Month: December 2020

Do you, or someone you know, ever start to feel dips in your energy, become irritable, and feel down every fall?  Keep reading to see if you may need to talk to someone about how you feel.

What is Seasonal Affective Disorder?

Seasonal Affective Disorder (SAD), or Depression with Seasonal Pattern, is a condition that comes and goes based on seasonal changes, appearing in the fall and going away in the spring/summer. This diagnosis should only be considered when the feeling is beyond the “winter blues” due to the lack of engagement in typical hobbies and/or outdoor activities due to weather.  Seasonal Affective Disorder can also occur during spring and summer although it is not as common to experience SAD during the warmer seasons.

There is debate regarding the cause of SAD. There is some that believe SAD is influenced by exposure to sunlight. Our bodies react to how much sun we are exposed to through our circadian rhythm. Our circadian rhythm is our natural clock that regulates many things, including mood and sleep.   Exposure to sunlight may also affect chemicals in our brain (serotonin) and our body (melatonin), which also influences how we feel.  Other experts do not believe there is enough evidence to support this theory, and connect mood changes to being inside more and being unable to engage in the same outdoor activities/hobbies that you enjoy.  This influence to mood can still benefit from treatment with a psychologist.

Who is at risk of developing SAD?

It is estimated that SAD makes up 10% of all reported cases of depression. Approximately 15% of Canadians will report at least a mild case of SAD in their lifetime, while 2-3% will report serious cases. People with a family history of any form of depression may also be at risk of developing SAD.  Canadians are particularly at risk, as we have decreased sunlight during the winter months.

If you have a history of depression or bipolar disorder, your symptoms may become worse seasonally.

What are the symptoms of Seasonal Affective Disorder?

If you have SAD, you may find yourself feeling many symptoms of depression, especially irritability, and you may be more sensitive in interpersonal relationships. People often report that their energy levels are unusually low, causing them to feel tired, heavy, or lethargic. As a result, you may feel that your regular sleep schedule doesn’t provide adequate rest. Oversleeping is commonly reported in SAD.

You may find that your appetite has changed, and you may crave foods that are higher in carbohydrates, starch, and fat. Some people report weight gain, especially when you are frequently eating “comfort foods” (e.g., high calorie and fast foods). You may lose interest in activities that you once enjoyed, which may cause you to develop a more avoidant or sedentary lifestyle. Physical intimacy may appear uninteresting or too demanding. You are also likely to feel stressed, distracted, sad, guilty, or hopeless.

Can Psychology Help Seasonal Affective Disorder?

There are many ways to reduce symptoms of SAD or the winter blues. The most widely recommended psychotherapy for SAD is cognitive behavioural therapy (CBT).  CBT helps individuals focus on immediate thoughts, moods, and feelings, which allows problems to be broken down and made more manageable. Your psychologist may also recommend lifestyle changes in the winter, such as opening blinds, going outside, and exercising. You can undergo CBT either alone or in a group setting. Research suggests that CBT can help improve present symptoms while providing you with a healthy defense for future episodes.

Other forms of psychotherapy commonly used for the treatment of SAD are counselling and psychodynamic therapies. These therapies allow you to discuss concerns and worries with a therapist in an open and confident environment. You may discuss feelings about yourself and others, or past experiences that could be influencing your symptoms. One goal is to identify any memories or feelings that could be influencing your current state of mind. Once possible causes have been identified, you will work through them to resolve any negative influences presently affecting you.

Are there other treatments for Seasonal Affective Disorder?

Some studies have identified light therapy as an effective method for improving symptoms. In this therapy, the user sits in front of a special light box or lamp for approximately 30 minutes a day. Light therapy can be administered in a doctor’s office, or at home with your own equipment on a schedule recommended by a clinician. You should consult with your doctor before beginning light therapy. Light therapy is not suitable for everyone as there can be negative side-effects associated with this treatment including eye strain, agitation, headaches, and nausea. Light boxes should only be purchased after a discussion with your treating professional, as not all light boxes are effective, and you may want to review with your treating professional the research regarding the use of light boxes.

Exposure to natural light can be helpful. Research has found benefits from exposure to sunlight within one hour from waking up in the morning, particularly for people with SAD. You can sit beside a window, keep your blinds open when you are home, trim branches that block light on your property, or take frequent walks outside with proper UV protection.

Most importantly, it is also encouraged that you live a healthy and balanced lifestyle to improve symptoms and reduce the severity of future episodes. Try incorporating exercise into your daily routine. Exercise will help increase your physical and mental well-being, ease your stress, and reduce feelings of lethargy. Eat a healthy diet and be mindful not to overindulge cravings for high sugar/starch/fatty foods. Make sure to stick to regular sleeping habits to combat fatigue and avoid oversleeping.  Additionally, make sure that you have a healthy level of vitamin D in your diet with your physician and/or pharmacist.

Although your symptoms may initially make this difficult, keep in regular contact with family and friends, both in person and via electronic means. These networks can provide opportunities to socialize and refresh your mood. Reach out to people in your support network for comfort and understanding. This can help ease feelings of guilt, isolation or hopelessness. Make sure to spend some leisure time doing activities that you find rewarding and gratifying. Practice mindfulness and pacing inside the home if you cannot make it outside (in front of windows if possible). Finally, exercise stress management techniques such as meditation and mindful breathing.

Alternatively, your physician may decide that medication, such as an antidepressant, is an effective treatment for you. Pharmacotherapy likely will be recommended for symptoms that are severe and have a significant impact on daily functioning. There are side effects with medications, which should be discussed with your prescribing professional.

