“Psychology Works” Fact Sheet: Workplace Burnout

What is Burnout?

Chances are you have said or thought to yourself “I’m burned out!” at some point. In everyday life, we often use the term burnout to mean that we are “exhausted” or “wiped out” or to refer to “exhaustion of physical or emotional strength or motivation, usually as a result of prolonged stress or frustration” (Merriam-Webster Dictionary). But in psychological research, burnout refers to more than just exhaustion. The term burnout is used to describe a group of signs and symptoms that consistently occur together and are caused by chronic workplace stress. Different uses of the same word can make things hard to understand – especially since even the terms themselves vary across sources – burnt out, burned out, burnout. Adding to the confusion, the term burnout appears in The International Classification of Diseases – 11th Edition (ICD-11) but it is not classified as a disease or a medical condition. In 2019, the World Health Organization identified burnout as an “occupational phenomenon” – something due to the conditions of work.

Burnout is defined in ICD-11 as: “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

 

  1. feelings of energy depletion or exhaustion;
  2. increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
  3. reduced professional efficacy.

Burnout refers specifically to the work environment and should not be applied to describe experiences in other areas of life.”

Researchers have identified exhaustion, cynicism and inefficacy as three key dimensions of the burnout experience. We all feel wiped out from time to time but if you are experiencing burnout, the exhaustion is overwhelming – you feel tired almost all of the time, both physically and emotionally. You will also perceive an increased mental distance or detachment from your job, or have a lot of negative and cynical thoughts related to your job. You may feel you dislike a job you previously were passionate about – and this lower engagement itself starts to feel frustrating. It will also be harder to work – you may notice a lower sense of efficacy (ability to produce a desired or intended result) and reduced productivity, accomplishment or ability to cope with the demands of your job. Everything feels overwhelming and the effects ripple into our personal lives.

It is important to keep in mind that burnout is not just an individual problem. Burnout is the result of multiple factors from the work environment. We experience stress when the job demands we face – physical, emotional, or otherwise – are greater than the job resources we have. Think about a campfire – if there is no wood to put on the fire and it’s pouring rain – it’s going to be hard to keep that fire going.

No one wants or chooses the experience of burnout. People would prefer to be engaged and have enough resources to keep up with the demands of work and their day-to-day lives.

How do you know if you are experiencing burnout?

Burnout often has an insidious onset – meaning it gradually emerges over time.

The stage for burnout is set by workplace stress. When job demands outweigh job resources, workers experience stress. When this stress goes on for a long time, or becomes chronic workplace stress, people may experience burnout. People experiencing burnout may notice changes in thoughts, behaviour, emotions, motivation, and bodily sensations. Some signs and symptoms associated with burnout can be found below.

Emotions & Motivations Thoughts Behaviour Body/Physical
Loss of motivation about work; low excitement and engagement

Decreased job satisfaction

Irritability, frustration, anger

Anxiety, worry, insecurity

Feeling alone in the world; desire to isolate oneself

Feelings of incompetence and failure; drop in self-confidence

 

Negative thoughts related to one’s job

Increased focus on errors, mistakes and failures

Cynicism about others’ intentions

Increased mental distance or detachment from one’s job

Negative or inappropriate attitudes towards clients, customers or colleagues

Loss of idealism; increased intention to leave the job

Difficulties with concentration, memory, judgment, decision-making

Difficulty producing the results you want or intend at work

Lower productivity or accomplishment; inefficiency

Procrastination

Withdrawal and social isolation

Absenteeism, Presenteeism

 

Persistent fatigue and exhaustion; feeling tired most of the time; low energy; feeling “worn out”

Pain (e.g., headaches, backaches); sore muscles

Increased susceptibility to cold, flus and infections

Sleep problems (e.g., difficulty falling or staying asleep, or early morning awakenings)

Gastrointestinal symptoms (e.g., digestive problems, ulcers); irritable bowel symptoms (e.g., abdominal pain, cramping); changes in appetite or weight

Skin problems (e.g., hives, eczema)

 

Workplace Burnout can be confused with some other mental health and stress related problems such as Trauma and Stress-Related disorders, Mood disorders such as Major Depression, and Anxiety Disorders. For more information on these issues, check out the related factsheets at https://cpa.ca/psychologyfactsheets/.

What causes burnout?

There are many different ideas about what causes burnout but most researchers agree that chronic work stress is a significant factor. Burnout is more likely to occur when job demands outweigh job resources.

Researchers also agree that both situational and individual factors may contribute or increase the likelihood of an individual developing burnout.

A number of risk factors for contributing to burnout have been identified:

Individual risk factors

  • Demonstrating perfectionism in every aspect of one’s work, without considering priorities
  • Placing too much importance on work (e.g., work as sole focus of life)
  • Low self-esteem, cognitive rigidity, emotional instability and external locus of control
  • Certain personal situations (e.g., major family responsibilities) disrupting work-life balance
  • Difficulties in setting limits and boundaries (leading to work-life imbalance)
  • Having high expectations of oneself and heightened professional conscience
  • Difficulty delegating or working with a team in a stressful environment
  • Inadequate adaptation strategies (dependence, poor time management, high need for support, unwise lifestyle habits, difficult interpersonal relationships)
  • A highly driven, ‘A-type’ personality that is high in competitiveness and need for control

Situational risk factors

  • Work overload
  • Lack of control and inability to participate in decisions related to the way one’s work is done.
  • Insufficient reward and recognition (e.g., financial compensation, esteem, respect) can be devaluing and heighten feelings of inefficacy.
  • “Toxic” Community where work relationships are characterized by unresolved conflict, lack of psychological support, poor communication, and mistrust.
  • Unfair treatment or incivility and disrespect can lead to cynicism, anger and hostility.
  • Values conflicts on the job, where there is a gap between personal and organizational values, can create stress as workers must make a trade-off between their beliefs and work they have to do.
  • Poorly defined responsibilities, ambiguous roles, and difficult schedules have also been identified as stressful when the situation persists.

What helps people with burnout?

The best practice approaches for burnout are multi-faceted, involving a high focus on self-care strategies for the individual, and reducing work environment stressors.

Burnout interventions should focus on both:

  • the individual (e.g., increase employees’ psychological resources and enhance coping; providing rest and respite from demands; enhancing the use of self-care strategies), and
  • the environment (e.g., change the occupational context and reducing sources of stress, primarily related to work demands).

There is more research on individual strategies than on environmental or organizational strategies. However, there is research evidence for the primary role of situational factors and it appears that individual-focused interventions are not sufficient to tackle severe burnout. Workplace stressors also need to be considered and addressed.

How can you prevent or deal with burnout?

For individuals

  • Change work patterns (e.g., work less, take more breaks, avoid overtime)
  • Develop coping skills (e.g., time management)
  • Improve interpersonal effectiveness skills (e.g., assertiveness and conflict resolution skills)
  • Prioritize self-care (e.g., exercise, eat healthy, get enough sleep)
  • Practice relaxation, meditation and/or mindfulness strategies
  • Obtain social support (from colleagues and family)
  • Change the way you think about your work (e.g., using Cognitive Behaviour Therapy)
  • Enhance self-understanding through psychotherapy
  • Enhance emotional intelligence skills (e.g., self-awareness and self-regulation of emotions, as well as other awareness)

For organizations

  • Ensure employees have a sustainable and manageable workload – where demands are realistic.
  • Involve employees in decisions that affect their work tasks so they have some opportunity to exercise professional autonomy and control/ability to access the resources necessary to do an effective job.
  • Recognize and reward employees for work well done.
  • Build a healthy community where employees have positive relationships and social support. Develop communication and conflict resolution skills so employees have effective ways of working out disagreements.
  • Develop fair and equitable organizational policies. Treat employees with appropriate respect.
  • Define organizational values, job goals and expectations.
  • Promote good health (including mental health) and fitness

How can psychologists help people with burnout?

Psychologists educate workplaces (leaders and employees) about burnout so they understand what it is and how to handle it, via all-team or leadership-specific workshops and professional development sessions.

Psychologists can also conduct assessments on individuals to help figure out if they are experiencing burnout and develop a plan for addressing it. Psychologists can help workplaces identify organizational factors that may be contributing to stress and burnout.

Psychologists can help you build individual skills, such as coping, stress management, time management, and emotional intelligence. Psychologists can help organizations develop programs for improving employee engagement, reducing stress, and preventing burnout.

Psychologists engage in research to help us better understand burnout and develop the best strategies for preventing and treating it.

Finally, Psychologists can advocate for people experiencing burnout.

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/.

You can find additional information and free self-help resources on mental health in the workplace and burnout at:

Sante mentale en milieu de travail:

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Melanie Badali, Registered Psychologist at the North Shore Stress and Anxiety Clinic, and Dr. Joti Samra, Registered Psychologist, CEO and Founder of MyWorkPlaceHealth.

Date:  May 17, 2021

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

Canadian Psychological Association
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: Relationship Distress

When does relationship conflict become relationship distress?

Conflict is a normal part of being a couple. However, all of us need to feel loved, understood, and respected by the people we are close to, and conflict in these relationships can undermine our emotional security. What makes the difference is how the conflict is handled. Couples who resolve conflicts constructively strengthen their relationships over time by improving intimacy and trust. Constructive strategies include stating opinions and needs clearly and calmly listening to and attempting to understand the partner’s point of view.

Conflict becomes destructive when needs are not expressed or when they are expressed in ways that criticize, blame, or belittle the partner. For instance, a woman who is hurt that her husband plays golf every weekend may accuse him of “selfishness” instead of expressing how lonely she feels when they are apart.

Although research does not provide a “one-size-fits-all” explanation for why certain couples are more vulnerable to distress than others, the critical nature of how couples resolve conflicts and provide emotional support to one another is widely agreed upon across the literature. However, there are several areas besides how couples handle conflict that have consistent support as factors that predict distress in relationships. For instance, various personal, social, economic, and environmental determinants of health (e.g., income status, job security, health status, education level, experiences of past discrimination), can act as external stressors that may exacerbate strains in the relationships. Individual differences, such as traits like neuroticism, may also impede relationship functioning.

When a couple is distressed, typically one partner takes the position of not saying how they feel while the other partner takes the position of blaming and criticizing. This pattern, which is very common in distressed relationships, tends to get worse over time. These couples often feel trapped in fights that are never resolved. Some couples may also handle conflict through means of avoidance. Avoiding conflict still damages relationships because partners become increasingly disengaged from one another.

Finally, couples who experience ongoing conflict can become aggressive with one another, and may push, slap, or hit each other during arguments. Importantly, other destructive forms of aggression include emotional and/or verbal harms, often manifesting as non-physical and control-oriented behaviour such as cyber aggression.

The impact of conflict on individuals and families is significant. Indeed, individuals who are repeatedly involved in relationship-related conflicts are at a higher risk for a variety of mental and physical health issues, notably depression, alcohol misuse, various illnesses, and increased mortality. They get sick more easily and die earlier than happily married couples.

Distressed couples do not cope well with life’s inevitable stressors, and they may run into problems even when they go through normal changes, like the birth of a child. Children who witness repeated conflict between their parents also are at risk for emotional and behavioural problems. One of the most serious impacts of relationship conflict is divorce. The most common reason given for divorcing is infidelity, with a lack or loss of intimacy being a key driver of the infidelity. Of course, ongoing and unresolved conflict contributes to both relationship distress and loss of intimacy.

How can psychology help?

Three distinct forms of psychological treatment have been shown to help distressed couples.

Behavioural Marital Therapy (BMT) and Cognitive Behavioural Couple Therapy (CBCT) involve helping couples to communicate more effectively and to problem-solve in ways that resolve their conflicts. Emotion-Focused Couple Therapy (EFT) tackles the unmet emotional needs underlying relationship distress. Instead of trying to solve problems, the couple therapist helps the partners to talk about their needs to feel loved and important to each other in ways that promote compassion and new ways of interacting.

Clinical trials of these therapies show that the majority of couples feel more satisfied with their marriages by the end of treatment. A few studies have also shown that the gains couples made in therapy are still evident two years later, or even that the couples’ relationships continued to improve.

Unfortunately, few couples seek psychological treatment early enough. As a result, programs for relationship enrichment and the prevention of conflict have been developed. These programs focus on improving communication and teaching conflict resolution skills to couples before they are in trouble. Often, they are offered to groups over a weekend or series of weeks. Although these programs are effective in the short-term, research shows that couples often have difficulty maintaining these new skills once the program ends. ‘Discernment Counselling’, which is considered a brief intervention, may be one means of approaching these issues.  Specifically, it helps couples to determine whether they wish to take steps toward divorce or to commit to working on the relationship for a set period of time.

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 by Valerie E. Whiffen, Ph.D. R.Psych., Private Practice, Vancouver, BC in October 2009.

Updates: It was first updated in September 2012 and again, by the CPA’s Head Office Staff and Dr. Cheryl Harasymchuk, Ph.D., Carleton University, in June 2021

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

Canadian Psychological Association
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: Preparing for an Interview

What to expect from an interview

A job interview is a social interaction between two or more individuals, (1) interviewer(s), and (2) a job applicant. Before an interview, it is likely that the interviewer and the job applicant know very little about each other. They have likely never met before, and the majority of the information would have come from the applicant’s resume, a pre-interview test results, or some initial correspondence via email or telephone.

As such, the interview process is a tool to gather additional information so both parties can make an informed decision about whether they want to continue or start an employment relationship.

For example, the interviewer is trying to assess two key “elements of fit”:

  • Person-job fit: based on skills and experience, is the applicant qualified to perform the duties of the position?
  • Person-organization fit: based on personality and values, will the applicant be a good fit with the company’s values, culture and preferences or interest?

At the same time, the applicant is trying to understand whether they will feel comfortable in that job/position and happy working for that organization, so they are also assessing the organization as a potential partner for this employment relationship. To promote themselves as a great place to work, the organization may highlight positive aspects about the job, the working conditions, and other organizational benefits during the interview.

During an interview, there is often some embellishment on both sides. For a job applicant, there is an incentive to put your best foot forward, which can lead to exaggeration or dishonesty about your skills or experience. In the same way, some organizations may embellish about the position, organization or benefits in order to recruit the best potential candidate.

