Month: October 2019

“Psychology Works” Fact Sheet: Female Sexual Dysfunction

Posted on by CPA Webmaster

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

Posted on by CPA Webmaster

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

Posted on by CPA Webmaster

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