Where can I get more information?

• Canadian Mental Health Association (BC branch): http://www.heretohelp.bc.ca/sites/default/files/seasonal-affective-disorder_0.pdf
• American Psychological Association (APA): provides information on symptoms management and how psychologists can help: http://www.apa.org/helpcenter/seasonal-affective-disorder.aspx
• Center for Addiction and Mental Health (CAMH): provides general information, as well as a short video about symptoms and treatments for SAD: http://www.camh.ca/seasonal_affective_disorder
• Information regarding the debate of the diagnosis: http://journals.sagepub.com/doi/abs/10.1177/2167702615615867

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:  https://cpa.ca/public/whatisapsychologist/ptassociations/

This fact sheet has been prepared for the Canadian Psychological Association by Sarah Amirault, Carleton University.

Date: July 2018

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

What is Social Anxiety?

It is common to feel some anxiety in social situations from time to time.  Many of us feel anxious when we’re at a job interview, on a first date, or giving a speech.  We all want to make a good impression and be liked.  However, some people feel very nervous and uncomfortable in social situations.  Individuals with social anxiety worry a great deal about doing something embarrassing and others thinking badly of them.  They tend to be very self-conscious and constantly feel “on stage.”  While some people with social anxiety fear lots of different social situations (e.g., meeting new people, going to parties, starting conversations, being the centre of attention, ordering food in a restaurant, etc.), some people only get anxious in very specific situations (e.g., public speaking).  When faced with feared social situations, individuals with social anxiety tend to experience the following:

• Thoughts: negative thoughts about themselves (e.g. “I’ll say something stupid,” “I’ll look anxious,” “I’ll have nothing interesting to say”) and how other people will react to them (e.g. “People won’t like me,” “Classmates will think I’m boring,” “Colleagues will think I’m weird”)
• Feelings: anxiety, fear, nervousness, embarrassment, shame
• Body reactions: sweating, blushing, trembling, shaking, racing heart, upset stomach, nausea, dizziness, lightheadedness, choking sensations, dry mouth
• Behaviours: avoidance of social situations (e.g., skipping the party, not going to a meeting or class, saying “no” to social plans with friends) and the use of safety behaviours, which include any actions used to try and feel safer and less anxious in a social situation (e.g., saying very little, avoiding eye contact, rehearsing what you say before you say it, not expressing your opinion, using alcohol or drugs).

When does social anxiety become a problem?

Social anxiety becomes a problem or is considered a disorder when it feels intense, happens a lot, causes us distress, and affects different parts of our lives including:

• Work and school (e.g., missing work or school, trouble participating in meetings or classes, poor performance at work or school, not pursing certain school programs or jobs/careers, and difficulty talking to bosses and co-workers or teachers and other students)
• Relationships and friendships (e.g., difficulty making and keeping friends, trouble dating, and difficulties being assertive and opening up to people)
• Recreational activities and hobbies (e.g., avoiding trying new activities or joining things such as going to the gym, joining a running club, or taking an art class)
• Day-to-day activities (e.g., difficulty completing daily activities such as grocery shopping, ordering food at a restaurant, making phone calls, asking for help, and using public transit)

Who has problems with social anxiety?

Anyone can have problems with social anxiety. You might not know from the outside that someone is suffering on the inside. When social anxiety causes distress and gets in the way of functioning in life, we call it Social Anxiety Disorder. It is one of the most common anxiety disorders, 8-12% of people being diagnosed at some point in their lives.

Research suggests that both genetics and environment can play a role in the development of social anxiety problems.  Social anxiety tends to run in families, which means if someone in your family has an anxiety problem you may be more likely to develop one.  Various life events or experiences, such as being teased or bullied, can play a role.  Social anxiety problems can develop slowly over time, often starting in elementary school or early adolescence, or after a particularly embarrassing or stressful event.

What treatments help people with social anxiety?

Pharmacological interventions (medications) can help people with Social Anxiety Disorder. Ask your family doctor (General Practitioner) or Psychiatrist about options.

Cognitive Behaviour Therapy (CBT) is the gold standard nonpharmacological treatment for social anxiety disorder. Scientific research shows that CBT helps people with social anxiety. CBT involves learning new ways of thinking (cognition) and acting (behaviour), which can lead to reducuctions in anxiety.  A typical course of CBT is 12 to 20 one-hour sessions.

People with social anxiety tend to overestimate the threat of social situations and underestimate their ability to cope with them. CBT teaches cognitive techniques (e.g., identifying and challenging unhelpful thoughts or beliefs) to help people feel less anxious and engage in social situations more.

People with social anxiety also tend to avoid feared social situations or people. Avoidance works well in the short term (e.g., anxiety temporarily goes down by skipping the party) but causes more problems in the long run (e.g., missing out on meeting new friends, sending yourself the message that that situation is dangerous and you can’t cope). A CBT therapist will help you gradually face your excessive fears. The process of “exposure” helps reduce anxiety by teaching people (through experience) that situations are safer than they think and they can manage them.

Mindfulness-based therapy and Interpersonal therapy can also help people with social anxiety; however, they appear to be less effective than traditional CBT. Mindfulness-based therapy (MBT) involves learning to pay attention to your thoughts, feelings, sensations, and surroundings in the present moment, without judging. Interpersonal therapy (IPT) involves exploring issues in relationships with other people to help you understand and improve interpersonal situations.

The good news is that psychotherapy has been shown to be effective for most people with social anxiety disorder, which means most people get better with treatment. However, it can take several weeks to months, or even longer to notice changes.  In terms of medication, it can take some trial and error to find the right medication.  So stick with it, change takes time.