Finally, there is a time element on all of this. There is a lot of information being shared in usually less than an hour. So there are cognitive demands on both sides to do a lot of things in a very limited amount of time.

Interviews can vary in a number of different ways, including format, interviewer(s), and medium:

Format

Type Brief Description Pros Cons
One-to-One One internal interviewer from the hiring organization Most common type of interview, making the format more predictable Singular perspective/assessment; more potential for bias
Panel Multiple interviewers from the hiring organization More diverse perspectives/less bias, can share tasks and responsibilities among interviewers More cognitively demanding for applicants to interact with multiple interviewers
Group Multiple applicants interviewing at the same time with one or more interviewers (e.g. for large organizations) Cheaper for the hiring organization; chance to “check” the competition for applicants May be more stressful for the applicant; fewer opportunities to put “your best foot forward” when being assessed alongside other applicants
Serial Back-to-back interviews at the same organization but with different interviewers Opportunity to gather different perspectives for the hiring organizations. Chance to meet with more people to assess the company for the applicant Cognitively demanding for the applicant; can be confusing as to who/what you said in each interview; requires a lot of preparation

 

Interviewer(s)

Type Brief Description Pros Cons
Supervisors/Colleagues Future supervisor or potential colleagues Opportunity to highlight in-depth expertise and background  (e.g. use of jargon and/or technical terms) Not always interview experts, which can lead to  interview being conducted in a very unstandardized way or introduce different types of bias
HR Professionals/

I/O Psychology Consultants

External professionals with expertise in interviewing/HR processes Expertise in how to conduct and/or design fair and appropriate interview assessments; more structured, less bias Not experts in the job/subject matter, so language needs to be adapted (avoiding jargon and/or technical terms)

 

Medium

Type Brief Description Pros Cons
In-person Face-to-face meetings between interviewer and candidate More room to clarify/expand on answers; opportunity to develop rapport and give-off a great impression using non-verbal cues Heightened pressure/interview anxiety; difficulties with scheduling and more costly
Phone Interview over the phone May mitigate some interview anxiety; eliminates geographic distance Less time to “sell yourself”; difficulties building rapport, zero non-verbal element
Synchronous Video Live/video-conference interview Similar to in-person, but more flexible and cheaper/easier to schedule Risk of technical issues, poor internet connection, limited non-verbal elements
Asynchronous Video Recorded video format Most flexible option (can complete where and when you want). Very standardized and thus fair by default Risk of technical issues, no interaction with an interviewer (so no verbal or non-verbal feedback), no opportunity to probe or follow-up

What kinds of questions can be asked?

(1)   Traditional / Popular

  • Examples: “what is your main weakness?” what is your main strength? where do you see yourself in 5 years? why should we hire you?”
  • Reatively easy to prepare because they are quite generic (a quick “google” to find most common questions should do the trick!)
  • Can be considered as poor/sub-optimal interviewing techniques

(2)   Knowledge-based

  • Examples: “what is the best technique to deal with…”
  • Focused on job-specific questions, such as tools, techniques, methods, concepts, etc.
  • As an expert in the field, you should have the background and expertise to answer these types of questions quite easily

(3)   Past-behavioural

  • Example: “tell us about a time when you’ve dealt with/experienced….?”
  • Based on actual behaviour – asked to reflect on what you have done in the past, ideally in a workplace or school-based context, to demonstrate whether you possess job-relevant skills or abilities
  • Aims to assess if you have specific skill(s) such as leadership, communication, problem solving, time management and stress management – the question is often matched to the type of skill they are trying to assess.
  • Can be considered as a “best practice” for interviewing

(4)   Situational

  • Example: “imagine that you are working in…?”
  • Based on intentions – aims to assess similar skills as past-behavioural questions by asking how you would handle a specific, hypothethical workplace situation/issue
  • May include some kind of dilemma or challenge you to decide between two or more potential alternatives to solve a problem
  • Usually includes a lot of details to create a specific context, including what the problem is, what you resourcing constraints are, etc.
  • Can be considered as a “best practice” for interviewing

(5)   Brainteasers

  • Example: “why are manhole covers round? how many ping pong balls can you put in a Boeing 747?”
  • Not looking for the right answer, but instead, aims to assess your cognitive/problem-solving processing: how do you react to this weird situation where you have a bit of pressure on you? What kind of logic you do follow?
  • Can be considered as poor/sub-optimal interviewing techniques

How to prepare for an interview

(1)   Try to identify the “selection criteria”

  • Selection criteria is what the company is looking for – what are the skills, abilities experiences qualifications that they want to assess in this interview?

How and where?

  • In the job ad → Role description and required qualifications, skills, or experience
  • On the company (career) website → Culture, values, etc.
  • Reaching out to connections within the organization
  • Using online job descriptions

(2)   Demonstrate how you can match the selection criteria

  • Identify potential questions and find a relevant experience

(3)   Use the STAR technique

When asked to describe a past experience or emphasize qualifications

  1. Situation – What was the context, when did it happen, what problem did you face?
  2. Task – What was your role, position, or responsibilities (e.g., leadership)?
  3. Action – How did you react, what action did you take, what decision did you make?
  4. Result – What was the result or outcome for you, your team, or your organization?

(4)   Use honest impression management tactics

What does that mean?

  • Present your skills, abilities, and experiences in a true but positive light
  • Emphasize how your beliefs, core values, or personality align with the interviewer’s or the organization’s
  • Take responsibility of your past errors or failures, but explain what happened, and describe how you learned from these experiences (e.g. providing contexting, such as COVID-19)

(5)   Apply effective coping strategies to manage interview anxiety

Use…

  • … emotion-oriented coping strategies (e.g., share your anxiety with others, like friends, family members, partners, colleagues)
  • … or problem-oriented coping strategies (e.g., practice, use breathing techniques)

Adapting to video interviews

As more and more businesses shift to a remote or hybrid working format, a lot of interviews are moving from in-person to video or technology mediated.

Video interviews come in two key formats: (1) synchronous video interviews (SVIs) using tools (e.g. zoom, skype), or (3) asynchronous video interviews (AVIs) using a platform where you actually are invited to go online and answers questions without any live interaction, and then those answers are watched later on by an interviewer.

SVIs AVIs
• Live interaction

• Similar to in-person

• Can be facing a panel of  interviewers

• Somewhat flexible (location)

• Not live (recorded only)

• Talking to your camera only a largely novel experience

• Multiple raters possible or  automatic (AI-based) scoring

• Very flexible (location + time)

• Preparation or re-recording  opportunities

Tips for video interviews

  • Use the same 5 tips as with traditional interviews
  • But also…
    1. Check your tech (computer, webcam, sound/mic, internet)
    2. Find the right time and place (quiet, natural light, book enough time, etc.)
    3. Consider your background (no distraction or bias-inducing content)
    4. Use options available to you (preparation time, re-recording)
    5. Practice even more!

For more information:

More on the psychology of interviewing from Dr. Nicholas Roulin: “The Psychology of Job Interviews.” (2017). Taylor & Francis.  https://www.google.ca/books/edition/The_Psychology_of_Job_Interviews/RS6EDgAAQBAJ?hl=en&gbpv=0

More on video interviewing: https://theconversation.com/how-to-land-a-job-when-companies-have-shifted-to-virtual-hiring-144997

An article on virtual hiring: https://theconversation.com/how-to-land-a-job-when-companies-have-shifted-to-virtual-hiring-144997

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Nicholas Roulin, PhD, Associate Professor of I/O Psychology, Saint Mary’s University

Date:  June 30, 2021.

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

Canadian Psychological Association
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: Strategies for Supporting Social Function in Children with Epilepsy

Introduction

Students living with epilepsy can display poor social processing (e.g., reading facial cues, understanding language nuances, taking perspective), lower level of functional independence, and lower educational status which can make it difficult for them in the social realm.

They may also remove themselves from social situations to avoid having an unpredictable or embarrassing seizure in front of their peers. This worry can be significantly reduced through teacher and classroom preparedness. If everyone knows what to expect prior to a student having a seizure and how to help when a student has a seizure the collective response can be reassuring and calming. It can reduce the worry of the student with epilepsy, their parent, teacher and classmates.

Social stigma is common in epilepsy and can lead to a child having low self-esteem and a reduction in motivation to engage with school learning and activities (Elliott et al., 2005).

In an Ontario survey or parents of children with epilepsy, 69% felt that their child was not doing well socially, and 57% were worried that their child would be teased or bullied at school (ESWO, 2018).

Children who do not socialize or interact with their peers are at risk for poor outcomes as adults (Camfield et al., 2014). Often the effects of seizure activity, medication and close adult supervision will have delayed the development of independence and emotional self-control in a child with epilepsy. To meet the social-emotional competence of their peer group, children with epilepsy may need more support.

Childhood-onset seizures can impact the development of basic and complex cognitive skills that form the core foundation for long term educational, vocational and interpersonal adaptation (Smith et al., 2013).

  • In some students with epilepsy, typical development milestones may have been missed and may need to be re-taught.
  • Throughout development, children are learning to share and to socially interact with others. Due to their epilepsy, some children may not have acquired these important skills and may have difficulty with social interaction. They may appear self-focused and not play well with others.
  • They may experience emotional or behavioural outbursts after relatively small issues because they do not have the social skills or emotional control to deal with their peers.
  • They may experience severe separation anxiety when they are away from their parents and/or withdraw socially and isolate themselves from their peers.

Adult Overprotection and Restrictions at School

Students may experience reduced autonomy due to ongoing seizures and the need for greater adult supervision.

A parent or teacher may overprotect the student with epilepsy as a way to cope with the unpredictable nature of seizures. Conversely, children and youth living with epilepsy may become over-reliant on parents or teachers.

Fearing that the student is not safe or will be injured, a parent or teacher may restrict the student’s activities and remove them from social encounters, recreation and school programming (Elliott et al., 2005).

Adult monitoring and placing restrictions on age/appropriate activities suggest to the students that they are not “like other children”, that the world is a dangerous place, and that they are not capable of doing things on their own. The restrictions can cause the student with epilepsy to experience dis- continuous and fragmented learning, to feel helpless or to withdraw from social groups.

Asking parents whether their child’s health care provider has placed restrictions on activities, and if so for what, can help to ensure students engage in the activities they are capable of doing.

Strategies to support the development of autonomy and prosocial skills

  • Provide opportunities that will help the student develop a sense of mastery.
  • Support the development of decision-making skills and resiliency.
  • Model and explicitly teach appropriate social behaviour.
  • Teach alternative behaviours to achievement the student’s social goal (e.g., other ways to gain attention, other ways to create fun).
  • Model ways of showing interest and respecting personal space.
  • Incorporate “Social Behaviour Mapping” to support the student’s understanding of what is acceptable and how to meet the expectations.
  • Encourage involvement in extracurricular activities of interest.

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 Dr. Mary Lou Smith, University of Toronto, The Hospital for Sick Children; Dr. Elizabeth N. Kerr, The Hospital for Sick Children; Ms. Mary Secco, Epilepsy Southwestern Ontario; and Dr. Karen Bax, Western University. 

Revised: June 22, 2021

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

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


References:

Camfield, P. R., & Camfield, C. S. (2014). What happens to children with epilepsy when they become adults? Some facts and opinions. Pediatric neurology, 51(1), 17-23.

Elliott, I. M., Lach, L., & Smith, ML. (2005). I just want to be normal: a qualitative study exploring how children and adolescents view the impact of intractable epilepsy on their quality of life. Epilepsy & behavior, 7(4), 664-678.

ESWO (2018). Living with Epilepsy: Voices from the Community, www.clinictocommunity.ca

Smith ML., Gallagher A, Lassonde, M. Cognitive Deficits in Children with Epilepsy. In Duchowny M, Cross H, Arzimanoglou A (Eds.). Pediatric Epilepsy, New York: McGraw-Hill, 2013, pp. 309-322.

“Psychology Works” Fact Sheet: Strategies for Supporting Optimal Psychological Function in Children with Epilepsy

Introduction

In an Ontario study of 144 parents, 111 expressed concerns about their child with epilepsy’s behaviour (ESWO, 2018).

Inattention, irritability, agitation, negativity and angry outbursts are frequent among children living with epilepsy. These issues may be primary or they may represent or mask anxiety and depression. Anxiety and depression do not necessarily present as the traditional signs of overt worrying, and changes in appetite or sleep patterns.

Feelings of irritability, anger, aggressiveness as well as anxiety and depression can occur from a few hours or a few days before a seizure occurs and then resume to a prior level after a child has a seizure. The change can be due to dysfunction in the neurons or seizures arising from the emotional control centres of the brain and/or be secondary to the consequences of living with epilepsy.

Anxiety and depression

The incidence rates of anxiety and depression among children with epilepsy are higher than in the general population, occurring in approximately a third of children living with epilepsy (Bermeo-Ovalle et al., 2016; Reilly et al., 2011; Ekinci et al., 2009).

There may be multiple causes for a child’s anxiety and depression:

Primary:

  • There may be structural abnormalities in the areas of the brain related to emotion regulation and mood.
  • Ongoing seizures may disrupt areas that control emotion regulation and mood.

Secondary:

  • Approximately one-third of children with new onset seizures report worrying about having another seizure (Besag et al., 2016).
  • Approximately one-third of children report worrying about talking to others about their epilepsy (Besag et al., 2016).
  • Students may also experience periods of intense emotional distress related to the unpredictability of their seizures and the loss of control over their bodies (Elliott et al., 2005).

Strategies to support positive behaviour and emotional well-being

  • Create a predictable schedule when possible.
  • Talk about emotions, label them, and discuss and model strategies for coping with emotions to help students develop emotional self-regulation.
  • Teach specific ways to identify and express feelings of stress and develop a concrete strategy for what to do in these situations:
    • Who should the child tell? What should the child say?
    • Give the student a script to follow.
  • Provide time away from the desk (walk around) – all kids need an escape.
  • Try to reduce or eliminate triggers.
  • Practice “time-in” by placing the student close to an adult so that they can feel the adult’s presence, which in turn may support the student to calm down and self-regulate.
  • Think of activities that can help the student (e.g., visual activities might be useful for a student with language impairments, sensory tools may assist others, a quiet place in the room might be useful).
  • Incorporate “Social Behavior Mapping” to support understanding of the outcomes of expected and unexpected behaviours.
  • Use language that promotes self-regulation (e.g., “it is time to calm down”, “try to think of something else”, “count to ten and breathe out”, etc.).
  • Empathize with the student’s feelings without focusing on the inappropriate behaviour.
  • Help de-escalate problems by using distractions appropriate for the student (e.g., humour, change of scene/activity/person working with them).
  • Organize family meetings.

