPT), Dialectical behaviour therapy (DBT), and Family Based therapy (FBT).

In CBT the focus is on relations among thoughts, feelings, and behaviours that contribute to disordered eating. In IPT the focus is on improving relationships and social functioning in an effort to reduce problematic eating behaviours. In DBT patients learn skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Family approaches such as FBT focus on assisting the family to work together in overcoming the eating disorder.

How effective are psychological methods of treating eating disorders?

The treatment that has received the greatest empirical support for bulimia nervosa and BED is CBT. Research investigating the best treatments for anorexia nervosa is ongoing. A comprehensive approach that addresses motivational issues, weight restoration, and underlying psychological issues is recommended. Family therapy has been shown to be a critical treatment component for younger clients.

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, go to https://cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by:

Dr. Josie Geller, Director of Research, Eating Disorders Program; Associate Professor, Department of Psychiatry, UBC.

Megumi Iyar, Doctoral student, Clinical psychology, University of British Columbia- Okanagan

Joanna Zelichowska, MA RCC, Eating Disorders Therapist, Vancouver BC

Lindsay Samson, Research Coordinator, Eating Disorders Program, St. Paul’s Hospital.

Revised: July 2019

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

 

“Psychology Works” Fact Sheet: Pre-employment Personality Assessment in Personnel Selection

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Research in industrial and organizational psychology indicates that personality traits are one class of variables that can predict job performance when the traits are job-relevant. Although other factors such as general mental ability, structured job interviews, and work samples can also predict performance, the current focus is on issues in using personality assessment in the personnel selection process. Challenges in optimizing the use of pre-employment personality testing involve a) identifying job-relevant personality traits; b) choosing a personality assessment; c) combining individual trait scores to obtain an overall applicant score; d) and managing the potential for dishonest responding. The current fact sheet examines each of these issues.

Identifying job-relevant personality traits

The process of deciding on which personality traits to use for personnel selection decisions is called a personality-oriented work analysis (see O’Neill, Goffin, & Rothstein, 2013). One new method that has shown considerable promise involves obtaining job-expert ratings of each trait’s relevance for the job. High-performing employees who have significant experience in the position are one source of potential job experts. Another source involves supervisors, as they are familiar with the job and they may provide greater objectivity. Critical, however, is that job experts have a strong understanding of personality, subtle differences between similar traits, and how traits relate to work behaviour.

The job experts rate each trait’s relevance for work performance (e.g., “how relevant is trait achievement for performing effectively on the job?”). A list of traits are identified for inclusion in the rating form by searching for potentially relevant traits from existing personality assessments or from the International Personality Item Pool (.org) website, which is operated by personality researchers. Definitions of traits can be obtained from test vendors or through inspection of the survey items, and these definitions need to be included on the trait relevance rating form. Job experts must consider the trait definitions carefully rather than relying solely on the trait names. The nature of job performance for the specific job also needs to be defined so that all job experts have a similar understanding of what constitutes effective performance in the position.

Other methods for identifying traits can be useful. For example, published research in primary studies or meta-analyses (quantitative summaries of prior studies) can provide useful indications of which traits are likely to forecast job performance. In general, research suggests that Conscientiousness is helpful in nearly every job. The usefulness of other traits, such as Risk Taking, Desire for Novelty, and Assertiveness likely depend on the specific job requirements (see Tett, Jackson, Rothstein, & Reddon, 1999).

 

Pre-employment personality assessments

Once you identify the job-relevant personality traits, you will need a reliable and valid instrument to measure personality. In this fact sheet we focus on one common method of assessment: the questionnaire. Other methods could involve the interview or behavior in problem-focused situations, but these are not addressed here. Typically, personality is measured by asking the job applicant to complete a well-researched personality assessment. Ask the test provider to point you to reliability and validity evidence detailed in the test manual, research postings on websites, and the published literature. Reliability and validity involve consistency of measurement and how well the assessment measures the targeted traits, respectively. Most personality assessments comprise a list of statements (50-350) measuring a smaller number of distinct traits (e.g., Sociability, Diligence, Cooperativeness). The respondent indicates the extent to which each statement accurately describes his or her typical behaviors, thoughts, or feelings. Comprehensive personality assessments can normally be completed within one hour, although most are shorter. These assessments provide scores on a constellation of personality traits, but only the traits from the personality-oriented work analysis should be considered in personnel selection hiring decisions.  You will need to consider the test-user qualifications required to use the particular assessment, bearing in mind that many vendors provide fee-for-training services to ensure assessments are interpreted appropriately. You should also use assessments developed specifically for pre-employment personality testing, which inquire about job-related behaviors rather than also inquiring about other areas of life. This keeps the focus on the work environment, maintains the applicant’s privacy, and offers stronger prediction (Shaffer & Postlethwaite, 2012).

Obtaining an overall score on the personality assessment

Interpreting applicant scores on many job-relevant personality traits can be challenging. Keeping subjectivity and potential bias in check involves calculating an overall assessment score for each applicant. This can be accomplished in a number of ways. One avenue is to use the average of the job-relevant trait scores. A second avenue is to take a weighted average of all the trait scores, wherein the weights consist of the job-relevance ratings from the personality-oriented work analysis. For example, imagine that the average job-relevance weighting for Risk Taking was 1.5, Achievement was .5, and Aggressiveness was -2.0. An applicant’s overall assessment score would be calculated by inserting his or her trait scores in the following weighted equation:

Overall score = 1.5*Risk Taking + .5*Achievement + -2.0*Aggressiveness

The overall personality assessment scores can then be used to assess applicants’ suitability for the job in combination with other pre-employment assessment activities (e.g., structured job interview). Note that the summed score is not a measure of a particular personality trait or other characteristic, but rather it is a score on which applicants can be rank ordered for hiring decision-making purposes (O’Neill et al., 2013). This is known as the actuarial approach, which is superior to human intuition and judgment based on a review of the candidate’s profile (see Lilienfeld, 2012). A third avenue is to derive the weights through data collection and empirical estimation. With large sample sizes and cross-validation this can be a useful alternative.

