“Psychology Works” Fact Sheet: Perfectionism

What is perfectionism?

Perfectionism is a multidimensional personality style that is associated with a large number of psychological, interpersonal, and achievement-related difficulties.

It is not a disorder but a vulnerability factor that produces problems for children, adolescents, and adults. People often confuse perfectionism with achievement striving or conscientiousness.

Perfectionism is distinct from these attitudes. It is a maladaptive pattern of behaviours that can result in a large number of problems. Achievement striving and conscientiousness involve appropriate and tangible expectations (often very difficult but attainable goals) and produce a sense of satisfaction and rewards.

Perfectionism, on the other hand, involves inappropriate levels of expectations and intangible goals (i.e. perfection) and a constant lack of satisfaction, irrespective of performance.

Perfectionism is a chronic source of stress, often leaving people feeling like failures even when other people see them as successful. Perfectionistic individuals require themselves to be perfect. This constant expectation is a source of stress and pressure and contributes to maladaptive ways of coping.

Dimensions of Perfectionism

Perfectionism involves three major components: perfectionism traits, perfectionistic interpersonal behaviours and perfectionistic thoughts concerning mistakes, expectations, failures, and self-criticism.

Perfectionism traits are enduring personality characteristics that reflect the need to be perfect:

  • Self-oriented perfectionism is the requirement for the self to be perfect.
  • Other-oriented perfectionism is the requirement that others (e.g., spouse, children, and other people in general) should be perfect.
  • Socially prescribed perfectionism is the perception that others (e.g., parents, boss, and other people in general) require oneself to be perfect.

Perfectionistic behaviours involve the need to appear or seem perfect to others:

  • Perfectionistic self-promotion involves the presentation of a perfect self-image to others.
  • Nondisplay of imperfection involves the avoidance or concealment of any behaviour that could be judged by others as imperfect.
  • Nondisclosure of imperfection involves the avoidance of verbally disclosing imperfections to others.

Finally, individuals with perfectionism will often engage in negative thoughts centered around the need to be or appear perfect and with harsh self-criticism, worry over errors, and self-blame.

Problems associated with Perfectionism

Individuals with these perfectionistic traits, behaviours and thoughts can experience a variety of negative outcomes. These problems can be found with perfectionistic children, adolescents, and adults. Here are some problems that have been found to be associated with perfectionism:

Psychological/Psychiatric Problems

  • Anorexia nervosa, anxiety, binge eating and bulimic disorders, depression, suicide thoughts and attempts.

Relationship Problems

  • Low self-compassion and the tendency to feel responsible for fulfilling others’ needs at the expense of one’s own, poor marital satisfaction, sexual dissatisfaction, and excessive anger towards others, social disconnection, difficulties with intimacy, loneliness, and social hopelessness (i.e. having negative expectations concerning future relationships).

Physical Health Problems

  • Prolonged elevations in stress responses, sleep problems, chronic headaches, cardio-vascular responses, and early death.

Achievement Problems

  • Workaholism, burnout, fear of failure, procrastination and self-handicapping (i.e. where individuals spend time finding excuses for poor performance rather than preparing for a performance).

Treatment Problems

  • Negative attitudes toward seeking help with professionals, difficulties in self-disclosing personal information which negatively impacts treatment, not being able to engage in treatment.

How can psychology help?

Because perfectionism is an ingrained personality style, psychotherapy is very appropriate and often tends to be fairly intensive and longer term (often more than a year).

Recent research has demonstrated the effectiveness of both group and individual therapy for treating perfectionism and its associated complications. There has been promising evidence for dynamic-relational group therapy, psychodynamic/interpersonal group therapy and cognitive-behavioural group and individual therapy in reducing perfectionism and its attendant difficulties.

Several Canadian studies are currently underway that focus on both fine-tuning current treatment approaches and evaluating the effectiveness of these treatments in children, adolescents and adults.

Where do I go for more information on Perfectionism?

For more information visit the following:

  • The Perfectionism and Psychopathology Lab at Hewitt Lab FAQs – https://hewittlab.psych.ubc.ca/faq-2/.
  • Hewitt, P. L., Flett, G. L., & Mikail, S. F. (2017) Perfectionism: A relational approach to conceptualization, assessment, and treatment. New York: Guilford
  • Greenspon, T. (2002) Feeing our families from perfectionism. Minneapolis: Free Spirit.
  • Egan, Sarah J., Tracey D. Wade, Roz Shafran, and Martin M. Antony. Cognitive-behavioral treatment of perfectionism. Guilford Publications, 2016.

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 Dr. Paul L. Hewitt, Ms. Sabrina Ge from the University of British Columbia and Dr. Gordon L. Flett, York University.

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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
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“Psychology Works” Fact Sheet: Racism

What is Racism? What Can We Do to Address it?

Racism is a combination of stereotypical thinking, negative and hateful emotions, and discriminatory acts targeting individuals or groups of individuals who are regarded as being inherently inferior, somewhat socially deviant, and deserving of inferior status in society. While all humans have the capacity to hold stereotypes and prejudices towards other groups, racism becomes a serious problem when one group or its individual members have the power to act on these views and evaluations of others.

  • Racism is a complex of social categorization and a system of behaviours that are deeply rooted in histories of colonization and slavery. The construction of a racial hierarchy by colonial powers continues to persist in creating advantages for those with power in maintaining their social, economic, and political dominance.
  • The groups which become the recipients of racism typically have distinct physical characteristics such as skin colour, facial features, and body types. Historically, these groups in North America and other Western countries tend to be people who have darker skin tone, are a minority, and are socio-economically disadvantaged (e.g., Black, Indigenous, and People of Colour (BIPOC). In this fact sheet we will focus on racism, but we recognize that racism exists in combination with sexism, homophobia and transphobia, classism, ableism, etc.

Individual Racism refers to internalized racism that resides within the person. Examples include anti-Black, anti-Indigenous, and anti-Asian sentiments, words, and actions. Believing that some groups are inherently inferior to others is an example of individual racism. People may endorse racism overtly or in more subtle ways.

Systemic Racism refers to the unfair practices and unequal treatment of the affected groups either as a result of institutional legitimization or by way of general consensus and long-standing informal practices among the majority and privileged groups. Systemic racism in North America provides a foundation for White Supremacy that allows oppression and exploitation of racialized minorities. Historical examples of systemic racism in Canada include:

  • 200 years of slavery from the 17th to the 19th centuries where Black and Indigenous peoples were the primary enslaved peoples.
  • Indian Act in 1876 essentially made Indigenous Peoples wards of the state. In 1894-1996 Canadian policy required Indigenous children to be taken away from their families and placed in residential schools run by Christian priests and nuns. These children were forced to abandon their cultural practices including their language.
  • 1885 Chinese Immigration Act required Chinese immigrants to pay a very high tax for coming to Canada while European immigrants were not required to pay this tax.

There is a tendency to frame racism as an issue of “good” people versus “bad” people, which often leads White people to seek to position themselves as “good” since they believe themselves to have good intentions, and therefore cannot be racist. This creates a pattern of avoiding being able to look at one’s own racist attitudes and behaviours. As such, BIPOC individuals can be met with an intensely defensive, and at times aggressive response, denying the racist behaviour. This dynamic serves to maintain White supremacy by silencing BIPOC individuals’ expressions of their experiences of racism.

What is the Psychology of Racism?

Racism is comprised of i) Social stereotypes; generalized thoughts, ii) Prejudice; negative attitudes and negative emotions, and iii) Discrimination; unfair and unequal actions against individuals due to their group membership.

Social Stereotypes and Biases in Judgements

  • It is a fundamental property of the human mind to divide the social world into the categories of similar-to-me (In-group) and not-similar-to- me (outgroup). This perception of similarity and dissimilarity with others may be based on clearly noticeable criteria such as the skin colour, gender, age, language, or they may be based on criteria not so clearly visible such as one’s belief systems, religion, culture, or ethnicity.
  • Due to familiarity and frequency of interactions with one’s ingroup members, one can identify and distinguish one’s ingroup members with relative ease. In contrast, the relative low familiarity with outgroup members is associated with the tendency to perceive and judge the outgroup as a whole. The result is Social Stereotypes or generalized thoughts about outgroups such as “natives are alcoholics” or “blacks are criminals”.
  • The tendency to perceive an outgroup as a whole is associated with the “They all look alike” effect. This may partially explain why police officers may make errors in identifying individuals from their unfamiliar “outgroups”. When this judgement error occurs within the context of systemic racism, more severe negative consequences can result, such as the police officer not only apprehending the wrong individual but also quickly meting out brutality against this individual if they happen to be from a BIPOC group.
  • Implicit Bias refers to having a stereotypical view of a category of people without having a conscious awareness of it. However, some circumstances can trigger them without the individual’s conscious awareness, which in turn may trigger a biased behavioural response. This may include an unintended racial slur or unintended unfair treatment of the individuals from the BIPOC groups.

Prejudice and Feelings of Hate

  • When negative stereotypes of a category of people are accompanied by negative attitudes and emotions such as anger, hate, irritability, and fear, it takes the form of prejudice.
  • Prejudice can be reflected in the feeling of discomfort, irritability, anger, pity and disgust towards members of racialized, ethnic, and cultural minority groups and avoiding associating with them. Yet there may be a denial of conscious awareness of this emotionally negative attitude.
  • Prejudice can also be paternalistic, condescending, and prescriptive; e.g., “You should be caring and kind. You are a Filipino”, or “You should do well on math. You are Chinese”.
  • When minority individuals do well and follow rules, they are viewed without prejudice. However, when minority individuals deviate from the norm, violate a law, perform below expectations, or give a negative feedback or assessment, the reaction from the privileged group member can be swifter and harsher. For example, if a Black professor gives good grades and favourable comments to students, they are viewed on par with a colleague from a White-European majority. However, if both professors give low grades and negative feedback to students, the Black professor is likely to receive far more harsh evaluation from their students compared to their White-European colleague.
  • Prejudice is reciprocal. That is, if one person dislikes or discriminates against another person, these attitudes and behaviours are returned. Those who express prejudice and engage in discriminatory practices cannot expect to be liked or accepted by those who are excluded. Hence, those individuals who are routinely excluded by systemic or individual prejudice are likely to retaliate against those who are the sources of such prejudice.

Discrimination: Unfair and Unequal Treatment

  • Discrimination is the behaviour of treating individuals differently, and to their disadvantage, based on their group membership.
  • Discriminatory acts can have serious impacts such as a physician who spends less time with a member of a racialized minority group or dismisses or misinterprets the seriousness of their symptoms and refuses due care. This act of discrimination may or may not be intentional, but the consequences can be serious.
  • Discrimination may be subtle and often non-verbal. For example, a bank teller may greet their ingroup members with extra courtesy, an extra smile, and may offer extra help, but may remain very formal and task-focused without offering any informal or personal courtesy to the member of the racialized minority group. Other examples include half-hearted or neglected greetings, showing signs of lack of interest while interacting, or not offering help when clearly needed, being quick in pointing out minor violation of some norms in a loud voice, (e.g., “Hey, you can’t sit there. It is for seniors only”).
  • Discriminatory practices are commonly found in employment settings. It may start with the preference for selecting candidates from the privileged groups for jobs, so fewer members of racialized minorities are called in for interviews. During the interview, discrimination is evident in behaviours such as spending less time on the interview processes and showing signs of discomfort or a lack of interest. Also, the racialized minority candidate may be offered a lower start-up salary. Discrimination may continue in the form of biased performance evaluations and not offering promotion despite one’s credentials. This highlights the importance of power differentials between groups. In other words, negative evaluations of others happen when one group is able to act on their negative stereotypes and prejudice towards another group.
  • The result is a “vertical mosaic” whereby at the top jobs in most organizations, we see individuals from the privileged group, notably from White-European background. At the bottom of the employment hierarchy; the low paying manual labor jobs such as cleaning and dish washing, we see an overrepresentation of racialized minority groups. This leads to economic disparity. For example, in 2016, more Black Canadians were unemployed compared to Canadians who were not visible minorities (12.5% vs. 7.3%). Also, the average income of Black Canadians was significantly lower than average income of Canadians who were not visible minorities ($35,310 vs. $50,225).
  • Discrimination is also reflected in the judicial and foster care systems. While Indigenous peoples make up only 3.8% of the total population, 23.2% of all people incarcerated in prison and 52% of children in care are Indigenous.
  • Experience of discrimination negatively impacts one’s physical and mental health. There is consistent and strong evidence that self-reported racism is associated with negative outcomes for physical health such as high blood pressure, heart disease, and obesity. It is also evident in increased mental illnesses such as depression, anxiety, distress, and substance abuse. The negative impact of racism on physical and mental health have been found amongst men and women of all ethnic groups including Blacks, Indigenous, Latinos, Asians, and Whites for all age groups (i.e., adolescents, university students, and adults).

How Do We Learn to Live Together Without Racism?

The approach to changing individual and systemic racism must be both at the individual level, and at the government, legal, and policy level.

  • Racism, if not checked has the potential to escalate. Genocides for example, do not occur overnight. Hence it is important to confront racism at its slightest and subtlest expression, in person or in social media. Signs and symbols of racially motivated oppression and harassments on smaller scales such as pranks, vandalism, racial slurs, and racial jokes must be confronted and addressed right away. Individuals for example, may confront their friends and relatives, and respond to negative social media posts by them.
  • The burden of bringing awareness and preventing hateful acts of prejudice and discrimination should not be solely on the shoulders of the racialized minority groups. Those who have the power and resources to help reduce prejudice and discrimination must step forward to become partners in making change. This will also establish the basis for trust between majority and minority groups, which will nurture racialized minority groups’ willingness to work with majority partners. It is crucial for both majority and minority groups to work together to bring about social transformation.
  • The psychological principle that familiarity and similarity lead to liking may be implemented by creating opportunities for people to increase interactions with the dissimilar “others”. This would allow them to find core similarities to enhance a sense of overall familiarity while understanding cultural differences. Education strategies including lesson plans for young children may include a focus on exploring similarities and understanding and appreciating differences among children.
  • Community activities and events must be inclusive of ALL cultural groups at all levels (organization, representation, participation). They must include majority and privileged community members alongside racial minority groups. Community programs should target fostering meaningful interactions and cooperation between privileged majority groups and racialized minority groups to reach a common goal.
  • Contact between individuals of different backgrounds has been shown to improve mutual acceptance. However, such contact is likely to be more effective when contact is voluntary; is among individuals of roughly equal status; and when it is supported by promoting inclusion and limiting discrimination. These conditions need to be put in place by enacting public policies and programs.
  • All social institutions (government, healthcare, education, family, etc.) need to recognize and actively commit to dismantling racist policies and behaviours. Measures and actions need to be put into place which favour equity, diversity and inclusiveness. This is achieved through several processes: (1) continuous education, training, and discussion; (2) holding ourselves accountable to prevent racism from being committed, as well as addressing racism when it is committed; and (3) organizing our institutions in a way that inherently favours diversity and social justice.
  • We must support policies and programs that promote the acceptance of people for who they are, and what matters most to them such as their cultural heritage, and religion.
  • Holding ourselves accountable for the ways that society has been structured to advantage White people, and for the racist actions at both individual and institutional levels, will enable social change towards living together without racism.

Where do I go for more information?

This fact sheet has been prepared for the Canadian Psychological Association by Gira Bhatt (Kwantlen Polytechnic University), Saba Safdar (University of Guelph), John Berry (Queen’s University), Maya Yampolsky (Université Laval), and Randal Tonks (Camosun College).

Date: August 10, 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
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“Psychology Works” Fact Sheet: Why Does Culture Matter to COVID-19?

Pandemics are complex dynamic systems that shift and change over time due to the influence of a huge and interacting set of variables. Cultural contexts, although they tend to change more slowly, are similarly complex. Research on cultural processes unfolding under pandemic conditions is therefore fraught with uncertainty. Nonetheless, thanks to research conducted during and after previous disease outbreaks combined with the first studies rapidly assembled in the first months of the current pandemic, we are in a position to make some initial evidence-based claims as cultural and cross-cultural psychologists.

Contemporary cultural / cross-cultural psychology rejects the idea that biology and culture are opposed. The SARS-CoV-2 virus is straightforwardly biological, as is the associated disease, COVID-19. Nonetheless, the cultural context shapes the ways in which people engage with this threat, affecting everything from pre-existing health status (and hence, vulnerability) and living conditions to how people react to the threat of the virus and to the measures being taken to combat it.

During the COVID-19 pandemic, we have already observed cultural variations in:

  • Pre-virus readiness for pandemics and other disasters
  • Transmission rates
  • Behavioural responses (e.g., mask-wearing, handwashing)
  • Official policies (e.g., “social distancing”)
  • Compliance with official policies

While our biological immune system is critical when we are infected with a virus, our behavioural immune system helps protect us from getting infected in the first place. It does so by helping us to detect pathogen cues and then to trigger relevant emotional and behavioural responses to these cues. Many aspects of this system are shaped by the local cultural context.

Indeed, some aspects of culture itself may have been shaped by variations in historical levels of infectious disease risk, leading to longstanding differences between cultural groups. For example, cultural groups with a high historical prevalence of pathogens tend to show lower levels of social gregariousness and greater concern about outgroup members.

We can understand the links between cultural context and COVID-19 at three levels: 1) macro-level of whole societies; 2) meso-level of families and communities; and 3) micro-level of individual people.

Macro-level of Whole Societies

Societies differ in numerous demographic ways relevant to COVID-19. For example, societies differ in terms of the strength of the economy, development of the healthcare system, urban population density, and degree of emergency preparedness.

These structural differences are shaped by longstanding cultural tendencies. For example, we would expect societies characterized by widespread valuation of a long-term time horizon to emphasize preparedness as compared with societies focused more on short-term concerns.

Political polarization can also lower trust, leading people to prefer advice from politically motivated sources and/or advice that fits with political preconceptions. Structural discrimination against certain ethnocultural groups can also compromise trust. There is an added concern that such polarization can lead different segments of society to act in conflict with each other rather than in pursuit of common goals.

Societies also differ in cultural patterns of values and behaviour. The extent to which people in a given society move between different locations, or geographical mobility, is associated with a set of skills that facilitate frequent shifts between different social networks, or relational mobility. Recent research has shown that the transmission rate during the 30 days after the first case of COVID-19 is correlated with societal levels of relational mobility. It appears that one problem with mobile societies is increased ease of transmission across geographical and social distances.

The extent to which people in a given society adhere closely to rules or look for opportunities to violate such rules can be understood as a distinction between tightness and looseness. Tighter societies are more likely to accept behavioural constraints. Particular advantages may accrue to societies able to maintain tight-loose ambidexterity: tight norms with sufficient looseness to promote ‘outside-the-box thinking’. This combination of self-restraint and creativity might be very helpful in pandemic situations, as both are needed.

Meso-Level of Families and Communities

Normative behavioural patterns in particular social networks can affect the transmission both of (a) an infectious disease and (b) ideas about the disease. Whereas the former requires study of how a virus propagates within and between bodies (e.g., increased contagion of a virus that survives for a long time on surfaces), the latter requires study of how ideas propagate within and between minds (e.g., increased believability of an idea frequently repeated by a source deemed credible).

Social networks accelerate transmission of harmful and helpful ideas about a given disease and what one ought to do about it. Such transmission can take place through conversation or observational learning, but also through traditional news sources or social media. Social capital, or the value that comes from our social networks and connections, varies across families and communities. Whereas a focus on strengthening intra-group connections (high bonding capital) would keep the virus in the local bubble, a focus on strengthening inter-group connections (high bridging capital) would allow the virus to be transmitted more widely.