How can psychologists help people with social anxiety?

• Psychologists educate people about social anxiety so they understand what it is and how to handle it.
• Psychologists conduct assessments that help clarify diagnosis and develop a plan for tackling social anxiety.
• Psychologists provide effective treatments, such as Cognitive Behavioural therapy (CBT).
• Psychologists engage in research to help us better understanding social anxiety and improve treatments.
• Psychologists can advocate for people with social anxiety. Currently, not every Canadian can freely and easily access evidence based psychological treatments for social anxiety disorder.

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 contact information of provincial and territorial associations of psychology, go to https://cpa.ca/public/whatisapsychologist/ptassociations/.

You can find additional information and free self-help resources on social anxiety at:

• http://www.anxietycanada.ca
• https://cmha.ca

This fact sheet has been prepared for the Canadian Psychological Association, in cooperation with AnxietyBC, by Dr. Melanie Badali and Dr. Kristin Buhr, Registered Psychologists at the North Shore Stress and Anxiety Clinic.

Date: June 29, 2018

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

What are enuresis and encopresis?

Enuresis means urinating (peeing) where you shouldn’t (e.g., in bed or in clothing). Encopresis means defecating (pooping) where you shouldn’t (e.g., in clothes or on the floor). To have enuresis or encopresis:

• A child must be old enough to be toilet trained, meaning 5 years old or older for enuresis and 4 years old or older for encopresis. Children younger than this probably just need more time to learn. You can look at our resources below on toilet training for more ideas on helping these children.
• The wetting or soiling (pooping) must also happen regularly. That means at least twice a week for enuresis and once a month for encopresis.
• The wetting or soiling must also happen That means this problem must happen for at least 3 months.

Some  children with enuresis only have problems at night (bedwetting), referred to as nocturnal enuresis. Enuresis and encopresis are separate problems, but they can sometimes occur together.

Enuresis is fairly common in young children, affecting about 5-10% of 5-year-olds. Enuresis becomes less common as children get older, but about 1% of those over 15 years old have it. Encopresis is less common, with about 1% of 5-year-olds having it.

It is important to know that children almost never wet or soil their clothes  to upset you! Most children would rather be able to use the toilet properly.

Why does my child have enuresis or encopresis? What are the risk factors?

There are many reasons children may develop enuresis or encopresis. Some common risk factors are:

• Lack of toilet training. Although some children seem to learn without being taught, many need someone to clearly teach them to use the toilet.
• Toilet training before the child was ready.
• Stress (e.g., birth of a younger sister or brother, moving, new daycare, etc.).
• Constipation (difficulty pooping) or pain when pooping.
• Eating too much “junk food” and not enough fibre (e.g., fruit, whole grains).
• Not drinking enough.
• Family history of enuresis (especially for bedwetting).
• Bladder infections.
• Distractibility (a distractible child may not listen to their body telling them they need to pee or poop).
• Anxiety about toilets, germs, bathrooms, or separation from mom or dad.

Sometimes the cause of a child’s enuresis or encopresis is unknown.  All we can do is try to help them cope with it and treat it as best we can.

Why are enuresis and encopresis a problem?

Children with encopresis or enuresis may develop low self-esteem, feel anxious or sad, and struggle with behavioural problems. Some children with encopresis or enuresis may feel alone and embarrassed, and may be teased by other children. Children with encopresis or enuresis may also struggle with learning and school, and tend to miss more school than their peers.

Encopresis and enuresis can also have a negative impact on the family. Having a child with encopresis or enuresis can be stressful for parents. They often worry about their child being teased at school and about what other families may think. Parents of children with encopresis or enuresis may feel judged, alone, anxious, and helpless. Parents may also become frustrated with their child and the other parent, which can be hard on their relationships.

How can psychologists help children with enuresis and encopresis?

Children with enuresis and encopresis often benefit from seeing a psychologist. Many children with enuresis and encopresis get better with time even without treatment. For these children, treatment simply helps it happen faster.

Psychologists can:

• Help children become aware of the signs their body uses to tell them they need to go to the bathroom.
• Explain enuresis and encopresis to families in a way that helps them see the accidents as the problem instead of placing the blame on the child.
• Provide behavioural treatment to encourage the child to use the toilet.
• Help parents guide their children in healthy eating and drinking habits that are important for bowel and bladder control.

There are many treatment options available for enuresis and encopresis.  Medical treatments can help and are sometimes necessary (e.g., the use of laxatives or enemas). Behavioural treatments have longer lasting results in treating enuresis and encopresis. Examples of common treatment approaches include:

• Dry bed training with a urine alarm for treating bedwetting. This approach involves having the child wake up in the night on a bathroom schedule and using an alarm to wake the child up if an accident happens. It is also important to praise the child when they stay dry!
• Enhanced Toilet Training for encopresis. This approach combines the use of a toileting schedule, modeling how to properly poop to the child, rewards, education on which body parts are involved with pooping, and medication.