Managing the potential for dishonest responding

There is a possibility that job applicants will respond dishonestly in order to achieve a favorable outcome, such as being selected for the job. In the research literature, this is often referred to as “faking.” Faking is an important concern, as it reduces the ability of the test to accurately forecast job performance and it can contribute to hiring suboptimal applicants. This is because some people fake more than do others, so it is more complicated than simply adding a constant to each person’s score (which would not interfere with the assessment’s predictive capacity). Although there is no perfect solution to the faking problem, there are currently two promising strategies to consider (see Rothstein & Goffin, 2006).

  1. Use a forced-choice assessment. Personality statements are presented in multiples, such as groups of four, and applicants are asked to choose one item that is “most like me” and one item that is “least like me”. The statements in each grouping are usually equalized for their desirability; therefore, it is more challenging to choose statements based purely on presenting a favorable image.
  2. Use a faking warning. Warning the job applicant that the personality assessment may detect individuals who provide dishonest responses, and possibly that there will be consequences for dishonesty (e.g., removal from further consideration), shows promise for reducing faking. Other approaches raised more recently in the literature involve warning the applicant that his or her responses will be compared with other application information for verification (e.g., reference checks, interview, biographical application blanks), that it is not in the applicant’s best interest to respond dishonestly, or that it is important to be truthful for ethical reasons. Keep in mind that any warning given to applicants must be genuine.

Where do I go for more information?

CPA Industrial and Organizational Psychology Section (CSIOP)

Within the larger field of psychology, Industrial-Organizational (or I-O) Psychology is a specialty area based on the scientific study of behaviour in organizations. I-O psychologists work to improve organizational functioning and employee well-being through management and communication systems, hiring practices, performance appraisal, leadership development, and training programs.

I-O psychologists also provide professional consultation to organizations in order to help enhance work productivity and employee satisfaction. More information can be found on the section website at: https://cpa.ca/aboutcpa/cpasections/industrialorganizationalpsychology/

Bridge Magazine Articles

  • Daniel, L. (2005). Staffing management: Use personality tests legally and effectively. Staffing Magazine, 1.
  • Krell, E. (2005). Personality counts. HR Magazine, 50.

Technical Guides

  • Society for Industrial and Organizational Psychology (2003). Principles for the validation and use of personnel selection procedures (4th ed.). SIOP Inc.
  • Principles for the Validation and Use of Personnel Selection Procedures (2018). Industrial and Organizational Psychology, 11(S1), 1-97. Doi:10.1017/iop2018.195.

Books

  • Christiansen, N., & Tett, R. P. (2013). Handbook of personality at work. New York: Routledge.
  • For a guide to personality-oriented work analysis:

O’Neill, T. A., Goffin, R. D., & Rothstein, M. G. (2013). Personality and the need for personality-oriented work analysis (pp. 226-253).

Research Articles

  • Lilienfeld, S. O. (2012). Public skepticism of psychology: why many people perceive the study of human behavior as unscientific. American Psychologist, 67, 111.
  • Rothstein, M. G., & Goffin, R. D. (2006). The use of personality measures in personnel selection: What does current research support? Human Resource Management Review, 16, 155-180.
  • Shaffer, J. A., & Postlethwaite, B. E. (2012). A matter of context: A meta-analytic investigation of the relative validity of contextualized and noncontextualized personality measures. Personnel Psychology, 65, 445-493.
  • Tett, R. P., Jackson, D. N., Rothstein, M., & Reddon, J. R. (1999). Meta-analysis of bidirectional relations in personality-job performance research. Human Performance, 12, 1-29.

 

This fact sheet has been prepared for the Canadian Psychological Association by Thomas A. O’Neill, PhD (Department of Psychology, University of Calgary), Deborah M. Powell, PhD (Department of Psychology, University of Guelph) and R. Blake Jelley, PhD, CHRP (School of Business, University of Prince Edward Island)

Revised: July 2019

 

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

“Psychology Works” Resource: Applying To Canadian Graduate Schools

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When do you start looking?

It is a good idea to start researching potential graduate psychology schools/programs a few years before you intend to apply. Although this may seem early, it will help you ensure that you have the necessary course requirements and research/work/volunteer experience to be a strong candidate. Application deadlines for graduate schools range from the beginning of December to the beginning of March. Be sure to give yourself enough time to complete the application packages by starting in the summer or fall of the last year of your undergraduate degree.

How do you choose a program?

One of the first decisions you will need to make is whether you want to pursue a graduate program that focuses on practice, research, or both. This decision will depend on your career goals. Different graduate programs will focus to a different degree on practice versus research.  For example, some subfields of psychology, such as cognitive and social, may have a greater emphasis on research and becoming a scientist and/or a professor. Alternatively, other psychology graduate programs have both an applied and research emphasis, including, but not limited to, those programs in clinical, counselling, school, neuropsychology, forensic, and industrial/organizational psychology.  Look on program websites and ask faculty/current/former students about the types of jobs students typically have upon graduation from the program, to help you make an informed decision. Also keep in mind that some universities offer unique programs specializing in methods, community psychology, history of psychology, etc.

Which universities have graduate programs in psychology?

The CPA website has a list of Canadian universities that offer degrees in psychology (https://cpa.ca/students/resources/canadianuniversities/ and https://cpa.ca/students/resources/Experimental).

If you are leaning towards a professional psychology degree in clinical, counselling, school, or neuropsychology, you should visit the CPA’s accreditation webpage to see which universities offer training that meets professional standards (https://cpa.ca/accreditation/CPAaccreditedprograms/). Note that not all universities or graduate programs are accredited, which could affect internship opportunities and future job prospects. Contact universities to determine their accreditation status. The Council of University Directors of Clinical Psychology website contains an information sheet specifically on applying to graduate school in clinical psychology (https://cudcp.wildapricot.org/resources/Pictures/ClinicalPsychGradSchool_Updated3.pdf).

What makes you a strong applicant?