The centrality of social connectedness in many communities is reflected through participation in communal events, which may feel obligatory (e.g., festivals, weddings, funerals). Emotional expressivity in certain communities may be associated with close talking, handshakes, kissing, loud exclamations, and so on. All of this is conducive to droplet projection, which further propagates the virus.

Measures taken to combat pandemic spread are also received differently depending on local characteristics. For example, families and communities differ in their acceptance of hierarchy—and hence, compliance with authority. One complicating question is who is a legitimate source of authority: do people look to public health officials, family members, religious leaders, or celebrities? Moreover, public health officials may require measures that directly contradict local imperatives; impeding appropriate burial of the dead, for example, can be emotionally charged.

Given that outbreaks of disease are associated with high levels of anxiety and uncertainty, the potential for increased intergroup tensions should not be underestimated. There is evidence that disease risk increases prejudice and discrimination against:

  • Outgroups that are disfavoured in general (e.g., visible minorities, Indigenous people, the poor and especially the homeless);
  • Outgroups that are specifically associated with the source of transmission of a given disease (e.g., East Asian Canadians, in the case of COVID-19);
  • Outgroup and even ingroup members that by vocation or circumstance have a higher degree of exposure to the disease (e.g., grocery store workers, healthcare workers—although in the latter case, there are also positive views).

Stigma has consequences, including stress/distress, barriers to effective healthcare, mistrust, distortion of public risk perceptions, hate speech/crimes, and other forms of marginalization. These consequences can further disease spread (e.g., stress weakens the immune system while healthcare barriers delay treatment).

Disfavoured groups, moreover, are at additional risk due to social inequalities. For example, certain minority groups are more likely to be found in jobs that involve high contact but low compensation. Disfavored groups can show ‘cultural mistrust’, understandable but problematic apprehension around official social structures (e.g., government, media, law enforcement, formal healthcare). Economic disadvantage is associated with higher likelihood of pre-existing health conditions that in turn appear to increase COVID-19 risks. For example, this combination of health vulnerabilities and reduced healthcare access is endemic to indigenous communities.

Importantly, stigma goes beyond disfavoured groups and can include people who are also being celebrated for their important role in fighting pandemics (i.e., healthcare workers). Fear of healthcare workers and their potential to spread disease may interact with cultural beliefs about health and illness. If pre-existing negative views about healthcare workers or conspiratorial beliefs that incorporate them are widespread in a given community, the problem increases. At the same time, these kinds of incidents have been reported for many diseases, including COVID-19, across a range of cultural settings, suggesting a degree of universality.

Micro-Level of Individual Psychology

People’s behaviours are based in their beliefs, the behaviours they observe in others (and interpret in light of their beliefs), and the behaviours they believe others expect of them. What a person believes and how they behave is strongly shaped by their cultural context. Individual differences that may in part be rooted in temperament—for example, in attention to health, hygiene, comfort with isolation, tendency to stay home when sick, and so on—are further shaped by local norms.

The tendency towards optimism versus pessimism is a good and relevant example of a dispositional trait that is shaped by cultural context. There is now considerable evidence suggesting that people living in East-Asian cultural contexts tend to hold a cyclical view in which positive and negative experiences tend to oscillate and balance out over time. In other words, a run of good fortune means that one’s luck will soon run out, but also vice versa. People living in Euro-American cultural contexts, by contrast, have a more linear view in which recent past and present experiences predict future experiences.

We can understand a long period of time without a serious pandemic as a run of good fortune, in which case we might expect cultural variations in whether we would expect people to respond with increased or decreased preparation for a future pandemic. In research conducted after the 2002 SARS outbreak, defensive pessimism was associated with traditional Chinese values and predicted increased anxiety about infection but also more consistent health behaviours, such as hand-washing. Unrealistic optimism, in contrast, predicted perceived imperviousness to infection, leading to better mood but also to lower intention to wash hands.

Tendency towards optimism versus pessimism is part of a cluster of personality traits that all share commonality with negative affectivity. Other examples include anxiety sensitivity and intolerance of uncertainty. Although negative affectivity emerges as an independent personality domain across a wide range of different cultural contexts, there is marked cultural variation in the extent to which negative affectivity is tolerated or minimized. Negative affectivity is associated with risk perception, leading to more distress but also more willingness to take recommended precautions.

Negative affectivity is also associated directly with the likelihood of symptom-like experiences. Anxiety about one’s health leads to increases in self-monitoring for signs of illness; moreover, anxiety itself can generate physiological reactions that might be mistaken for such signs. For example, increased anxiety can be accompanied by increased heart-rate, sweaty palms, trembling, shortness of breath, and so on, all of which could look like signs of illness. Note that some migrants and minority group members might already have elevated anxiety and uncertainty.

Experiences that might be mistaken for disease can thus be produced by a combination of:

  • Ideas about pandemic disease symptoms circulating in a given community;
  • Culturally-shaped tendencies to monitor particular bodily sensations; and
  • Individual differences in negative affectivity.

Moreover, the very fact of paying attention to certain sensations can make them more salient. In some cases, the concern that one might have caught a dangerous disease can generate further anxiety, thus worsening these sensations. These kinds of feedback loops could lead to intra- and inter-group differences in the symptoms that are discussed and expressed.

Conclusion: What Should We Do?

The struggle against COVID-19, will require the ingenuity of biological scientists across a variety of disciplines. Nonetheless, the potential contributions of the behavioural and social sciences should not be underestimated. The pandemic, along with the measures taken to combat it, is shaped in important ways by culture. What, then, are the implications?

An unprecedented number of people worldwide are concerned about the same disease and are experiencing broadly the same distancing measures. As such, there may be a temptation to focus on the similarities. At a minimum, policy-makers, healthcare workers, and the public at large should keep in mind that the pandemic experience may be very different for different people. These differences are shaped by the society in which one lives, the communities of which one is a part, and culturally-shaped individual variations. Complicating matters, appreciation for difference does not mean treating all responses equally when it comes to effectively mitigating a pandemic. Clearly, some cultural patterns are more effective than others.

Nonetheless, understanding that people have reasons for their beliefs and actions is important. Such understanding can help combat stigmatizing attitudes and better tailor strategies to work with different cultural communities. For example, public health officials and other policy-makers might work with religious leaders to spread information about the need to rethink traditional public celebrations. Debunking false information once it has taken hold is extremely difficult. Cultural understanding can help in developing strategies to ‘prebunk’ these ideas: combating this information in advance, in ways acceptable to the target population.

Clinicians, meanwhile, are now practicing in very different ways compared to earlier this year. There has been a major uptake of online service delivery methods, some of which may continue into the foreseeable future. Nonetheless, even when a client is alone on a screen, it is important to keep in mind the web of influences around them. Clients may hold very different culturally-shaped beliefs about the pandemic, different from each other and also different from the clinician.

At the same time, cultural traditions can be a source of resilience, as sources of wisdom about how to make sense of and prepare for uncertainty for example. We should remember, moreover, that interventions are not limited to majority-culture healthcare workers and minority patients. The people on the front-line represent many different cultural groups. As with clients, this can mean specific, underappreciated stressors for minority group healthcare workers—but also potential access to a wider range of cultural resources.

Regardless of whether one is focusing on the laypeople or officials, patients or healthcare workers, we believe it important to be wary of claims that people from a given cultural background will therefore act in a predictable way. Such an approach can inadvertently promote stereotypes, a notable danger during a time of heightened anxieties. The complexities of research in a rapidly changing pandemic context further bolster the argument for caution. Yet, a rapidly shifting landscape fraught with cultural anxieties demands an evidence-based, culturally-attuned approach, and one that can be communicated quickly and effectively.

For cultural and cross-cultural psychologists, the overall message is clear:

  • Culture is integral to understanding societal, community, family, and individual responses to pandemics;
  • Keeping culture in mind leads to much more nuanced and effective responses to individual circumstances.

We expect many more findings to flesh out this overall message over the next several years. Nonetheless, we have every reason for confidence that such findings will serve to confirm and reinforce these core ideas.

Where do I go for more information?

To obtain  important and up to date information about COVID-19, visit the Public Health Agency of Canada (PHAC) website at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

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 Andrew G. Ryder, Associate Professor, Concordia University, Jewish General Hospital; John Berry, Professor Emeritus, Queen’s University; Saba Safdar, Professor, University of Guelph; and Maya Yampolsky, Assistant Professor, Université Laval.

Date: May 27, 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Phobias

What is a phobia?

A phobia is an excessive and persistent fear of a situation (e.g., enclosed places, driving, flying, seeing blood, heights) or an object (e.g., animals such as rats, snakes, spiders, dogs, or birds).

The focus of an individual’s fear is generally anticipated harm or danger related to the situation or object (e.g., having an accident while driving, being bitten by a dog) or fear of losing control and having anxiety-related physical sensations (e.g., panicking in an enclosed place, fainting upon seeing blood).

The fear is considered excessive because it is out of proportion to the actual level of danger associated with the situation. When an individual with a phobia is exposed to the feared stimulus (the object or the situation) or related cues (things that remind us of the object or situation), an immediate anxiety response is triggered that can sometimes grow into a full-blown panic attack. Consequently, people with phobias either avoid the feared situations or objects or they endure them with a lot of distress.

For example, an individual with a phobia of snakes experiences an anxiety reaction in a number of situations including seeing a snake on television, being outside in grassy or wooded areas where snakes may live, and seeing things that resemble a snake such as a coiled garden hose in the yard.

Phobias are quite common and occur in almost one in every 10 Canadians. There are four main types of phobias: animal type (e.g., spiders, dogs, and rodents), natural environment type (e.g., storms, heights, and water), blood-injection-injury type (e.g., seeing blood, getting a needle, having a medical procedure), and situational type (e.g., enclosed places, flying, driving). Phobias that do not fit into these four categories fall into a fifth category referred to as “other type” (e.g., fears of choking or vomiting). The most common phobias are those of animals and heights.

Blood-injection-injury and animal phobias typically begin in early childhood whereas situational and natural environment phobias begin later, usually in the late teens and 20s. Approximately 75% of individuals with a blood-injection-injury phobia report a history of fainting in response to the phobic stimulus.

These features of phobias are outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, (American Psychiatric Association, 2013):

  • Significant fear or anxiety about a specific object or situation (in children, this may be expressed through tearfulness, tantrums, clinging, or freezing);
  • The phobic stimulus nearly always triggers immediate fear or anxiety;
  • The phobic stimulus is avoided or endured with intense distress;
  • The fear or anxiety is excessive or out of proportion to the actual danger posed by the phobic stimulus;
  • The fear, anxiety, or related avoidance typically lasts for at least 6 months;
  • The fear, anxiety, or related avoidance causes significant distress to the individual or interferes with their daily social, occupational, and/or other important activities.

Phobias have a strong effect on a person’s life. They cause a lot of distress and can make it very difficult to function normally in social situations, at work, or in other domains.

For example, an individual with a snake phobia may avoid pleasant activities such as gardening, nature walks, camping or playing a game in a field. A person with a height phobia may not take a job in an office on a high floor of an office tower. A person with a flying phobia may turn down a promotion because the new position requires flying to meetings across the country. An individual with a phobia of needles or medical procedures may avoid necessary treatments or routine blood tests because of their phobia, putting their health at risk.

Although many phobias are triggered by experiencing a traumatic event in the phobic situation (e.g., getting stuck in an elevator or having a panic attack while flying), a number of individuals do not remember a specific time or event that caused their fear and report a more gradual development.

Thus, there are a number of ways to develop a phobia, including direct learning (having a traumatic experience with the phobic object or situation), vicarious learning (seeing someone else being frightened of the phobic object or situation ), and informational transmission (hearing about a scary event through the media or a family member or being told that a specific object or situation is dangerous).

We are more likely to develop fears of some objects and situations than others. For example, it is much easier to develop a fear of a snake than a flower. In fact, our fear of snakes may have helped us to survive over the centuries. Our own unique personality factors (such as a disgust reaction to certain stimuli) and our stress levels at the time of a traumatic event can also lead to the development of a phobia.

What psychological approaches are used to treat phobias?

The treatment of choice for specific phobias is cognitive behaviour therapy (CBT).

It focuses on slowly and safely exposing a person to their feared object or situation. This is called an exposure-based treatment because it involves repeatedly approaching the target of one’s fear until it no longer produces a strong fear reaction.

Many studies have shown that exposure-based CBT is highly effective for the treatment of specific phobias.

In fact, specific phobias are considered to be the most treatable of the anxiety disorders. Most people with a phobia can achieve significant improvement or full recovery in as few as one to five sessions. This form of treatment has been used for adults, adolescents, and children.

CBT has been found to be effective when administered in a self-help book format as well. Recent developments in treatment have used virtual reality to assist in exposure to situations that are difficult to replicate, such as flying and heights.

Generally, medications are not considered effective for the treatment of specific phobias. However, it is not uncommon for individuals with phobias to be prescribed low doses of benzodiazepines (anti-anxiety medication) to be taken in the phobic situation (e.g., when flying). Although this will not eliminate the fear, it allows the person to function in the situation.

Where do I go for more information?

For more information on phobias visit 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, click http://www.cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet was prepared for the Canadian Psychological Association by Dr. Randi E. McCabe, Clinical Director of the Mood, Anxiety, and Seniors Mental Health Services at St. Joseph’s Healthcare Hamilton and Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University, and updated by Dr. Irena Milosevic, Clinical Psychologist at St. Joseph’s Healthcare Hamilton and Assistant Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University.

Revised: May 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Grief, Bereavement and COVID-19

COVID-19 is an infectious disease that is not only posing significant risk to public health and the way we cope with our daily lives; it is also posing a significant challenge to how we are dying and how we are mourning loved ones. 

Death and Dying

Physical distancing restrictions related to COVID-19 have meant that many individuals are dying – or facing the prospect of dying – without the presence of family and friends around them, causing them feelings of isolation and psychological distress. Due to the strains facing health care workers and facilities, individuals in palliative care may also not be having their advanced-care directives fully realised (e.g., preferred location of death, life-prolonging measures).[i] This can be particularly problematic and distressing for those who are cognitively aware that their directives are not being met.

Those same restrictions are also causing distress for family and friends who are not being permitted to  be with loved ones when they are ill or dying, thereby preventing the opportunity to hold someone’s hand, have a last meaningful conversation, affirm a bond, make amends, or simply say good-bye.[ii] Further causing distress is the haste with which some current provincial restrictions are forcing families to decide where to send a body within 1-3 hours of death, depending on whether the death occurred in hospital or in a long-term care facility.

Impacts on Mourning

Different cultures have their own customs and rituals for mourning.  Physical distancing restrictions are also making it hard for people to come together socially with other mourners to grieve, spend time with or pay their final respects to the deceased, provide support to one another, and/or find comfort in their cultural or secular traditions, thereby contributing to grieving challenges and feelings of isolation.[iii] 

When loved ones do not have the opportunity to say good-bye and cannot come together to provide physical comfort, they may not have the necessary closure – also known as ambiguous loss – they need to properly grieve.[iv] They may feel anger at those that have put the restrictions in place; regret at not having a chance to hold someone’s hand or make amends; worry that a loved one may not be being given appropriate care or necessary pain relief; and guilt over one’s own powerlessness and inability to be with a loved one in their time of need.

It is unknown how long physical distancing measures will be in place; as such, it is important for people to find new ways to both recognize the dying process and cope with grief.  During the dying process, to the extent possible, video calling can connect patients with family members who are separated because of travel and/or visitor restrictions, offering some sense of comfort to patients in their last days and moments. Following death, friends and family can come together virtually, make use of online memorials, write more elaborate obituaries, and/or plan to hold services at a time when physical distancing restrictions are no longer in place.[v] While these measures are providing some means of honouring the deceased, they nonetheless cannot replace the physical comfort and connectedness one feels from a hug or hand-shake.

Disrupted, Complicated or Prolonged Grief

Although grief is a normal response to loss, “the grieving process itself is very individualized and personal such that everyone processes and experiences grief differently”.[vi]  For many, coming together for a funeral or other cultural ritual to honour the death of an individual is an essential – and normal – step in the bereavement process. Not being able to come together to mourn may not only lead to ambiguous loss, these circumstances may also increase the likelihood of one experiencing disrupted, complicated or prolonged grief.

When Psychological Distress Becomes Too Much

Individuals experiencing disrupted, complicated or prolonged grief are at increased risk of substance use, sleep disorders, impaired immune functioning and suicidal thoughts.[vii]

While spiritual leaders are themselves being restricted from being with individuals as they pass and performing any last rites of passage, they can be a source of comfort to loved ones to help them cope with the loss. Psychologists and other mental health providers can also help with disrupted, complicated or prolonged grieving.

If the following signs and symptoms increase or worsen over time and impair overall functioning, they might signal need for help to cope with one’s grief:

  • Sleeping poorly, too much or too little
  • Avoiding others, even within the confines of social distancing
  • Experiencing headaches, stomach problems, neck or back pain
  • Crying excessively and all the time
  • Talking less and being withdrawn
  • Feeling dazed or disconnected from self or the reality
  • Feeling anxious, depressed or having panic attacks
  • Feeling angry, guilty, helpless, numb, or confused
  • Not wanting to get out of bed
  • Having difficulties concentrating or focusing
  • Excessive eating for comfort
  • Drinking more alcohol or taking prescription drugs more than prescribed
  • Having little patience
  • Feeling overprotective of loved ones

 

It is important to remember that most of us have had some of the signs and symptoms listed above at one time or another, and that COVID-19 has led to increased stress for most people.  If you have a number of these signs and symptoms and they

  • persist beyond a couple of weeks
  • persist to the point where you are not able to carry out the home or work-related activities permitted by social distancing advisories
  • are accompanied by intense feelings of despair, hopelessness, helplessness or suicidal thoughts

 

you are well advised to consult a regulated health care professional such as a psychologist, your family physician, psychiatrist, or other mental health provider. 

Resources:

Ontario Palliative Care Network, 2020. Planning for Palliative Care Delivery during the COVID-19 Pandemic. http://www.virtualhospice.ca/covid19/

Where do I go for more information?

To obtain  important and up to date information about COVID-19, visit the Public Health Agency of Canada (PHAC) website at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

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. Lisa Votta-Bleeker, Deputy Chief Executive Officer, Canadian Psychological Association; Dr. Katy Kamkar, Clinical Psychologist, Centre for Addiction and Mental Health (CAMH) and Chair of the CPA’s Traumatic Stress Section; and Ms. Eva Sheppard-Perkins, Canadian Psychological Association.

Date: May 11, 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

[i] Arya, A., Buchman, S., Gagnon, B. and Downar, J., 2020. Pandemic palliative care: beyond ventilators and saving lives. Canadian Medical Association Journal, 192(15), pp. E400-E404.

[ii] https://www.apa.org/topics/covid-19/grief-distance

[iii] Leong, I., Lee, A., Ng, T., Lee, L., Koh, N., Yap, E., Guay, S. and Ng, L., 2004. The challenge of providing holistic care in a viral epidemic: opportunities for palliative care. Palliative Medicine, 18(1), pp.12-18.

[iv] https://www.apa.org/topics/covid-19/grief-distance

[v] Wolfelt, A., 2020. Exploring the Natural Complications of the “Whys” of Funerals During the Coronavirus Pandemic – Center For Loss & Life Transition. [online] Center for Loss & Life Transition. Available at: https://www.centerforloss.com/2020/04/funeral-whys-during-coronavirus/.

[vi] https://weareunsinkable.com/when-struck-by-a-dark-cloud-grief-loss/

[vii] Shear, K.M. 2015. Complicated Grief, New England Journal of Medicine, Vol. 372, No. 2, pp: 153-160..