Listed below are some ways parents and caregivers can help. See a psychologist for more support in using these:

• Reduce shame: When children poop and pee in inappropriate places such as their pants, they frequently feel shame and embarrassment. Parents may accidentally add to these feelings by showing their frustration, anger, or disappointment towards the child when accidents occur. This shame and embarrassment can lead to children having more difficulty with using the toilet. Talking about the issue in a way that externalizes the toileting difficulties (e.g., “That tricky poop is causing us some problems, isn’t it?”) helps to take the blame off of the child.
• Encourage and model healthy habits: Healthy, fibre-filled foods and fluid intake play a key role in helping children struggling with enuresis and/or encopresis. It is important to explain to children how what we eat and drink is related to our bowel and bladder control. Knowing that children are constantly learning from watching others, we can be helpful with healthy eating examples.
• Help your child identify their need to go: We know that our bodies give us clues when we need to pee or poop. Children with enuresis or encopresis may not notice these. We can help by pointing out these signs to children in a clear, non-judgmental way. For example, saying, “Your legs are crossed. That might mean you need to pee. Let’s go!”

Are there other professionals we should see?

Medical doctors and nurse practitioners can help rule out other causes of your child’s wetting or soiling. They can also help your child with constipation and pain when pooping.

Dieticians can help with ideas for a healthy, fibre-filled diet to help maintain your child’s ability to poop regularly.

Physiotherapists can help your child strengthen the muscles needed to hold pee and poop in. They can also help children learn to pee and poop on command (learn to open and close their sphincters voluntarily) and can help your child figure out when they need to go.

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, please visit:   https://cpa.ca/public/whatisapsychologist/PTassociations

• Canadian Family magazine for tips on toilet training
  • https://canadianfamily.ca/kids/toddler-and-preschool/11-must-have-potty-training-tips/

 

• American Academy of Family Physicians
  • Enuresis, https://www.aafp.org/afp/2014/1015/p560-s1.pdf
• Psychology Today
  • Encopresis, https://www.psychologytoday.com/ca/conditions/encopresis
  • Enuresis, https://www.psychologytoday.com/ca/conditions/enuresis
• Summit Medical Group
  • Encopresis, https://www.summitmedicalgroup.com/library/pediatric_health/hhg_encopresis_from_constipation/
  • Enuresis, https://www.summitmedicalgroup.com/library/pediatric_health/pa-hhgbeh_wetting/
• UCanPoopToo, http://www.ucanpooptoo.com/
  • See especially Encopresis Tips for Parents, http://www.ucanpooptoo.com/parent-tips

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Jennifer Theule, Brenna Henrikson, and Kristene Cheung, University of Manitoba

Date: February 7, 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

What is health anxiety?

Most people have felt anxious about their health or the health of loved ones at some point in their lives. In fact, we are often faced with health situations in which it is entirely appropriate to feel some anxiety. For example, you may be waiting for the results of a biopsy or your friend may have just been diagnosed with a serious illness. It is natural to feel anxious and upset in these situations. Similarly, most of us worry about death and dying from time to time. Experiencing anxiety about illness and death is normal.

Worries about health and dying can become a problem if they get in the way of living and enjoying life. Health anxiety involves fears of having or developing a serious disease such as cancer, heart disease, or multiple sclerosis. Health anxiety is often associated with high levels of worry, substantial focus on bodily symptoms, repeated checking for signs and symptoms related to health concerns, focus on death and dying, and frequent efforts to obtain reassurance from family members, friends, or health care professionals. Some people with health anxiety avoid going to doctors because of fears of being diagnosed with a serious disease or because of dissatisfaction with previous health care experiences. Individuals with health anxiety may also avoid other situations related to illness and death, including activities such as spending time with loved ones who are ill, attending funerals, and writing a will.

Worries about health may be triggered by experiences such as everyday symptoms (a skipped heartbeat, a headache), a frightening experience such as finding a breast lump, or coping with illness or death of a loved one. Anxiety may also be triggered by stories about health issues in the community or media. Worries may be mild and transient or they may have a more severe and chronic course, waxing and waning over time. Some individuals may worry about one specific illness or body symptom, while others worry about many. Health anxiety can occur on its own and may then be termed illness anxiety disorder.  It may also be part of other problems such as panic disorder, generalized anxiety disorder, obsessive-compulsive disorder and depression. People who have diagnosed medical conditions may also experience high levels of anxiety as a reaction to their health problems. In some circumstances, the level of health anxiety may be excessive and may interfere with normal functioning and enjoyment of life.

How prevalent is health anxiety?

Estimates suggest that 3-10% of the general population suffer from significant health anxiety. Up to 30% of the population experience intermittent or milder fears about their health. This is a relatively common problem and one that can cause significant interference. It can also be costly to the health care system when it results in high levels of health service utilization.

What are the main causes of health anxiety?

There are a variety of factors that may contribute to the development and onset of problems with health anxiety. These include:

Genetics: Some people are born with a temperament that leads them to be more prone to experiencing anxiety than most people. In addition, most forms of anxiety run in families to some degree.

Family background and childhood experiences: Individuals who experience a stressful family life during their childhood (such as family conflict, high family stress, or abuse) are more likely to develop problems with anxiety and depression. People who have problems with anxiety in general may be more likely to also have worries and fears about health and illness.

Social Learning: We can learn many things from our parents, siblings, or other significant people in our lives. Sometimes these lessons can be positive but at times we can pick up negative things from those around us. Children often model what their parents or siblings do. For example, if an anxious parent avoids a range of situations, children watching this are likely to behave in similar ways (i.e., engaging in avoidance).

Parents or other important people can also pass on fears through verbal communication. For instance, fearful or anxious people may be overly concerned about potential dangers and often communicate these fears to their children by saying certain things, such as: “If you have a stomach ache you had better stay home and be in bed until you feel better” or “Did you hear about Sally – she was fine one day then she was diagnosed with brain cancer, and now she’s dead”.  In this case, viewing health as fragile and illness as painful and deadly may lead a child to become focused on health concerns, avoid certain situations, or worry excessively about illness and death.