University admission requirements vary. By starting your search in the 1st or 2nd year of your undergraduate degree, you can shape your experiences to be certain you have the necessary pre-requisites for the graduate programs to which you intend to apply. Looking at the admission requirements will help you determine whether your degree, undergraduate coursework, and scores on standardized tests (if applicable) meet their standards. Statistics are usually available online to let you know how competitive the admission process is and the likelihood that you will be considered a strong applicant.

Most graduate psychology programs require applicants to have strong marks (typically above 80%), particularly in psychology courses and often in research methods or statistics. Another common requirement is to have completed an undergraduate honours thesis and to have additional research experience (volunteer or work). Some universities also require the Graduate Record Examination (GRE) or other standardized tests (e.g., the Test of English as a Foreign Language [TOEFL] for Francophone students applying to Anglophone universities). Taking these tests takes preparation, and you must plan ahead in case you need to re-take the test and to ensure that the results are available before graduate school application deadlines. You can find more information about the GRE and additional resources on how to best prepare, such as how to create a study plan, here: https://www.mastersdegree.net/how-to-study-for-the-gre/

Finally, many graduate programs require reference letters. Be sure to ask people who know you and your experiences well (e.g., research advisor, professor who taught you in an upper year course), as reference letters are very important in the decision process.

How long is graduate school?

Some graduate programs end with a Master’s degree (Master of Arts – M.A.; Master of Science – M.Sc.; or Master of Education – M.Ed.), while others continue on to a Doctoral degree (Doctor of Philosophy – Ph.D.; Doctor of Psychology – Psy.D.; or Doctor of Education – Ed.D.).  At a minimum, a Master’s takes 1-2 years, whereas a Doctorate takes an additional 3-5 years to complete. Combined Master’s and Ph.D. programs also exist at some universities. Career aspirations, finances, family situation, and time commitment will influence the type of program you pursue and the length of time it takes.

What are the program requirements?

Graduate programs differ in the type of courses they offer, how many they require you to take, and how much time they expect you to dedicate to them. Opportunities provided for research, practicum placements, teaching, and mandatory internships also differ across graduate schools. Check the requirements for potential programs on their websites to ensure they match your career plans.

How do you pick an academic advisor?

The most significant relationship you will develop during your graduate studies is the one between you and your faculty supervisor. Finding and connecting with a professor that has similar research interests as you not only increase your chances of being accepted to that university, but also ensures that the time you spend in graduate school will be worthwhile and satisfying. University departmental webpages tend to provide lists of their faculty members, along with their bios, research interests, and contact information, including how to get in touch with their current graduate students. Researching and contacting possible faculty advisors to ask whether they are accepting graduate students in the upcoming year is a vital part of picking the right graduate school.

Some universities place most of the acceptance decision on the faculty member’s willingness to take on the student. Start early to make contact with possible supervisors at universities you think you might want to attend. From your first contact (likely by email), make sure you familiarize yourself with their work and come up with potential avenues of research that you would be interested in investigating. Remember, you are starting an important relationship; be polite and patient in waiting for a response.

How do you pay for graduate school?

Post-secondary education can be expensive, with tuition fees varying considerably depending on the graduate school. Graduate schools will usually report approximately how much you should expect to pay in tuition and additional fees per semester on their websites, as well as whether any internal scholarships, teaching assistantships, and research assistantships are possible. Applying to private, provincial/territorial and federal scholarships/grants can also help pay for your studies and cost of living as a graduate student. For more information on Canada’s graduate scholarships for master’s and doctoral studies, visit the websites of Canada’s tri-councils:

If you want funding for your first year of graduate school, you need to submit the application the year before you intend to start (the year you are applying). Applications are typically due early in the fall semester (October/November).

You may also wish to consult with Canada’s National Student Loan Service Centre and/or see what student aid programs are available in the province/territory in which you live as per examples below:

Province /Territory Program Link
Alberta Alberta Student Aid
British Columbia British Columbia Student Aid
Manitoba Manitoba Student Aid
New Brunswick New Brunswick Student Financial Services
Newfoundland and Labrador Newfoundland and Labrador Student Aid
Northwest Territories Northwest Territories Student Financial Assistance
Nova Scotia Nova Scotia Student Assistance
Nunavut Nunavut Student Funding
Ontario Ontario Student Assistance Program (OSAP)
Prince Edward Island Prince Edward Island Student Financial Services
Quebec Quebec Student Financial Aid
Saskatchewan Saskatchewan Student Loans
Yukon Yukon Student Financial Assistance

A final note

When choosing the number of schools to which to apply, find a balance between quantity and quality to increase your chances of being accepted. Also be sure to get the advice of current graduate students. Good luck!

Where can you find more information?

This fact sheet was initially prepared for the Canadian Psychological Association by Mr. Colin Capaldi (Carleton University) and later updated by Ms. Lyndsay Evraire (Western University).

Revised: October 2021

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Resources:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

“Psychology Works” Fact Sheet: Physical Activity

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The psychological benefits of physical activity: An active body keeps a healthy mind

Healthy living involves many things including daily exercise, eating healthy and well-balanced meals, managing stress, and getting a good night’s rest. Physical activity is a very important part of maintaining both physical and psychological health.

Research shows that physical activity has important psychological benefits. For example, exercise can improve your mood and help you feel more confident and competent. It can help prevent and manage depression and anxiety, increase energy, reduce stress, and improve mental alertness and stamina.

Some kinds of physical activity like team sports provide a social support network which can have lots of benefits including friendships, improved mood and a better quality of life.

What type of physical activity and how much do I need to do to feel better?

There is not one specific formula of physical activity that works for everyone. Many studies have shown that including aerobic activities (i.e. activities such as running or bicycling that condition the heart and lungs to meet the body’s increased need for oxygen) and weight resistance in a physical activity routine is important for fitness.

However, the duration, frequency, and type of physical activity depend on the individual’s current level of fitness and fitness goals. It is generally suggested that individuals should do thirty minutes of moderate exercise such as brisk walking, three to five times per week.

Improvements in mental health however can come from any form of physical activity whether it is aerobic or non-aerobic in nature and whether it is done all at once or in small spurts. Examples include gardening, golf, walking the dog, playing sports, etc.