“Psychology Works” Fact Sheet: Research Funding Information as relates to COVID-19

Canada’s COVID-related Research Support

Public health emergencies such as COVID-19 affect the lives of people, families and communities. In early March, the Government of Canada announced an investment of more than $275 million in funding for research on measures to combat COVID-19. Of this investment, $27 million was allocated to research through the three federal research funding agencies―the Canadian Institutes of Health Research (CIHR), Natural Sciences and Engineering Research Council (NSERC), and the Social Sciences and Humanities Research Council of Canada (SSHRC) ―the Canada Research Coordinating Committee, through the New Frontiers in Research Fund, the International Development Research Centre and Genome Canada. The international research community, research funders and public health institutions are cooperating to look for novel solutions, from new vaccines to more effective communication about the pandemic. To date, over 95 projects led by Canadian researchers are focussed on developing and implementing measures to rapidly detect, manage, and reduce transmission of COVID-19, as well as assess its impacts.

Information from Canada’s Tri-Funding Agencies

If your research is funded by a federal agency such as CIHR, NSERC or SSHRC, review each agency’s websites for information on how your current and/or future research may or may not be impacted.

CIHR

CIHR is closely monitoring the evolution and impact of the novel coronavirus (COVID-19), and is taking action to support its grants, scholarship and awards recipients, as well applicants and peer reviewers. Visit this page regularly for messages from CIHR President, Dr. Michael Strong, and updated information for the research community: https://cihr-irsc.gc.ca/e/51917.html.

SSHRC

As the COVID-19 situation continues to evolve, SSHRC management is assessing additional measures that may be needed to support SSHRC-funded students, postdoctoral fellows and research personnel and address concerns. Visit this page regularly for updated information on the impacts of COVID-19 on SSHRC’s policies and programs: https://www.sshrc-crsh.gc.ca/news_room-salle_de_presse/covid-19-eng.aspx.

NSERC

NSERC continues to adjust its operations as it monitors the evolution and impact of COVID-19. Visit this page regularly for messages from CIHR President, Dr. Alejandro Adem, and updated NSERC program information in relation to COVID-19: https://www.nserc-crsng.gc.ca/Media-Media/NewsRelease-CommuniqueDePresse_eng.asp?ID=1139.

Other Funding Sources

Others may have funding from sources other than the tri-agencies (for example, provincial funding, associations, foundations, private industry, universities); in that case, check in with your funding provider to assess the impacts of COVID on your research funding and deadlines.

Where do I go for more information?

To obtain  important and up to date information about COVID-19, visit the Public Health Agency of Canada (PHAC) website at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

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. Lisa Votta-Bleeker, Deputy Chief Executive Officer, Canadian Psychological Association.

Date: May 7, 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Guidance for Psychology Students as Relates to COVID-19

As the COVID-19 situation evolves around the globe, students’ day-to-day lives are being increasingly disrupted: courses have been moved from in-person settings to online formats; visits with friends and families have been prohibited; access to resources such as the on-campus library, student counselling services, or other campus spaces has been lost; some students have had to leave, quickly in some cases, their student residence; in-person conferences have been cancelled; competition and application deadlines have been delayed; internship, residency and co-op/practicum placements have been cancelled or altered; and for some, research projects have been interrupted.

This document provides an overview of Canada’s COVID-related student funding support, as well as resources to help psychology students deal with the impact of the coronavirus on their research, training, and academic work.

More detailed information specific to Canada’s research funding support and information from the funders can be found in the CPA’s Fact Sheet on Research Funding Information as Relates to COVID-19 (https://cpa.ca/corona-virus/cpa-covid-19-resources/).

Information from Canada’s Tri-Funding Agencies

Canada’s tri-funding agencies (Canadian Institutes for Health Research – CIHR; Social Science and Humanities Research Council of Canada – SSHRC; Natural Science and Engineering Research Council of Canada – NSERC) are closely monitoring the evolution and impact of COVID-19 and are taking necessary actions to support its grant, scholarship, fellowship, and awards recipients; support its applicants and peer reviewers; protect their staff; and modify their operations. Below are links to messages from the tri-agencies.

Each agency is also regularly updating their websites with messages from the presidents and updated information for the research community.

Student Support; Awards, Scholarship and Fellowship Competition Deadlines

The Government of Canada has announced significant emergency support for students and recent graduate impacted by COVID – expanded student and youth programming, enhanced student financial assistance for Fall 2020, Canada Emergency Student Benefit, Canada Student Service Grant, and International Students. Information on this support can be found here: https://www.canada.ca/en/department-finance/news/2020/04/support-for-students-and-recent-graduates-impacted-by-covid-19.html

In early May, the tri-agencies announced that training award recipients (master’s, doctoral, and postdoctoral) may defer the start date of their award, or request an unpaid interruption of up to four-months for reasons related to the COVID-19 situation (https://cihr-irsc.gc.ca/e/42405.html#05_04_2020). For master’s and doctoral award holders, this can be adjusted to align with the next available start date (May 1, 2020; September 1, 2020; or January 1, 2021). The agencies will continue to support training award holders who, given the challenges posed by the COVID-19 situation, can only devote part-time hours to their research. They may continue to hold their awards and will be paid at the full amount. The amount will not be prorated, and the end date of the award will remain unchanged.

Visit the program webpages listed below for additional information specific to the following student award, scholarship and fellowship competitions and what impact COVID may or may not be having on their deadlines:

Other Funding Sources

Students with funding from sources other than the tri-agencies (for example, provincial funding, associations, foundations, private industry, universities); in that case, check in with your funding provider to assess the impacts of COVID on your research funding and deadlines.

Studying from Home

Given the many weeks since physical distancing has been in place, and schools have transitioned to virtual learning, many students have already set up home workspace.  Nonetheless, below are a few things to keep in mind when studying from home:

  • Remember to have realistic expectations for your work and progress during a global pandemic. It is okay if you feel that you do not have the mental or emotional capacity to produce knowledge or undertake research during a global crisis.
  • If possible, set up a dedicated workspace where you can keep study materials and have virtual classes or group chats, so that you keep your studies separate from the rest of your life. Try to remember proper ergonomics when setting up your workspace.
  • Take some time to make sure you have all necessary resources at your disposal to effectively conduct your studies, as this could help mitigate potential stressors. For example, install any required software on your computer or order a headset and webcam for online classes. Reach out to your professor or students’ union if you need support and resources.
  • As much as possible, keep your study space quiet and free from distractions. If you have roommates, you could use headphones (ideally noise-cancelling headphones) to drown out noise. Make sure your space is inviting so you want to spend time there (you could sit by a window or add a plant or favourite trinket to your desk).
  • Contact your internet provider for free or low-cost internet options if you do not have Wi-Fi at home and are unable to access the online resources that can help you continue your education.

 

 

Setting a schedule for school and life

  • Maintain a consistent routine: This includes sleep-wake times, exercise, and work/school schedules. It can be easy to do schoolwork all day because it feels like there is nothing else to do. Establishing and maintaining a routine will help you maintain a sense of normalcy and keep your schoolwork and home life separate.
  • Take breaks: It’s important to take breaks to rest your eyes, your mind and your body. If it’s hard for you to remember to take breaks, you could set up a timer for 90 minutes and then take a 15-minute break.
  • Check in with supervisors/professors about expectations: Maintain good communication with your supervisors and professors. Have a clear understanding about whether moving to online classes changes expectations around assignments, exams, and other academic requirements. For example, you could ask for flexibility on timelines given your current time zone.
  • Stay connected to others: Develop a plan to keep in touch with friends, family, and colleagues. Schedule regular phone calls or facetime chats. Tap into social media and tech platforms that allow virtual group gatherings.

Impacts on Graduate Students, Student Research, and Professional Training

Graduate students and trainees have been particularly impacted during CVOID-19 due to stressors arising from financial uncertainty; pressure to graduate within a given time frame and before funding runs out; managing research and teaching responsibilities; and disruption in academic work and transition to remote learning. During these times, students would be benefit from:

  • Talking to one’s university’s research officer to understand what, if any, impacts COVID-19 will have on any student funding one may have (e.g., scholarships, bursaries, fellowships).
  • Assessing if one’s research can be conducted through online surveys or if one’s research protocol can be moved to an online experiment.
  • Talking to one’s supervisor/professor(s) about working on publications, while not losing sight of the mental and emotional resources required to cope with COVID-19.

Professional Training Impacts

Some graduate students and trainees have also been particularly impacted by disruption to practicum/co-op placements, internships, and other face-to-face skill building activities. Students should talk to their department head or co-op/practicum coordinate (if applicable) about the impacts of cancelled practicum placements and co-op work terms, as well as options for extending work terms with placement providers and finding new placements.

With respect to the impact on internships, the CPA, Canadian Council of Professional Psychology Programs (CCCPP), and the Association of Canadian Psychology Regulatory Organizations (ACPRO) issued a joint statement recognizing the impact COVID-19 is having on the operation of professional psychology training programmes and on their faculty, staff and students (https://cpa.ca/cpa-ccppp-acpro-statements-regarding-covid-19/).  It is important to understand that decisions about training will be made at several levels (https://ccppp.wildapricot.org/news). The first level is between the internship program and the university, as they jointly determine if the requirements for the internship have been met. The second level of decision making lies with the regulators, who will make independent decisions on a case-by-case basis about whether a candidate for licensure/registration/certification has met the provincial standards that are outlined in legislation and bylaws.

Conference Cancellations

The pandemic has also resulted in the cancellation of many in-person conference and knowledge mobilization activities, which is also impacting students and trainees in terms of lost opportunities to present at or attend conferences.  Until such time that in-person conferences can resume, students should seek opportunities to present and/or participate in virtual conferences. The CPA’s national convention will be offered virtually in July and August 2020; check the CPA’s website regularly for more information on how to participate and/or present at the virtual event.

If you had been accepted to submit at a conference and the conference was cancelled, contact the conference organizers regarding their policy about creating an abstract book or conference proceedings, noting the conference acceptance on your CV, and obtaining the word on how to do so. The CPA will be preparing an abstract book of all accepted presentations; below is information on how to cite your presentation if you were accepted to present at the CPA’s 2020 National Convention in May 2020.

Surname, Initial. & Surname, Initial. (2020, May 27-30).  Title of accepted submission. [specify type of presentation – poster, Gimme-5, 12-minute talk, etc.]. 81st Canadian Psychological Association Annual National Convention, Montréal, Quebec, Canada. (insert link to Abstract Book PDF when available) (Conference cancelled due to COVID-19)

Alternative Learning Opportunities

  • Register for online continuing education offerings, from the CPA as your national association or from one of the provincial psychological associations, many of which are presently free or significantly discounted.
  • Explore or deepen your learning of new research methods or statistical applications by downloading freely available software.
  • Learn more about Open Science(https://cos.io/)and the preregistration (https://cos.io/prereg/)
  • Source publishers that are providing free access to books and journals online.
  • Take in the APA webinar (https://www.apa.org/education/coping-webinar-students)in which psychologists Lynn Bufka and Vaile Wright discuss ways for undergraduate and graduate students to navigate the shifting COVID-19 crisis.

Self-Care and Student Wellness

During this time, it is important to take care of yourself and pay attention to your mental well-being.

Where do I go for more information?

To obtain  important and up to date information about COVID-19, visit the Public Health Agency of Canada (PHAC) website at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

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. Lisa Votta-Bleeker, Deputy Chief Executive Officer, Canadian Psychological Association.

Date: May 7, 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Guidance for Psychology Faculty and Researchers as Relates to COVID-19

COVID-19 is not only impacting everyday life; it is also impacting faculty and research teams in many ways, from how to transition to online classes, how to work and best support students remotely, how to adapt current research projects while ensuring the welfare and safety of research subjects, and how to pay salaries/stipends and other costs that may be modifying or halting research.

With the transition to virtual education, researchers and faculty are working diligently to protect their research participants and animal subjects, their students, their scholarship, and in some cases, their careers. In the interim, below is some information that may provide helpful guidance in navigating these difficult times.

More detailed information specific to Canada’s research funding support and information from the funders can be found in the CPA’s Fact Sheet on Research Funding Information as Relates to COVID-19 (https://cpa.ca/corona-virus/cpa-covid-19-resources/).

Working Remotely

Since mid-late March, most people have been working remotely. This has required faculty, staff and researchers to ensure they had all mission critical information with them; they were using university-approved security protocols to analyze and store data off-site; and they had a laptop, charger, webcam, contact information for team members and access to any electronic materials that would have been needed.  Knowledge of Skype, Zoom, Hangouts/Google-Meet and other video-conference software has become a must to stay connected virtually.

Maintaining Research

Given COVID-19, research that brings people physically close together or in large gatherings has been most impacted. Policies regarding how to conduct research during emergencies are university specific, and you should follow your institution’s emergency or disaster-preparedness policies for guidance to deal with COVID-19’s impact on your research and career/degree-completion impacts.

Information from Canada’s Tri-Funding Agencies

Canada’s tri-funding agencies (Canadian Institutes for Health Research – CIHR; Social Science and Humanities Research Council of Canada – SSHRC; Natural Science and Engineering Research Council of Canada – NSERC) are closely monitoring the evolution and impact of COVID-19 and are taking necessary actions to support its grant, scholarship, fellowship, and awards recipients; support its applicants and peer reviewers; protect their staff; and modify their operations.

Each agency is also regularly updating their websites with messages from the presidents and updated information for the research community.

Check in with your program officer

While Canada’s funding agencies have extended deadlines, it is nonetheless important to think creatively about how to sustain your research over at least the next three to six months. Stay in regular touch with your university’s program officer and share how the crisis is affecting your work and how you plan to keep making progress.

Maintain communication with your research team

Frequent communication is important to sustaining research projects, assessing how your team members are coping, and maintaining social connectedness. Consider daily or weekly video-meetings to set goals and/or action items. Reassure your staff that it is okay to not be as productive during these challenging times. To the extent possible, cross-train staff, deploy them to work on other tasks, and if not already done, have calls forwarded to a project staff person’s cellphone.

Modify your research and analysis

With the stoppage of face-to-face human research or temporary closure of research labs, researchers who rely on face-to-face interaction or in-lab work to collect data have had to either pause their research or transition their research to online.  If you are shifting to remote data collection and storage, keep in mind that changing methodologies may you require that you notify your institution’s review or ethics board and potentially, updating consents to participate. Modifications to methodologies in the midst of a study will have to be accounted for in future analyses.

Supporting Students and Trainees

Students and trainees are most vulnerable right now due to stressors arising from financial uncertainty; pressure to graduate within a given time frame and before funding runs out; managing research and teaching responsibilities; disruption in academic work and transition to remote learning;  cancelled or altered co-op placements, internships, and residencies; and lost conference presentation/attendance opportunities. If you are able, help them progress toward their goals and be flexible about deadlines.

Encourage students to visit the Government of Canada’s website for information on its emergency support for students and recent graduate impacted by COVID: https://www.canada.ca/en/department-finance/news/2020/04/support-for-students-and-recent-graduates-impacted-by-covid-19.html.

Encourage them to visit the tri-agency’s websites for information on extensions for training award recipients and competition deadline information pertaining to the Canada Graduate Scholarships, Vanier Canada Graduate Scholarships, Banting Postdoctoral Fellowships, and NSERC’s Undergraduate Student Research Award – to name just a few.

If students have been awarded funding from sources other than the tri-agencies, direct them to contact the funding provider to obtain information on impacts to deadlines.

Stay in touch with your students and have conversations with them about how they plan to carry on their work during this new reality, while reminding them that it is okay to feel that they do not have the mental or emotional capacity to produce knowledge or continue their research during these challenging times.

More detailed information specific to COVID and psychology students can be found in the following CPA Fact Sheets: Guidance for Psychology Students as Relates to COVID-19 and Student Wellness during COVID-19 ((https://cpa.ca/corona-virus/cpa-covid-19-resources/).

Supporting Junior Colleagues

Junior colleagues are also particularly vulnerable right now. If possible, senior faculty may be able to offer data sets they can work with or provide opportunities to collaborate on existing research projects.

If you are an early career researcher yourself, document how the crisis is affecting your research and talk to your chair about potential impacts on your tenure path. With the cancellation of most in-person conferences, seek opportunities to network virtually, participate in the work of your national or provincial psychological association, or participate in other scholarship activities (e.g., online continuing education, serving as a peer reviewer).

Self-care

While this is a very challenging time for everyone, it is important to remember that all of your department colleagues and research peers are in the same position.  Eventually, research activities will resume, as will in-person classes. In the interim, it is important for faculty and researchers to take care of themselves.

During this time, some psychology faculty may have increased demands to provide mental health services and supports to their students in ways that might otherwise not have been expected to before COVID019. Check in with your department and your university’s counselling services for information on available resources for students, while ensuring you have the necessary supports for yourself.

Be cognizant of the impacts of too many virtual meetings and too many emails. With the transition to working remotely, there has been a vast increase in the number of virtual meetings; while virtual meetings are effective at maintaining connectedness and communication, many are feeling overly fatigued by the number of video-conference meetings that now are required to deal with issues that once would have been addressed via an in-person meeting or by walking to someone’s office.  The same can be said of email.

In addition to supporting students, research staff and transitioning to remote learning, many faculty and researchers are also juggling the responsibilities – and fatigue – of being educators to their children who may also be at home.

Conferences and COVID-19

Given the state of the pandemic globally, in-person knowledge mobilization and sharing events such as conferences are being cancelled or postponed; in some cases, in-person conferences are being transitioned to virtual events to enable both the delivery and sharing of research findings and continuing education activities.  This is the case for the CPA’s 2020 Annual National Convention which was scheduled for May 2020 in Montréal, QC, but will be delivered as a virtual event over the summer of 2020.

A poster or presentation that was peer reviewed and accepted to a conference can still be included in your CV, even if the conference was cancelled. The CPA has a recommended format for citing cancelled presentations; this information was sent to all individuals that had a presentation accepted for inclusion in the CPA’s national conference (see below).

For individuals OPTING TO participate in the CPA’s virtual event, the format is as follows:

Surname, Initial. & Surname, Initial. (2020, insert dates of virtual event).  Title of accepted submission. [specify type of presentation – poster, Gimme-5, 12-minute talk, etc.]. 81st Canadian Psychological Association Annual National Convention, Montréal, Quebec, Canada. [insert link to virtual event when available]

For individuals OPTING NOT TO participate in the CPA’s virtual event, the format is as follows:

Surname, Initial. & Surname, Initial. (2020, May 27-30).  Title of accepted submission. [specify type of presentation – poster, Gimme-5, 12-minute talk, etc.]. 81st Canadian Psychological Association Annual National Convention, Montréal, Quebec, Canada. [insert link to Abstract Book PDF when available] (Conference cancelled due to COVID-19)

If the conference at which you were scheduled to present is not being transitioned to a virtual event or you are unable to participate in the virtual event, you can consider sharing your poster and/or presentation through the Open Science Framework (OSF). For more information, see OSF meetings.

Making the Transition: Moving your Course to a Virtual Environment

The need for a rapid transition from in-person instruction to online platforms has necessitated a steep learning curve for many faculty. It is important to remember that although effective, there are significant differences between in-person and online delivery of education:

  • Most adult education research shows that the maximum length of an online session should be less than two hours: attention spans begin to wane after as little as 15 minutes and engagement is challenging through a computer screen. Longer lectures should be broken up into more digestible portions.
  • There are some techniques that can help keep learners engaged; for example, some webinar or e-learning platforms provide the ability to create polls that will encourage participants to pay attention and answer topical questions in real time.
  • In creating lesson plans, keep in mind that topics and learning objectives should be kept focused and self-contained in order to maintain clarity and continuity. Schedule time for a brief recap at the start of each session but keep the path well-defined and easy to follow.
  • Consider adding more self-directed elements if possible; short projects, additional readings, and putting students into small groups to discuss material virtually can add value between sessions and contribute to the overall goals of the course while placing the onus on students to engage with the material.
  • Most importantly, stay connected to your students. If this is the first time you are delivering material online, take this opportunity to learn from your students regarding what does – and does not – work. Maintain your goals, clarify your benchmarks, and be open to learn and experiment.