Illness and death experience: Health anxiety may also be related to stressful experiences with illness and death in childhood or during the adult years.

What psychological treatments are used to treat health anxiety?

The primary psychological treatment that has been shown to be effective with this problem is cognitive-behavioural therapy (CBT). This treatment involves:

• understanding anxiety and how problems with anxiety can develop;
• decreasing specific behaviours such as checking one’s body for symptoms and asking for reassurance about one’s health;
• learning how to counter the excessive worries about health and illness;
• overcoming avoidance of situations related to illness and death using exposure strategies;
• learning to face worries about illness realistically and directly which can reduce the fear associated with these thoughts;
• coping with fear of death by emphasizing the importance of accepting the reality of death and enjoying life to the fullest; and
• general anxiety management strategies such as relaxation techniques and increasing exercise.

How effective are psychological methods of treating health anxiety?

Research demonstrates that cognitive-behavioural treatment is helpful in reducing fears about having and/or getting a serious illness. Studies show that individuals receiving from 6 to 20 treatment sessions generally report decreased illness fear and a reduction in accompanying depression. Both individual and group treatments are effective.

Where do I go for more information?

For the public:

• Overcoming Health Anxiety: Letting Go of Your Fear of Illness. By K. Owens & M. Antony (2011). Oakland, CA: New Harbinger.
• It’s Not All in Your Head: How Worrying About Your Health Could be Making You Sick – and What You Can Do About It. By G.J.G. Asmundson & S. Taylor (2004). New York: Guilford Press.
• Ten Simple Solutions to Worry. By Kevin Gyoerkoe & Pamela Wiegartz (2006). Oakland, CA: New Harbinger.
• https://www.anxietycanada.com/anxiety-disorder/health-anxiety/
• https://adaa.org/understanding-anxiety/related-illnesses/health-anxiety
• https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Health-Anxiety

For the professional:

• Treating Health Anxiety and Fear of Death: A Practitioner’s Guide. By P. Furer, J.R. Walker, & M.B. Stein (2007). New York: Springer.
• Treatment of Health Anxiety and Hypochondriasis: A Biopsychosocial Approach. By J. Abramowitz & A. Braddock (2008). Ashland, OH: Hogrefe & Huber.
• Treating Health Anxiety: A Cognitive-Behavioral Approach. By S. Taylor & G.J.G. Asmundson (2004). New York: Guilford Press.
• Tackling Health Anxiety: A CBT Handbook. By H. Tyrer (2013). London: RCPsych Publications.

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/unpsychologue/societesprovinciales/.

 

This fact sheet has been prepared for the Canadian Psychological Association by Patricia Furer, Ph.D., C.Psych., Dept. of Clinical Health Psychology, University of Manitoba.

Revised: June 2020

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

Most of us have experienced at least one traumatic event in our life. The events can have long lasting impact on our life, on our sense of self and identity, our belief system and on our overall functioning, whether personal, social, or occupational. We might have constant distressing memories of the upsetting or traumatic event, have bad dreams, feel that we are constantly on guard for any signs of threat or danger, fear of an impending doom or something bad happening, feel emotionally numb, feeling withdrawn, not having much tolerance for stress or public, feel angry, irritable, anxious, ashamed or guilty, or feel excessively jumpy.

Trauma has an individual impact. Each person might experience and feel the symptoms of trauma differently. For some PTSD is associated with emotional dysregulation such as flashbacks, distressing memories of the trauma, feeling excessively jumpy and being constantly on guard whereas for others, it is related to emotional numbness and self-isolation.

The majority of individuals exposed to potentially traumatic events experience posttraumatic symptoms, shortly after the traumatic event. Over time, in particular within the first month or so, the symptoms tend to gradually improve. In some cases, however, the symptoms can increase over time, create more emotional and psychological distress and interfere with overall functioning. In the latter case, the symptoms might be reflective of diagnosis of posttraumatic stress disorder.

There are as well risk factors that can increase vulnerability to PTSD (e.g., childhood adversity and abuse; high stress), risk factors during PTSD (e.g., accumulations of traumatic incidents; lack of social support), and risk factors following PTSD (e.g., financial or relationships strains; physical injuries); and the risk factors can contribute to severity and duration of posttraumatic stress reactions and impact functioning and recovery. Furthermore, the risk factors that contribute to the development of PTSD are not the same risk factors maintaining PTSD.

If the symptoms do not improve over time, and exacerbate over time, in particular over a month, cause more distress or you feel that you have more and more difficulty engaging in your daily activities or responsibilities and/or the symptoms are impacting your overall functioning then you might be suffering from PTSD. In such case, seeking professional from a mental health professional such as a qualified clinical psychologist can be helpful.

What are the symptoms of PTSD?

The Diagnostic and Statistical Manual of Mental Disorders, 5^th edition, DSM-5, (American Psychiatric Association, 2013)[1], defines PTSD and its four clusters of symptoms, including intrusive memories of the trauma, avoidance of trauma related stimuli, negative changes in mood or cognitions, and arousal symptoms.