Many people say they “feel better” after regular exercise, regardless of the type of activity. We are likely to keep doing things that we enjoy, that are easy to fit into our daily routines, and that leave us feeling good.

I don’t know where to start: The importance of goal setting in physical activity

When choosing the right type of physical activity for you, it is important to set realistic goals and give yourself the time necessary to achieve the goals. Many people start out with unrealistic expectations.

For example, they want to lose weight in too short a period of time or they exercise too often and for too long periods of time. If you set a goal you cannot meet, you can end up feeling disappointed, ineffective, and you are more likely to give up. Set goals that you can easily achieve and increase the goals slowly.

Changes in health (e.g. weight loss, improved cardiovascular fitness) can take time so it is important to set behavioural or performance goals against which to measure your success.

Examples of behavioural goals might be the number of flights of stairs climbed per day or the number of walks per week. Try to make your goals specific (e.g., I will walk 2 kilometres three times per week).

If your goals are too general (e.g., I will walk more) they are difficult to measure and provide less motivation. Boredom with routine can affect motivation also so variety in your training program can help. If you are unsure of what are your appropriate fitness goals seek help from fitness and/or health professionals.

How much and when is it too much? The psychological signs of overtraining

Many of us lead very busy lives and struggle to manage all our responsibilities. It is important to make taking time for ourselves a priority and to find ways to help you do so.

We all have individual limits for what we can take on physically and mentally. If we take on too much too quickly, training exceeds the ability to adapt and overtraining can occur.

Overtraining is also known as burnout, overwork, or overstress and its signs can be quite varied and include a sudden inability to complete workouts, fatigue, trouble sleeping, loss of appetite, mood disturbances (i.e. irritability, depression, apathy/poor attitude towards training, loss of motivation to train, and/or mental exhaustion) and increased susceptibility to injury/illnesses.

The cause of overtraining is usually: not resting enough or doing too much of the same exercise. The longer the overtraining occurs the more rest is required. Therefore, early detection is very important. Your mind and body need time to recover.

If you realize that your workouts are suffering and you have lost interest and energy, it is important to take a break from your routine. Pushing through a period of overtraining instead of taking a rest can lead to significant mental health problems.

Where do I go for more information?

You can get more information about physical activity from the Public Health Agency of Canada at http://www.phac-aspc.gc.ca.

They also have a physical activity guide that might be helpful to find ways to incorporate physical activity in your life. Additional information can be found on the Health Canada website at http://www.hc-sc.gc.ca.

Before engaging in physical activity, speak with your family physician to make sure you are healthy. Sometimes exercise can be dangerous to people with certain illnesses or conditions.

For other useful sport and activity related websites visit:

Canadian Heritage at http://www.pch.gc.ca.

The Canadian Wheelchair Sports Association at http://www.cwsa.ca/.

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, go to https://cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Associations by Dr. Hannah Marchand, University of Ottawa.

Revised: July 2019

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

“Psychology Works” Fact Sheet: Bipolar Disorder

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What is bipolar disorder?

We all experience changes in moods from time to time depending on events we go through in life. But when these mood swings become more dramatic and severe and impair a person’s ability to function as usual at work, school, or in relationships, it may indicate the presence of a serious mood disorder.

Bipolar disorder, previously known as Manic-Depressive Illness, is a mental disorder that is characterized by severe mood swings cycling between periods of intense “highs” (mania or hypomania) and periods of intense “downs” (depression).

In mania, the individual experiences elevated perhaps extremely good mood, elation, or highly irritable mood that lasts for at least one week. This considerable increase in mood is accompanied by high levels of energy, combined with a noticeable decreased need for sleep.

The individual usually has a boost in self-esteem, tends to talk more and faster, experiences racing thoughts, and is easily distracted. Mania is also characterized by an increase in goal-oriented activities, and often leads to excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., excessive and irrational spending, sexual indiscretions, reckless driving).

In more severe forms, mania can be accompanied by psychotic symptoms such as hallucinations or delusions and almost always requires hospitalisation. Hypomania, a milder form of mania, causes less impairment but can often go unnoticed for several years before receiving appropriate diagnosis and treatment.

In the depressive phase of bipolar disorder, symptoms of clinical depression (or Major Depressive Episode) need to be present for at least two weeks and are similar to symptoms of unipolar depression (see the Canadian Psychological Association’s fact sheet on Depression).

These symptoms include depressed mood or sadness, loss of interest in most activities, decreased activities or social withdrawal, changes in appetite, increased or disturbed sleep, fatigue or low energy, decreased sexual desire, difficulties in concentration or making decisions, feelings of worthlessness and suicidal thoughts or plans.

In more severe forms, clinical depression can be life threatening and require hospitalisation as suicide is a significant threat in bipolar disorder.

In Canada, 2.2% of individuals will experience bipolar disorder at some point in their lifetime. Bipolar disorder usually starts in late adolescence or early adulthood, but it can also begin as early as childhood. If affects both men and women equally.

Bipolar disorder is a highly recurrent disorder, meaning that most individuals with bipolar disorder will experience several episodes during the course of their lifetime. Significant mood symptoms between episodes, problems with being able to get back to work, as well as relationship difficulties and break-ups are common in bipolar disorder.

Although we don’t know exactly what causes bipolar disorder, we do know that genes and chemicals in the brain play a strong role in making people vulnerable to developing the disorder.

Stress alone does not cause bipolar disorder, but episodes of mania or depression are often triggered by stressful life events. Risk factors for relapse in bipolar disorder include abusing alcohol or drugs, not taking psychiatric medication as prescribed, and changes in routine leading to lack of sleep or irregular sleeping habits.

What psychological approaches are used to manage bipolar disorder?

Pharmacotherapy, or drug therapy, is essential for the treatment of bipolar disorder. It usually involves the use of one or more mood stabilizers, such as Lithium, combined with other medications.

There is now strong evidence that psychological interventions can be added to drug therapy in order to help people better manage their illness and reduce repeated experiences of mood episodes.