The following is a list of some valuable resources to assist you in your transition.

Resources Provided by the APA

Staying Professionally Active

Recognizing the emotional and mental toll that the pandemic may be taking on some individuals, others may want or need to stay professionally active during this time. Below are some ways in which individuals can stay professionally involved.

  • Take a Continuing Professional Development course from the CPA’s online offerings, from a provincial/territorial association, or from other relevant professional associations.
  • Create and/or review your individual professional learning plan.
  • Expand your learning of research methods – quantitative and/or qualitative – or statistical applications, particularly those offering downloadable software at no cost.
  • Take the opportunity to read new journal articles; the CPA’s three journals (Canadian Psychology, Canadian Journal of Behavioural Science, Canadian Journal of Experimental Psychology) are available to all CPA members via the CPA’s members only portal.
  • Subscribe to the APA’s PsychNetGold database through the CPA and have access to the following: PsycINFO, PsycARTICLES, PsycBOOKS, PsycEXTRA, and PsycCRITIQUES.
  • Submit articles for publication consideration.
  • Volunteer to serve as a reviewer for one of Canada’s funding agencies.
  • Start working on grant applications.
  • Attend virtual conferences.

 

Where do I go for more information?

To obtain  important and up to date information about COVID-19, visit the Public Health Agency of Canada (PHAC) website at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

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. Lisa Votta-Bleeker, Deputy Chief Executive Officer, Canadian Psychological Association.

Date: May 7, 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Cognitive Disorders and Dementia

What Is Cognition?

Cognition is how people process information. It is the ability of your brain to register, consolidate, store and retrieve information to solve problems. Cognition depends on several mental functions including attention, perception, memory, language, and reasoning.

What Is Dementia?

Dementia is the advanced stage for a cluster of clinical neurodegenerative disorders involving deterioration of cognitive abilities with resulting changes in behaviors that interfere with the ability of an individual to function independently in everyday life. There are two major classifications of dementias: neurodegenerative disorders and vascular dementias. There may be as many as fifty different forms of dementias.

Dementia is usually defined as a change in two or more areas of cognition that results in the reduction of an individual’s ability to function independently. It is not a disease but a condition that results from any of several neurodegenerative or vascular disorders. The many dementia syndromes can progress slowly or in a stepwise fashion dependent on the underlying disorder.

Dementia can result from damage that affect the nerve cells (neurons) of the outer layer (cortex) or the inner structures (subcortex) of the brain. The symptoms vary according to the areas of the brain that are most affected.

For example, the Alzheimer neurodegenerative disorder affects mostly cortical areas of the brain that involve acquiring or learning new information (amnesia), ability to perform skilled acts or use tools (apraxia), use of language (aphasia), or ability to perceive objects or people (agnosia).

Parkinson is another neurodegenerative disorder that primarily affect subcortical regions and symptoms include movement disorders (tremor, stooped posture, initiation of movement), speech and voice abnormalities (slurring, stuttering), and attention. There are memory problems, but they primarily involve the ability to retrieve information and less so to acquire information.

How Common Is Dementia?

Approximately 6.4% of Canadians above the age of 65 have some form of dementia but the prevalence increases substantially as we get older. Dementia occurs in approximately 2% of individuals between the ages of 65 to 74 but increases to 30% over the age of 85.

What Conditions Result in Dementia?

Alzheimer’s syndrome accounts for about 50% of all cases. It involves gradual damage and ultimately the death of neurons. The most common early symptom is memory loss that involves rapid forgetting. Affected individuals cannot recall recent events such as conversations or significant personal events.

Another common early symptom is difficulty remembering the names of people, even family members, and difficulty thinking of the most appropriate word to use.

Alzheimer’s is slowly progressive and may go on for several years before the person dies. As the disease progresses, more areas of cognitive function become involved, including spatial orientation, language, and the ability to perform sequences of learned skills. The individual typically becomes bedridden in the end stage and death occurs due to secondary causes, such as falls or infections.

Vascular dementia involves repeated damage to areas of the brain caused by blockages in the blood vessels. It can occur after a stroke or several strokes or brief periods of disrupted blood flow to the brain (transient ischemic attacks or TIAs). The symptoms are variable and depend on where the strokes are located. Vascular dementia can progress as Alzheimer’s disease does, but the progress may not be as gradual. Sudden worsening of cognition, relating to the immediate effects of a stroke or TIA, can be followed by periods of slight improvement. As the individual has more strokes, however, the severity of cognitive dysfunction worsens in a stepwise fashion.

Lewy-body spectrum, along with vascular dementia, account for the second and third most common causes of neurodegenerative disorders. Individuals with Lewy-body spectrum have symptoms like those exhibited by individuals with Parkinson, including tremor, rigid and stiff movements, flat facial expressions, as well as cognitive symptoms, such as memory loss, fluctuating attention, difficulty reasoning and difficulty putting together a sequence of movements. Individuals with Lewy-body spectrum frequently experience visual hallucinations early on and, less frequently, auditory hallucinations. Like Alzheimer’s syndrome, it progresses slowly.

Other Conditions That Result in Dementia Include:

  • Parkinson’s neurodegenerative disorder;
  • Mixed Alzheimer’s-Vascular dementia;
  • Chronic traumatic encephalopathy;
  • Frontal-Temporal neurodegenerative disorders;
  • Limbic encephalitis;
  • Normal pressure hydrocephalus;
  • Progressive supranuclear palsy;
  • Jakob-Creutzfeldt disease;
  • Idiopathic basal ganglia calcification;
  • Corticobasal neurodegeneration;
  • Multi-system atrophy;
  • Amyotrophic lateral sclerosis;
  • Korsakoff neurodegeneration;
  • Huntington’s disease.

Are Some Dementias Reversible?

Yes, if the symptoms result from some of the following conditions: 

  • depression;
  • drug polypharmacy;
  • metabolic and nutritional imbalance;
  • Vitamin B12 deficiency;
  • Normal pressure hydrocephalus
  • Hypothyroidism
  • cardiovascular disorders.

Do We Know What Causes Alzheimer’s Disease and Other Types of Dementia?

In the last 20 years, there has been promising but also frustrating research efforts to identify the neurological dysfunction that characterizes Alzheimer’s disease. The consensus is that there is probably more than one cause that will require combinations of therapeutic efforts including cognitive and behavioral ones.

A small proportion (2%) of Alzheimer’s syndrome is inherited but, for most cases, the exact causes are still unknown. There are genetic factors that predispose an individual to develop the disease. Not all individuals having the genetic factors however will develop Alzheimer’s syndrome, which has led scientists to believe that there are important interactions between a person’s environment and genetic makeup.

Are There Treatments for Dementia?

There are currently a few medications that have been shown to ease the symptoms of Alzheimer’s disease but do not stop or prevent the disease. Examples of medical treatments include donepezil (Aricept ®), memantine (Ebixa®) and rivastigmine (Exelon ®).

Cognitive and behavioral treatments are also used to help individuals and their care partners compensate for specific cognitive disorders. Individuals with memory loss can learn to use aids, such as a Day-Timer or other electronic assistance to help remember things. Well-designed and predictable environments can also help in reducing excessive disability. Sustained care partner support and training in the use of behavior management techniques are also very helpful.

What Is Mild Cognitive Impairment (MCI)?

MCI is a state characterized by impairment of one or more cognitive processes, but the impairment does not result in a significant impact on the individual’s ability to function independently. The causes can be as varied as the causes of neurodegenerative disorders.

In fact, some individuals with MCI will go on to develop neurogenerative disorders. It is estimated that, after 5 years, approximately 50% of individuals that were initially identified as MCI develop some type of neurodegenerative disorder, most commonly Alzheimer’s syndrome. MCI is difficult to diagnose however, up to 25% of individuals initially diagnosed with MCI will not be found to have the condition on follow-up assessment.

What Can Psychologists Do to Help People With Cognitive Disorders & Dementia?

 The consequences of various neurodegenerative disorders are severe cognitive impairments like memory, perception, language, and executive functions. 

Psychologists have much to offer in assessing spared and impaired cognitive functions, in doing clinical research, and in designing intervention programs to minimize the effects of cognitive impairments.

 Some of the ways a psychologist can help include: 

  • provide clinical neuropsychological evaluations which are efficient and sensitive tools when combined to various biomarkers for the diagnosis of various dementias;
  • providing education to help understand the cognitive impairments and how they relate to changes in the individuals’ behavior and the impact of cognitive impairments on everyday activities;
  • providing training to individuals to help them compensate for their cognitive impairments;
  • teaching family members, friends or care partners, means of helping the individual;
  • providing the family members, friends or care partners, with coping skills to deal with cognitive and challenging behaviors;
  • providing access to community support services. 

 

Signs of Possible Cognitive Impairment That Warrant Further Investigations: 

  • difficulty remembering names of people they have been introduced to recently;
  • needing the repetition to questions or comments due to the individual not being able to recall the information;
  • requiring reminders to ensure they remember appointments;
  • forgetting to take medications – this can involve either not taking their medications or “double-dosing” because they forgot they took them;
  • forgetting significant recent events such as vacations, birthdays, anniversaries, to pay bills on time;
  • misplacing or losing personal items;
  • getting lost in familiar surroundings, or not recognizing landmarks;
  • difficulty recollecting the name of a familiar person and marked difficulty recalling the most appropriate word to use. 

Note: In order to be of significance, these problems should occur more frequently than the average person of the same age would experience.

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, visit . The Canadian Register of Health Service Providers in Psychology also has a listing service and can be reached through http://www.crhspp.ca.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Guy Proulx, Director, The Glendon Centre for Cognitive Health, Glendon College, York University. https://centerforcognitivehealth.ca

Revised: April 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

Information Fact Sheet: COVID-19 Government Support for Employees

During the current Covid-19 Pandemic, a number of Canadian Governments have announced programs designed to support employers, with the specific goal of mitigating some of the economic consequences of Canada’s response to small business.

As a result of social distancing and other policies, economic activity in Canada has dramatically slowed.  This has resulted in financial stress for those businesses that continue to operate, often resulting in the need lay off some or all of their employees

The government initiatives continue to evolve in real time, and this fact sheet will be updated on a regular basis to keep up with the changes.

While this Fact Sheet focusses on the Federal initiatives, the reader is encouraged to check with their provincial and municipal governments for additional support which may be available

Federal Government

Canada Emergency Response Benefit

What is it? This taxable benefit would provide $2,000 a month for up to four months for workers who lose their income as a result of the COVID-19 pandemic.

Please note: This benefit replaces the previously announced Emergency Care Benefit and the Emergency Support Benefit.

Who can apply? CERB will cover Canadians who have lost their jobs, are sick, quarantined, or taking care of someone who is sick with COVID-19, as well as working parents who must stay home without pay to care for children who are sick or at home because of school and daycare closures.

It will apply to wage earners, as well as contract workers and self-employed individuals, who would not otherwise be eligible for Employment Insurance (EI), and who have not worked for 14 days

How to apply: The federal government announced that an application portal will be available by the week of April 6th. Applicants will also be able to apply, via an automated telephone line, or via a toll-free number.

This information will be updated.

For more information: https://www.canada.ca/en/department-finance/economic-response-plan/covid19-individuals.html#new_canada_emergency_response_benefit

Employment Insurance – Sickness Benefit

What is it? Employment Insurance sickness benefits can provide you with up to 15 weeks of financial assistance if you cannot work for medical reasons. You could receive 55% of your earnings up to a maximum of $573 a week.

Who can apply? Those who are sick, quarantined or have been directed to self-isolate due to COVID-19.

How to apply: Complete an online application as soon as possible after you stop working. As part of the COVID-19 response, the government of Canada will waive the requirement to provide a medical certificate to access EI sickness benefits, as well as the one week waiting period.

For more information: https://www.canada.ca/en/services/benefits/ei/ei-sickness/apply.html

Employment Insurance – General Benefits

What is it? Employment Insurance (EI) provides regular benefits to individuals who lose their jobs through a shortage of work or lay-offs and are available for and able to work, but can’t find a job.

Who can apply? Employees who were employed in insurable employment, lost their job through no fault of their own, and have been without work for at least seven days, and have worked for the required number of insurable employment hours in the last 52 weeks.

How to apply: Review the requirements and collect the necessary information at the following link, and click on the “Apply” link to begin your application.  https://www.canada.ca/en/services/benefits/ei/ei-regular-benefit/apply.html

For more information: https://www.canada.ca/en/services/benefits/ei/ei-regular-benefit.html

Key Links:

Finance Canadahttps://www.canada.ca/en/department-finance/economic-response-plan.html

Canada Revenue Agency (Income Tax Issues)https://www.canada.ca/en/revenue-agency/campaigns/covid-19-update.html

Employment and Social Development Canada (Employment Insurance Issues) – https://www.canada.ca/en/employment-social-development/corporate/notices/coronavirus.html

Canadian Payroll Association – Frequently Asked Questionshttps://payroll.ca/PDF/Resources/Payroll-and-Covid19-Infoline.aspx

 

This fact sheet has been prepared for the Canadian Psychological Association

Date: April 15, 2020

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

Canadian Psychological Association
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

Information Fact Sheet: COVID-19 Government Support for Employers

During the current COVID-19 Pandemic, a number of Federal, Provincial and Territorial  governments have announced programs designed to support employers, with the specific goal of mitigating some of the economic consequences on Canada’s  small businesses.

As a result of social distancing and other policies, economic activity in Canada has dramatically slowed.  This has resulted in financial stress for those businesses that continue to operate. 

The government initiatives continue to evolve in real time, and this fact sheet will be updated on regular basis to keep up with the changes.

While this Fact Sheet focusses on the Federal initiatives, the reader is encouraged to check with their provincial, territorial and municipal governments for additional support which may be available

Federal Government

Temporary Wage Subsidy for Employers

What is it? The Temporary Wage Subsidy for Employers is a three-month measure that will allow eligible employers to reduce the amount of payroll deductions required to be remitted to the Canada Revenue Agency (CRA).  There was an earlier version of this program that has been replaced.

The subsidy is equal to 10% of the remuneration you pay between March 15, 2020, and June 15, 2020, up to $1,375 per employee and to a maximum of $25,000 total per employer.

Who can apply? Eligible employers include non-profit organizations, registered charities, or Canadian-controlled private corporations (CCPC).

How to apply: This subsidy can be calculated to reduce the amount of current remittance of federal, provincial, or territorial income tax that you send to the CRA by the amount of the subsidy.

For More Information: https://www.canada.ca/en/revenue-agency/campaigns/covid-19-update/frequently-asked-questions-wage-subsidy-small-businesses.html

Canada Emergency Wage Subsidy (CEWS)

What is it?  The CEWS provides for reimbursement of up to 75% of an employee’s wages (maximum $847/week), for a 12 week period (March 15- June 6). Recently, the Federal Government announced that the program will be extended to the end of August 2020; more details are still forthcoming

Who can apply? Eligible employers which include individuals, public and private taxable corporations, partnerships consisting of eligible employers, registered charities and NPOs, who have a experienced a 15% or more year over year decline in revenue (comparing March 2020 to March 2019) or a 30% year over year decline (for April and May)

How to apply:  Businesses will be able to apply on-line through the My Business Account CRA portal or as a web-based application, expected to be open by end of April

For More Information: https://www.canada.ca/en/department-finance/news/2020/04/the-canada-emergency-wage-subsidy.html

Supplemental Unemployment Benefit Program (SUB)

What is it? Employers can use a Supplemental Unemployment Benefit (SUB) plan to top-up their employees’ weekly earnings when they are unemployed due to a temporary stoppage of work. Payments are not considered earnings and are not deducted from EI benefits.

Who can apply? Employers undergoing a temporary stoppage of work due to training, illness, injury or quarantine.

How to apply: SUB plans are registered by Service Canada. Plans must be registered before their effective date. Officers from the SUB program assess employers’ SUB plans against the requirements set out in the EI Regulations. SUB program Officers also help employers develop SUB plans that meet the requirements of the EI Regulations.

For More Information: https://www.canada.ca/en/employment-social-development/programs/ei/ei-list/ei-employers-supplemental-unemployment-benefit.html

Work-Sharing Program

What is it? Work-Sharing (WS) is a program that helps employers and employees avoid layoffs when there is a temporary decrease in business activity beyond the control of the employer. The program provides EI benefits to eligible employees who agree to reduce their normal working hours and share the available work while their employer recovers. Work-Sharing is an agreement between employers, employees and the Government of Canada.

The Government of Canada has put in place Work-Sharing (WS) temporary special measures for employers affected by the downturn in business due to COVID-19. This includes

Who can apply? Typically used for forestry and steel workers, this has program has been extended to all employers from March 15, 2020 to March 14, 2021, and the maximum possible duration of an agreement has been extended from 38 weeks to 76 weeks.

How to apply: Employers must submit an application to a work-sharing agreement and a Work-Sharing Unit Form to the relevant regional Service Canada office. (See more: https://www.canada.ca/en/employment-social-development/corporate/notices/coronavirus.html#h4.04)

For more information: https://www.canada.ca/en/employment-social-development/corporate/notices/coronavirus.html#h4.02

Business Resources

Support for Financing and Business cash flow

Canadian Emergency Business Account (CEBA)

What is it? The Canadian Emergency Business Account (“CEBA”) is intended to provide interest-free loans up to $40,000 to small businesses and not-for-profit organizations. Should 75% of the amount be repaid before December 31, 2022, the remaining balance can be forgiven

How to apply? Organizations should contact their financial institution to understand the specific details of how to apply.  Application deadline is June 30 2020.

For More Information:   https://ceba-cuec.ca/

Business Credit Availability Program (BCAP)

What is it? The Business Credit Availability Program (BCAP) is intended to help Canadian businesses obtain financing during the current period of significant uncertainty.

How to apply? Employers seeking support through BCAP should contact the financial institutions with whom they have a pre-existing relationship, so that the financial institutions can assess their case.

For More Information: https://www.canada.ca/en/department-finance/programs/financial-sector-policy/business-credit-availability-program.html

Other Programs

Research support – on May 15 2020, the Federal Government announced a new program to add $450m in new funding to support research in Canada.  The link for the announcement is here: https://pm.gc.ca/en/news/news-releases/2020/05/15/prime-minister-announces-support-research-staff-canada

This page will be updated as more details are forthcoming.

Flexibility for Businesses Filing Taxes

What is it? The deadline for businesses to pay any income tax amounts that become owing or due after March 18, 2020 and before September 1, 2020 has been extended to September 1, 2020. This means you will not be assessed any penalties or interest if your balance due is paid by September 1, 2020.

For more information: https://www.canada.ca/en/revenue-agency/campaigns/covid-19-update.html

This fact sheet has been prepared for the Canadian Psychological Association

Date: May 25, 2020
Your opinion matters! Please contact us with any questions or comments about any of the CPA’s Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet:  Emotional and Psychological Challenges Faced by Frontline Health Care Providers During the COVID-19 Pandemic

This is a time of tremendous uncertainty and change as the world faces the challenges of the COVID-19 pandemic. While some stressors are universal, frontline health care providers also face unique challenges in terms of physical risk, as well as emotional and psychological toll during this time of heightened, prolonged medical demand.