PTSD symptoms^[2] for adults, adolescents, and children older than six; symptoms must persist for more than one month:

1. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the followings:
   1. Directly experiencing the traumatic event(s).
   2. Witnessing the event occurring to others
   3. Learning that the traumatic event(s) occurred to a loved one such as family member or a close friend; and in such case, the event(s) must have been violent or accidental.
   4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s). For instance, police officers conducting child abuse investigations. The exposure in this category is work related.
2. Intrusion symptoms:
   1. Recurrent, distressing and intrusive memories or images of the traumatic event(s).
   2. Distressing dreams or nightmares related to the traumatic event.
   3. Flashbacks, a sense of reliving the event or acting or feeling as if the event were recurring. Note: children may re-enact the event in their play.
   4. Experiencing psychological distress following any triggers related to the traumatic event or any cues that might resemble the event.
   5. Experiencing physiological reactions following triggers. For instance, heart pounding, sweating, and/or chest pain.
3. Persistent avoidance:
   1. Avoidance of distressing memories, thoughts, or feelings about the trauma.
   2. Avoidance of reminders of the trauma. For instance, location, going out alone, conversations, some people or objects, some materials on TV, and/or activities related to the event. It also not uncommon to engage in safety behaviours such as leaving the house always accompanied; when sitting in public, ensuring the back is against the wall.
4. Negative alterations in cognitions and mood:
   1. Inability to remember certain important aspect of the traumatic event(s).
   2. Exaggerated negative beliefs about self, others or the world. For instance, “I am a failure”, “I am weak”, “I cannot trust anyone”, “the world is completely dangerous no matter where you go or what you do”.
   3. Distorted cognitions about the cause or consequences of the traumatic event. In such case, it leads to either blaming self and/or blaming others. For instance, “it is my fault it happened”, “I should have done this, done that”.
   4. Persistent negative emotions such as feeling constant anxiety, guilt or shame.
   5. Diminished interest in activities or hobbies previously enjoyed
   6. Feeling emotionally numb or emotionally distant or cut off from others. For instance, you know you love your family but feel emotionally distant or numb and have difficulty feeling the love.
   7. Inability to experience positive emotions such as feeling happy or love.
5. Marked alterations in arousal:
   1. Irritable behavior and angry outbursts. It could be either verbal or physical
   2. Reckless or self-destructive behavior. For instance, if alcohol is consumed excessively to reduce distress then that can also be a type of self-destructive behaviour.
   3. For instance, feeling constantly on guard for signs of threat or danger.
   4. Exaggerated startle response. For instance, feeling excessively jumpy at any sound or noise.
   5. Difficulties with concentration, focusing or attention or memory.
   6. Sleep disturbance. For instance, difficulty falling or staying asleep; early morning awakening.

The American Psychological Association (APA)^[2] developed a guideline that provides recommendations on psychological and pharmacological treatments for posttraumatic stress disorder (PTSD) in adults. The guideline is based on recommendations of the Institute of Medicine report, Clinical Practice Guidelines We Can Trust (IOM, 2011).

Among many recommendations, strong recommendations are provided for the following interventions:  cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), cognitive therapy (CT), and prolonged exposure therapy (PE). For pharmacological treatment, there are recommendations for fluoxetine, paroxetine, sertraline, and venlafaxine. There are significant individual differences as well as comorbidities among mental health conditions and comorbidities between mental and physical health conditions. Co-morbidities such as depression, anxiety disorders, substance use disorders, personality disorders, or and/psychosis are common. Thus, a comprehensive assessment to help with a comprehensive case conceptualization and whole person management approach can subsequently help towards optimizing treatment options for each person. It is recommended to always consult with your mental health professional and prescribing physician for any pharmacological treatment that might help concurrent with evidence-based psychological treatment.

Self-care, including for instance, balanced healthy diet, proper sleep hygiene, exercise, seeking quality support, managing thoughts and emotions, setting meaningful and realistic graduated goals, active problem solving, and remaining hopeful are among the many proactive strategies that help towards health, quality of life and well-being.

Where do I go for more information?

More information about PTSD/treatment of PTSD can be found at:

• American Psychiatric Association https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
• Australian Centre for Posttraumatic Mental Health https://www.phoenixaustralia.org/
• International Society for Traumatic Stress Studies (ISTSS) https://istss.org/home
• Institute of Medicine (IOM) of the National Academies of Sciences, Engineering, and Medicine https://www.nationalacademies.org/hmd/about
• United Kingdom’s National Institute for Health and Care Excellence (NICE) https://www.nice.org.uk/
• US Department of Veterans Affairs and Department of Defense (VA, DoD) https://www.healthquality.va.gov/
• World Health Organization (WHO) https://apps.who.int/iris/bitstream/handle/10665/85119/9789241505406_eng.pdf;jsessionid=F8FFF3C6CF9401DDCD81EEA15A16C564?sequence=1
• Global Collaboration on Traumatic Stress – https://www.global-psychotrauma.net/
• Canadian Mental Health Association: http://www.cmha.ca/
• Centre for Addiction and Mental Health (CAMH) https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/posttraumatic-stress-disorder
• National Institute of Mental Health:  http://www.nimh.nih.gov
• Anxiety Disorders Association of Canada, http://www.anxietycanada.ca/
• Society of Clinical Psychology of the American Psychological Association, http://www.apa.org/divisions/div12

Where can I get more information about psychology/psychologists?

Provincial associations of psychology:  https://cpa.ca/public/whatisapsychologist/PTassociations/

Psychology Foundation of Canada: http://www.psychologyfoundation.org

American Psychological Association (APA): http://www.apa.org/helpcenter

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:  https://cpa.ca/public/whatisapsychologist/PTassociations/

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Katy Kamkar, Ph.D., C. Psych, Clinical Psychologist & Chair, Canadian Psychological Association, Traumatic Stress Section.