Strategies to support the student’s self esteem

  • Set the student up to make progress in something that matters to them.
  • Help the child to develop an “Island of Competence”, for example: introduce them to sports, drama, music, art, mechanics, volunteering, friendships, computers, biking, martial arts, scouting, 4H, faith-based groups, etc.
  • Assist in developing responsibility and making contributions.
  • Find opportunities where the student can help younger children.
  • Provide leadership roles in the classroom.
  • Encourage the student in solving class problems.
  • Offer choices regarding topics, schoolwork and homework.
  • Give encouragement and positive feedback.
  • Recognize the student’s academic and non-academic accomplishments.
  • Recognize at least one of the child’s strengths each day.
  • Acknowledge that it’s ok to make mistakes.
  • Model acceptance when you make mistakes.
  • Avoid overreacting to mistakes.
  • Accept mistakes as part of the learning process.
  • Use errors as teachable moments.
  • Praise the process.
  • Praise effort.
  • Praise persistence.

Some children may benefit from a psychological or psychiatric evaluation and may require psychological or pharmacological treatment.

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 Dr. Mary Lou Smith, University of Toronto, The Hospital for Sick Children; Dr. Elizabeth N. Kerr, The Hospital for Sick Children; Ms. Mary Secco, Epilepsy Southwestern Ontario; and Dr. Karen Bax, Western University.

Revised: June 22, 2021

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

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


References:

Bermeo-Ovalle, A. (2016). Psychiatric comorbidities in epilepsy: we learned to recognize them; it is time to start treating them. Epilepsy Currents, 16(4), 270-272.

Besag, F., Gobbi, G., Caplan, R., Sillanpää, M., Aldenkamp, A., & Dunn, D. W. (2016). Psychiatric and behavioural disorders in children with epilepsy (ILAE Task Force Report): epilepsy and ADHD. Epileptic Disorders, 18(s1), S8-S15.

Ekinci, O., Titus, J. B., Rodopman, A. A., Berkem, M., & Trevathan, E. (2009). Depression and anxiety in children and adolescents with epilepsy: prevalence, risk factors, and treatment. Epilepsy & Behavior, 14(1), 8-18.

Elliott, I. M., Lach, L., & Smith, ML. (2005). I just want to be normal: a qualitative study exploring how children and adolescents view the impact of intractable epilepsy on their quality of life. Epilepsy & behavior, 7(4), 664-678.

ESWO (2018). Living with Epilepsy: Voices from the Community, www.clinictocommunity.ca

Reilly, C., Agnew, R., & Neville, B. G. (2011). Depression and anxiety in childhood epilepsy: a review. Seizure, 20(8), 589-597.

 

“Psychology Works” Fact Sheet: Strategies for Cognitive Challenges in Children with Epilepsy

Cognitive issues present in the majority of children with epilepsy

Cognition refers to a variety of skills such as attention, processing speed, learning and remembering, intellectual reasoning abilities, expressing and understanding language as well as planning and problem solving.

Cognitive issues are often present early on in the course of epilepsy or may even predate the onset of seizures (Smith et al., 2013; Besag et al., 2016).

The most common issues affecting academic achievement are:

  • Attention
  • Processing Speed
  • Memory
  • Intellectual Disabilities

Students with epilepsy may also have difficulties in executive, language, and motor functions, which may impact their performance in school.

The cognitive, psychological and social consequences of epilepsy play a major role in school success and in determining the educational and occupational outcomes of a student living with epilepsy.

Attention is readily impacted because attention networks are widely distributed throughout the brain

Sustained attention, or the ability to remain focused for extended periods of time particularly if something feels boring or tedious, is a common issue for many students with epilepsy.

ADHD is significantly more common in children/youth with epilepsy than the general population. Approximately 30 to 40% of children/youth with epilepsy meet criteria for ADHD (Besag et al., 2016). The inattentive subtype is most common. Males and females are equally represented.

Educational and behavioural supports used for any student with attention problems can be effective for children living with epilepsy.

 Strategies to support students who have attention issues

  • Set up the environment to reduce distractibility.
  • Consider having the student sit at the front of the class, close to the teacher and away from doors and windows.
  • Provide the opportunity for access to a quiet workspace.
  • Consider the effect of the atmosphere: calm, music, colours.
  • Provide notes in advance.
  • Provide clear, explicit, concise instructions.
  • Use engaging and varied activities, emphasizing the student’s interests.
  • Tailor appropriately paced/time activities.
  • Use visual prompts: timetable or checklists.
  • Gain attention before giving instructions: use eye contact/child’s name.
  • Provide prompts to attend (look, listen, respond).
  • Modify/limit the task length (clear beginning/clear end).
  • Have the student identify something to look forward to after the work is done.
  • Encourage the student to participate actively in the classroom to maintain attention.
  • Provide regular work breaks.
  • Alternate intense working periods with periods of recreation.
  • Assist in breaking down information into short pieces that are “do-able”.
  • Offer a lot of positive feedback and try to limit corrective feedback.
  • Identify and encourage strengths.
  • Use reward systems to boost self-esteem.
  • Evaluate the student using short tests over a series of days.

Slow or inconsistent processing speed is common, resulting in:

  • Variable responding
  • Slower reaction time on tasks
  • Difficulty in working quickly and methodically
  • Difficulty in learning a routine
  • Difficulty keeping pace with lessons
  • Gaps in learning
  • Frustration

Strategies to support students who have slow processing speed

  • Speak at a slower pace and provide concise information.
  • Use sequential and clear language.
  • Simplify tasks by dividing information into chunks.
  • Use a multisensory approach – visual, auditory, kinesthetic.
  • Recap and fill in the gaps in learning as much as possible.
  • Give extra time.
  • Use cueing mechanisms to prepare student for changes.
  • Teach independent strategies (e.g., write lists, pack homework and class notes into knapsack after each subject to avoid rushing at the end of the day).
  • Provide visual/written information to support verbal instructions.
  • Use visual timetables and colour coding.
  • Provide a note taker or audio or video record of lesson.
  • Offer longer times for writing and exams.
  • Avoid competitions (fastest first).

Memory is vulnerable to seizure activity

70% of children living with epilepsy report issues with memory in their daily lives (Smith et al., 2006) and over 50% of children with ongoing seizures display weakness in some aspect of memory when formally assessed (Reilly et al., 2014).

Memory is a complex operation which can be affected by other cognitive processes, such as attention, effort, self-monitoring, speed of information processing, the use of strategies, and organization.

For memory to work properly, the brain needs to continuously monitor itself. Seizures can interfere with the brain’s self-monitoring process.

Memories before a seizure can be lost because the brain does not store them properly.

After a seizure, confusion and fatigue can stop memory processes from working correctly.

Interictal discharges (i.e., abnormal firing of neurons below a level that would cause a seizure) disrupt the formation and retrieval of memories.

Memory issues involve consolidating, retaining and transferring newly learned information.

The most common issues with memory experienced by students living with epilepsy include:

  • Forgetting what they have just heard or read.
  • Forgetting remote events such as special trips they went on.
  • Retrieving words or information that are needed in the moment in order to express their ideas or to participate in class discussions.
  • Abnormally rapid forgetting of information that they had previously learned.

Strategies to support students who have memory issues

  • Activate learning by making topics meaningful to the student.
  • Find ways to relate the content being discussed to the student’s prior knowledge or interests.
  • Use different learning styles (visual, auditory, kinesthetic).
  • Teach information in clear, small chunks.
  • Establish routines; keep things in the same order.
  • Use hands-on activities.
  • Repeat the important messages and information.
  • Teach mnemonics, and use music cues, drills.
  • Ask the student to generate his or her own memory cues.
  • Use visual aids: photobooks, checklists, task cards, keywords, timetables, post it notes, pictures.
  • Encourage the use of a journal to keep track.
  • Allow the student time to review.
  • Give students and parents review materials and lessons that the student can do at home or at a later date.
  • Recognize that rote learning will require effort and support.
  • Create an environment where students do not have to rely heavily on memory (open book, access to computer, access to notes).
  • Focus less on information retrieval by recall and more on recognition.
  • Avoid tests that emphasize memorization (e.g., fill-in-the-blank items).
  • Provide students with a list of formulas for math and science, having them select and apply the appropriate one.
  • Have the student practice retrieving the information to be learned (using cues, recognition, exercises).
  • Communicate with parents via planners or online about class programs.

Intellectual reasoning abilities

Intellectual reasoning abilities refer to general mental abilities.

Compared to other individuals their age, a greater number of students with epilepsy will experience mild (Low Average), moderate, or significant weaknesses in their intellectual reasoning abilities (Prasad et al., 2014).

Those with significant weaknesses will meet criteria for an intellectual disability (i.e., at or below the 2nd percentile for their age).

Overall, approximately 15-25% of children with epilepsy meet criteria for an intellectual disability; however, rates are higher when only children with ongoing seizures are considered (Reilly et al., 2014).

Strategies to support students with weak reasoning abilities

  • Check for understanding.
  • Provide concrete examples.
  • Teach reasoning overtly by talking out loud, modelling, and offering rehearsal.
  • Be direct – express complex ideas as simply as possible.
  • Provide opportunities for experiential learning.
  • Set up opportunities for learning to be reinforced at home.

Executive functioning

Students with epilepsy, as well as those with ADHD and learning disabilities, can display problems with executive functioning.

Executive functioning refers to a set of self-directed skills including:

  1. Concentrating on things.
  2. Planning and organizing problem solving approaches.
  3. Regulating emotions, behaviour, and attention.
  4. Cueing oneself to use previously learned information.
  5. Initiating activities.

Strategies to support students with executive functioning and organization

  • Change the environment to support skills.
  • Set up and have the student follow routines; when activities become habitual, they require less active processing and are less likely to be forgotten.
  • Use short instructions and have students check off each step as it is completed.
  • Use visual prompts.
  • Use engaging, varied activities and learning styles.
  • Use eye contact.
  • Modify the tasks to support development.
  • Provide the student with more time.
  • Tailor the pace and time of activities.
  • Provide regular breaks, including those with physical exercises.
  • Limit multi-tasking; focus the student on one activity at a time to reduce the demand on working memory and to limit distractions.
  • Consider the effect of the class atmosphere on learning and remove distractions.
  • Give warnings well ahead of time for changes in routine to aid with transitions.
  • Proactively plan for changes in routine whenever possible.
  • Check notebooks frequently.
  • Have duplicate copies of worksheets for students who misplace items.
  • Model problem-solving explicitly (thinking out loud).
  • Use step-by-step problem-solving approaches and provide a template.
  • Prior to initiating the task, teach the student to divide the activity into multiple steps.
  • Model organizational strategies throughout the school day.
  • Teach students how to use a planner.
  • Break the planner into sections: a calendar with sufficient space for writing daily activities, address book, general to-do list, assignment due date.

Language and communication

Children living with epilepsy may experience language difficulties. Sometimes the disturbance relates to difficulty in a broad range of receptive and expressive skills. Some types of epilepsy may produce specific patterns of difficulty.

Strategies to support students who have language and communication difficulties

  • Speak clearly, slowly and be specific.
  • Use non-verbal communication to enhance verbal instructions.
  • Allow more time and check for understanding.
  • Repeat and rephrase instructions.
  • Use open ended questions to promote dialogue.
  • Use group work and role play.
  • Teach key words.
  • Use visual prompts (objects, photos, pictures, symbols).
  • Classify and group objects and pictures together.
  • Teach singing.
  • Engage the student in conversation – include new words and explain their meaning.
  • Encourage parents to read to the child every day.
  • When the lesson contains a new or interesting word – pause and define the word.
  • Play word games.
  • Have a daily checklist of take-home materials in the student’s planner.
  • Provide a daily schedule on the board or in the student’s planner.
  • Provide parents with important dates/reviews/tests.
  • Support word retrieval.
    • Provide phonemic and/or semantic cue.
    • Encourage visualization and gestures.
    • Encourage self-cueing.
  • Consider consultation with or assessment by speech and language therapist.

Motor co-ordination

Children with epilepsy may experience problems in motor functioning, including both reduced fine-motor and gross-motor skills.

  • Slow motor output
  • Weakness in both sides or one side
  • Gait and balance issues
  • Difficulties with coordinated movement

These issues may have implications for handwriting and note-taking, and for moving between one class and another.

Strategies for fine motor issues

  • Provide a note taker to scribe for the student.
  • Provide hand-out of board work.
  • Offer the opportunity to take tests orally to access understanding.
  • Provide extra time for assignments and tests.
  • Consider key-boarding as an alternative to printing or cursive writing.
  • Check to see if the student is eligible for Special Equipment (e.g., SEA claim for a computer).

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 Dr. Mary Lou Smith, University of Toronto, The Hospital for Sick Children; Dr. Elizabeth N. Kerr, The Hospital for Sick Children; Ms. Mary Secco, Epilepsy Southwestern Ontario; and Dr. Karen Bax, Western University.

Revised: June 22, 2021

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

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


References:

Besag, F., Gobbi, G., Caplan, R., Sillanpää, M., Aldenkamp, A., & Dunn, D. W. (2016). Psychiatric and behavioural disorders in children with epilepsy (ILAE Task Force Report): epilepsy and ADHD. Epileptic Disorders, 18(s1), S8-S15.

Prasad, A. N., Burneo, J. G., & Corbett, B. (2014). Epilepsy, comorbid conditions in Canadian children: analysis of cross-sectional data from cycle 3 of the National Longitudinal Study of Children and Youth. Seizure, 23(10), 869-873.