The information that follows is intended to help frontline health care providers across professional disciplines to better recognize the challenges and stressors that may be impacting them during the COVID-19 pandemic. Increasing awareness of stress and strategies to cope with the demands of frontline healthcare may be helpful to better navigate coping during this difficult time. Coping may include accessing resources, whether that is drawing on personal resources and strengths, accessing support of friends, family, or colleagues, or reaching out to psychologists or other mental health professionals.

Challenges that frontline health care providers may experience at this time may include:

COVID-19 Information Overload

Many frontline health care providers would find it difficult to answer YES to the question, “Do you have any time in your day that is not filled with thinking about or talking about COVID-19?”  Given that addressing COVID-19 directly or indirectly is a necessary aspect of one’s work for frontline health care providers at this time, there may be diminishing returns from seeking out even more information. It is also a time when many of the rules for the general public don’t apply to frontline health care providers (e.g., staying home). This can be distressing or confusing in some ways and also make it less useful to be seeking out COVID-19 related information that does not apply personally.  Finding realistic ways to protect some time to think about, talk about or engage in activities unrelated to COVID-19 can have benefits in terms of emotional well being and fatigue, as well as ability to be present and engaged at work.

  • Many frontline health care providers are receiving lots of COVID-19 related questions and requests for information from friends and family members. For example, loved ones may be asking about what they should do to stay safe or what is happening in medical settings, and front line health care providers may feel an obligation to engage in such discussions.  This is a time when credible information is readily available to the general public.  Frontline health care providers may wish to consider making requests of loved ones to have some non-COVID-19 related conversations and explaining why that would be helpful for them. Friends and family may appreciate the opportunity to be supportive in this way and are likely unaware of the impact that focusing only on COVID-19 may be having on health care providers.
  • For health care providers whose social circles are made up mainly of other health professionals, it may be helpful to protect some time (e.g., 15 minutes) at the beginning of virtual gatherings to talk about anything other than COVID-19. This would also give participants the opportunity to opt out of later pandemic-related discussions if they so choose.
  • Being mindful of COVID-19 oversaturation, the start of the day is one opportunity to make some change. As opposed to waking up and checking one’s phone in bed, it can be helpful to make the mindful decision to get out of bed, go to the bathroom, brush one’s teeth, maybe take a shower before making the conscious decision with alert mind to check one’s messages. Though this is a time when much is urgent, things can wait until one has the chance to brush their teeth.
  • When possible, scheduling time to read news/emails/social media if that is something that someone needs or wants to do rather than checking throughout the day can be helpful. Social media is often used as a quick break in our days but at this time, the content may not feel like an escape. Identifying some alternative activities to do either during brief breaks at work or for longer periods at home can be helpful such as listening to music, engaging in movement, reading a book.
  • Working on the health care frontlines also likely means that one’s social media feeds and email inboxes are particularly bombarded with COVID-19 related content. This can give a skewed view of what is happening in non-medical settings, much of which is beautiful. For example, people engaged in physical/social distancing are finding new ways of connecting online (e.g., eating dinner together remotely via zoom or facetime, etc.), the act of speaking on the phone to friends and families has had a resurgence beyond short text communications, gyms and dance studios are offering free online classes, artists are giving free lessons online, museums/art galleries are offering free virtual tours, and across the country people are banging pots and pans together at 7:30pm each night to show their support for health care providers. Recognizing that there is a world beyond the hospital walls even during this pandemic can be reaffirming for frontline health care providers as can be the knowledge that outside of those walls, people are very grateful for the sacrifices that frontline health care providers are making for the safety of everyone.
  • While there are many online activities currently being offered, frontline health care providers may have very little time to research these activities. For example, there are now many online, interactive, fun, free activities for children of all ages. Reaching out to friends or family to request that they find and share such information may be helpful and lighten the load of frontline healthcare providers who are parents.

Fear and Uncertainty about Safety of Self and Others

Many frontline health care providers are understandably experiencing fear and anxiety related to their own safety and the possibility of putting others at risk. Keeping such fears to oneself and pushing on may work in the short term but are not sustainable strategies, particularly during this time of prolonged, chronic stress and physical and emotional demand without a clear end date. Identifying which of these fears are having an impact can be a start to identifying helpful strategies to cope, including considering when it may be helpful access support whether personal, professional, or from a health care provider such as your family physician or a psychologist or other mental health care professional.

  • Many frontline health care providers have been coping with fears related to not having enough or appropriate Personal Protective Equipment and perhaps even having to make decisions that feel unsafe at times but fit with current demands of working during this pandemic. In certain fields, individuals may be coping with a sense of “when” rather than “if” about contracting illness.
  • Health care providers who have to self-isolate, or who were already on a leave when the outbreak occurred, may experience feelings of discomfort or guilt about not doing their part for the public during this time of great need. Self-disclosing symptoms and isolating when mandated is a very important contribution. Given that that this situation may well continue for some time, there will be periods when others are unable to work. Finding ways to use time “off” to rest and replenish can have benefit both now and also in enhancing readiness and resilience when one returns to work. However, it may be challenging for some to know how to use time off to engage in healing, self care or fun activities rather than ruminating about not working or oversaturating with COVID-19 information.
  • Some frontline health care providers are making, or worrying about having to make, difficult decisions about separating from family in order to protect them. This is a time when thinking of creative ways to stay in contact with loved ones without making unreasonable demands on oneself may be helpful. For example, having zoom or facetime on briefly while children are eating, playing, or getting ready for bed with no expectations of meaningful conversation can help to maintain a sense of connection during this time of forced physical separation. Outside of work, virtually reading a story or asking a child about something fun that happened in their day may also maintain connection.
  • While taking care of and having compassion for others may come naturally to frontline health care providers, being compassionate to oneself may be more difficult. Often individuals who are very compassionate to others find it difficult to be self-compassionate and instead engage in harsh self-criticism in the face of challenge.  Without self compassion, the likelihood of burnout increases. During this time of requiring so much service to others, it can be helpful for health care providers to find ways to show warmth and caring for themselves. In the face of self-criticism and challenge, it can be helpful to ask oneself how you would speak to someone else in your situation, a colleague or a friend.  What tone of voice would you use? What words would you use to support them in a compassionate way?

Difficulty Staying Present and Attending to One’s Needs

Staying present and engaged in the face of stress and workload demands are important skills for frontline health care providers at all times, but perhaps even more relevant during a chronically stressful period with no known end date.

  • Anxiety can make it challenging to stay present as one ruminates about the past or worries about the future. Taking a few seconds at various points throughout one’s work shift to physically stretch, have a mindful sip of water, to take a few, slow breaths, or naming one’s emotions can be incredibly helpful in staying present and addressing one’s needs in the moment. Some health care providers regularly engage in these brief moments of presence (e.g., before moving onto a next clinical interaction, before or after charting, before entering one’s place of work) to help with clinical engagement and efficiency.
  • This may be a time when individuals are prone to engaging in overpreparation (see COVID-19 Information Overload) with diminishing or even negative impact. Trying to read enough, learn enough until one “feels” prepared can be problematic in a situation such as this in which there is much that cannot be predicted. It can be useful to ask oneself, am I reading this to lessen anxiety or because it is necessary for my work and will have direct impact on my work tomorrow or the next day?  Health care providers have lots of experience coping with things that are unexpected and reminding themselves that they will do so again now as needed may be reassuring.
  • Frontline health care providers may be coping with exacerbation of pre-existing health issues or develop new ones during this time of stress and physical demand that can make it harder to engage in the challenging work they are facing. Many important types of healthcare, physical and psychosocial, , are now being carried out remotely online or by phone with availability of flexible times at off peak hours. As frontline health care providers, it may be helpful to consider accessing care for yourself at this time such as booking an online appointment with a physiotherapist, for example, to address the considerable physical toll of your current work demands, or contact a psychologist or other mental health professional for support and to address new or existing issues that one faces. It may be beneficial to review, or ask a spouse to review, an extended health benefits available to you through work or other private insurance . Additionally, many initiatives across the country are being put in place to offer services to frontline health care providers. This is also a time to make sure that one’s own prescriptions are filled and maintaining adherence to self-care in as much as that is possible.
  • In addition to coping with fear and anxiety about larger, population-based health needs related to COVID-19, frontline health care providers may also be coping with a number of challenges associated with doing things in accordance with new processes and procedures. For example, using new Personal Protective Equipment and trying to maintain physical distance in certain circumstances may change how one communicates with one’s team members or adds to physical discomfort; working with new teams and in new settings due to redeployment can make even familiar procedures feel less familiar, more cumbersome, and more uncomfortable; working with colleagues who are also facing tremendous stress and workload can impact the emotional tone of work interactions.  Being cognizant of the cumulative impact of even seemingly small stressors can be helpful and make it more likely that individuals engage in helpful strategies to address (e.g., using strategies to be present, eating something in the morning rather than running on empty, stretching to relieve muscle tension regularly rather than wait for pain or discomfort to heighten).
  • During this pandemic, familiar activities and places of community that add meaning, enjoyment, and enhance health are not available in a physical sense. Being unable to attend one’s regular religious services, attend a favourite fitness class, go running with a running group, or join friends for brunch can make it harder to find balance in the face of tremendous work demands. This is a time to remember that “some” moves us forwards as opposed to engaging in “all or nothing” strategies. Being creative about how to interact virtually and take advantage of the many fun, free online led activities that are available can be helpful. If someone feels too depleted to research these options, they could consider reaching out to non-healthcare friends or family to ask for their help.
  • It can be valuable for front line health care providers to check in with themselves about their current alcohol or other substance use, particularly if such use is aimed at relieving stress or numbing discomfort or emotional pain, helping with sleep, or if frequency has increased. Some individuals may have had difficulties with substance use in the past and this new, significant period of stress and increased time spent alone outside of work may increase the likelihood of reinitiating problematic coping strategies.
  • In addition to considering strategies or accessing resources to address difficulties with sleep, it may be helpful to consider ways in which one might be restricting one’s own sleep even if not experiencing any difficulties falling or staying asleep. For example, some frontline health care providers may be going to bed later to engage in more reading about COVID-19 in social media posts or watching the news. Relatedly, checking one’s phone after waking up in the night can result in staying awake as opposed to falling back asleep. It is also important to consider how fatigue may be impacted by factors other than sleep such as nutrition, diet, and physical activity.
  • Attending to one’s needs for support from loved ones remains important during this time of stress, even for frontline health care providers. Health care providers may sometimes want to protect their loved ones from their worries or their stresses. Health care providers would benefit from considering how and when to ask for support from loved ones and also communicating what would not be helpful at this time. Being a health care provider does not make one immune to the worry and stress of COVID-19 and non-medical friends and family will understand this.

How Can Psychologists Help?

Relevant to the potential impact of working under the stress of the COVID-19 pandemic, psychologists are experienced in assessing and helping individuals cope with issues such as anxiety, fear, distress, trauma, and grief. Learning skills to tolerate and cope with uncertainty, addressing longstanding or new unhealthy habits, addressing sleep difficulties, finding support for stressed relationships, and finding ways to maintain resilience through difficult situations are just some examples of what one may choose to address with a psychologist in a supportive and confidential therapeutic relationship.

Where do I go for more information?

To obtain  important and up to date information about COVID-19, visit the Public Health Agency of Canada (PHAC) website at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

The CPA maintains a regularly updated page of psychology-related COVID-19 resources https://cpa.ca/corona-virus/

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 CPA by Anita Gupta, Ph.D., C.Psych., a clinical, health and rehabilitation psychologist whose clients are physicians working on the frontlines in Toronto, Ontario.

Date: March 29, 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144 | Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Student Wellness and COVID-19

As the COVID-19 situation evolves around the globe, students’ day-to-day lives are being increasingly disrupted. From courses being moved from an in-person setting to online classes and not being able to visit friends and family, to not having access to the resources such as the library, the mental health clinic, or other spaces on campus, to having to leave residence, and conferences being cancelled, students’ lives are being affected in many ways.

As you deal with the impacts of COVID-19 on your life and the implications for your loved ones and the world at large, it is important to prioritize your mental health, as well as your physical well-being. The Canadian Federation of Students has partnered with the Canada Psychological Association to bring you resources in this unprecedented time of stress and help you cope with a changing world.

The information that follows is intended to help students cope psychologically in the face of health risks like COVID-19. It does not convey important information that you should know about how the virus is contracted, its signs and symptoms, how to decrease your risk of contracting the virus and how the virus is treated. For important and up to date information about COVID-19 visit  the Public Health Agency of Canada (PHAC) website at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

Mental Health Risks Associated with COVID-19

It is important to remember that it is normal to be emotionally affected by events like wide-spread illnesses and that everyone will react differently to current world events. It is also important to remember that although these events may feel overwhelming, we are strong and resilient and have access to tools which can help us cope with stressors. Signs of stress can look like:

  • Fear and worry about your own health and the health of your loved ones
  • Changes in sleep or eating patterns
  • Difficulty sleeping or concentrating
  • Worsening of chronic health problems
  • Increased use of alcohol, tobacco, or other drugs

If you are experiencing any of these, remember to be patient with yourself as you are navigating a rapidly evolving situation and coping with many stressors and major changes.

Coping with Stress and Anxiety

During this time, it is really important to take care of yourself and pay attention to your mental well-being. Here are some tips to manage stress and anxiety:

  • Follow health and safety guidelines: Check credible sources such as the Public Health Agency of Canada and Health Canada to reduce the risk of contracting the virus. Remember that the media reports things that go wrong more often than things that go right. We hear about and pay more attention to the few people who might have been made very sick or who have died from an illness than we do about the many more people who have successfully recovered from an illness.
  • Take breaks from the news: While it’s important to stay informed and take guidance from health experts, hearing about the pandemic repeatedly can be upsetting. Make sure to take breaks from the news, including social media. If you want to stay informed but are becoming overwhelmed, set aside a set amount of time to check the news every day or sign up for a daily newsletter from a reputable news source.
  • Take care of your body: Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and do not increase your consumption of alcohol and drugs. YouTube can be a great place to find at-home workouts, guided meditations, or tips and tricks on cooking nutritious meals.
  • Take care of your mind: To cope with times of uncertainty, it can be easy to dive into a series, watch movies endlessly or jump on board with other mindless distractions for long periods of time. While this does help us escape current realities, it can feel unproductive and potentially unhealthy to disengage for too long. Consider, instead, choosing distraction activities that keep your mind thoughtful and stimulated. Is there a list of books you would like to read? Are there some podcasts that were suggested by like-minded friends? Consider listening to audiobooks while completing chores or other projects to keep yourself active throughout the day. Try to consciously choose the information you take in, such as historical or biographical reads, and watch out for those distractions that are engaged in out of convenience.
  • Connect with others: Your community is there for you in times of physical distancing. Connect with your loved ones and people you trust about your concerns and how you are feeling. Apps like Skype, FaceTime and Whatsapp allow you to call your friends and family through an internet connection so you don’t have to use your phone plan minutes.
  • Ask for help: Call a health care provider such as a psychologist, social worker, counsellor, family physician, or psychiatrist, if stress gets in the way of your daily activities for several days in a row.

International Students can have a harder time connecting with family abroad due to possible unstable internet communication. Here are other ways to stay connected with your community:

  • Reach out to a classmate: Chatting with peers can open doors to deeper connections and friendships. At this moment, a lot of people understand the need for connection and are open to making new friends!
  • Join an online group for international students: You are not alone. There are many international students in Canada going through similar experiences and coming together. Check out these Facebook groups: International Student Network and Migrant Students United!

Studying from Home

You might be used to going to the library or getting together with friends at a coffee shop to study, and the line between classes and everyday life can become more and more blurred as you are respecting physical distancing measures. Here are some tips to help you get set up for continuing your studies from home:

Your study environment

  • Dedicated study or workspace: If possible, set up a dedicated workspace where you can keep study materials and have virtual classes or group chats, so that you keep your studies separate from the rest of your life. Try to remember proper ergonomics when setting up your workspace.
  • Having resources at your disposal: Take some time to make sure you have everything you need at your disposal to effectively conduct your studies, as this could help mitigate potential stressors. For example, install any required software on your computer or order a headset and webcam for online classes. Reach out to your professor or students’ union if you need support and resources.
  • Comfort and quiet: As much as possible, keep your study space quiet and free from distractions. If you have roommates, you could use headphones (ideally noise-cancelling headphones) to drown out noise. Make sure your space is inviting so you want to spend time there (you could sit by a window or add a plant or favourite trinket to your desk).

Setting a schedule for school and life

  • Maintain a consistent routine: This includes sleep-wake times, exercise, and work/school schedules. It can be easy to do schoolwork all day because it feels like there is nothing else to do. Establishing and maintaining a routine will help you maintain a sense of normalcy and keep your schoolwork and home life separate.
  • Take breaks: It’s important to take breaks to rest your eyes, your mind and your body. If it’s hard for you to remember to take breaks, you could set up a timer for 90 minutes and then take a 15-minute break.
  • Check in with professors about expectations: Maintain good communication with your professors. Have a clear understanding from your professor about whether moving to online classes changes expectations around assignments, exams, and other academic requirements. For example, you could ask for flexibility on timelines given your current time zone.

Impacts on Graduate Students and Student Research

For some students, COVID-19 has had significant impacts on your research. Graduate students have been particularly impacted during this crisis. The combination of financial uncertainty, pressure to graduate within a given time frame and before funding runs out, managing your research and teaching responsibilities, disruption in their academic work, and lost conference presentation opportunities underscores the importance of prioritizing your mental health and well-being. Remember to have realistic expectations for your work and progress during a global pandemic. It is okay if you feel that you do not have the mental or emotional capacity to produce knowledge or undertake research during a global crisis. Here are other tips for coping as a student researcher:

  • Create a daily routine and set realistic goals for yourself.
  • Reach out to your department for support and stay in touch with your supervisors and have conversations about how you plan on carrying on with your work during this new reality.
  • If you had been accepted to submit at a conference and the conference was cancelled, contact the conference organizers regarding their policy about noting the conference acceptance on your CV, and obtaining the word on how to do so.
  • Talk to your university’s research officer to understand what, if any, impacts COVID-19 will have on any student funding you may have (e.g., scholarships, bursaries, fellowships).
  • See if your research can be conducted through online surveys or if your research protocol can be moved to an online experiment.
  • If possible, use this time to talk to your professors about working on publications, while not losing sight of the mental resources required to cope with COVID-19.

Keep Busy and Beat Boredom

Self-isolation and physical distancing have drastically changed the way we conduct our daily lives. Boredom is a common response as we adjust to staying home to help flatten the curve. Keep busy in order to stave off boredom and potential impacts on your psychological response to COVID-19. Here are some ideas:

  • Stay connected: There are different online platforms for games/entertainment to help you stay connected with your loved ones. Some popular applications are SnapChat, TikTok, Houseparty, Zoom, and Jackbox.
  • Jump on a viral challenge: There are countless challenges on social media that encourage people to try something different and share it with the online community. Try “draw something”, “until tomorrow” or “see a dog, send a dog”. For more ideas, check out this news article.
  • Discover a new hobby: You could use the extra spare time to try new activities such as zines, journaling, visiting museums virtually, karaoke, virtual escape rooms, and more! Additionally, consider checking out popular online courses as many websites are currently offering free lessons for the foreseeable future. If you have been interested in trying your hand at a new creative pastime, online courses can give structure and provide advice to help with that learning curve. Try engaging creatively in projects such as drawing, sewing or playing a new instrument.
  • Organize!: COVID-19 has shown the scale in which we need governments to fund public services such as healthcare and education. This pandemic can also be a window of opportunity to re-envision a just society. Liaise with activist organizations such as the Canadian Federation of Students, Fight for 15 & Fairness, Migrant Workers Alliance for Change, Climate Strike Canada, Our Time and other groups to get involved.