Psychoeducation consists of giving patients and their relatives’ adequate knowledge about bipolar disorder and teaching illness self-management skills, so that people have a better understanding of their illness and its treatment. Psychoeducation is usually given in short-term (i.e., 5 to 10 sessions) group format.

Cognitive-Behavioural Therapy (CBT) and Interpersonal Therapy (IPT) are both short-term forms of psychotherapy that have been shown effective in the treatment of mood disorders, including depression and bipolar disorder.

In bipolar disorder, Cognitive-Behavioural Therapy uses psychoeducation and mood monitoring to help people identify triggers of mood episodes and develop a written relapse prevention plan.

Increasing activities in depression, reducing activities in mania, and correcting over-negative or over-positive thoughts are also strategies used in CBT. An adapted version of IPT, Interpersonal and Social Rhythm Therapy (IPSRT), has also been shown effective for bipolar disorder.

The main goals of IPSRT are to help people better deal with relational difficulties and learn how to maintain a stable and healthy daily routine in order to regulate important biological rhythms, such as sleep, that can trigger mood episodes like mania.

Family Therapy interventions, which have been found to be helpful in schizophrenia, have also been successfully adapted to bipolar disorder.

In Family Focused Therapy (FFT) patients and their families learn how to better understand bipolar disorder by getting information on the disorder and its treatment (psychoeducation) and learning communication and problem-solving skills in order to deal more effectively with the consequences of bipolar disorder.

Finally, social support is also very important for people with bipolar disorder and therefore joining local support groups for mood disorders may be helpful.

Where do I go for more information?

More information regarding bipolar disorder can be found on the following websites:

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, go to http://www.cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Martin D. Provencher. Dr. Provencher is a Registered Clinical Psychologist in the Province of Québec and is Full Professor at L’École de psychologie de l’Université Laval in Québec City. His primary interests include Cognitive-Behavioural Therapy, mood and anxiety disorders, Bipolar Disorder and Generalized Anxiety Disorder.

Revised: June 2019

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

 

“Psychology Works” Fact Sheet: Parenting Challenges

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Parents play the most important role in children’s development

Psychological research and practice show us that parents are the most important influence on their children.  As rewarding as it can be to be a parent, it can also be a difficult job at times.  To be a good parent takes knowledge, a great deal of practice, a lot of flexibility and openness to keep learning. Just as our children grow and learn so must our parenting. Whether parenting with a partner, in one or two homes, or as a single parent, parents need support from family, friends, and their community. Parenting some children poses additional challenges that can tax the patience and the skills of even the most devoted parent.

Two basic ingredients – love and structure

The formula is simple: children need both love and structure to grow and thrive.  Putting this into practice is not always easy.  A loving relationship is essential for children to develop confidence and self-esteem. Parents show love in different ways according to their personal style and cultural background. Love is shown by smiles, hugs, compliments, interest in the child and by being available to spend time with them.

Regular time devoted entirely to the child (without distraction from phones, TV, or the computer) is the foundation of a good relationship. It also helps children to learn that they can turn to their parents when they are troubled. As children reach adolescence they still need special time with parents, but it may look different from when they were younger. Without a warm and loving relationship with their parents, children and youth are at risk for low self-esteem and lack of confidence. They may try to find other, more negative ways to get attention and to feel good about themselves such as, acting-out, risky behaviour to impress their peers, or using drugs and alcohol.

A loving relationship is necessary, but is not enough to ensure healthy development. Children also need structure, consistency and an appropriate level of monitoring. From an early age, children benefit from routines that help them know what to expect each day. Parents show children the limits of acceptable behaviour by setting clear rules and expectations. Parents help children to learn that their actions have consequences. By noticing and commenting on appropriate behaviour, parents strengthen good habits.

Physical punishment, yelling and humiliation hurt children. There are other and much more effective ways to address child’s misbehaviour.  When parents routinely attend to the child’s behaviour they want to encourage, mild logical consequences (such as temporary loss of privileges) or brief time-outs are effective alternatives to physical punishment and yelling. By using suitable positive and negative consequences parents can help their children learn to set their own limits and make good choices. Without structure, children may have difficulty learning self-control and the ability to follow rules independently.

Parents should never underestimate how much children learn from watching their behaviour.  We can provide an example of either positive or negative behaviours to our children. Through our own behaviour we can teach problem solving, impulse control, the healthy expression of feelings (both positive and negative), patience and tolerance.  Of course we have to be just as aware of how we may teach them poor coping skills, substance misuse, violent or bullying behaviour, or unhealthy ways of engaging in conflict. Parents are teachers in everyday life and this is a huge responsibility as the impact that we have is tremendous.

Always the same, but constantly changing…

Children of all ages need love and structure. As children get older, parents need to change the ways they show love and provide guidance. A baby thrives on rocking, broad smiles, and singing. A teenager is likely to feel cared for by a parent who is a good listener while driving to an activity. In helping a toddler to learn that it is not acceptable to pull the cat’s tail, the parent may say “No” firmly and provide guidance on how to stroke the cat gently. Because teenagers need to develop responsibility and the ability to make healthy independent decisions, parents should negotiate with them about issues such as curfews and appropriate dress. Parents have to learn when to step back.  So for example, they might give choice to a young teenager over hairstyle, which is a temporary outcome, but be firm when it comes to tattoos which have more long term outcomes.  Successful parents promote growing independence in their children and help them to make good decisions.  At times that means that we have to allow enough space for our children to make mistakes so that they can learn from these situations as well and become more resilient to future challenges.

Parenting can be especially tough at times…

Adults may find parenting especially challenging when they are having a hard time making ends meet, feeling stressed at work, dealing with separation or divorce, or when a child or adult in the family suffers from a mental or physical illness. Children present a variety of challenges depending on their temperament, developmental level, learning style and cognitive abilities.

There are supports to help parents as they strive to help their kids. Sometimes these supports focus on fine tuning a parent’s skills to address specific situations or difficulties that their child might be experiencing.  Sometimes parents can benefit from more formalized supports.  Parents of children with, for example, mood, anxiety, acting-out or learning disorders are likely to benefit from evidence-based psychological services.