Reilly, C., Atkinson, P., Das, K. B., Chin, R. F., Aylett, S. E., Burch, V. & Neville, B. G. (2014). Neurobehavioral comorbidities in children with active epilepsy: a population-based study. Pediatrics, 133(6), e1586-e1593.

Smith, ML., Elliott, I. M., & Lach, L. (2006). Memory outcome after pediatric epilepsy surgery: objective and subjective perspectives. Child Neuropsychology, 12(3), 151-164.

Smith ML., Gallagher A, Lassonde, M. Cognitive Deficits in Children with Epilepsy. In Duchowny M, Cross H, Arzimanoglou A (Eds.). Pediatric Epilepsy, New York: McGraw-Hill, 2013, pp. 309-322.

“Psychology Works” Fact Sheet: Helping Children with Epilepsy Succeed in School

Introduction

Epilepsy is defined as a “disease of the brain characterized by a predisposition to generate epileptic seizures, and by the cognitive, psychological, and social consequences of this condition” (Fisher et al., 2005).

Understanding epilepsy and the cognitive, psychological, and social consequences of the condition is the first step in supporting students living with epilepsy. Other Psychology Works Fact Sheets address these consequences.

Understanding the brain, seizures, and the impact of seizures on brain function

The human brain contains billions of specialized cells, called neurons. The electrical and chemical signals these cells transmit and receive are at the heart of how the brain functions. Everything we do, think, say, and feel is the result of the signals that are generated by the neurons in the brain.

The brain is often compared to a computer – a processing unit that receives inputs and generates outputs. However, the brain is so much more than a simple input-output device. The brain is a living organ that modifies itself based on the experiences and the interactions we have with our environment. It is the control centre of our thinking, problem solving, consciousness, emotions, physical movement, and social behaviour. Brain cells form new connections when we have new experiences.

The lobes of the brain

Frontal Lobe
The frontal lobe provides executive control over the brain’s higher functions. Executive functioning is related to self-directed skills, including concentrating on things, planning, organizing, problem solving, as well as cueing ourselves to regulate our emotions and attention, and to use previously learned information.

Temporal Lobe
The temporal lobe helps form longer-term memories. Behaviours, emotions and language comprehension are also associated with structures in the temporal lobe.

Parietal Lobe
The parietal lobe helps process sensory information (e.g., touch), left and right orientation, as well as aspects of spatial relationships and language functioning.

Occipital Lobe
The occipital lobe is involved in visual processing and perception.

The Brain as a Network
Many parts of the brain work together to support complex functions. There is communication between different parts of the brain to enable us to carry out complex tasks that are important for school success, such as language, attention, reading, and mathematics.

What is a seizure?

Sometimes the neurons in the brain don’t signal properly and cause a sudden burst of electrical energy in the brain or what is known as a seizure.

Seizure symptoms depend on where in the brain the abnormal bursts of electrical activity occurs. Seizures may be observed as a transient change in sensation, movement, behaviour, or consciousness. Because the brain is responsible for a wide range of functions, there are many different types of seizures.

Between seizures, some students continue to have heightened electrical discharges in their brain (called interictal discharges) which are not strong enough to cause a seizure but cause transient issues with attention, thinking, memory, and behaviour.

Epilepsy is more than recurrent seizures

Epilepsy is a spectrum disorder with varying presentations of:

  1. Seizure frequency
  2. Seizure types
  3. Seizure severity
  4. Seizure control: some students have good seizure control while others have seizures which are persistent and severe
  5. Chronicity: some students outgrow their seizures and others do not
  6. Types of cognitive, psychological, and social problems
  7. Severity of cognitive, psychological, and social problems

For each student living with epilepsy, the effect of a seizure has on his or her brain and consequently the related cognitive, psychological (behavioural, emotional), and social abilities will be different. While some students with seizures affecting only one area or lobe of the brain may have very specific problems associated with that lobe, many students with epilepsy experience problems across multiple domains. Students living with epilepsy may be similar to students with other types of neurological damage (e.g., Traumatic Brain Injury).

Some students living with epilepsy will have very few barriers to achievement while others are at risk of poor school performance and poor outcomes as adults.

Epilepsy is an invisible condition

If a student walked into a classroom with a cast on his or her arm, we would immediately recognize that he or she had an injury. We would not expect the student to throw a baseball or use a badminton racquet with the injured arm. It would be easy to modify most activities because we could see and understand the impairment.

Students living with epilepsy have an invisible condition. You cannot tell that they have epilepsy unless they are actively having a seizure. It is not possible to see “the cast” on the part of the brain where the seizures originate.

The cognitive, psychological, and social consequences associated with epilepsy are frequently unrecognized (Reilly et al., 2014).

The seizure is the tip of the iceberg. Below the surface of the iceberg lie the invisible or unrecognized consequences: the cognitive, psychological, and social impacts associated with this brain disease. It is important to recognize these consequences to ensure success at school.

School attendance

  • Students with epilepsy may miss lessons or miss content even when they are present in class.
  • They have higher rates of school absenteeism to recover from seizures, attend medical appointments, and to establish new treatments.
  • Social factors including embarrassment, teasing, and bullying also impact school attendance.
  • Some schools unnecessarily send students home when they have seizure at school or exclude them from activities due to concerns that they may have a seizure.
  • A student who is absent 15 days per school year will have missed the equivalent of one full year of instructions by the end of Grade 12.

Reducing restrictions at school

While it may seem like limiting a student’s physical activity is in his or her best interest, doing so may actually encourage social isolation and interfere with many opportunities for the student to learn and practice important physical literacy and social skills.

Every effort should be made to include students in physical activities such as gym, recess, lunch, extracurricular sports, and field trips. There is evidence that seizures are less likely to occur if the student is engaged in satisfying and motivating activities, whether they are mental or physical.

Excessive adult monitoring and limit setting may actually increase seizure activity.

Medication side effects

Not all students with epilepsy experience medication side effects.

Side effects are most likely to occur when a new medication is introduced, the dosage of an existing medication is increased, or when the student is on more than one medication.

Potential side effects of anti-seizure medications may include:

  • Fatigue
  • Drowsiness
  • Slower information processing speed
  • Difficulties with attention and memory
  • Problems with dizziness and coordination
  • Double vision
  • Changes in mood, behaviour, and appetite

Developing a communication plan with families is helpful to document seizure activity and observations following medication changes.

Fatigue is a consistent complaint of students living with epilepsy

The underlying brain abnormality causing the seizures, the recovery after a seizure, and the medications to treat the seizures can make a student feel exhausted.

Some students have frequent seizures at night causing them to be tired, irritable, or to function poorly the next day.

Students with epilepsy need plenty of sleep and may go to bed earlier than their peers. They may fall asleep in class or nap when they arrive home from school.

Fatigue can make it difficult for students with epilepsy to participate fully in academic endeavours and to concentrate for long periods of time. Fatigue may make it difficult to finish homework or to participate in after-school programs.

Strategies to help students with fatigue

  • Offer less intensive classes later in the day.
  • Reduce the amount of work you expect the student to complete within a specific amount of time.
  • Offer frequent breaks.
  • Do assessments over a series of several days.
  • Reduce the amount of homework you assign.
  • Reduce the course load for older students.
  • Develop a communication plan with the parent and student to document seizure activity, medication changes and side effects.

Variability in functioning from day to day is typical

A student’s presentation can be variable from day to day and within days.

Good Days: You will observe times when a student living with epilepsy is available to learn, engages in discussions, appears to make connections, and displays an even temperament.

Bad Days: You may observe other times when the student appears to be readily distracted, has forgotten previously learned information, or may be irritable.

Without support, what does the future hold?

The potential trajectory for children with epilepsy is demonstrated through adult outcome data:

Studies around the world indicate that in adulthood, people living with epilepsy have:

  • Lower education
  • Higher unemployment
  • Higher rates of poverty
  • Higher rates of unplanned pregnancy
  • Higher rates of mental health problems

In Canada, the projected indirect economic cost due to premature death and disability in epilepsy are approximately $3 billion in a year, second only to brain injury among all neurological conditions (PHAC, 2014).

For students living with epilepsy, school education and learning represent the primary interactive biopsychosocial components associated with their health outcomes.

Providing school-based support to students with epilepsy has the potential to reduce the burden of epilepsy on the student, parent, and school community. Developing skills and confidence in the early years may alter the negative trajectory for the student with child-onset epilepsy.

General strategies for teachers to improve school success

  • Meet with the parents to understand the child’s epilepsy and to develop a plan of care.
  • Empower students who had seizures by engaging them in the discussion on what to do and how it feels to have epilepsy.
  • Invite a community-based epilepsy educator to provide you and your colleagues with an epilepsy professional development session.
  • Invite a community-based epilepsy educator to provide age-appropriate videos or presentations explaining epilepsy and seizure first aid to the entire class.
  • Ensure that the entire class understands what to expect when a classmate has a seizure and how they can help.
  • Minimize known seizure triggers: heat, dehydration, lights, stress, fatigue in the classroom.
  • Provide a rest area.
  • Prevent social and emotional challenges by providing proper information to the class following the occurrence of a seizure.
  • Promote social interaction.
  • Keep the child in class following a seizure so they can develop social and emotional coping skills.
  • Participate in epilepsy awareness programs, Purple Day for epilepsy, international days and fundraisers.

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 Dr. Mary Lou Smith, University of Toronto, The Hospital for Sick Children; Dr. Elizabeth N. Kerr, The Hospital for Sick Children; Ms. Mary Secco, Epilepsy Southwestern Ontario; and Dr. Karen Bax, Western University.

Revised: June 22, 2021

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

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


References:

Fisher R.S., Van Emde Boas W., Blume W., Elger C., Genton P., Lee P., Engel Jr, J. (2005). Epileptic seizures and epilepsy: Definitions proposed by the International League Against Epilepsy and the International Bureau for Epilepsy. Epilepsia, 46(4):470–472.

PHAC (2014). Public Health Agency of Canada, & National Population Health Study of Neurological Conditions (Canada). Mapping connections: An understanding of neurological conditions in Canada.

Reilly, C., Atkinson, P., Das, K. B., Chin, R. F., Aylett, S. E., Burch, V. & Neville, B. G. (2014). Academic achievement in school-aged children with active epilepsy: A population-based study. Epilepsia, 55(12), 1910-1917.

 

“Psychology Works” Fact Sheet: Asthma in Children

What is Asthma?

Asthma is a medical condition that involves inflammation of the airway in the lungs. Asthma currently has no cure and is therefore considered a chronic condition. While some children can outgrow asthmatic symptoms, asthma often requires long-term management. The primary symptom of asthma is recurrent cough, and it can also include symptoms such as shortness of breath, wheezing, or chest tightness. It is the most common chronic condition around the world affecting children’s lower airway.

Asthma affects about 8.3% of children (Akinbami et al., 2016). Boys are more likely to have asthma up until adolescence (i.e., 11-12 years old), but girls are more likely to have it during adolescence and into adulthood. Several factors exist that might put a child at a higher risk of developing asthma or experiencing asthmatic symptoms. Primary risk factors can include obesity, being exposed to smoke or alcohol during pregnancy or after birth, being around other chemicals or toxins in the environment (e.g., pesticides), living in a dusty residence or area, or having a history of respiratory infections. There is also a genetic component to asthma: 35-95% of children with asthma will also have a parent with the condition. In fact, a primary factor of asthma is the genetic tendency to develop allergic disease. Finally, children living in poverty and residing in certain areas of Canada are more likely to have asthma. This indicates that many types of privilege (such as socioeconomic, geographic, and racial privilege) can play a role in asthma, and highlights that marginalized groups typically face asthma at higher rates.

If your child is suspected of having asthma, a medical doctor may confirm a diagnosis by using a simple breathing test like “spirometry”, where your child would be asked to exhale into a sensor after taking a deep breath in. An asthma diagnosis is usually based on a decrease or obstruction of airflow, and the diagnosis can usually be confirmed if symptoms improve after the use of a bronchodilator. Bronchodilators and other asthma treatments are explained in the next section.

How is Asthma Treated?

Treatment for asthma in children is usually based on how severe symptoms are. Your doctor may suggest a bronchodilator (i.e., “reliever puffer”) as the first treatment approach, to help relax muscles in the lungs and widen the airway. For children whose lungs seem to function pretty well but who are dealing with occasional daytime symptoms, reliever puffers like salbutamol are often the only necessary treatment. These puffers are designed to provide a quick relief of symptoms.

For children with more long-term symptoms, inhaled steroids (i.e., “controller puffer”) like mometasone might be suggested to help control symptoms. Doctors generally work with families and children to find the best dose of medication.

If bronchodilators or inhaled steroids are not effective at any dose, doctors might search for other diagnoses because bronchodilators or inhaled steroids have been found to work for most children with asthma. Other issues that might cause asthma-like symptoms are allergies, sinusitis (an inflammation of the sinuses), acid reflux, physical activity (e.g., running or playing sports), reactions to certain fungi, or problems with vocal chords.

For severe cases of asthma, a doctor might prescribe medication that can be taken orally, often combined with bronchodilators or inhaled steroids. These medications might involve oral corticosteroids like prednisone, or alternate medications that are designed to reduce inflammation in the airway. Doctors might suggest medications given by injection (e.g., allergen immunotherapy or omalizumab) in cases where other treatments are not successful or not recommended.

In addition to medical treatments, psychological interventions for asthma may be suggested for many reasons. For example, certain situations may “trigger” asthma symptoms, such as intense exercise or being in cold weather for too long. So, psychological treatment may involve recommendations about how to identity these triggers and limit them to manage symptoms, while still finding ways to engage in enjoyable activities. Taken together, management for asthma may involve a combination of medical and psychological interventions which can often be difficult to implement and navigate for families.

What Can Psychologists Do to Help?

Psychologists can help with several aspects of asthma management, including those described below:

a.      Perceiving Symptoms

Children or adolescents may sometimes have difficulty describing their symptoms or how their medications are helping to control symptoms. Approximately 15-60% of asthma patients struggle to describe symptoms (Janssens et al., 2009), which can lead to an overuse of medication.