When Psychological Distress Becomes Too Much

It is normal to be emotionally affected by events like wide-spread illnesses and that everyone will react differently to current world events.  However, if any of the following signs and symptoms persist beyond a couple of weeks, persist to the point where you are not able to carry out the home or work-related activities permitted by physical distancing advisories, and are accompanied by intense feelings of despair or helplessness or suicidal thoughts you are well advised to consult a regulated health care professional such as a psychologist, your family physician, a nurse practitioner, psychiatrist, or other mental health provider. 

  • Sleeping poorly, too much or too little
  • Avoiding others, even within the confines of social distancing
  • Experiencing headaches and stomach problems
  • Crying
  • Talking less
  • Feeling anxious, depressed or having panic attacks
  • Feeling angry, guilty, helpless, numb, or confused
  • Thinking about or watching too much television on COVID-19 or pandemics
  • Not wanting to get out of bed
  • Having difficulties concentrating
  • Excessive eating
  • Drinking more alcohol or taking more prescription drugs
  • Having little patience
  • Feeling overprotective of loved ones

Where do I go for more information?

To obtain  important and up to date information about COVID-19, visit the Public Health Agency of Canada (PHAC) website at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

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 Genevieve Charest and Sofia Descalzi (Canadian Federation of Students) and Dr. Lisa Votta-Bleeker and Samantha Stranc (Canadian Psychological Association).

Date: April 2, 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Helping Teens Cope with the Impacts of and Restrictions Related to COVID-19

Adolescents are likely to be strongly affected by public health emergencies such as the novel coronavirus (COVID-19). Public health directives to reduce transmission have likely meant cancellations of organized sport teams and recreational activities, missed celebrations, cancelled school trips, reduced or lost employment, loss of opportunities to socially engage with peers, and loss of in-class academic learning – proms, graduations and exams may soon follow. These impacts, combined with indirect exposure to the virus through social and TV media coverage, may challenge their coping skills in very significant ways.

The stressors of COVID-19 come during a period of great physical, social and emotional change for adolescents.  At a time when they are forming identities, beliefs and values, they may be more likely than adults to act impulsively, push boundaries and assert their invincibility.  These latter behaviours may make them particularly vulnerable to contracting an infectious disease like COVID-19. 

Some Reactions to Expect

In general, most teens are strong, sensible and have good social support systems that will help them cope and respond well to distressing events. Nevertheless, a major stressful event or public health emergency can have many effects on teens. Some common reactions include:

  • Worries, fears, and anxiety about their safety and the safety of family and friends
  • Fear of other major emergencies
  • Negative ideas about and mistrust of others, particularly those of different backgrounds
  • Increase in disruptive behaviours, for example arguing, defiance, angry outbursts
  • Increased crying, sadness or depressed feelings
  • More difficulty concentrating or paying attention
  • Variations in energy levels – either less active and tired, or more active, impatient and agitated
  • Problems sleeping – either sleeping too much or not enough
  • Problems eating – either eating too much or not enough

How to Help

Teens need the adults in their lives to pay attention to their feelings and reactions. Remember that:

  • teens can cope with stressful situations, and you can help them.
  • they will express their feelings in different ways, both directly and indirectly.
  • teens need your assurances that they are safe and that you will be there for them if they feel upset.
  • teens will be impacted by the ways in which they see parents and other adults handle the situation, so it is important to be mindful of your own reactions and engage in good self-care.

This experience of lockdowns, forced closures, and physical distancing is new for most people in today’s world.  Your teens are likely in the house more during this pandemic than they have been for a long time and will be again after the pandemic has settled; cherish this time with each other.

Don’t over-react. Many of the reactions that teens may show at this time, including a certain amount of moodiness and arguing, can be normal features of adolescence. You should, however, pay attention to behaviours that are new and to any that are really disturbing to you and show understanding and support. If the behaviours are dangerous or seriously disruptive, or if they don’t improve after a few weeks, parents, family members or teachers should help the teen to get help.

On the other hand, teenagers may pretend not to be affected or concerned in an effort to convince themselves they are invincible or to appear “above it all” and “cool.” In reality, they may be scared, confused, worried and in need of your help.

Here are some suggestions on how to help your teenagers cope:

Grief and Loss. Grief includes shock, denial, anger, numbness, sadness, and confusion; it is a normal response to loss of all kinds, including those associated with the real or feared losses during public health emergencies. Nothing like COVID-19 has ever happened before in most of our lifetimes. Because of the changes to our daily lives as a result of COVID-19, teens are missing once-in-a-lifetime events, such as school trips to Europe, graduations, proms, and there is no way to stop or rewind the clock so that they can have these moments back. While loss of life may trump the loss of a prom, losing out on milestone events is significant and painful for everyone.  Let them talk to you about what they are missing; don’t dismiss their concerns and distress. Hear them and understand that these are big moments in their lives and let them grieve the loss of these experiences. Explain that it can take time to get over a loss and encourage them to be patient with themselves and with others.

Honest Reassurance. Offer reassurance based on the real steps that are being taken to address the situation and explain the importance of following public health directives such as physical distancing.  Admit that there are things you just don’t know, including how long the current situation will last. However, don’t hesitate to tell them that many people are working to ensure everyone’s safety, and that by following public health directives we decrease the chance that anything will happen to them or you.

Listen to what they have to say about the events and how they perceive them. Provide them, as best you can, with factual information and help them distinguish opinion from fact. Try not to lecture or interrupt.

Humour. When dealing with difficult circumstances, watching or listening to something humorous can be helpful. However, some teens may crack jokes about tragedies in “an unconscious effort to distance themselves from their fears”.  Discourage disrespectful jokes while not cutting off lines of communication.

Anger. Teens, and people in general, may feel angry about what they have lost. Anger is often based on feelings of threat, fear, helplessness and vulnerability. Turn the conversation to the underlying feelings; tell them how you feel and options to best deal with these feelings.

Affection. Be patient with teens and with yourself. Find simple, daily ways to show teens that you love them — hugs, words of praise, fun time together.

Comforting Friends. If teens have friends who have been directly affected by COVID-19, help them find ways of comforting them; they may avoid talking to them out of fear of causing more pain. They may need help to know how to offer comfort and support, especially in these times of physical distancing.

Social Media and TV Coverage. Both you and your teenager may want to limit exposure to news coverage of the virus.  Teens should not be shielded from the facts about the virus but watching too much new coverage can put them, and anyone for that matter, in an emotionally overloaded, anxious state. Watch TV news coverage together and talk about what you are seeing, hearing, and feeling.

Maintain Family Routines. Maintain family routines, particularly around sleeping and eating. Schedules help: waking up at a set time, schoolwork, leisure time, outside time when possible.

For most of us, times of stress may not be good times to make important decisions.  If teens are quite upset by COVID-19 events, encourage them to take the time they need to think through any big decisions.

Appropriate Adult Behaviour and Responses. Talk to teens about what you think and feel about the circumstances related to the virus so they can understand them better. They will gain confidence to deal with their own feelings if you show them that you have strong feelings and that you can cope with them in healthy ways.

Vulnerable Teens. Stressful events and an ongoing climate of uncertainty and worry can have a greater impact on teens who are vulnerable. This may include teens who have experienced serious bullying, difficult family separations, deaths in the family, family violence, sexual assault, a traumatic refugee experience, clinical depression, an anxiety disorder or other mental illness, a history of drug/alcohol abuse, self-injury or suicide attempts. Some vulnerable teens may experience a return or worsening of mental health problems or unhealthy behaviours, up to and including suicide attempts.

Teens, Technology and Physical Distancing

Disasters and emergencies are often times when people and communities would normally come together in friendship and social support.  COVID-19 however is different because we cannot physically come together.  While we must keep physically distant from each other to reduce spread of the virus, we don’t have to keep our social distance.  We just have to engage with others in a different manner; one with which teens are usually more familiar than their parents!  

One of the ways to stay connected socially while physically distancing is by staying connected online. In fact, physical distancing requirements may have little impact on the current generation of teens who are used to socializing through their cell phones, tablets and apps like Houseparty and Snapchat.  Online contact can help teens stay connected to their peers, especially if teens can videochat with their friends or co-play mobile games with their friends.

Online contact can also allow teens to stay connected with family members and loved ones who are far away and/or may be challenged by the physical distancing requirements. In this case, teens can be a helpful source of connectedness and support for loved ones, particularly those who may be elderly or vulnerable.

During physical distancing, school websites and libraries can make use of technology to help students complete online-based schoolwork; online resources may also be used for virtual extracurricular classes, science projects, and Lego challenges.

Helpful Activities for Teens

Teens can benefit from participating in activities that can help them feel better while still maintaining physical distancing, such as:

  • Relaxing Activities. Encourage activities like reading, listening to music, taking a walk, riding bikes, etc.
  • Diaries and Drawing. Some teens benefit from writing their thoughts and feelings in a diary, or drawing/painting about their feelings.
  • Recreational Activities. Vigorous physical activities and sports help reduce stress, and make people feel more alert, happy and energetic. While many teens have lost participation in organized sports, they may still be able to practice or play their favourite sport at home, or take up a new physical activity, such as biking or running.

Families can also embrace this time by engaging in activities together such as: tackling household projects previously put on hold, doing chores, painting or re-decorating a teen’s room, trying out new recipes, exercising together, playing board games and doing puzzles, watching movies, and going for family walks.

When to Seek Help

Some teens may be more at risk for a persistent or strongly negative response, or even for suicidal behaviours. Be watchful and prepared to seek professional help if your teen shows some of the responses listed below and keep communication open by checking in to see how they are doing. They may benefit from talking with a health professional such as a psychologist, social worker, physician, nurse or psychiatrist who can help them understand and deal with how they are feeling.

  • Behaviour problems
  • Learning problems
  • Angry outbursts
  • Withdrawal from family and technology-based connectedness to their friends
  • Frequent nightmares or other sleep disturbances
  • Physical problems such as nausea, headaches, weight gain or loss
  • Feeling very anxious or afraid
  • Ongoing sadness or depression
  • Hopelessness about life or the future
  • Increased risk-taking or problems with the law
  • Abuse of alcohol, street drugs, medicines or solvents
  • Suicidal thinking or behaviour

Where do I go for more information?

To obtain important and up to date information about COVID-19, visit the Public Health Agency of Canada (PHAC) website at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html or your local health authority.

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 

Kids Help Phone:  https://kidshelpphone.ca/

 

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Lisa Votta-Bleeker, Deputy Chief Executive Officer, Canadian Psychological Association.

Date: March 31, 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Psychological Impacts of the Coronavirus (COVID-19)

Infectious diseases, like any life stressor, challenge the way we cope. Whether we learn about them on television or experience them personally, we can feel upset, fearful and anxious as a result, both for our own personal safety and that of our family, friends, colleagues, and community. Stressful events can also bring up feelings and memories of previous traumatic events thereby compounding the distress that we feel.

The Novel Coronavirus (COVID-19) is one such infectious illness that currently poses significant risk to public health and we are all challenged by it. It is important to remember that it is normal to be emotionally affected by events like wide-spread illnesses, and that there are steps we can take to help us cope.

The information that follows is intended to help people cope psychologically in the face of health risks like COVID-19. It does not convey important information that you should know about how the virus is contracted, its signs and symptoms, how to decrease your risk of contracting the virus and how the virus is treated. For  important and up to date information about COVID-19 visit  the Public Health Agency of Canada (PHAC) website at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

While people vary in their response to a crisis, for one like COVID-19, it is likely that more people will see impacts on their mental health and well being than will suffer serious physical affects of the illness. People who may respond more strongly to the stress of a crisis include:

  • Older people and people with chronic diseases who are at higher risk for COVID-19
  • Children and teens
  • People who are helping with the response to COVID-19, like doctors, nurses, and other health care providers, or first responders
  • People who have mental health conditions including problems with substance use
  • People who tend to worry – particularly about their health, or who have experienced a previous or recent traumatic event
  • People who live alone or have few social supports

Assessing and Coping with Risk

Stress during an infectious disease outbreak can include:

  • Fear and worry about your own health and the health of your loved ones
  • Changes in sleep or eating patterns
  • Difficulty sleeping or concentrating
  • Worsening of chronic health problems
  • Increased use of alcohol, tobacco, or other drugs

 

Taking care of yourself, your friends, and your family can help you cope with stress and helps to make your community stronger. Coping strategies can include:

  • Staying informed and taking guidance from experts to help you most accurately assess your personal risk of getting physically sick. Consulting expert sources such as infectious disease practitioners, family physicians or nurse practitioners, public health hotlines, or government websites (such as Health Canada, Public Health Agency of Canada, Centre for Disease Control, and the World Health Organization) for information.[1]
  • Following the health and safety guidelines of such agencies as the Public Health Agency of Canada and Health Canada to minimize your risk of contracting the virus. Remembering that the media reports things that go wrong, or exceptional events, more often than things that go right, or common events. We hear about and pay more attention to the few people who might have been made very sick or who have died from an illness than we do about the many more people who have successfully recovered from an illness.
  • Balancing gathering information and heeding safety guidelines to reduce risk with not letting the gathering of information or the attention to safety guidelines unduly preoccupy you.

Things to Keep in Mind about Stress

It is important to remember that:

  • People are strong and resilient, and generally have the skills they need to cope with the stressors they will face in a lifetime.
  • Not everyone reacts to the same event in the same way and not everyone shows their distress in the same way.
  • The ways in which children and communities cope and react to a stressor are influenced by how they see parents, caregivers and community leaders cope and react.

Taking Care under Times of Stress

Taking care of yourself:

  • Hearing about the pandemic repeatedly can be upsetting, so take breaks from watching, reading, or listening to news stories, including social media.
  • Take care of your body. Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs.
  • Connect with others. Talk with people you trust about your concerns and how you are feeling – even when engaging in social distancing.
  • Maintain as normal a routine as possible, including engaging in activities you enjoy.
  • Call a health or mental health care provider if stress gets in the way of your daily activities for several days in a row.

Taking care of your family:

The threat of illness can be particularly upsetting to children and teens. Children and teens react, in part, to what they see from the adults around them. When parents and caregivers deal with the COVID-19 calmly and confidently, they can provide the best support for their children.

There are many things you can do to support your child or teen

  • Given them the opportunity to talk about their concerns about the outbreak, tell them the truth, reassure them, and let them know they can count on you.
  • Let them know it is ok if they feel upset or scared and talk to them about ways to cope with their feelings.
  • Limit your family’s exposure to news coverage of the event, including social media.
  • Try to keep up with regular routines to the extent possible. If schools are closed, create a schedule for learning activities and relaxing or fun activities; if organized activities are cancelled, try to engage in the activity (or an adaptation of the activity) at home.

 

If you notice that your child or teen’s behaviour has changed significantly, discuss the situation with them. Behavioural changes such as the ones below might also suggest a need to contact a regulated health care professional for additional help.

  • Excessive crying or irritation in younger children
  • Returning to behaviors they have outgrown (for example, toileting accidents or bedwetting)
  • Changes in sleeping patterns (too much or too little) or appetite (eating too much or too little)
  • Excessive worry or sadness
  • Unhealthy eating or sleeping habits
  • Irritability and “acting out” behaviors in teens
  • Poor school performance or avoiding school
  • Difficulty with attention and concentration
  • Avoidance of activities enjoyed in the past
  • Unexplained headaches or body pain
  • Use of alcohol, tobacco, or other drugs

Taking care of people impacted by quarantine

Quarantine – or isolation from others for a period of time – is an important public health tool used to prevent those who are infected or who may be infected from infecting others.  It involves being confined to your residence, with little or no direct contact with other people. Not surprisingly, almost everyone finds this to be upsetting, albeit to varying degrees.

During quarantine, it is important to maintain a connection with the outside world. This can be done by using the telephone, the Internet and social media. Although it may not be as good as seeing people face to face, it allows you to maintain meaningful contact with people.

When coming out of quarantine, people may experience different feelings, including:

  • Mixed emotions, particularly relief
  • Fear and worry about your own health and the health of your loved ones
  • Stress from the experience of monitoring yourself or being monitored by others for signs and symptoms of COVID-19
  • Sadness, anger, or frustration because friends or loved ones may have unfounded fears of contracting the disease from contact with you, even though you have been determined not to be contagious
  • Guilt about not being able to perform normal work or parenting duties during quarantine
  • Other emotional or mental health changes

 

For friends and loved ones of people in quarantine, although your contact with someone in quarantine may be significantly reduced, it is important to be reassuring and listen in a compassionate way. Contact him/her as often as is appropriate, thereby limiting their feelings of isolation. Talk to other people you trust about how you feel in response to the situation.

 

Most people will be able to handle quarantine without serious difficulty; however, some may have some significant mental health problems coping while in quarantine or when released. If this is the case, consult a regulated) health professional with mental health expertise who can assess the situation and provide the necessary care.

When Psychological Distress Becomes Too Much

Stressors such as the risk of illness associated with a pandemic will affect people differently. We can be affected psychologically (e.g., feeling worried), as well as physically (e.g., sleeping poorly). Stressors that are beyond our personal control are especially difficult to cope with well. Signs and symptoms that might signal a psychological problem or disorder for which professional help might be beneficial include:

  • Sleeping poorly, too much or too little
  • Avoiding others, even within the confines of social distancing
  • Experiencing headaches, stomach problems, neck or back pain
  • Crying
  • Talking less
  • Feeling anxious, depressed or having panic attacks
  • Feeling angry, guilty, helpless, numb, or confused
  • Thinking about or watching too much television on COVID-19 or pandemics
  • Not wanting to get out of bed
  • Having difficulties concentrating
  • Excessive eating
  • Drinking more alcohol or taking more prescription drugs
  • Having little patience
  • Feeling overprotective of loved ones

 

It is important to remember that most of us have had some of the signs and symptoms listed above at one time or another, and that COVID-19 has led to increased stress for most people.  If you have a number of these signs and symptoms and they

  • persist beyond a couple of weeks
  • persist to the point where you are not able to carry out the home or work-related activities permitted by social distancing advisories
  • are accompanied by intense feelings of despair or helplessness or suicidal thoughts

 

you are well advised to consult a regulated health care professional such as a psychologist, your family physician, a nurse practitioner, psychiatrist, or other mental health provider. 

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 

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Lisa Votta-Bleeker, Deputy CEO, Canadian Psychological Association.

Date: March 20, 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

[1] https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html; https://www.cdc.gov/coronavirus/2019-ncov/index.html; https://www.who.int/

“Psychology Works” Fact Sheet: Psychological Practice and the Coronavirus (COVID-19)

COVID-19 has demonstrated profound impact on the health of individuals and communities and on the delivery of health services, at precisely the time when health services are what individuals need, both for their physical and mental health.  Health care leaders and governments are advising and requiring changes to all manner of services so that face-to-face contact between people is minimized in the service of flattening the curve of virus transmission.

In recent years, there has been a burgeoning interest in digital services that support telepsychology and growing evidence that psychological treatments can be effectively delivered in this format[i]. However, embracing telepsychology can be daunting, especially for private practitioners who do not have institutions on which to rely for assurance about the privacy and security of any digital service they employ. Further, there are unique skills, competencies and considerations to practicing telepsychology.  Concurrently, however, with COVID-19, psychology practitioners are challenged to provide continuity of care to their patients.  Telepsychology would certainly enable them to deliver services without the COVID-19 transmission risks when services are delivered face-to-face.