Date: August 2020

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

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Experiencing Anxiety Related to Climate Change

Climate change is a “long-term change in the average weather patterns that have come to define Earth’s local, regional, and global climates.”[1] Because of the uncertainty and severity of climate change, people are seeking treatment for negative feelings related to climate-related events and the future of our planet.  These negative feelings may include a sense of powerlessness and hopelessness about the current and future state of the natural environment, one’s own quality of life in relation to climate-related events, and about general human health and wellbeing.

What Contributes to Anxiety Related to Climate Change?

Feelings of anxiety about the state of the Earth’s climate can be experienced before, during, and after a climate-related event[2]:

Before a Climate-related Event

Warnings of climate-related events, such as hurricanes, storms, and wildfires, can cause acute worry about personal safety, the safety of loved ones, and/or the safety of homes and other property. Worry may also be experienced when people consider the possibility of impending and serious environmental problems—in the body of environmental psychology literature, this is known as habitual ecological worrying[3]. Individuals experiencing this type of worry may cope better by adopting pro-environmental attitudes and actions. Sometimes this form of worry can become less constructive if it is associated with feelings of loss, helplessness, frustration, and an inability to improve the situation. In the environmental psychology literature, this is known as eco-anxiety.[4]

During a Climate-related Event

Human mental health can be significantly affected during a rapid climate-related event. Victims of these events may quickly and unexpectedly lose property and belongings. Some may also lose family members and friends to disasters caused by climate change. Human mental health can also be impacted by climate-related events that occur gradually over time. For example, those who live in areas of the world where climate change has significantly affected landscapes and livelihoods tend to report a deep sadness, or solastalgia, about environmental change.

After a Climate-related Event

When a loss of friends and family, community, homes and belongings, employment, and economic certainty occurs because of a climate-related event, the results can be far-reaching and long-lasting. Outcomes may include depression, post-traumatic stress disorder (PTSD), grief, despair, aggression, interpersonal difficulties, substance abuse, and even suicide. In some cases, individuals may develop a condition called the climate change delusion,[5] characterized by a belief that one’s actions, no matter how insignificant, will have a serious negative effect on those suffering through climate-related events.

Who is Most Vulnerable?

Gifford and Gifford (2016) reference studies indicating that anxiety related to climate change tends to strongly affect children, older adults, individuals with pre-existing mental health conditions, and people with fewer economic resources. For example:

• Children with anxiety about climate change may experience symptoms such as low mood, anxiety, nightmares, flashbacks, social withdrawal, and difficulty being separated from caregivers. These symptoms have been shown to be more severe in children than adults and may persist later in life.
• Older adults can be more physically vulnerable to changes in the climate around them, and are sometimes less able to employ effective coping mechanisms, such as pro-environmental behaviours, during times of distress.
• People with fewer economic resources may also be more vulnerable to climate-related events as a result of their living conditions, employment conditions or status, a lack of access to resources, goods and services, and inability to engage in pro-active eco-conscious behaviours.
• Individuals living in countries with fewer resources available to protect people against the ramifications of climate-related events may become more severely affected by climate change.

How can Psychologists Help People who are Experiencing Anxiety about Climate Change?

Psychologists have the knowledge and expertise to help people process the negative effects of climate change on mental health, as well as to encourage effective and positive behavior.[6]

Psychological Practice and Services

Although some people may cope with their concerns about climate change by engaging in some form of climate-related activism (e.g., avoiding the use of single-use plastics, recycling, using less water, and so on), others may cope by disengaging or worrying excessively. Psychological therapies can help individuals experiencing anxiety about the climate to gain control over their worries, decrease their anxiety, and improve their overall quality of life. Therapies that can be effective are:

• Cognitive re-evaluation therapy to help correct thinking patterns that cause and increase worry
• Problem-solving training to learn better ways to solve everyday problems
• Exposure therapy to help confront and control, rather than avoid and be controlled by, fear
• Progressive relaxation to help decrease some of the physical symptoms of anxiety.[7]

For children, youth and young adults who have experienced a climate-related event or are experiencing anxiety about the climate, psychologists working in schools, colleges, and universities are available for support in school and academic settings.

Psychological Science

Psychological research can provide answers to existing and emerging climate-related questions. Whether the focus is to change destructive behaviors, like minimizing the use of motor vehicles, or to embrace beneficial actions, like using public transit, psychological research is key to understanding how people think about the environment and economic issues.[8]

Advocacy

Individuals, organizations, and all levels of government have a critical role to play in both understanding and addressing the relationship between climate change, health, the economy, and the behaviour of individuals. Effective responses to climate change will require promoting behavioural change at the individual and collective levels. Environmental psychologists can assist organizations and government in the development of education programs and public policies that overcome the discrepancies between what people understand about climate change and their everyday behaviours related to the environment.[9] For those experiencing anxiety and other mental health issues, appropriate funding for mental health services at all levels of society is important.

Knowledge Mobilization

To increase awareness of climate change as well as promote more responsibility and behaviour change on the part of Canadians, understanding how people process information and make decisions is important. Accurate and consistent information about climate change should be provided to individuals by trusted and knowledgeable organizations in an encouraging manner. Messages should be motivating and focus on the positive outcomes of prevention strategies, rather than be discouraging or frightening.

For More Information:

More information on the intersections between psychology and climate change can be found in these references:

• Gifford, R. (2011). The dragons of inaction: Psychological barriers that limit climate change mitigation and adaptation. American Psychologist 66, 290–302.
• Steg, L., & Vlek, C. (2008). Encouraging pro-environmental behaviour: An integrative review and research agenda. Journal of Environmental Psychology, 29, 309-317.