Psychologists can help children and adolescents learn ways to identify and describe their symptoms comfortably. This is often accomplished by helping focus increased attention on bodily sensations and recognizing situations in which symptoms may present themselves. Psychologists can similarly help children recognize “trigger” situations, in which symptoms might be more likely to arise (e.g., in cold weather). By optimizing the way that children can describe symptoms and recognize triggers, management of asthma can be improved.

b.      Coping

Asthma is often a stressful illness that requires tough adjustments in psychological, emotional, and behavioural areas. Psychologists can help children and families by discussing strategies that could help them cope with asthma.

Some situations are particularly challenging for children and families with asthma, such as moving to a new school or switching to a new medication. A psychologist can work with families to promote helpful coping strategies such as problem-solving rather than unhelpful strategies such as ignoring or denying issues. Research has shown that using helpful coping styles can have a positive effect on children’s quality of life (Braido et al., 2012).

c.       Adhering to Treatment

There are many factors that can get in the way of children and families adhering to the treatments that are prescribed or suggested by healthcare providers. Some of these interfering factors can include misunderstanding how to take medications, embarrassment about taking the medications in public, denial surrounding the illness, difficulties incorporating treatments into a daily schedule, forgetfulness, or lack of knowledge about the importance of management.

Psychologists can help children and families identify barriers that might be getting in the way of adhering to treatments. For example, they can share relevant strategies and educate families about the importance of taking medication and structuring the day to incorporate treatment activities. Psychologists can then help children and families make practical changes to help them adhere to medications.

Adherence can become particularly challenging when children are becoming more independent and beginning to take their medications themselves. Many parents are highly motivated to help their children adhere to their medications, but it can often be difficult to translate responsibilities from parent to child during this period of increasing independence. Psychologists can focus on areas such as motivation and setting reminders to help older children remain adherent as they become more independent.

d.      Parent-Guided Strategies

Parenting a child with asthma can be particularly challenging, especially since children with asthma have been shown to demonstrate more emotional and behavioural challenges than their peers without asthma. Parents who have children with asthma may report higher levels of stress or psychological distress as a result.

A psychologist can work with caregivers (either alone or together) to troubleshoot issues related to caregiving such as managing stress, regulating emotions, coping effectively, optimizing parenting approaches, improving the ways parents and other family member interact with children, and helping with adherence to medications.

e.      Navigating Anxiety Associated with Asthma

Children with anxiety symptoms or anxiety disorders can face particular challenges when navigating their asthma. A primary source of distress among children higher in anxiety involves beginning to associate anxiety-related shortness of breath with asthma.

Psychologists can help children and families recognize that shortness of breath is also a common symptom of anxiety, and they can help children develop strategies to distinguish between, and think differently about, the situations that might be inducing breathing problems due to anxiety versus asthma. They might also discuss ways to regulate worry (e.g., relaxation exercises) that arises in the face of true asthma symptoms.

What Types of Interventions Do Psychologists Use to Help with Asthma?

Psychologists might use several different types of therapies or techniques when providing help for asthma-related concerns. Two common types of therapy are described below.

a.   Cognitive-Behavioural Therapy (CBT)

Cognitive-Behavioural Therapy (CBT) is a psychological treatment approach that uses strategies focused on thoughts, feelings, and behaviours. Many of the strategies mentioned on this fact sheet may be incorporated into a CBT plan to address difficulties with asthma. For example, a CBT plan often involves education about the illness, identifying behaviours that interfere with treatment, and addressing anxiety associated with symptoms.

With regard to the “cognitive” piece of CBT, psychologists can help by engaging children and families in discussions about thoughts that might interfere with their management of asthma. For example, thoughts about medication being “unimportant”, assumptions about what children believe their peers think about asthma medications, or parental fears about children taking medications incorrectly can all interfere with optimal asthma management. Psychologists using a CBT model will typically help children and families improve their functioning by helping them notice unhelpful thoughts about asthma, “challenge” these thoughts, and engage in behaviours to test and support more helpful thoughts.

b.   Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT) focuses on acceptance and mindfulness strategies that can help people engage in behaviours connected to their values.

Psychologists who use ACT can help parents to be aware of their thoughts and feelings surrounding asthma, to accept and adapt to challenging situations, and to take actions that allow them to help their children in a value-driven way.

ACT has also been found to be useful with adolescents directly. Psychologists can work with adolescents in areas similar to parents: increasing awareness of thoughts and feelings, heightening acceptance and flexibility in asthma-related situations, and making health-related decisions that are linked to their values.

Are Psychological Interventions Effective?

The short answer is, yes; psychological interventions are effective for asthma! Research has demonstrated that psychological interventions involving educational, cognitive, behavioural, and family components are beneficial for children and adolescents (Oland et al., 2017). These interventions have been shown to be helpful in homes, school settings, and medical settings.

However, it is worth noting that most of the research conducted on childhood asthma has been conducted in unique ways. For example, studies have often included children with different levels of asthma or have tested the level of children’s symptoms using different tools. This has made each set of research findings quite different from one another. A large review of psychological interventions for childhood asthma was proposed in September 2019 (Sharrad et al., 2019), so it is likely that findings from this review will emerge to shed further light on asthma management.

Even though psychological interventions have been shown to be effective (and often very important for improving outcomes for families), since medical management is the primary treatment for asthma, families should contact a medical doctor if they suspect a diagnosis of asthma or believe there are problems with the current medical management of a child’s asthma.

Helpful Resources?

Visit these websites for useful asthma resources:

  1. Asthma Canada: https://asthma.ca/
  2. The Canadian Lung Association: https://www.lung.ca/
  3. The Children’s Asthma Education Centre: http://asthma-education.com/
  4. You Can Control Your Asthma: https://cumming.ucalgary.ca/research/icancontrolasthma
  5. The Canadian Thoracic Society: https://cts-sct.ca/guideline-library/

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 Jason Isaacs (PhD student at Dalhousie University), in consultation with Dr. Dimas Mateos (MD at IWK Health Centre) and Martha Greechan (RN at IWK Health Centre).

Date: March 17, 2021

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

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

References:

Akinbami, L. J., Simon, A. E., & Rossen, L. M. (2016). Changing trends in asthma prevalence among children. Pediatrics, 137(1), e20152354.

Braido, F., Baiardini, I., Bordo, A., Menoni, S., Di Marco, F., Centanni, S., … & Canonica, G. W. (2012). Coping with asthma: Is the physician able to identify patient’s behaviour? Respiratory Medicine, 106(12), 1625-1630.

Janssens, T., Verleden, G., De Peuter, S., Van Diest, I., & Van den Bergh, O. (2009). Inaccurate perception of asthma symptoms: a cognitive–affective framework and implications for asthma treatment. Clinical Psychology Review, 29(4), 317-327.

Oland, A. A., Booster, G. D., & Bender, B. G. (2017). Psychological and lifestyle risk factors for asthma exacerbations and morbidity in children. World Allergy Organization Journal, 10(1), 35.

Sharrad, K. J., Sanwo, O., Carson-Chahhoud, K. V., & Pike, K. C. (2019). Psychological interventions for asthma in children and adolescents. Cochrane Database of Systematic Reviews, 2019(9).

 

“Psychology Works” Fact Sheet: Physical Activity, Mental Health, and Motivation

The Canadian Society for Exercise Physiology (CSEP) recommends that adults aged 18 or older do at least 150 minutes/week of moderate-to-vigorous intensity exercise, with each session lasting at least 10 minutes. All adults should also do muscle and bone-strengthening exercises at least twice/week. Older adults (65+) with poor mobility should regularly do activities that help to improve balance and prevent falls (e.g., yoga).

Canadian statistics show that most adults don’t meet these requirements, with levels of physical activity decreasing as people age. This is a particular problem for people with kids, as children and youth look to adults to model good behaviours; statistics show that only 15% of children (5-11 years) and 5% of youth (12-17 years) meet their recommended level of physical activity (60 minutes/day).

What Do “Moderate” and “Vigorous” Mean?

The definitions of “moderate” and “vigorous” physical activity depend on your age, health status, current level of activity, and relative level of (dis)ability. For example, a young, able-bodied athlete might not be affected by a brief walk, while an older, generally inactive person with poor mobility might experience this as “vigorously intense.” The following guidelines can help:

  • Moderately intense physical activities should noticeably raise your heart rate. While you’re doing moderately intense physical activity, you should be able to have a conversation, but not be able to sing your favourite song.
  • Your resting heart rate increases a lot while doing vigorously intense physical activity, although you shouldn’t feel uncomfortable as a result. While doing a vigorously intense activity, you shouldn’t be able to say more than a few words without having to take a breath.

What Are the Mental Health Benefits of Physical Activity?

Regular physical activity comprised of both cardiovascular and resistance exercise, has many mental health benefits. The longer you stick with your exercise schedule and the more often you exercise, the more benefits you’ll see. For example, research shows that regular physical activity can help:

  • Prevent depression and anxiety disorders and may be as effective as psychological and pharmaceutical treatments for depression and anxiety;
  • Reduce day-to-day stress;
  • Particularly among middle-aged individuals, reduce the risk of cognitive decline, measured as a slowing in attention, memory, and concentration, later in life;
  • Individuals perform better than others their age on tests of cognitive ability (e.g., memory, attention, processing speed);
  • Boost academic performance (e.g., grades) in children, youth and young adults;
  • Lower the risk of developing neurodegenerative diseases (e.g., Alzheimer’s Disease) and can make the symptoms of these diseases less severe (e.g., issues with memory, concentration, attention);
  • Increase self-reported happiness and lower levels of sadness and loneliness, both in the short-term and later in life;
  • Reduce feelings of fatigue, improve sleep quality, and lower your risk of insomnia (provided vigorous exercise is not done too soon before bed);
  • Enhance the impact of the treatment of addictions, particularly in the reduction of cravings;
  • Boost self-esteem, itself a key sign of good mental health and overall well-being, from early childhood straight through older adulthood; and
  • Aid in the treatment of eating disorders, chronic pain (tailored to your physical abilities), post-traumatic stress disorder, schizophrenia, and body dysmorphic disorders (i.e., being obsessed with a real or imagined physical “flaw”).

Why Does Physical Activity Have These Benefits?

There is no single reason why physical activity has mental health benefits. Instead, research suggests that benefits come from the combined physiological, psychological, social, and neurological effects of exercise.

  • Physiological: Physical activity both boosts your body’s production of endorphins and endocannabinoids, which are chemicals that help you to relax, feel more pleasure, and feel less pain, and reduces the amount of cortisol (i.e., “stress hormone”) that your body produces.
  • Psychological: Regular physical activity helps to increase feelings of self-esteem and self-efficacy, or how much you believe in yourself to accomplish important goals. Short bursts of exercise can also make you happier in the moment by interrupting negative trains of thought.
  • Social: People who exercise regularly tend to have bigger social networks and stronger relationships with friends and family. The regular face-to-face interaction that comes from group exercise (e.g., fitness classes, team sports) boosts your mood and can help to prevent depression.
  • Neurological: Physical activity helps your brain to use and produce more dopamine and serotonin – chemicals produced in your brain that make you feel happy. People who exercise regularly also have more blood flow to the brain, better brain functioning, and even have more brain matter in certain areas (e.g., hippocampus, which is associated with memory).

How Do I Get Started and Stay Motivated?

Before you get started, you should ask yourself why you want to exercise, and what types of exercise might be best for you based on your physical (dis)abilities, personality, and goals. Consult your family physician for help in developing a healthy and realistic exercise plan.

Some of the most common reasons for not exercising include: not having enough time; not having enough money; not having enough energy; and feeling uncomfortable (physically or socially). Solutions for these can include:

  • Planning to exercise frequently, but in short bursts (i.e., 10 minutes or more).
  • Scheduling your day so you exercise when you tend to have more energy, and always try to do what you can.
  • Finding free or low-cost activities that you enjoy (e.g., walking, cycling, or pick-up sports).
  • Not pushing yourself too hard and trying to find an environment where you feel comfortable and motivated (e.g., home, outdoors, with a buddy).

Once you’ve started your exercise program, there are many ways to help you stick with it. Researchers from numerous areas of psychological research (e.g., clinical, sport, and social psychology) suggest that you:

  • Make a plan and set regular, concrete goals.
  • Don’t delay.
  • Be realistic in choosing and committing to an exercise regimen.
  • Remind yourself why exercise is important to you every day and whenever you’re facing difficulties.
  • Ensure you eat regular, well-balanced meals and sleep regularly.
  • Focus on you and your accomplishments, not what other people are doing.
  • Track your progress and celebrate small gains.
  • Make physical activity part of your daily routine.
  • Don’t do the same thing every time and try to do activities you enjoy.
  • Plan for how you’ll deal with potential obstacles or distractions.
  • Practice self-compassion, especially when you haven’t met your daily or weekly goals.
  • Find an exercise buddy who’s similar to you (e.g., age, fitness level, ability level).

Where Can I Go for Help or to Learn More?

Visit the CSEP website for physical activity guidelines: http://www.csep.ca/en/guidelines/get-the-guidelines.

Community and recreation centres offer a variety of programs that can help you add physical activity to your daily routine.

Drop-in sports and fitness classes are a great way to sample what’s available before committing to anything.

See a psychologist to discuss motivational tips, concerns you may have related to self-image and exercising, and strategies specific to your needs.

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

CPA Sport and Exercise Psychology Section: https://cpa.ca/aboutcpa/cpasections/sportandexercise/v

American Psychological Association (APA) Division 47: http://www.apadivisions.org/division-47/

This fact sheet has been prepared for the Canadian Psychological Association by Matthew Murdoch, Canadian Psychological Association.

Date: November 2016

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: Attachment in Children

What is attachment?

Attachment is a special emotional relationship between two people, with an expectation of protection. Usually when we talk about attachment, we’re talking about the relationship between a child and his or her parents or caregivers. Sometimes we talk about attachment in romantic relationships as well. The attachment between parents and children is our focus here.

Almost every child attaches to someone. When they don’t, it is usually because of unfortunate circumstances, such as being raised in an orphanage or experiencing severe abuse or neglect. Children with no attachments are very rare and may have an attachment disorder. They, along with and their caregivers, usually need professional help. Attachment disorders are not our focus here. Information on attachment disorders can be found at: http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Attachment-Disorders-085.aspx

Children can attach to a small number of adults, usually those who take care of them. They don’t usually attach to other children. Although children can have great relationships with lots of adults (teachers, babysitters, family friends), they don’t really attach to those people. They like them and trust them because their experience in their attachment relationships tells them that it is safe to do so.