How can psychology help?

Research has helped psychologists to learn about parenting that works and to develop a range of services for families. Parent support provides information about normal child and adolescent development as well as problem behaviours. It helps parents use positive approaches to parenting that help the child to learn and develop. Parent support is offered face-to-face, via workbooks, and on-line to groups, couples, and  individuals, to help parents learn and practice strategies that research has shown to be effective in promoting positive relationships and in reducing misbehaviour.

Parents learn how to notice and pay attention to behaviour they want to encourage, how to set clear routines and expectations, and how to effectively deal with problem behaviour. Parent support is most effective when parents have opportunities to observe and practice the techniques they are learning. Following this type of parent support, parents increase their use of positive strategies and the majority of children show significant improvements in their behaviour, both in the short and long term.

Parents can also notice signs and symptoms that suggest there is a problem. It is ideal to address problems early on, before they become much harder to handle.

Parents who have their own problems such as feeling depressed, anxious, or in an unhappy relationship, may require help with their own problems as well as getting parenting support. Cognitive-behavioural therapy is effective in helping parents deal with their own problems such as depression, anxiety, chronic pain, or marital distress.

Cognitive-behavioural therapy is effective in improving communication, anger management, and problem solving in the family.

Where do I go for more information?

For more information visit:

The Incredible Years – Parents & Teachers. A series of interlocking evidence-based programs for parents, children, and teachers, supported by over 30 years of research:  www.incredibleyears.com

Triple P Parenting. Positive Parenting Program works for toddlers and teens. Get parenting tips and classes in Canada; face-to-face or online: www.triplep-parenting.ca

 You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, click https://cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Catherine M. Lee, Professor Emerita, School of Psychology, University of Ottawa who is also a consultant with Triple P Canada. 

 

Revised: June 2019

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

 

“Psychology Works” Fact Sheet: Diabetes

Posted on by CPA Webmaster

What Is Diabetes and How Prevalent Is It?

Diabetes is a well-understood disease in which the body either cannot produce insulin or cannot properly use the insulin it produces. Type 1 diabetes occurs when the pancreas is unable to produce insulin, whereas Type 2 diabetes occurs when the pancreas does not produce enough insulin or the body cannot use the insulin it produces effectively. Most Canadians with diabetes have Type 2 diabetes (90%), which is strongly associated with obesity, inactivity, and unhealthy eating patterns and aging.

According to Diabetes Canada, approximately 10% of Canadians currently live with Type 1 or Type 2 diabetes, with the prediction that this will rise to 12% by 2034.[1] The estimated total cost to the healthcare system in 2024 was $18.25 billion, with out-of-pocket expenses of up to 12% of family income for those with Type 1 diabetes and up to 7% of family income for those with Type 2 diabetes. The 2025 International Diabetes Federation Atlas estimates that 589 million adults currently live with diabetes world-wide (~11%), with this number expected to increase to 853 million by 2050.[2]

Prediabetes is a diagnostic category, which, although not Type 2 diabetes per se, reflects the beginning of insulin resistance and is associated with metabolic risk (especially macrovascular risks). Evidence suggests that taking action early, especially health behaviour change, can delay the onset of Type 2 diabetes.

How Is Diabetes Treated?

Many people think that diabetes treatment is very straightforward once the right amount of medication or insulin has been determined. Unfortunately, management is much more complicated. Successful management rests on the person actively engaging in self-management and prioritizing diabetes tasks over other life tasks. Important psychological milestones associated with successful self-management include disease acceptance, treatment acceptance, and readiness for self-management. Psychological intervention can aid in helping people with diabetes achieve these outcomes.

The treatment of diabetes rests on following a daily routine of medication or insulin usage, self-monitoring blood glucose levels (either by self-testing using a lancet or using a continuous glucose monitoring device), and adhering to healthy eating and activity guidelines. All of these tasks must be performed multiple times per day in a highly coordinated fashion. Diabetes is a disease that is managed primarily by a complicated regime of self-care behaviour. It has been estimated that adhering to all of the behavioural requirements of self-management would require over an hour a day for Type 2 diabetes and more than 1.5 hours per day for Type 1 diabetes.

Diabetes self-management is difficult for several reasons:

  1. The demands of diabetes self-management can be overwhelming. Ideally, when people learn new and complicated routines, they try out new behaviours in a gradual way, eventually making them part of the new routine. Yet, with diabetes, the individual must quickly learn a large number of new behaviours and they must begin performing them all immediately and at once (e.g., the newly diagnosed individual is instructed in self-testing, dietary modifications, medication/insulin usage, and exercise at a minimum).
  2. Diabetes self-care is complex involving the multiple impacts of several factors that work in opposite directions. For example, activity, insulin, and the passage of time lower blood glucose, whereas food and stress elevate blood glucose.
  3. A principle of successful behaviour management is the opportunity to take breaks or “time out” from difficult tasks. However, with diabetes self-management, there are no weekends off, no vacations, and no retirement. The demands of diabetes self-care are constant.
  4. Diabetes management can be frustrating because effort does not always produce predictable results. There are times when individuals do all that they are asked and still their control is not what they expect.

While most people with diabetes will live with it for life, for those with Type 2 diabetes, it may be possible to achieve remission. Diabetes remission is a term recently introduced to describe a person with Type 2 diabetes who, primarily through significant weight loss (~15% of body weight), can maintain normal glycemic levels without the need for medication. Adherence to healthy behaviours appears key to the maintenance of diabetes remission for those who can achieve it.

What Are the Psychological Implications of Living with Diabetes?

There are a number of psychological aspects of living with diabetes that interfere with function, health, and quality of life.

Diabetes distress is a recently validated construct that refers to distress associated with the emotional burden of diabetes, the regimen of diabetes self-management, the social stigma associated with diabetes, as well as interpersonal distress associated with relationships with family and friends and relationships with healthcare providers. There are a series of validated diabetes distress instruments, which can be self-administered, scored, and interpreted by accessing www.diabetesdistress.org.