Psychology Organizations and COVID-19:

  1. Some of Canada’s regulatory bodies of psychology across the country have issued information and updates about COVID which practitioners can consult:
    1. College of Psychologists of Ontario http://www.cpo.on.ca/Templates/Default-Inner-Page.aspx?id=2262
    2. College of Psychologists of British Columbia https://collegeofpsychologists.bc.ca/covid-19-updates/
    3. Psychological Association of Manitoba https://www.cpmb.ca/
    4. College of Psychologists of New Brunswick https://www.cpnb.ca/2020/03/18/information-to-members-re-covid-19/
  1. The CPA, as well as some of Canada’s provincial and territorial associations of psychology, have also posted resources about COVID-19:
    1. Canadian Psychological Association https://cpa.ca/corona-virus/
    2. Psychologists Association of Alberta https://psychologistsassociation.ab.ca/
    3. British Columbia Psychological Association https://www.psychologists.bc.ca/blog/covid-19-resources-preparedness
    4. Association of Psychology of Newfoundland and Labrador http://www.apnl.ca/
    5. Ontario Psychological Association http://www.psych.on.ca/

Resources and Factors for Practitioners to Consider when Employing Digital Services

  1. Be informed about the skills, considerations and competencies of practicing in the digital world. This would be important for you as the service provider and for any student or other provider who delivers the service under your supervision. The following link posts a number of recent article and guidelines on the topic https://kspope.com/telepsychology.php
  1. BMS, the insurance broker who provides the professional liability insurance program to CPA members and the provincial and territorial member associations of the Council of Professional Associations of Psychology (CPAP), along with Gowling WLG, the preferred legal provider that services the program, have authored an article on continuity of care and virtual health services. This article is specific to the Canadian context and practitioners are well advised to review it https://cpa.ca/docs/File/Insurance/COVID-19_Telehealth%20Resource_2020%20(PSY).pdf

It covers key topics such as

  • Being licensed where you are practicing from and where your services are received.
  • Ensuring your professional liability insurance is in place to cover you from where you deliver service and where it is received.
  • Ensuring the privacy and security of any digital platform you employ and that you collect informed consent from your patients to deliver services to them in this manner.
  • Ensuring that any other means of communicating with patients (e.g. email) enables you to comply with applicable privacy legislation.
  • Whether or not you provide telepsychology services during the time of pandemic, you should consider all means of continuity of care for your patients.
  1. The Canadian Psychological Association (CPA), the Association of Canadian Psychology Regulatory Organizations (ACPRO), and the Association of State and Provincial Psychology Boards (ASPPB) all have guidelines on telepractice that practitioners are advised to consult.

https://cpa.ca/aboutcpa/committees/ethics/psychserviceselectronically/

http://www.acpro-aocrp.ca/documents/ACPRO%20Model%20Standards%20for%20Telepsychology%20Service%20Delivery.pdf

https://www.apa.org/practice/guidelines/telepsychology

  1. The regulatory bodies of psychology in Canada’s Maritime provinces have a Memorandum of Understanding around telepsychology practice across their jurisdictions

http://www.nsbep.org/mou-with-memorandum-of-understanding-telepsychology-now-includes-all-maritime-provinces/

  1. The American Psychological Association (APA) has posted its Office and Technology Checklist for Telepsychology Services. https://www.apa.org/practice/programs/dmhi/research-information/telepsychological-services-checklist Informed consent checklist for telepsychology services https://www.apa.org/practice/programs/dmhi/research-information/informed-consent-checklist

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Karen Cohen, CEO, Canadian Psychological Association.

Date: March 18, 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

[i] https://psycnet.apa.org/record/2014-50698-007

http://www.diva-portal.org/smash/record.jsf?pid=diva2%3A1271635&dswid=6311

“Psychology Works” Fact Sheet: Working from Home During COVID, With and Without Children

The Novel Coronavirus (COVID-19) is an infectious illness that currently poses significant risk to public health and is rapidly changing the work landscape in Canada.  The current recommendations from the Public Health Agency of Canada (PHAC; https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html) about social distancing have an obvious impact on our work lives.

Many employers in Canada are recommending that non-essential employees work from home.  This step ensures not only that potential person-to-person transmission of COVID-19 is reduced in the workplace, but also reduces the need for people to take public transit to get to work.  Schools – including colleges and universities – are also closed or being closed to curb the spread of COVID-19, which will likely lead to parents and children sharing “workspaces” for an extended period of time.  The information that follows is intended to help people understand the basics of working from home, as well as some ideas for managing home environments, especially ones with children!

Your work environment

In order to effectively work from home, it is important to establish an environment that is conducive to doing so.  The needs of your individual work environment will likely vary, but some basics to consider include:

  • Dedicated workspace: When at all possible, try to set up a dedicated workspace where you can store your documents, have conference calls or virtual meetings, and generally separate your work responsibilities from your home and/or caregiving responsibilities.

 

  • Appropriate technology: Being effective when working remotely requires that you have the technology necessary to perform your tasks.  Consider your work needs with respect to communication (e.g., access to your office voicemail, headset and webcam for virtual calls), appropriate software on your laptop or other devices, access to any files that you may need at work, as well as sufficient internet connectivity to manage your day-to-day business. Confirm with your employer, that you have the support and resources to meet all privacy and security requirements of your work when working from home.

 

  • Comfort and quiet: it is important for your workspace to be comfortable and quiet to minimize distractions and encourage you to visit your workspace when required – a challenge in a shared space!

Setting a schedule for work and life

As noted above, the COVID-19 pandemic will likely require parents, their partners, and their children, to share “workspaces” for a longer period of time than is typical for them.  Although most people can imagine working around each other’s schedules for a day or two, managing a balance between multiple people’s schedules in the same space may be challenging for some.

People are driven by routines, and disruptions to those routines can be stressful.  This is true for adults, and doubly-true for children. When working from home, having a set schedule that approximates your (and your children’s) typical schedule can be helpful to ensure that you maintain your productivity and a sense of normalcy for your children.

The separation of your home and work schedules (or home and school schedules) is typically easier when those locations are physically separate.  Here are some suggestions for sharing space:

  • Maintain a consistent routine when possible: this includes sleep-wake times, exercise, and work/school schedules. Establishing and maintaining these routines will help everyone maintain a sense of normalcy.  It is also helpful to establish a coordinated schedule for everyone (you and your children) to ensure that you are able to maximize the time that you can dedicate to your work without impacting your children’s care.

 

  • Don’t use extra time for work: given the sharing of spaces between work and home, it can be easy to feel the need to “check-in” to our workspace outside of our normal work hours to complete a small task. It is important to also have boundaries with ourselves regarding work and home life.

 

  • Take breaks: although this may sound intuitive to many people, it is important to practice self-care and remember to take breaks. Breaks are likely more automatic in an office environment when others can suggest a walk or a coffee, but they are just as important when working from home.  Breaks can help you rest your eyes from long hours in front of a computer screen, re-orient you to important tasks, or just give your brain a break and let you check on your family.

 

  • Be flexible: Although this may sound counterintuitive when trying to maintain a consistent routine, be prepared to be a little bit flexible with respect to the hours you are “at work”. Your coordinated schedule may not fit into a typical 9-5 workday, and that is okay as long as a balance between your work needs and your family’s needs is being maintained. 

 

  • Understand your employer’s expectations: Have a clear understanding from your employer about whether work from home changes any of your usual responsibilities or their expectations.

Maintaining good communication and boundaries

Sharing space with your children and other family members during these times will require increased attention to boundaries and the maintenance of open communication.  Everyone in your family wants to get their needs met and ensuring that you have established clear boundaries with everyone will support the sustainability of your work-from-home environment over the long term.

  • Good communication: This means good communication with your colleagues and your family.  With colleagues, you may need to “over-communicate”; let them know that you may be interrupted during meetings, but that you will try to manage the situation as best as you can (having a strategy for quickly managing this, such as reaching out to a partner for help (if possible), or having a snack/bottle/activity ready for children will help).

 

  • Good boundaries: This also means setting good boundaries between yourself and your family, and yourself and your colleagues.  For family members, with the help of a schedule (see above), it will be important to ensure that your work time is protected as best as it can be.  This can be as simple as trading off childcare duties with your partner (if possible), or establishing a “do not disturb” signal for your children.  With colleagues, it is important to emphasize that you will “log-off” outside work hours, meaning that you can set end enforce the expectation that you will not be checking work emails/messages outside the hours you have set as your “work” hours.

Keeping children entertained or engaged during work hours

Although establishing a good work environment, good communication, and an effective schedule are helpful, it is also important that your children are entertained and/or engaged while you are working.  How to do this will depend greatly on how old your children are; what works to entertain a toddler will generally not work for a teenager.  What follows are some points to consider for some of the major age groups:

  • Babies and toddlers: Young children generally require the most attention and flexibility from their parents. It might be helpful to plan for meetings or tasks that require your full attention during your children’s naps, attend virtual meetings with your camera disabled so you can feed or hold your child while on a call or in a meeting, or if possible, plan to trade off responsibilities with your partner around important work engagements.  Again, any of these steps will require good communication with your family and colleagues regarding your current work-from-home situation.

 

  • Early and elementary school-age children: Working from home for an extended period of time with school-age children will likely mean balancing their schoolwork and other activities with your work schedule. It may be helpful to set a schedule with your children around expectations for schoolwork vs. free time.  It will also be helpful for your children to know when and how they can communicate with you (e.g., make up a fun way to communicate, along with reasonable expectations for response time).  Other strategies, such as relaxing limits on screen time during an important meeting, having a “boredom box” filled with fun activities and toys that your children can access during your workday, or even sending your children outside to play (if it is safe to do so) will allow for increased productivity for you.  Finally, allowing children access to online educational tools or setting up supervised video-chatting between them and their friends might help alleviate some of their boredom and leave you with more time for work and yourself.

 

  • Middle-schooler and teenagers: As children mature, it is often appropriate (and helpful) to get them to participate more actively in setting their schedules and managing their daily tasks and expectations. Creating a schedule that they can independently follow, setting daily goals regarding school and housework, and setting boundaries around your work time will be helpful.  Finally, discuss appropriate screen time limits, bedtimes, and ways for your child to stay physically active and connected with friends and peer groups, even if virtually.

Where do I go for more information?

To obtain  important and up to date information about COVID-19, visit the Public Health Agency of Canada (PHAC) website at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

If you are having difficulties with managing a prolonged self-isolation, 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. Stewart Madon, Accreditation Registrar and Ethics Officer, Canadian Psychological Association.

Date: March 17, 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Anxiety Related to Food Allergy in Children

What is food allergy?

If your child has a food allergy, their immune system misinterprets a certain food as harmful and reacts by triggering an allergic reaction. Almost 500,000 Canadian children under 18 years of age have an allergy to food (Soller et al., 2015). The severity of allergic reactions to food is unpredictable and symptoms may range from itchy skin and hives to anaphylaxis. Anaphylaxis is a potentially life-threatening reaction that can affect different parts of the body. Food is one of the most common causes of anaphylaxis in children.

According to Health Canada, the “priority food allergens” or most common foods triggering an allergic reaction are egg, milk, peanut, fish, crustaceans (e.g., lobster, shrimp) and molluscs (e.g., scallops, clams), sesame, soy, tree nuts, wheat and triticale (hybrid of wheat and rye), and mustard.

Food allergy currently has no cure, and therefore, it can be thought of as a chronic medical condition that requires long-term management.

How is anxiety related to food allergy?

Some of the physical symptoms of an allergic reaction (e.g., trouble breathing, dizziness, lightheadedness, feelings of panic, abdominal pain, diarrhea, nausea, vomiting) can be very similar to what we feel when we are anxious. This similarity can make it difficult for some children to tell the difference between feeling unwell because they are having an allergic reaction to something they have eaten, versus having a non-life-threatening experience of feeling anxious.

Managing a food allergy requires a high degree of awareness and vigilance. Exposure to a food that you are allergic to carries risk and can have significant health consequences. At the same time, eating and drinking are essential activities we must do every day to stay healthy and they can’t be avoided! Some anxiety keeps people on guard and helps them to stay safe; too much anxiety can get in the way of our happiness and ability to function each day.

If some anxiety is expected (and even helpful!), how do I know when anxiety related to food allergy has become a problem?

Vigilance about exposure to food allergens is very important to keep children safe, therefore, some anxiety is expected. However, when the anxiety begins to interfere significantly with your child’s involvement in age appropriate activities and/or affects their behaviour, it is considered a problem. For example, the fear of having contact with an allergen may lead some children to make extreme changes in their behaviour to try to avoid this risk altogether. Parents must pay attention to potential changes that may indicate that their child’s anxiety is causing them problems.

What kinds of behaviours might mean that professional support is needed for my child?

  • Refusing to attend school or extreme resistance to get there in the morning
  • Refusing to participate in extracurricular activities (e.g., birthday parties, playdates, attending lessons away from home)
  • Becoming clingier or experiencing distress about being away from caregivers
  • Excessive label reading and/or an excessive amount of questions about whether foods are safe to eat
  • Excessive hand washing
  • Extreme, unnecessary restrictions in eating and drinking
  • Significant changes in mood, sleep, or other behaviours

Parents managing a food allergy often worry a lot about their child’s safety and they may experience heightened stress due to the need for constant planning and vigilance to prevent exposure to allergens. Parents need to educate caregivers at school and other settings about how to keep their child safe (and then trust these adults to put the necessary safety procedures in place).

It is important to keep in mind that your child learns from you and models their own behavior after yours, so high levels of parental anxiety and stress can have a negative impact on children. If you find you are spending a lot of time worrying about your child’s food allergy and safety, and it’s impacting your behaviour or ability to function at home or work, you may benefit from meeting with a psychologist specializing in the treatment of adult anxiety.

How can psychologists help children and their families who have a lot of anxiety due to their food allergy?

Psychologists can assist with many aspects of the management of anxiety related to a food allergy.

Cognitive-Behavioural Therapy (CBT)

CBT is a well-studied treatment that has been demonstrated to be effective in treating anxiety in children and youth. CBT is most often used with children 8 years of age or older, but it can also be modified (with a focus on parental involvement) for children as young as preschool age. CBT can help your child learn the relationships between anxiety and unhelpful thoughts and behaviours. Then, your child can be taught ways to think about challenging situations in a more realistic and manageable way. Your child can also be taught strategies to help them identify and better cope with the physical symptoms of anxiety.

Using these strategies, your child can then practice doing activities they are fearful of (like going to playdates or eating something after checking the label a few times instead of many times) in steps that are gradual and safe. This is called behavioural exposure and is an important part of the treatment of anxiety. Psychologists may consult with other health professionals (e.g., allergist, nurse, dietitian) to learn more about specific allergies and to help develop a treatment plan that will be safe and tailored to the unique needs of your child.

CBT is also commonly used with adults to address anxiety that is unrealistic and impairing. Using this treatment approach, caregivers can be taught to recognize unhelpful thinking patterns about their child’s food allergy, learn ways to manage their own anxiety in a more helpful way, and decrease unnecessary interference caused by anxiety related to the allergy.

Self-Advocacy

Psychologists may also help with self-advocacy (e.g., helping your child to be comfortable asking questions about food ingredients and labels, or refusing to eat foods that may put him/her at risk). These skills are important to develop to increase independence, also because bullying is commonly experienced by children with a food allergy (Lieberman et al., 2010).

Oral Immunotherapy

Psychological support may be needed for families exploring or undergoing oral immunotherapy (OIT), a potential treatment for some individuals with food allergy. OIT is a medically supervised treatment in which a person eats small amounts of the food they are allergic to (their allergen) in clinic/hospital and home settings. The amounts of the food allergen are given in gradually increasing doses until the person can eat a certain amount without having a reaction, so long as they are on this treatment. This will help protect them if accidental exposure to the food allergen occurs.

For OIT, families must go from fearing exposure to a specific food with potentially life-threatening consequences and completely restricting exposure, to encouraging a child to eat small amounts of that same food in a supervised way. Understandably, this can result in increased anxiety for the whole family. Psychologists can assist families with decision-making related to whether this potentially life-changing treatment is worth pursuing or continuing, for those undergoing treatment. They can also help children and their caregivers learn tools to manage anxiety they may experience during treatment.

Maintaining a Balance

Individuals with a food allergy must work to avoid their food triggers while also maintaining a high quality of life. A psychologist can help families achieve balance between following prescribed safety practices (e.g. avoiding the food allergen, having an emergency plan, carrying an epinephrine auto-injector such as an EpiPen® when age appropriate) and continuing to participate in activities that are important to the family.

Where can I find more information?

  1. Visit these websites for additional information:
  1. Consult with a registered psychologistto find out if psychological interventions might be helpful to you and your family. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, visit https://cpa.ca/public/whatisapsychologist/PTassociations.

References

  • Lieberman, J. A., Weiss, C., Furlong, T. J., Sicherer, M., & Sicherer, S. H. (2010). Bullying among pediatric patients with food allergy. Annals of Allergy, Asthma & Immunology, 105, 282-286.
  • Soller, L., Ben-Shoshan, M., Harrington, D., Knoll, M., Fragapane, J., Joseph, L., Clarke, A. E. (2015). Adjusting for nonresponse bias corrects overestimates of food allergy prevalence. The Journal of Allergy and Clinical Immunology: In Practice, 3, 291-293.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Joanne Gillespie, IWK Health Centre, and reviewed by Food Allergy Canada.

Date:  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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Coping with and Preventing COVID-19

What is COVID-19?

COVID-19 is a new coronavirus that is rapidly spreading throughout the world. According to the WHO, it is classified as a pandemic. Most people (80%) experience mild symptoms, although the virus is most harmful to seniors (over 65 years of age) and people with compromised immune systems (e.g., with cancer, chronic inflammatory conditions like rheumatoid arthritis) and pre-existing medical conditions (e.g., cardiovascular disease, uncontrolled hypertension or diabetes, and chronic lung diseases).

How is COVID-19 transmitted?

Similar to seasonal flu, people can get infected with COVID-19 if they inhale water droplets containing the virus, such as when someone sneezes on them, or by touching a surface contaminated by the virus (e.g., a hand-railing) and then touching their nose or mouth or rubbing their eyes.

What should you do if you think you have COVID-19?

The following symptoms may appear 2-14 days after exposure.

  • Fever
  • Cough
  • Shortness of breath.

If you think you have been exposed to COVID-19 or if you develop symptoms (e.g., a fever or respiratory symptoms like such as cough or difficulty breathing), isolate yourself, stay home and call your healthcare provider and/or local health authority immediately (see: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/2019-novel-coronavirus-information-sheet.html#pha). You will be asked to describe your symptoms and travel history. They will advise you on how to get tested and/or treatment.

If you are sick with COVID-19 or suspect you are infected with the virus that causes COVID-19, follow the steps below, as outlined by the Public Health Agency of Canada (PHAC) and the Centers for Disease Control (CDC), to help prevent the disease from spreading to people in your home and community.

  • Stay home (except to get medical care in case of symptom deterioration)
  • Avoid using any form of public transportation
  • Separate yourself from other people and animals in your home
  • Wear a facemask if you are sick (wearing masks does not protect you from others who may be sick)
  • Cough and sneeze into your arm or elbow
  • Immediately dispose of used tissues
  • Clean your hands often
  • Avoid sharing personal household items (particularly towels)
  • Clean all “high-touch” surfaces every day
  • Monitor your symptoms and seek prompt medical attention if your illness is worsening (e.g., difficulty breathing)
  • Call ahead before visiting your doctor

What is the best way to keep safe?