Although almost all children do develop attachments, attachments can vary in their level of “security.” Psychologists, researchers, and therapists often categorize attachment relationships. The main categories are secure, insecure, and disorganized. Most children (about 60%) are securely attached. Secure attachments are the best for children’s development. Disorganized attachments lead to the most difficulties in mental health and behaviour. Children can have different styles of attachments with different caregivers.

What are the different styles of attachment?

Securely attached children explore what is around them when their caregiver is nearby. They also check in by looking at their caregiver regularly. If their caregiver leaves they usually stop exploring. When their caregiver returns they are happy to see them and calm down quickly if they are upset. Secure attachments have been shown to help children learn, empathize, develop relationships, cope with stress, handle fear, and be independent.

There are two types of insecure attachment. In insecure avoidant attachment, children don’t appear to care whether their caregiver is there or not, but they actually care a lot. These children usually explore a lot. When their caregiver returns after leaving them these children often ignore them, but if we measure their stress response using physiological measures like heart rate, we find that they’re actually quite upset.

Children with resistant insecure attachment often appear clingy. They usually stick close to their caregiver and don’t explore much. They get very upset when their caregiver leaves them. They are not easily calmed when their caregiver returns.

Children with disorganized attachments are more unpredictable. As babies, they might do unusual things like freezing or coming to their caregiver with their head turned away. As preschoolers they tend to be bossy and controlling.

How do attachments develop?

Attachments develop over time as a child and caregiver interact. It is innate or “hard-wired.” When a child has a need, their caregiver responds. For example, if a child falls off her bike and her caregiver comes over and comforts her, the child learns to expect that. On the other hand, if the caregiver yells at her she learns to expect that. It isn’t so much what happens in any one situation, so much as the pattern of reactions that matter. Over time, the child learns what will happen when they have a need. Will their caregiver respond kindly and fulfill their need? Ignore them? Yell? This pattern determines the attachment style between a child and a specific caregiver. You can’t always see someone’s attachment style. It is only activated (turned-on) when they’re in need (e.g., stressed, sick, scared, or hurting).

Children also learn what they need to do to get their needs met. Do they need to ask, yell, or cry? Eventually, kids start to expect all relationships to be like their attachment relationships. So they start to trust people, be unsure of people, hide their feelings, or not know what to expect. They also learn how they should behave in relationships.

When does attachment develop?

The building blocks of attachment start soon after birth. Attachment becomes clearer around 6 to 9 months of age, Each of us develops an attachment style that characterizes our approach to relationships over the course of our lifetime, but attachment styles can change based on experiences or in response to treatment.

How do I help my child securely attach?

There are lots of things you can do to help your child securely attach. First, try to be there for them when they need you. Second, let them explore or interact with what is around them when they’re ready. Here are some other things you can do:

  • Be sensitive to your child’s needs and emotions and try to respond in a way that is in tune with them.
  • Talk about feelings: your feelings and their feelings. Label everyone’s feelings and indicate that it’s okay to feel whatever you feel. You can do this even when they’re babies.
  • Stay with your child when they’re upset. Even when your child is misbehaving, you need to show them you love them. Don’t send them away or threaten to leave.
  • Enjoy your child: play with them, laugh with them, read with them, watch their television shows.
  • Follow your child’s lead. This shows them you value their ideas and thoughts.
  • Take charge when needed. This helps your child feel safe.
  • Be consistent, predictable, and stable. This helps kids feel safe.
  • Set limits. Too much freedom makes kids feel anxious, even if they think they want it. You need to be the strong one who lets them know what are safe limits.
  • Accept them for who they are. You don’t need to approve of their behaviour, but you need to love them whatever they do.

What if I make a mistake?

It’s okay! Attachments are built on thousands of experiences and are always able to change. Research shows that kids need “good enough” parents not perfect parents. In fact, there’s something to be said for a child facing some adversity (not too much, but a little). This teaches children that they can manage these situations and helps build resilience.

What if my child isn’t securely attached?

There are a variety of different attachment-based therapies available that are supported by research. These include Parent-Child Interaction Therapy; Circle of Security; Watch, Wait, and Wonder; Interaction Guidance, Reflective Family Play, and others. See a psychologist or talk to your child’s paediatrician for appropriate evidence-based local referrals. The above-mentioned therapies and others supported by research should be favoured. There are some other therapies that indicate they are for attachment, but that are not evidence-based.

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 and your child. 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 Jen Theule, Ph.D., C.Psych., University of Manitoba.

November 2016

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: Gender Dysphoria in Adolescents and Adults

What is gender dysphoria?

Gender dysphoria refers to the distress that some people feel with their physical sex and/or gender role.

Some theorists propose that gender exists on a spectrum rather than being fixed opposites. Most people experience the sense that their physical bodies (i.e., female/male) are a good reflection of their gender identities (i.e., their internal sense of gender, or core gender) as women and men – they are cissexual/cisgender (the Latin prefix “cis” meaning “the same”). The term transgender (or increasingly, trans) refers to the many different ways that a person may experience their gender identity as different than the one assigned to them at birth. Some people experience a more marked inconsistency between the physical bodies they were born into and their gender identities. For example, they may have male genitalia and have been raised as male, yet identify as a woman. Still others identify more androgynously or feel they occupy a more middle space on the gender spectrum (e.g., genderqueer), and yet others might have a more fluid sense of gender (e.g., non-binary, gender-fluid). Those who feel less categorical may indicate a preference on a gender spectrum, such as being transfeminine or transmasculine.

How common is gender dysphoria?

It is a complex task to establish solid prevalence rates among hidden, and stigmatized, populations and there are no large-scale population studies of gender identity of which we are aware. Recent community-based research efforts such as Ontario’s Trans Pulse Project have proposed innovative methods to best approximate prevalence, such as respondent-driven sampling. Public health and epidemiology principles suggest that the prevalence rates of health issues capture only those who present for treatment and that these numbers represent the metaphorical “tip of the iceberg”. Of note, anecdotally, gender identity clinics across Canada have seen a significant surge in number of referrals over the past few years. Another clear referral trend is trans women and men presenting in fairly equal numbers, where it was previously thought that there were many more trans women than trans men. A recent demographic study conducted by the Trans Pulse Project shows that trans communities are diverse in age, sexual orientation, ethno-racial and educational backgrounds, and relationship and parental status.

Gender dysphoria in adolescents

Gender dysphoria in adolescence may be accompanied by depressed mood, anxiety, and behavioural problems, all of which can considerably heighten the adolescent’s distress. The Standards of Care outlined by the World Professional Association for Transgender Health (WPATH, 2012) recommend a careful assessment involving the family, and ample opportunities for an adolescent’s gender exploration. If indicated, staged medical interventions are advised, often beginning with fully reversible ones such as puberty-delaying or –blocking hormones, to integrate and evaluate their effects before moving on to a next stage. Additional clinical competencies are required for working with adolescents.

Gender dysphoria in adults and transitioning

How people manage their gender dysphoria is a highly individual process that can depend on factors such as degree of dysphoria, financial resources, health status, and social support including relationship status and human rights protections. People may choose to live in accordance with their assigned/physical sex and not undergo any physical changes. Some might present themselves in a manner consistent with their core gender only in certain situations, such as at home or with specific groups of friends. Others may choose to live socially in accordance with their core gender through changes to their name and/or appearance, without undergoing any medical changes. Many adults with gender dysphoria do seek to change their body, however, to bring it more in line with their gender identity, a process called “medical transition”. They may do this by means of hormonal treatment, electrolysis, chest/breast surgery, cosmetic surgeries, gonadal and/or genital surgery. For those who feel it right for themselves, transition generally has a relatively high degree of satisfaction. Moreover, emerging research shows that there is a significant reduction in symptoms of distress and/or psychopathology during the process of medical transition, particularly after the initiation of hormone therapy (Heylens et al., 2014; Keo-Meier et al., 2015). Similarly, timely access to care and medical transition was among the factors associated with a strong reduction in suicide risk among a large Canadian community sample (Bauer et al., 2015).

How people access care for medical transition depends on the kind of intervention they desire and where they live in Canada. Hormone therapy can masculinize a body (with testosterone) or feminize a body (with an anti-androgen and estrogen source). Results can vary significantly depending on such factors as age and genetics. Hormones have some reversible and some irreversible effects, and can take approximately two years to determine their full effect. Increasingly, family doctors with training are prescribing hormone therapy, some on an informed consent model and some with assistance from a mental health professional with special competence in this area, or endocrinology, where indicated (LGBT Health Program, 2015).

Gender affirming surgeries are covered by many (but not all) of the provincial and territorial Ministries as insured services under the public health care plan. Among those where coverage is available, not all available surgeries are considered insured services. Even in cases of provinces with good coverage, there may be financial costs, such as travel, and the emotional toll of long wait lists for surgical assessments and/or surgery. In order to access these surgeries, clients must meet criteria for Gender Dysphoria (GD), along with what are considered eligibility and readiness criteria. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) outlines the criteria for GD as a “marked incongruence between one’ s experienced/expressed gender and assigned gender” for a minimum of six continuous months, defined by at least 2 of the following: (1)  marked incongruence between experienced gender and primary and/or secondary sex characteristics, (2) a strong desire to be rid of one’s primary and/or secondary sex characteristics on account of a marked incongruence with experienced gender, (3) a strong desire for the primary and/or secondary sex characteristics of the other gender, (4) a strong desire to be the other gender, (5) to be treated as the other gender, or (6) a strong conviction that one has the typical feelings of the other gender (there is language to also acknowledge an alternative gender). To meet criteria, there must be evidence of distress about the incongruence. GD subtyping is with, or without, a disorder of sexual development. There is now a post-transition specifier for those living full-time as themselves with the help of one transition-related medical intervention.

The World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) (Coleman et al., 2012) are a set of international guidelines for the care in working with trans clients, whose interpretations may differ based on national and regional context and health policies. The SOC have different eligibility and readiness criteria for different surgeries; the more significant the surgery, the higher the bar. Candidate recommendations for surgery are provided by a mental health professional with diagnostic powers (including psychologists and psychological associates) and special competency in Gender Dysphoria. Recommendations for gonadal and genital surgeries require two mental health recommendations and that clients be of legal age (18). Eligibility criteria for gonadal and genital surgeries is one year of continuous hormone therapy. A further eligibility criterion for genital surgeries is one continuous year of Gender Role Experience, where the person presents in their core gender in everyday public life, as part of a lived informed consent. There is also a set of readiness criteria for every surgery, which includes aspects such as having good mental health stability, social support, and knowledge of the intervention, its risks and a thoughtful aftercare plan. Requirements vary across provinces and territories, however, and individuals who are considering physical interventions are advised to consult with a local or regional mental health professional with competence in this area. Some provinces have identified providers or organizations empowered to carry out assessments for publically-funded surgeries. The Canadian Professional Association for Transgender Health (CPATH; contact information below) may be a useful resource.

There have been more recent provincial and federal policy changes to reflect the reality that some trans people, for a variety of reasons, do not have transition-related surgeries (TRS- also known by some as sex reassignment surgeries). For example, the Ontario Human Rights Commission’s case of XY (2013) found that the bar of needing TRS to change one’s sex designation on provincial identity documents was discriminatory and now a letter from a medical doctor or psychologist suffices. Federally, a changed birth certificate can now be the basis for a changed sex designation on one’s Canadian passport (2015). Some community members are calling for the option of a gender neutral identity marker.

What causes gender dysphoria?

The exact cause of gender dysphoria remains unknown. Researchers have been trying to understand how much of gender identity is the result of nature (biological influences) or nurture (social or environmental influences). There is evidence to suggest that both have a role. There are debates about at what age gender identity is considered fixed, however, many would generally agree this is around the time of puberty. This means for those who clearly meet criteria for GD, therapy will not change their identity, nor would it be considered ethical do try to do so. If indicated, a social and/or medical transition is considered the treatment of choice.

Although gender dysphoria has been viewed as a mental health issue in recent history, it was not always this way. Recorded history includes many descriptions of people, from a range of cultures, who did not fit into the simple categories of male or female. In some cases, these people were highly regarded by virtue of their insight into both female and male worlds (e.g., 2-Spirited People of the 1st Nations, 2008). It is important to remember that the idea of two opposite sexes may be a recent, Western idea.

What is the Role of Psychologists?

The psychologist’s role in working with adults with gender dysphoria is varied and generally includes the following:

  • Assessing and identifying a client’s gender dysphoria;
  • diagnosing and providing treatment for any co-occurring mental health conditions (such as anxiety or mood-related problems) or substance use;
  • exploring with the client the range of treatment options and their implications;
  • determining readiness for hormonal or surgical treatments;
  • helping clients adjust to their changing life circumstances as they transition;
  • educating family members, employers, and institutions about gender dysphoria; and
  • advocating on behalf of individuals to ensure that school and work environments are accepting and accommodating of gender diverse adolescents and adults, and their gender expression.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Bauer, G.R., Scheim, A.I., Pyne, J., Travers, R., & Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada. BMC Public Health, 15: 525

Coleman, E., Bockting, W. O., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J, et al. (2012). Standards of Care for the health of transsexuals, transgender and gender-nonconforming people, 7th version. World Professional Association of Transgender Health.

Heylens, G., Verroken, C., De Cock, S., T’Sjoen, G., and DeCuypere, G. (2014). Reassignment therapy on psychopathology: A prospective study of persons with a gender identity disorder. Journal of Sexual Medicine, 11, 119-126.

Keo-Meier, C.L., Herman, L.I., Reiser, S.L., Pardo, S.T., Sharp, C. & Babcock, J.C. (2015). Testosterone treatment and MMPI-2 improvement in transgender men: A prospective controlled study. Journal of Consulting & Clinical Psychology, 83, 143-56.