You can consult a registered psychologist to find out whether psychological interventions might be helpful for you. For the names and locations of provincial and territorial psychological associations, please visit https://cpa.ca/public/whatisapsychologist/PTassociations/

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Lindsay J. McCunn, Vancouver Island University, Mr. Alexander Bjornson, Vancouver Island University, and Dr. Robert Gifford, University of Victoria.

Date: December 1st, 2020

Please contact us with questions or comments about any of the Psychology Works Fact Sheets at factsheets@cpa.ca

Canadian Psychological Association

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

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[1] https://climate.nasa.gov/resources/global-warming-vs-climate-change/

[2] Gifford, E., & Gifford, R. (2016). The largely unacknowledged impact of climate change on mental health. Bulletin of the Atomic Scientists, 72, 292-297.

[3] Verplanken, B., & D. Roy. (2013). ““My worries are rational, climate change is not”: Habitual ecological worrying is an adaptive response.” PLoS ONE, 8 (9), e74708.

[4] Rabinowitz, P. M., & A. Poljak. (2003). “Host-environment medicine: A primary care model for the age of genomics.” Journal of General Internal Medicine, 18 (3), 222–227.

[5] National Wildlife Federation. (2011). The psychological effects of global warming on the United States and why the U.S. mental health care system is not adequately prepared. National Forum and Research Report, February 2012. https://www.nwf.org/pdf/Reports/ Psych_Effects_Climate_Change_Full_3_23.pdf.

[6] https://www.theguardian.com/environment/2020/oct/08/anxiety-climate-crisis-trauma-paralysing-effect-psychologists

[7] https://cpa.ca/docs/File/Publications/FactSheets/PsychologyWorksFactSheet_GeneralizedAnxietyDisorder.pdf

[8] https://cpa.ca/docs/File/Government%20Relations/Canadian%20Psychological%20Association’s%202020%20Pre-Budget%20Submission.pdf

[9] https://cpa.ca/docs/File/Government%20Relations/Canadian%20Psychological%20Association’s%202020%20Pre-Budget%20Submission.pdf

What are the symptoms of depression in older adulthood?

The Canadian Psychological Association’s fact sheet on Depression lists the symptoms of depression. These symptoms also identify depression in older adults. Symptoms typically manifested by older adults suffering from depression include loss of energy, decreased interest and pleasure in usual activities, pain and somatic complaints, and complaints of memory problems.

Who is affected?

Depression should not be seen as the unavoidable fate of older age. Still a number of seniors experience depression. On the one hand, the rate of major depression in older adults is relatively low, touching 3-5% of older adults aged 65 and over living in the community. On the other hand, the prevalence of symptoms of depression in this population is significantly higher, with about 15% of older persons in the community reporting significant levels of depressive symptoms

Some subgroups of older adults present a higher risk for depression, in particular individuals afflicted by chronic disease, older adults living in long-term care and nursing homes, and those providing care for a family member (e.g., to a partner suffering from dementia).

What are the other problems associated with depression?

Depression increases the risk of death in older adults by 2 to 3 times. Depression constitutes the most important factor associated with risk of suicide in old age.

Depression amplifies the functional disabilities produced by physical illness, interferes with treatment and rehabilitation, and further contributes to decline in physical and cognitive functioning.

Why is depression often missed and/or under-treated among seniors?

Depression can be hard to detect in older adults for several reasons. Older adults are often reluctant to admit to psychological symptoms or difficulties and are more likely to communicate their psychological distress by complaining of physical symptoms. Several symptoms of depression (e.g. sleep problems, feeling fatigued, and lack of energy) also naturally occur in older adulthood; as such, in some cases these symptoms may be mis-attributed to normal aging rather than depression. Also, the myth that it is normal for older adults to feel some amount of depression may result in true cases of clinical depression being overlooked.

What are the causes of depression in later life?

A history of depression in earlier adult life is a risk factor for depression in later adulthood. Chronic health problems and the loss of spouse, especially for men, can be associated with depression. Major depression may also occur after experiencing a cerebrovascular accident (stroke).

Factors such as loss of control and independence as the result of illness and/or disability, loneliness, and lack of social support can also lead to depression in older age.

What psychological approaches are useful to treat depression among seniors?

Several psychological treatments for depression used with young and middle-aged adults are also effective with older adults. In particular, cognitive behaviour therapy, interpersonal therapy, problem- solving therapy and reminiscence therapy are treatments whose efficacy is supported by empirical research.

Cognitive-behaviour therapy helps individuals with depression become aware of how thoughts influence mood and behaviour and learn to correct negative ways of thinking in order to alleviate depression.

Interpersonal therapy helps the depressed person cope with current stresses and challenges in interpersonal relationships – in particular in the context of conflicts, grief and bereavement, changes in roles, and social support.

Problem-solving therapy helps individuals with depression develop effective problem-solving skills to cope with current difficulties, such as managing a health condition or adjusting to living in a nursing home.

Reminiscence therapy helps individuals with depression re-evaluate personal memories in order to rediscover a sense of worth and life coherence and meaning.

These psychological treatments are safe and effective alternatives to medications, with combined drug and psychological treatment often used for complex cases.

Psychological treatments can be particular useful for people who are unable to, or unwilling, to take antidepressant medications.

Where do I go for more information?

More information on depression in older adults, including more detailed descriptions of psychological treatments and other supports, can be found in the National Guidelines for Seniors’ Mental Health: The Assessment and Treatment of Depression, Canadian Coalition for Seniors’ Mental Health (2006).

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. Philippe Cappeliez, Emeritus Professor, School of Psychology, University of Ottawa.

Revised: March 2020

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