Other important psychological consequences of living with diabetes include fear of hypoglycemia and, for those with Type 2 diabetes, psychological insulin resistance (negative attitudes toward the use of insulin when insulin is required due to beta cell insufficiency). Moreover, those living with diabetes may be more likely to develop an eating disorder than those not living with diabetes. One specific eating disorder associated with Type 1 diabetes is called Type 1 Disordered Eating (T1DE), which involves withholding insulin for the purpose of losing weight.

Diabetes-specific psychological issues interfere with health and quality of life and can be associated with the development of depressive or anxiety disorders.

What Can Psychologists Do to Help People with Diabetes?

Diabetes presents a significant challenge and stress for people with diabetes and those who support them. Psychologists can play a valuable role in helping people live well with diabetes (see here for a recently published report on the roles and competencies of the clinical psychologist in diabetes care).

Psychologists are well trained in emotion management and behaviour change interventions. The Clinical Practice Guidelines from Diabetes Canada recommend psychological screening and support for all individuals living with diabetes. Psychologists work with individuals with diabetes and/or their loved ones in several ways:

  1. They can help the newly diagnosed individual to understand the impact of this diagnosis and their role in managing it.
  2. They can problem solve to help the individual learn the daily behaviours needed for successful maintenance.
  3. They can recognize and treat psychological distress including depression and anxiety that may develop when living with an unpredictable disease.
  4. They can help in assisting the individual to develop and maintain the motivation needed to follow the daily routine of self-care.
  5. They can provide strategies for how to deal with social pressures (e.g., regarding food/drink choices, exercise) that don’t align with the individual’s self-management routine.

Where Can I Go For More Information?

The following websites provide useful information on diabetes and self-care:

Breakthrough T1D (formerly the Juvenile Diabetes Research Foundation) and Diabetes Canada have launched a diabetes-specific training program to educate Canadian mental health providers in diabetes, with the view hope of increasing access to trained mental health providers. A directory of graduates of this training program is being created to improve referral options for those seeking psychological support for diabetes management (https://directory.jdrf.ca)

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial, and some municipal associations of psychology may make available a referral list of practicing psychologists that can be searched for appropriate services. For the names and coordinates of provincial and territorial associations of psychology, go to  https://cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Michael Vallis, Associate Professor, Family Medicine, Dalhousie University.

Revised: August 2025

Your opinion matters! Please contact us with any questions or comments about any of the PSYCHOLOGY WORKS Fact Sheets:  factsheets@cpa.ca

[1] https://www.diabetes.ca/getmedia/9c717b08-e53e-47c4-a522-c0937ce0861b/2024-Backgrounder-Canada-EN_FINAL_1.pdf

[2] https://diabetesatlas.org/data-by-location/global/

“Psychology Works” Fact Sheet: Cancer in Adults

Posted on by CPA Webmaster

The Psychological Consequences of Cancer in Adults

Having cancer can be a distressing and stressful experience for patients and their family members, and can lead to a variety of psychosocial difficulties. While there are many different types of cancer – over 200 – each with its own particularities, there are some similarities in their psychological consequences. For example, most cancer patients report some symptoms of anxiety (e.g., fear of recurrence and of dying) and/or depression to varying degrees. Cancer and its treatment can also produce other symptoms with a strong psychological component such as insomnia, fatigue, pain, sexual difficulties, trouble concentrating, and memory problems. Body-altering cancer treatments (like mastectomy, oral facial surgery) can also lead to problems of self-esteem and body image.

Cancer-related Factors that Increase the Risk of Psychological Distress

The Canadian Association of Psychosocial Oncology (CAPO), along with many other countries throughout the world, has endorsed ‘psychological distress’ as the ‘Sixth Vital Sign’ to be assessed at crucial times of the cancer care trajectory with every patient.  Numerous factors can contribute to the risk of psychological distress, such as:

  • Receiving a cancer diagnosis at a young age is more likely to interfere with life projects (family, career) and can bring with it psychological difficulties. In addition, young people are often parents and have children to take care of, which may be more difficult when they are ill. Cancer treatment administered at a younger age can also result in premature menopause and infertility and have a negative impact on one’s sense of femininity and masculinity, which can be very distressful.
  • Cancer affects men and women differently. Studies have shown higher rates of psychological distress (including symptoms of depression and anxiety) in women with cancer. Research also suggests that men tend to show their psychological distress differently with more irritability, low sexual interest, extra devotion to work, and substance abuse. It also appears to be harder for men to reveal their distress and ask for help.
  • People who have suffered from a past psychological disorder are at a greater risk of experiencing psychological distress in reaction to cancer.
  • A more advanced cancer at diagnosis and having experienced a cancer recurrence have been found to be associated with greater psychological distress, a greater fear of cancer recurrence and lower quality of life.
  • Cancer treatments have many side effects that may increase psychological difficulties. For example, treatment-induced menopause (or “andropause” in men) is a side effect that may impact mood, sleep, sexual functioning, concentration, and memory. Fatigue is another undesirable effect of cancer treatment that has been shown to be associated with increased psychological disturbances and impaired quality of life. Pain is another distressful symptom that may due to the cancer itself but also to its treatment. Following cancer treatment (e.g., chemotherapy), individuals often report having cognitive difficulties. While most cognitive impairments are short term, some remain long-term and can affect one’s ability to work at the same level as prior to treatment for cancer.
  • The quantity and quality of social support (practical help, emotional support, information) from the people in one’s circle may be affected by cancer. Some close friends or relatives may be uncomfortable with the disease and keep their distance. Others may become closer. It is easier to live with cancer with an adequate social support.
  • “Passive” coping strategies such as behavioural avoidance (e.g., not reading about cancer, not asking questions to your oncologist about the illness) and cognitive avoidance (e.g., trying not to think about cancer) have been shown to be less effective coping strategies. It is often better to confront reality, even if this is harder to do at first.

Does Stress Cause Cancer? Do You Need to Keep a Positive Attitude to be Cured?