LGBT Health Program (2015). Guidelines and protocols for hormone therapy and primary health care for trans clients. Toronto: Sherbourne Health Centre. http://sherbourne.on.ca/lgbt-health/guidelines-protocols-for-trans-care/

2-Spirited People of the 1st Nations (2008). Our relatives said: A wise practices guide – voices of Aboriginal trans people. Toronto: http://www.2spirits.com/

Resources

  • Canadian Professional Association for Transgender Health (CPATH). CPATH is an interdisciplinary professional organization devoted to the health care of individuals with gender variant identities.cpath.ca
  • Rainbow Health Ontario. This provincial program offers educational trainings, public policy advocacy and an online resource database to improve the health of LGBT people and access to competent care. http://www.rainbowhealthontario.ca/
  • Vancouver Coastal Health Transgender Health Information Program. This BC-wide information hub providing access to information about gender affirming care and supports.http://transhealth.vch.ca
  • World Professional Association for Transgender Health (WPATH; formerly known as the Harry Benjamin International Gender Dysphoria Association). WPATH is an international multidisciplinary professional association devoted to promoting evidence-based care for transgender health. WPATH provides ethical guidelines concerning the care of individuals with gender dysphoria, as well as a membership directory and resource lists.wpath.org

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, go to https://cpa.ca/public/whatisapsychologist/ptassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Nicola Brown, Ph.D., C.Psych., Centre for Addiction and Mental Health, ON.

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: Chronic Pain

What is chronic pain?

Chronic Pain is pain that does not go away. When pain lasts longer than 3 or 6 months, or beyond the usual time of recovery, it is said to be chronic. Different types of chronic pain exist, many of which are not clearly understood. Chronic pain may be associated with an illness or disability, such as cancer, arthritis, or a phantom limb. Some types of pain start after an injury or accident and become chronic over time. Others may begin gradually, as is sometimes the case with low back pain. In some types of chronic pain, like migraine headaches, the pain is recurrent, rather than constant. There are many other kinds of chronic pain, such as postsurgical pain, fibromyalgia, and neuropathic pain. In some cases, the cause of the pain remains unknown.

Research indicates that between 10% and 30% of Canadians experience chronic pain. The direct and indirect costs associated with this are staggering, with estimates in the billions of dollars annually. Women tend to have slightly higher rates of chronic pain than men. People of all ages can experience chronic pain, but it is most common in middle age (for additional information about pain in the elderly, please see the CPA “Chronic Pain Among Seniors” Fact Sheet). Chronic pain can make simple movements hurt, disrupt sleep, and reduce energy. It can impair work, social, recreational, and household activities. People who have been injured in accidents may develop other symptoms, such as anxiety and depression. Chronic pain can have a negative impact on financial security and, in some cases, it can contribute to alcohol or drug abuse. It can also disrupt marital and family relationships.

Pain is invisible. As a result, many people who experience chronic pain feel misunderstood and/or alone in their suffering. Some people feel judged or stigmatized, whereas others believe pain is “all in their head.” Pain is, indeed, “all in the head” because the brain is located in the head, and the origin of pain resides in the brain. Because chronic pain can negatively impact quality of life and functional abilities, it is not surprising that more than a quarter of people who experience chronic pain also experience significant depression or anxiety.

Medications are often used to treat chronic pain. Indeed, medications can help, however, the suitability of long-term use needs to be carefully considered and monitored.

How can a psychologist help a person with chronic pain?

Psychologists focus on many aspects of chronic pain, including assessment, treatment, research, teaching, and advocacy. In terms of treatment, psychologists use several different approaches and techniques to help people with chronic pain improve their quality of life, regain their sense of purpose, and improve their functional abilities. Psychologists address important themes, such as acceptance and loss, and they help people with chronic pain through support, education, and skill building in areas such as relaxation, mindfulness, problem solving, goal setting, sleep, assertiveness, and adaptive thinking.

Cognitive behavioural therapy (CBT) is a form of psychological treatment that focuses on thoughts, feelings, and actions. It aims to help people think and behave in more adaptive ways. Acceptance and commitment therapy (ACT), another psychological approach, focuses on acceptance, choice, and committed action. It aims to help people live in ways that are consistent with their core values. Mindfulness meditation is yet another approach that can help individuals with persistent pain. In all cases, a basic treatment goal is to improve functioning and quality of life, as opposed to eliminating pain symptoms. A vocational assessment examines a person’s interests, aptitudes, and abilities. It can be useful for individuals who may need to change the way they work or the type of work they do. Psychotherapy for anxiety and/or depression can be helpful for individuals experiencing chronic pain, as can treatment for drug or alcohol abuse, when required. Couple, marital, or family therapy can also be beneficial for addressing pain-related interpersonal difficulties.

Are psychological approaches effective?

Numerous scientific studies have demonstrated the effectiveness of psychological approaches in helping people with chronic pain. Psychological treatments have been shown to improve quality of life and functioning in many life domains, such as activities of daily living, emotional health, and interpersonal relationships. Following psychological treatment, people report they are more active, more confident, and more in control of their lives, as well as less depressed and less anxious. In many cases, they endorse reductions in pain and physical symptoms. Even though people may continue to experience pain, it is often more manageable.

Although individual therapy may be offered, people experiencing chronic pain are often treated in groups where they are able to share their experiences with others. Because chronic pain is complex, psychologists frequently work in interdisciplinary or multidisciplinary teams comprised of other health care professionals, such as physiotherapists, occupational therapists, physicians, nurses, and social workers. Again, the primary treatment goal is to help people with chronic pain develop satisfying and healthy lifestyles. Interdisciplinary chronic pain rehabilitation programs are as effective in reducing pain intensity as medications and medical interventions; however, they are more effective in decreasing medication use, reducing health care utilization, improving functional activities, improving mood, and promoting return to work.

How can research help?

In addition to working directly with people who experience chronic pain, psychologists have contributed significantly to our understanding of chronic pain through many types of research. For example, some studies focus on reducing the incidence of chronic pain through injury prevention or early intervention programs. Other studies examine the effectiveness of chronic pain treatments. Some researchers examine how psychological variables influence pain and suffering, whereas others study the role of the central nervous system in a variety of chronic pain conditions.

Where can I get more information?

For information about chronic pain, you could contact the Chronic Pain Association of Canada (www.chronicpaincanada.com) or the Canadian Pain Society (www.canadianpainsociety.ca).

Information about pain in children is available at the web site entitled “Pediatric Pain – Science Helping Children” at Dalhousie University, http://pediatric-pain.ca/ .

Consultation with or referral to a registered psychologist can help guide you as to the use of the therapies mentioned in this Fact Sheet.

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. John Kowal, a private practice psychologist.

Revised: January 2021

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

Canadian Psychological Association
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: Bullying Among Children and Youth

What is bullying?

Bullying among children and youth is defined as repeated, unwanted aggressive behaviour(s) by a youth or group of youths. It involves an observed or perceived power imbalance. It can result in physical, social, or educational harm or distress for the targeted youth.[1]

  • The power imbalance may be based on differences in size, strength, ability, popularity, appearance/body size, race/ethnicity, culture, religion, financial resources, sexual orientation, gender identity/expression, or any other difference.
  • Bullying is a relationship problem. Over time, the person who is bullying feels more and more powerful and the person who is being bullied feels more and more helpless, shamed, and trapped.
  • Bullying requires relationship solutions. That is, solutions that create safety and social-emotional growth for those who bully, those who are bullied, and those who witness it.
  • Bullying happens most often when few adults are around (e.g., school playgrounds, hallways, cyberspace).
  • At least 1/3 of bullying is experienced beyond school boundaries (e.g., recreation settings, online).

Forms of bullying

  • Physical bullying: physical aggression such as hitting, kicking, shoving, stealing or harming property.
  • Verbal bullying: teasing, name calling, put-downs, shaming, threatening or humiliating others.
  • Social bullying: excluding others, damaging friendships, negative gossiping, spreading rumours etc. This is also known as indirect or relational bullying.
  • Cyber bullying: is the use of electronic communication technology to bully others. The technology itself creates a power imbalance. It reaches youth anywhere and at any time, messaging is instantaneous, the audience can be huge, and the messages can be permanent.

How common is bullying?[2],[3]

In 2018, a large and representative sample of Canadian youth in grades 6 through 10 were asked whether they have been involved in bullying over the last two months.

  • 36% of the sample reported they had been involved in bullying at least once over this time period.
    • 6% bullied others
    • 20% were bullied
    • 9% reported they both bullied others and were bullied
  • Being bullied is more common among girls than boys – approximately 1 in 3 Canadian girls are bullied.
  • Bullying others is more common among boys than girls.
  • Teasing or name calling is the most common form of bullying for both boys and girls.
  • Bullying rates in Canada have remained relatively stable over the last 12 years. Relative to other wealthy nations, Canada ranks in the middle in terms of bullying rates (23rd out of 35 nations).

Bullying – The role of peers

Observational research of elementary school children showed that bullying incidents occurred every 7 minutes on the playground and bystanders were present for 85% of these incidents.[4] Bystanders influence bullying dynamics in both ways:

  • When bystanders remain passive observers, this sends the message that bullying is acceptable. The bigger the audience, the longer the bullying incident lasts.[5]
  • When bystanders intervene, the bullying stopped within 10 seconds in 57% of observed incidents.[6]

Defending against bullying is a complex, social-emotional task for bystanders. They must recognize the event as bullying, take responsibility for helping, and have the skills necessary to intervene successfully. Research suggests that defending can take multiple forms[7]:

  • Comforting: Offering emotional support to the person being bullied.
  • Reporting: Telling a teacher or another adult about the bullying.
  • Solution-focused: Using assertiveness or problem solving to stop the bullying.
  • Aggressive: Using retaliation against the aggressor.

Youth should be encouraged to defend using the behavior that is safest and most effective for them in the moment. Boys tend to defend aggressively and may need help to develop more prosocial intervention strategies[6].

Who is at risk?

Of being bullied?

  • Those with few friends who are seen as unable to defend themselves
  • Those with a disability, neurodevelopmental difference, special healthcare need, intellectual exceptionality (both gifted and learning disability)
  • Overweight children and youth
  • LGBTQ children and youth report being bullied significantly more and more severely than other students[8]

Of bullying others?

  • Children and youth who believe that bullying is normal
  • Those who have friends who bully
  • Not all children and youth who bully are alike. Some are popular and socially skilled, while others have behaviour problems and few friends.

Dangers and psychological impacts

Bullying is a health issue. It is linked to both short and long-term mental and physical health problems and academic under-achievement.[9]  Strong and supportive relationships with parents, a caring and responsive school environment, and positive relationships with family and friends can all help protect against long-term harm. The harm related to bullying is related to:

  • Severity and frequency of the bullying behaviour
  • Pervasiveness of involvement in bullying (e.g., is bullying happening in just one relationship or place, or in many relationships and places?)
  • Chronicity of involvement in bullying (how long has the bullying gone on? Have there been other bullying problems in the past?)

Children and youth whose bullying involvement has been severe/frequent and/or pervasive, and/or chronic require the most intensive and focused support.

Research has documented many immediate and long-term negative impacts of bullying involvement[10]:

  • Negative impacts of bullying are significant and have been found across all cultures.
  • For some individuals, the impacts can last throughout life.
  • Lessons learned about the abuse of power in relationships from bullying may carry over to: sexual harassment, dating aggression, intimate partner violence, workplace harassment, child and elder abuse.
  • Children and youth who both bully others and are bullied tend to have the most severe and enduring problems, including the negative impacts in both lists below.

Negative impacts linked to bullying others[11]

  • Depression
  • Substance abuse
  • Aggression and anti-social behaviour
  • Sexual harassment and dating aggression
  • Academic problems and increased school dropout rate
  • Delinquency and criminal behaviour

Negative impacts linked to being bullied[12]

  • Depression, anxiety, mood disorders
  • Substance abuse
  • Low self-esteem and social confidence
  • Isolation and loneliness
  • Poor peer relationships
  • Stomach aches, headaches
  • “Toxic stress” or enduring low grade systemic inflammation which is linked to disease[13]
  • School absenteeism and learning problems
  • Contemplating, attempting, or committing suicide

How can psychologists help?

In Schools?[14]

  • Provide training for staff members on how to promote healthy relationships and social climates, and to identify and address bullying issues.
    • After training, teachers report feeling more supportive toward children who are bullied and more confident handling bullying issues.
  • Recommend school policies that address prevention, intervention and evaluation. [15]
  • Develop intervention strategies for children who are involved in bullying problems that develop social-emotional capacity and skills. Counsel students and families dealing with impacts of bullying and victimization.

Those who bully others?

  • Help them recognize and understand the negative impacts of their bullying on others and on themselves.
  • Support understanding of human rights to safety, respect, and dignity.
  • Help develop the ability to control behaviour, resist peer pressure, and use problem solving strategies.
  • Help find ways to use their power in a positive way (e.g., identify leadership roles).
  • Find opportunities to engage in positive social experiences with a diverse mix of peers where the focus is on making a contribution to the greater good (e.g., peer mentoring, or peer mediation)

Those who are bullied?

  • Help develop an immediate plan of safety so they can feel comfortable attending school and participating in community activities.
  • Listen, empathize, and reduce shame and self-blame.
  • Help them understand and assert their human rights to safety, respect, and dignity.
  • Help find ways to build self-esteem, confidence and healthy interests.
  • Find opportunities to form positive friendships with peers.

Bystanders?

  • Support understanding of human rights and healthy relationships.
  • Educate about bullying and its impacts on health and well-being.
  • Use role-play and scripts to teach bystanders specific skills for standing up to various bullying situations, instead of being passive or joining in.
  • Run workshops to build assertive communication skills and problem solving skills, and peer pressure resistance.

Where can I get more information?

Additional information about bullying can be found at www.prevnet.ca.  For downloadable resources, see Factsheets and Tools for Schools at http://www.prevnet.ca/resources/bullying-prevention-facts-and-tools-for-schools

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 Annie Tang, Dr. Joanne Cummings, Dr. Debra Pepler, and Kelly Petrunka, PREVNet.  This fact sheet was updated by Dr. Wendy Craig, Dr. Debra Pepler,  and Laura Lambe.

February 2021

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

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


[1] Centers for Disease Control and Prevention (2014). Retrieved from http://www.cdc.gov/violenceprevention/pdf/bullying_factsheet.pdf.