Currently, there is no vaccine for COVID-19. Human behaviour is key to the spread of COVID-19, and behavioural strategies may help to reduce transmission. The best way of protecting yourself is to wash your hands regularly with soap and water before and after meals and after touching ‘public’ surfaces (like doorknobs or handles).  Keep your hands away from your face and cover your coughs and sneezes (e.g., coughing into your arm). The recommended way of doing these things may be different than how you are used to doing them.  Using evidence-based behavioral strategies may help you adapt your daily routines to keep you safer:

  1. Up-skill how you wash your hands: Washing our hands is often part of our daily routines already, but to be effective in preventing transmission of the virus, most of us probably need to wash our hands better and for longer:
    • Make sure you have soap or alcohol-based* hand sanitizer available; if you’re worried about dry hands, bring moisturiser with you (*alcohol content should be 60% or higher)
    • Wash your hands for at least 20 seconds. Humming a song (e.g. happy birthday) that lasts that long may help with timing. (“If I’m washing my hands, I will hum happy birthday!”)
    • Put soap on the back and front of your hands, under your nails and between your fingers
    • Make it more salient: consider making it more memorable by telling yourself “when washing my hands, I will wash them as if I just cut up a jalapeno and need to take out my contact lenses!”
  2. Social Distancing: Social distancing is a term applied to certain actions that are taken by Public Health officials to stop or slow down the spread of a highly contagious disease, and ensure our public health system can continue to meet the demands placed on it. The figure below depicts the critical role that social distancing can play to reduce the spread in a short period of time. Social distancing is one of the most effective measures for reducing the overall speed of transmission, to protect and preserve the capacity of the healthcare system to care for severe cases. Social distancing is specific to limiting physical/in-person connections. It is important to stay connected to each other through other means to maintain our connections and support one another (email, phone, social media)

    Social distancing measures include limiting large groups of people coming together, closing buildings, and canceling events.  Examples of social distancing measures can include: suspending classes in or closing schools, modifying hours of operations for services, changing workplace practices to allow flexible shift plans and tele-work, closing theatres, cancelling large scale indoor and outdoor events (e.g. sporting events, concerts, parades, festivals), and suspending or limiting transportation means.
  3. Am I really touching my face that much? Yes! To be transmitted, COVID-19 needs access, and that is usually through your nose, mouth or eyes. Over the course of the day, most people touch their face a few dozen times, often without realizing it. Potentially effective behavioural strategies to stop touching your face are:
    • Use ‘if-then’ plans to ‘program’ that automatic part of your brain to be more aware of when you touch your face to curb this behaviour. For example, “If I find myself resting my hand on my chin, I will remind myself that I want to stop the spread of COVID-19”.
    • Ask your family/friends/coworkers to monitor and give you feedback on how often you touch your face without realizing it; make a game out of it to track each other, aiming to touch your face less. You might be amazed at how often you touch your face without realizing it.
  4. Replace handshakes and kissing cheeks: Shaking hands and kissing cheeks are common ways of greeting in Canadian society. Developing alternative ways of friendly connection during the COVID-19 outbreak. Bumping feet, elbows, or bowing could avoid transmission while maintaining our important social connections. While initially a bit awkward, explaining why may help to normalize it.
  5. Restrict all non-essential travel until further notice:
    • Canada’s chief public health officer, Dr. Theresa Tam, is advising all Canadians to postpone or cancel all non-essential travel outside of Canada until further notice.
    • If you plan to travel, stay informed of Canadian travel advisories as well as those for your travel destination.
    • If you are flying, confirm travel policies and restrictions with your airline (this includes ensuring return or alternate flights can be secured should flight restrictions change).
    • Ensure you have appropriate health and travel insurance – including cancellation insurance ‘for any reason’.
    • When considering whether or not to travel, keep in mind that local and foreign travel restrictions and border controls are changing everyday. If you do decide to travel, be aware that borders could close at any time and you may be forced to extend your stay.
  6. Get the vaccine once it becomes available: Current estimates by the World Health Organization (WHO) are that developing a vaccine is at least 18 months away. When a vaccine is made available, it is important to make the time to get vaccinated for yourself, as well as for those who can’t be vaccinated due to medical and other reasons. We can help everyone stay safe if all of us get vaccinated, because we won’t spread infection. This is called “herd immunity.” When it comes to vaccination, ensuring the greatest amount of community coverage is key for optimal prevention and protection of vulnerable populations (seniors, those with health conditions).

Psychological reactions to COVID-19: Why are they important?

Psychological factors play an important role in how people and communities respond to illness and manage its spread.

Some people under-respond to the threat of COVID-19. These people think the danger is exaggerated.  Under-responders may not practice good hygiene, they don’t get vaccinated, and they don’t stay home if they’re sick; these behaviours help infection to spread. To accurately assess the risks of COVID-19, check out the websites of the PHAC, WHO or CDC (see below for links to updated resources). Under-responding could spread infection to family and friends.

Some people over-respond to the threat of COVID-19. These people become highly anxious about the infection and may go to great lengths to keep themselves safe. They may become xenophobic (i.e., needlessly frightened of foreign people), may needlessly wear protective masks (while wearing a mask may prevent you from spreading your infection to others, masks are not effective in preventing you from catching an infection from someone else), and may hoard supplies of food and other necessities. Over-responding by one person seeds fear in others because fear is contagious, so the more you see people buying toilet paper makes you believe that toilet paper may run out, leading you to rush out and stock up (needlessly). Moreover, if you hoard food, toilet paper, or hand sanitizer that you are not likely to need for example, then other people in your community have less access to them.

What can people do to stay calm but remain appropriately vigilant? 

  1. Listen to the advice of health authorities such as PHAC, the WHO and CDC for more local information about if/how COVID-19 is spreading in your area. See resources below.
  2. Change your habits around washing hands, touching your face, socializing and coughing – see behavioural strategies above.
  3. Some degree of concern is reasonable if it leads you to be proactive and take appropriate precautions, like staying home or social distancing, hand washing and sanitizing, and refraining from unnecessary travel. Otherwise, you should feel confident about carrying on with your everyday life as usual, with some minor adaptations. For example, if you typically go to the gym for your workout, consider going for a walk or a run in your neighborhood. If you go to a restaurant, skip the buffet and order a la carte. As long as there is no evidence of ‘community transmission’ (which is transmission of the virus from person to person through community contact rather than contracting it through travel), you should feel confident about maintaining several aspects of your routine, including going out.
  4. Keep things in perspective by consulting sources of information that are balanced and evidence-based, such as the PHAC, the WHO, and other credible sources (see links below). Remind yourself that the graphic images on the Internet, or the rumors on social media, may exaggerate the actual threat. The images of empty shelves in supermarkets are compelling visuals but are not necessarily common and may be confined to certain areas. No one is posting images of full shelves and calm shoppers because those images aren’t newsworthy. If you feel anxious when following news media or social media, limit your exposure.
  5. Fear is contagious. If you act frightened or engage in panic buying, then others will react with fear as well. You have a responsibility to your loved ones, friends, and the rest of the community to deal with the COVID-19 outbreak in a sensible, reasoned manner. Try to “lead by example”.
  6. Remind yourself that the current crisis will pass, and life will return to normal.

Where can I get more information?

How can I tell whether I should seek professional help for COVID-19-related stress or anxiety?

Look for warning signs such as the following:

  • Persistent anxiety, worry, insomnia, or irritability.
  • Needlessly avoiding social contacts to the point that you become unnecessarily isolated.
  • Persistently checking your body (e.g., taking your temperature many times each day) or persistently seeking reassurance about your health from doctors, friends, family, or the Internet.
  • Performing excessive or unnecessary hygiene precautions, such as wearing a facemask at home or repeatedly washing your hands when there is no need to do so.
  • Abusing alcohol or drugs, or overeating, as a way of coping with stress.
  • Feedback from friends or family that you seem unusually worried or stressed out.

How can I get help with stress or anxiety?  Psychological treatments can be very effective, sometimes more effective than medication, in helping people recover from anxiety.  To find a psychologist, you can consult the psychological association in your province or city.  A list of them can be found at https://cpa.ca/public/whatisapsychologist/PTassociations. Your local hospital, community health clinic, local public health department, or primary care provider (e.g., family doctor or nurse practitioner) may also be of assistance.  

This fact sheet has been prepared for the Canadian Psychological Association by Steven Taylor, Ph.D., R.Psych., Department of Psychiatry, University of British Columbia, Kim Lavoie, Ph.D., FCPA, FABMR, Montreal Behavioral Medicine Center (MBMC) and Department of Psychology, University of Quebec at Montreal (UQAM), and Justin Presseau, Ph.D., Clinical Epidemiology Program (Ottawa Hospital Research Institute), and School of Psychology and School of Epidemiology and Public Health (University of Ottawa).

Prepared: March 12, 2020
Updated: March 13, 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario K1P 5J3
Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657


[i] https://www.cdc.gov/coronavirus/2019-ncov/about/index.html

[ii] https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html

“Psychology Works” Fact Sheet: Concussions

What is a Concussion?

A concussion is an injury to the brain that is caused when a force is applied to the head or body. Concussions are the most common type of head injury, with an incidence of 210,000 per year in Canada (Longman & Rach-Longman, 2017).  Concussions are often referred to as mild traumatic brain injuries (mTBI) because they do not cause external visible damage. Instead, they produce changes to the chemical composition of the brain that temporarily interfere with brain functioning.

Concussions can be caused by a direct blow to the head (e.g., in sports or through physical altercations), abrupt speed changes that affect head and body movement (e.g., motor vehicle collisions), or by exposure to an explosion (e.g., in combat situations) (Friesen, 2017).

What are the Symptoms of a Concussion?

Brain injuries are classified as mild, complicated mild, moderate or severe, depending on the injury characteristics within minutes to hours of an injury. Concussions are also known as mild traumatic brain injuries.  Concussive injuries may or may not include a loss of consciousness but do involve at least an alteration of consciousness (e.g., being dazed, confused, incoherent, disoriented, or having significant incoordination) and/or an inability to form memories around the time of injury (i.e., posttraumatic or anterograde amnesia). The symptoms following a concussion are not specific to concussions as they are often found in other non-brain injuries (e.g., orthopedic injuries), and can include a combination of:

  • Physical Symptoms such as headache, dizziness, sensitivity to noise and light, blurred or double vision, alterations in sleep, nausea and vomiting;
  • Emotional and Behavioural Symptoms such as irritability, mood changes, anger, sadness, frustration, depression, anxiety; and
  • Cognitive Symptoms such as confusion, disorientation, trouble concentrating, slowed thinking, and short-term memory problems(Friesen, 2017).

When Should an Individual Seek Help?

If one is suspected to have experienced a concussion, regardless of whether symptoms are mild or severe, it is important to immediately see a physician to rule out a more serious brain injury that can become life threatening.

When can an Individual Return to Work, School or Sports?

Clinical recovery from a concussion usually occurs between 10 days and three months post-injury (Plourde, Kirkwood, & Yeates, 2017). Recovery time will vary, depending on: severity of the injury, number of symptoms experienced immediately post-concussion, pre-injury psychological or neurodevelopmental conditions, one’s psychosocial environment, and clinical management strategies. (Plourde, Kirkwood, & Yeates, 2017)

Risk factors for prolonged symptoms include: history of previous concussion(s); female gender; co-morbid medical conditions (e.g., migraines) or psychological conditions (e.g., depression, anxiety, PTSD); history of learning or attention difficulties; substance abuse; and adolescent age range.

To date, a consensus regarding effective treatment for concussion has yet to be identified. Research tells us that the brain needs time to heal and clinicians have typically recommended an initial but brief (i.e., a few days to a week) period of physical and mental rest, enough and good quality sleep, a healthy and balanced diet, and relaxation (Holland Bloorview Kids Rehabilitation Hospital). Mild physical exertion may be beneficial in the recovery process, starting as soon as three days post injury, as tolerated. (Longman & Rach-Longman, 2017)

Decisions regarding returning to school, work, and sport should be made in consultation with a physician or neuropsychologist and, ideally, the decision should be informed by results obtained through a multidisciplinary assessment as needed (e.g., clinical neuropsychologist, vestibular physiotherapist, etc.).

How can a Psychologist Help?

Psychologists (neuropsychologists, clinical psychologists, sport psychologists, school psychologists) can help in numerous ways related to concussions including assessment, treatment, and conducting research.

Assessment. A clinical neuropsychologist is a licensed psychologist with expertise in brain- behaviour relationships and knowledge of the interplay among neurological, psychological, and behavioural factors (Ontario Psychological Association, 2016). Neuropsychologists have expertise in the areas of assessment, intervention, and psychometrics in the context of brain injury, are uniquely qualified to interpret measures of cognitive and emotional functioning; and can objectively determine the presence or absence of neurocognitive and emotional sequelae of concussion. (Plourde, Kirkwood, & Yeates, 2017)

Treatment. Neuropsychologists are well positioned to educate patients about concussion symptoms and recovery patterns, and to recommend compensatory strategies (e.g., academic or work accommodations) to manage presumably transient cognitive symptoms of concussion during the recovery process. (Plourde, Kirkwood, & Yeates, 2017)

Additionally, in the case of psychological or emotional difficulties following a concussion (e.g., heightened attention/focus on symptom experience; depression; anxiety; emotional dysregulation) short-term psychological treatment may be recommended. Treatment for clinically diagnosed psychological conditions is typically provided by a clinical psychologist and may address emotional responses to concussion and the associated changes in activity and family dynamics. Patients requiring medications are referred to a medical practitioner (i.e., physician or psychiatrist).

Research. Psychologists engage in research and practice across a wide range of topics, having to do with how people think, feel and behave, many of which are connected to concussions. Psychological research specific to brain functioning, brain disease or illness (e.g. Post-Concussive Syndrome, Second Impact Syndrome, Chronic Traumatic Encephalopathy), individual differences and risk factors, family dynamics, treatment modalities, and protective equipment are some of the areas in which psychologists conduct research that is key to understanding, treating and preventing concussions.

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

References and Resources from Other Organizations

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Lisa Votta-Bleeker, Deputy Chief Executive Officer, Canadian Psychological Association

Date:  January 2020

The author and the CPA would like to thank Dr. Christopher Friesen, Director, Friesen Sport & Performance Psychology, and members of the CPA’s Section for Psychologists in Hospitals and Health Centres for their assistance during the development of this fact sheet.

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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Female Sexual Dysfunction

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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Pediatric Palliative Care

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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Pediatric Oncology

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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Alcoholism

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://www.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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

 

“Psychology Works” Fact Sheet: Grief in Adults

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

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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Irritable Bowel Syndrome

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

Canadian Psychological Association
141 Laurier Avenue West, Suite 702
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Tel:  613-237-2144
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“Psychology Works” Fact Sheet: End Of Life

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 a number of 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 undergo a number of losses, 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.

Quality health care at the end of life

What do people want from the health-care system at this stage? Patients say that, first of all, 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 have to 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 up 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 a number of 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.

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.

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.

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 revised fact sheet has been 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.

Revised: August, 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
141 Laurier Avenue West, Suite 702
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Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Autism Spectrum Disorder

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
141 Laurier Avenue West, Suite 702
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Tel:  613-237-2144
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“Psychology Works” Fact Sheet: Arthritis

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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Eating Disorders

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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

 

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

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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Applying To Canadian Graduate Schools

When do you start looking?

It is a good idea to start researching potential graduate 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).

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.

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/). 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 their 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. 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 increases your chances of being accepted to that university, it 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 and federal scholarships/grants can also help pay for your studies and cost of living as a graduate student. View the (), SSHRC (http://www.sshrc-crsh.gc.ca/), NSERC (http://www.nserc-crsng.gc.ca/) and CIHR (http://www.cihr-irsc.gc.ca/) websites as a starting point for more information on provincial and federal scholarships. For up-to-date information about Master’s level funding, visit http://www.nserc-crsng.gc.ca/Students-Etudiants/CGSHarmonization-HarmonizationBESC_eng.asp. 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).

A final note

When choosing the number of schools to which to apply, find a balance between quantity and quality in order 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 has been prepared for the Canadian Psychological Association by Mr. Colin Capaldi (Carleton University) and Ms. Lyndsay Evraire (Western University).

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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Physical Activity

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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

 

“Psychology Works” Fact Sheet: Bipolar Disorder

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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

 

“Psychology Works” Fact Sheet: Parenting Challenges

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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

 

“Psychology Works” Fact Sheet: Diabetes

What is diabetes?

Diabetes is a well-understood disease that results from either pancreatic (beta cell) failure (Type 1 diabetes) or insulin resistance (Type 2 diabetes).

According to Health Canada (https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54982-eng.htm), 7.3% of Canadians over 12 have diabetes.

The majority of Canadians with diabetes have Type 2 diabetes (90%), which is strongly associated with obesity, inactivity, and unhealthy eating patterns and aging.

In 2017, an estimated 425 million people worldwide had diabetes, with estimates that the number of people with diabetes in the world will reach 629 million by 2025 (International Diabetes Federation Atlas, 2017 (www.diabetesatlas.org)

Prediabetes is a diagnostic category, which, although not Type 2 diabetes per se, it reflects the beginning process 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.

The key to living well with diabetes is to avoid problems which arise from prolonged hyperglycemia (elevated blood glucose levels) or repeated episodes of hypoglycemia (low blood glucose levels).

In order to achieve a balance, individuals with diabetes must regulate their behavior on a daily basis.

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.

The treatment of diabetes includes following a daily routine of medication or insulin usage, self-testing blood glucose levels multiple times per day (twice a day if on pills and four times per day if on insulin), and a specific diet and exercise/activity.

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.

Diabetes self-care is difficult for a number of reasons. For example, 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).

Further, 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.

Another principle of successful behaviour management is the opportunity to take breaks or “time out” from difficult tasks. However, there are no weekends off, no vacations, and no retirement. The demands of diabetes self-care are constant.

Finally, 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.

What can psychologists do to help people with diabetes?

Psychologists can play a valuable role in helping people live well with diabetes. Diabetes presents a significant challenge and stress for diabetics and those around them. There are a number of psychological aspects of living with diabetes that interfere with function, health and quality of life.  In specific, diabetes distress is a recently validated construct that refers to distress associated with the emotional burden of diabetes, the regimen of diabetes self-management, as well as interpersonal distress associated with relationships with family and friends and relationships with healthcare providers. Fear of hypoglycemia is another important psychological consequence for many people living with diabetes, as is what has come to be called psychological insulin resistance. All of these diabetes-specific psychological issues place the individual at increased risk for depressive disorders.

Young people, especially young women with Type 1 diabetes, are at risk for developing eating disorders (weight loss through insulin omission).

Psychologists are well trained in emotion management and behaviour change interventions. They work with individuals with diabetes in a number of ways. They can help the newly diagnosed individual to understand the impact of this diagnosis and their role in managing it. They can problem solve to help them learn the daily behaviours needed for successful maintenance.

Psychologists are trained to recognize and treat psychological distress including depression and anxiety that can develop when living with an unpredictable disease.

Psychologists can be helpful in assisting the individual to develop and maintain the motivation needed to follow the daily routine of self-care. As well, family therapy and strategies to deal with social pressures are often beneficial to those with diabetes and their loved ones.

Are psychological interventions effective?

A number of research studies have evaluated the role of psychological interventions in diabetes. Behaviour change interventions have been shown to be helpful in improving self-care and diabetes control. A recent study of Type 2 diabetes demonstrated the importance of stress management.

Reducing diabetes distress, depression and anxiety has also been shown to help improve the quality of life of those with diabetes. Further, recent studies have shown that psychological interventions can also improve motivation to perform the self-care behaviours.

The Clinical Practice Guidelines from Diabetes Canada recommend psychological screening and support for all individuals living with diabetes. Further, diabetes self-management education is based on motivational and behaviour change interventions.

Where do I go for more information?

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

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 http://www.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: 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
141 Laurier Avenue West, Suite 702
Ottawa, Ontario    K1P 5J3
Tel:  613-237-2144
Toll free (in Canada):  1-888-472-0657

“Psychology Works” Fact Sheet: Cancer in Adults

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

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