Some people believe that stress or other psychological factors (like past traumas, grief, depression) may have caused their cancer. Although this belief is very common, numerous studies have looked at this and have not established a link between stress and the onset or progression of cancer. Cancer is a very complex disease. It has many causes, including certain genes, hormones, viruses, behaviours (e.g., smoking, sedentary lifestyle, exposure to sunlight) and environmental factors (e.g., asbestos). Cancer arises from a combination of these factors that vary from person to person.

Another widely held belief is that a person’s attitude plays a determining role in recovery and that a positive attitude and fighting spirit will give a better chance of being cured. Once again, there is no scientific evidence for this idea in the literature.

Why is it important to change these beliefs? Because studies have shown that they increase the risk of psychological distress associated with cancer. More precisely, blaming yourself for your cancer (for example, believing you got cancer because you have been unable to cope with your stress) is associated with more psychological symptoms like depression and anxiety. Similarly, the belief that a cure will depend on your mental attitude can be very detrimental because it’s impossible to be positive all the time when you’re suffering from a disease like cancer. As soon as a negative feeling arises, which is completely normal even in the absence of cancer, it brings with it a strong sense of guilt (“it will be my fault if my cancer returns, I’m too stressed”) which may lead to a sense of hopelessness and symptoms of depression and anxiety. On the other hand, if you have too many negative thoughts, leading to persistent feelings of depression, anxiety, guilt and anger, there are effective strategies to reduce their impact. This may not affect your longevity, but will clearly improve your quality of life.

What Kinds of Interventions Can Help People with Cancer?

Anyone with cancer may experience some psychological distress, but not all need professional help. If your worries, sadness or other difficulties are severe or are affecting your daily functioning and quality of life, speaking with a psychosocial counsellor such as a psychologist is a good idea.

A number of psychological treatments have been shown to be effective in the treatment of cancer-related distress, depression, and anxiety. Cancer centres throughout Canada all have counselling services for cancer patients and their family members and can either provide specific interventions and/or have information on how best to access specific services locally. For example:

  • Psychotherapy is an intervention that allows an individual, a family, a couple, or a group to talk openly and confidentially about their concerns and feelings with a trained professional. The question as to whether psychotherapy is best when used alone or in combination with an anti-depressant/anti-anxiety medication depends on the problem and its severity. Examples of specific psychotherapeutic interventions include cognitive-behavioural therapy (CBT) and mindfulness-based interventions.
    • The efficacy of CBT in helping people cope with cancer is well established. If you choose this type of psychological intervention you will learn how to modify certain behaviours. For example, if you have reduced your activities, a behaviour that increases the likelihood of depression, you will be encouraged to reintroduce pleasant and energizing activities into your daily schedule. Also, if you have a tendency to have negative thoughts, cognitive strategies will help you question and change them into more realistic interpretations. For example, if you are worried about your cancer returning and dying from it, you will learn to look at the real chances of something like that actually happening and to better live with this uncertainty.
    • Although the efficacy of mindfulness-based interventions has been less studied in the context of cancer, they can be very beneficial. If you opt for this approach you will learn how to concentrate on the present moment and to be more accepting of your negative emotions. Mindfulness-based interventions have gained in popularity and are often offered in cancer centers. There are also several smartphone apps available.
  • New and emerging strategies for therapy and self-management such as professionally facilitated on-line support groups (e.g., CancerChatCanada; https://cancerchat.desouzainstitute.com ) and telemedicine-facilitated counselling via videoconferencing  (e.g., Skype, Facetime) from you home with a trained psychosocial oncology counsellor are becoming more and more available.
  • Support groups allow you to share your experience with other people living with the disease and can help you to feel less alone. You can contact the Canadian Cancer Society (www.cancer.ca) to learn about the services they can provide and the support resources offered in your community.
  • Anti-depressants and anti-anxiety medications are often prescribed to patients with cancer to reduce their psychological distress, help them sleep better, and to reduce some of cancer treatments’ side effects (e.g., antidepressants for hot flashes), especially when these problems are severe. All medications have side effects. If the side effects that you experience are too disturbing or if you prefer not to take a medication, talk to your doctor about effective alternatives. It is often more effective to combine medication with psychotherapy.
  • Physical exercise is particularly effective in reducing the fatigue associated with cancer and can have beneficial effects on many other symptoms like anxiety, depression and insomnia, although it isn’t generally sufficient to treat severe psychological disturbances. It’s important to start gradually and, ideally, to seek the services of a professional (e.g., kinesiologist) who can help you prepare a personalized program, make sure that exercise is safe for you, and follow you in your training.
  • Wellness interventions such as yoga and relaxation favor well-being and the release of tension. More general interventions like these can produce positive effects but they are rarely enough to treat severe psychological distress.
  • Consulting a couple or a sex therapist can be very helpful to better cope with the effects of cancer and its treatment on the quality of your conjugal relationship and your sexual functioning.

Where can I get more information?

  • Canadian Cancer Society; cancer.ca
  • Savard, J. (2010). Faire face au cancer avec la pensée réaliste. Montréal : Flammarion Québec.

 

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial, and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, please visit:  http://www.cpa.ca/public/whatisapsychologist/PTassociations

This fact sheet has been prepared for Canadian Psychological Association by Dr. Josée Savard, School of Psychology, Université Laval, CHU de Québec-Université Laval Research Center and Université Laval Cancer Research Center.

The author and the CPA would like to thank Dr. Scott Sellick, Thunder Bay Regional Health Sciences Centre for his assistance during the development of the first version of this fact sheet.

Revised: June 2019

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

 

Joint Letter from CPA, Ontario Psychologists Association and CAPDA (March 2019)

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The CPA and the Ontario Psychological Association (OPA) and the Canadian Academy of Psychologists in Disability Assessment (CAPDA) wrote a letter to express their profound concerns over the September 2018 motion approved by the Council of the College of Psychologists of Ontario (CPO) to continue registration of psychology practitioners at the master’s level and, further, to grant then the title “Psychologist”. This 2018 motion overturns a 2013 decision of the Council to stop registering master’s practitioners of psychology.