[2] Craig, W., Pickett, W, King, M. (2020) The health of Canadian youth: Findings from the health behavior in school-aged children study. Public Health Agency of Canada, retrieved from https://www.canada.ca/en/public-health/services/publications/science-research-data/youth-findings-health-behaviour-school-aged-children-study.html#ch10

[3] UNICEF (2020). Canadian companion to the UNICEF report card 16. Retrieved from: https://www.unicef.ca/en/unicef-report-card-16

[4] Craig, W. & Pepler, D. (1997).  Observations of bullying and victimization in the schoolyard. Canadian Journal of School Psychology, 2, 41-60.   See: http://www.prevnet.ca/sites/prevnet.ca/files/research/PREV-Craig-Pepler-1997-Communique-peers.pdf for a downloadable research summary of this article.

[5] O’Connell, P., Pepler, D., & Craig, W.  (1999) Peer involvement in bullying: Issues and challenges for intervention. Journal of Adolescence, 22, 437-452.

[6] Hawkins, D.L., Pepler, D., & Craig, W. (2001). Peer interventions in playground bullying. Social Development, 10, 512-527.  See http://www.prevnet.ca/sites/prevnet.ca/files/research/PREV-Hawkins-etal-2001-Communique-peer-intervention.pdf for a downloadable research summary of this article.

[7] Lambe, L. J., & Craig, W. M. (2020). Peer defending as a multidimensional behavior: Development and validation of the defending behaviors scale. Journal of School Psychology78, 38-53.

[8] Taylor, C. & Peter, T., with McMinn, T.L., Schachter, K., Beldom, S., Ferry, A., Gross, Z., & Paquin, S. (2011). Every class in every school: The first national climate survey on homophobia, biphobia, and transphobia in Canadian schools. Final report. Toronto, ON: Egale Canada Human Rights Trust.  Retrieved from: http://egale.ca/wp-content/uploads/2011/05/EgaleFinalReport-web.pdf.

[9] Hymel, S. & Swearer, S. (2015). Four decades of research on school bullying. American Psychologist, 70, 293-299.

[10] Hymel, S. & Swearer, S. (2015). Four decades of research on school bullying. American Psychologist, 70, 293-299.
See also: Takizawa, R., Maughan, B., & Arsenault, L. (2014). Adult health outcomes of childhood bullying victimization: Evidence from a five-decade longitudinal British birth cohort. Am J Psy in Advance. Retrieved from http://ajp.psychiatryonline.org/data/Journals/AJP/0/appi.ajp.2014.13101401.pdf.
See also:  Ozdemir, M., & Stafttin, H. (2011). Bullies, victims, and bully-victims: A longitudinal examination of the effects of bullying victimization experiences on youth well-being. Journal of Aggression, Conflict and Peace Research3, 97-102.

[11] Farrington, D.P. & Toffi, M. M. (2011).  Bullying as a predictor of offending, violence, and later life outcomes.  Criminal Behaviour and Mental Health (21)2, 90-98. See also: Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2014). Bullying in childhood, externalizing behaviors, and adult offending: Evidence from a 30-year study. Journal of school violence13(1), 146-164.

[12] Bowes, L., Maughan, B., Ball, H., Shakoor, S., Ouellet-Morin, I., Caspi, A., Moffitt, T.E., and Arseneault, L. (2013). Chronic bullying victimization across school transitions: The role of genetic and environmental influences. Development and Psychopathology, 25, pp 333-346.

13 Copeland, W. E., Wolke, D., Lereya, S. T., Shanahan, L., Worthman, C., & Costello, E. J. (2014). Childhood bullying involvement predicts low-grade systemic inflammation into adulthood. Proceedings of the National Academy of Sciences111(21), 7570-7575.
See also: Rueger, S. Y. & Jenkins, L. N. (2014). Effects of peer victimization on psychological and academic adjustment in early adolescence. School Psychology Quarterly, 29, 77-88.
See also: Vaillancourt, T., Hymel, S., & McDougall, P. (2013). The biological underpinnings of peer victimization: Understanding why and how the effects of bullying can last a lifetime. Theory into Practice52(4), 241-248.

[14] Pepler, D. & Rodrigues, B. (in press). Bullying prevention: Re-imagining a non-violent and healing learning environment for all students at school. In E. Cole and M. Kukai (Eds.)
Mental Health Consultation and Interventions in School Settings: A Scientist–Practitioner’s Guide, pp. 339-357. Boston: Hogrefe Publishing.

[15] Ttofi, M. M., & Farrington, D. P. (2011). Effectiveness of school-based programs to reduce bullying: A systematic and meta-analytic review. Journal of Experimental Criminology7(1), 27-56.

“Psychology Works” Fact Sheet: Quitting Smoking

According to the most recent Canadian Tobacco, Alcohol and Drugs Survey, about 4.2 million people in Canada over the age of 15 smoke tobacco. This is the lowest national smoking rate ever recorded, but is still about 15% of the adult population, with provincial rates ranging from 11% in B.C. to 20% in New Brunswick. Smoking is a leading cause of illness and early death in Canada, reinforcing the need to bring this national smoking rate down even further to allow all Canadians to live longer, healthier lives.

Quitting smoking reduces your chances of developing many physical conditions (e.g., cancers, heart disease, respiratory diseases). Quitting smoking also has a lot of mental health benefits. Compared with those who continue to smoke, people who quit smoking experience the following benefits for many years after quitting: less stress and anxiety; fewer symptoms of depression; more frequent positive emotions; higher overall quality of life; and feeling healthier in general.

Why is Smoking So Addictive?

Nicotine is the major addictive chemical in cigarette smoke and acts very quickly in your body, reaching your brain in about 10-20 seconds. Within about 2 hours of finishing your cigarette, nicotine levels in your body drop by 50%. This leads to cravings, feeling anxious or irritable, and generally feeling ‘down.’

Nicotine affects a number of important chemicals in your brain and body, which can boost your mood, reduce stress, make you feel energized, and even reduce pain. However, these effects are short-lived and most common in new or occasional smokers. This is because your body adapts to these changes over time, resulting in a need to smoke more over time in order to feel any of these effects – or just feel ‘normal.’

Although nicotine is very addictive, it’s not the only reason why people have trouble quitting. For regular smokers, lighting up a cigarette is often part of a routine. Whether you smoke after dinner, on work breaks, or when socializing, smoking in response to daily triggers can make it more difficult to quit.

What Treatments Are Available?

Quitting smoking involves managing the physical symptoms and breaking the links between smoking and how you feel, what you do, with whom who you spend time, and how you see yourself. As a result, it often takes many attempts, and many treatment types, before you’re able to quit successfully.

Quitting “cold turkey” is one of the most common approaches, but it’s also one of the least effective. A number of treatments are proven to help make your quit attempt a success:

  1. Behavioural Therapy: These treatments target the beliefs, attitudes, and behaviours that support an addiction. Common therapies include cognitive behavioural therapy, acceptance and commitment therapy, and functional analytic therapy.
  2. Nicotine Replacement Therapy (NRT): NRT comes in two forms: slow release (e.g., nicotine patch) and rapid-delivery (e.g., nicotine gum, inhalers). NRTs help to reduce cravings and withdrawal symptoms by releasing small amounts of nicotine into your body, but are not addictive.
  3. Prescription Medication: In Canada, two major prescription drugs are used to help people quit smoking: varenicline and bupropion. These drugs affect nicotine receptors in your brain and help to reduce cravings and withdrawal symptoms. Varenicline also helps to make smoking less pleasurable.

Note: You should always consult a doctor for information on the risk of side-effects or interactions before using NRTs or prescription medications.

What Works?

Varenicline is the most effective on its own, but all three types of treatment work. While using at least one of these treatments can boost your odds of successfully quitting by as much as 80%, research shows that the best way to quit is by combining treatments. The two most successful combinations are:

  • Combined NRTs, which involve using a combination of a slow-release NRT (e.g., nicotine patch) and a rapid-delivery form (e.g., nicotine inhaler).
  • Combined Pharmacotherapy and Behavioural Therapy. You can boost your chances of quitting by using pharmacotherapy (i.e., NRT or prescription drugs) while getting help to quit from a licensed mental health professional (e.g., registered psychologist).

Quit-lines and online help, whether on their own or combined with other treatments, can also increase your likelihood of staying smoke-free.

What Doesn’t Work?

Aversion therapies (e.g., smoking until you feel sick), alternative tobacco products (e.g., chewing tobacco, snuff, e-cigarettes, and alternative therapies (e.g., hypnotherapy, acupuncture, and natural herbs and remedies) don’t improve your odds of quitting.

How Can I Help Myself Quit?

Whatever route you choose, keep in mind that it can be incredibly difficult to quit smoking. Even if it takes you many tries, you can eventually succeed.

Whether it’s your first attempt or your fifth, psychological research shows that there is much you can do to make your quit attempt a success:

  • Set concrete and realistic goals (e.g., set a specific ‘quit date’).
  • Start using treatments before you quit.
  • Tell your friends and family that you’re quitting and let them know how they can help.
  • Embrace change in your daily routine, social circle, and motivations.
  • Find a buddy who is also trying to quit.
  • Gradually reduce your smoking before you quit.
  • Start by reducing the amount you smoke.
  • Reward yourself, even for small gains.
  • Make a plan to deal with withdrawal symptoms (e.g., headaches, sadness, irritability, anxiety) in the first 1-4 weeks after quitting. These are signs that your body is recovering.
  • Follow the 4 Ds to help deal with cravings: Distract yourself, Drink water, take Deep breaths, and Delay smoking for as long as possible.
  • Get active.
  • Keep your focus on what you don’t enjoy about smoking rather than what you enjoy.
  • Forgive yourself if you have the occasional cigarette.
  • Keep yourself busy.
  • Understand your triggers and learn how to manage them.
  • Replace cigarettes with other things, activities, and people that you enjoy.
  • Re-identify yourself as a “non-smoker” or “former smoker” to your friends, family, co-workers, and yourself.
  • Accept that this will be difficult for a while, but the rewards will last a lifetime.

Where Can I Go For Help?

Your family doctor can help you to develop a plan for quitting, figure out which treatments might be most effective, and refer you to other health care professionals who can also help you quit smoking. Doctors can also advise you on the safety of NRTs and medications (e.g., side-effects, interactions).

Registered psychologists can help you develop a plan for quitting and provide therapy that will help you quit. Psychologists can offer a variety of effective therapies and will work with you to figure out which one is likely to work best for you. Check with your provincial or territorial psychological association at https://cpa.ca/public/whatisapsychologist/ptassociations/ to find a psychologist in your area who can help you quit smoking.

Health Canada and the Canadian Cancer Society offer a free, confidential ‘quitline’ at 1-866-366-3667. Their telephone counsellors are trained to provide support and help you create a plan for quitting.

You can also seek online help at http://breakitoff.ca/, which includes support forums, information on treatments, self-help resources, and a mobile app.

This fact sheet has been prepared for the Canadian Psychological Association by Matthew Murdoch, Canadian Psychological Association.

Date: August 2016

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: Insomnia

What is insomnia?

Many people, about 20-25% of the population, are dissatisfied with their sleep. Among these, some have a specific sleep disorder called insomnia. Insomnia is defined as persistent trouble getting to sleep or staying asleep that affects daytime functioning or causes distress. When the sleep difficulty occurs at least three nights per week and continues for at least three months, it is called chronic insomnia disorder. At least 10% of the adult population have chronic insomnia.

Common triggers of insomnia include stress at home, work or school; relationship changes; loss; health conditions; anxiety; depression; and pain. Stimulants such as caffeine and nicotine can also lead to sleep difficulty.

Chronic insomnia can be maintained by factors other than those that triggered it initially. Racing thoughts, worries about not sleeping, staying in bed when not sleeping, and irregular sleep schedules often serve to sustain the cycle of insomnia. Sometimes, the fear of not sleeping or trying too hard to sleep is enough to prevent sleep from arriving.

Insomnia can be a serious problem. It causes daytime fatigue, irritability, impaired attention and concentration, reduced enjoyment of relationships and decreased work productivity. It has also been found to increase the risk of depression, Type 2 diabetes and heart disease.

What psychological approaches work in treating primary insomnia?

Good sleep hygiene is important for a good night’s sleep (e.g., cutting down on caffeine or alcohol at bedtime, avoiding light and noise, increasing exercise). If you already have good sleep hygiene and still have insomnia, then the following approach may be helpful for you.

The recommended first treatment for chronic insomnia is called “cognitive behavioural therapy for insomnia”, or CBT-I. This psychological treatment has been shown through research to effectively improve sleep. People also feel less fatigued, they function better, and their mood improves.

The behavioural, cognitive and relaxation components of CBT-I are outlined here:

  • The behavioural components help you learn how to connect your bed with good sleep and to regulate your sleep schedule. For example, you discover what to do when you can’t sleep, when to go to bed and when to get up in order to get solid sleep.
  • The cognitive therapy component helps you control the worry and racing thoughts that interfere with sleep. For example, you learn how to deal with concerns about getting through the next day if you can’t sleep.
  • Relaxation techniques reduce bedtime mental and physical tension.

How effective are psychological methods of treating insomnia?

Research demonstrates that 70–80% of people with insomnia benefit significantly from 4 to 6 sessions of CBT-I, and continue to have improved sleep for months or years.

CBT-I is as effective as, or more effective than, sleep medications and produces longer lasting improvements in sleep. CBT-I is also effective in reducing the use of sleep medications, which can interfere with alertness and motor coordination and cause dependency.

CBT-I is more effective for chronic insomnia than either sleep hygiene alone or relaxation techniques alone.

You can consult with a registered psychologist to find out if they offer psychological treatments for insomnia, specifically CBT-I. 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. Judith Davidson, Queen’s University.

Revised: August 2020

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

Canadian Psychological Association
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: Attention Deficit/Hyperactivity Disorder

What is attention-deficit/hyperactivity disorder (ADHD)?

ADHD is characterized by developmentally inappropriate levels of inattention, hyperactivity, and impulsivity, that impair a person’s functioning. Some individuals have problems with all three types of symptoms, whereas others have problems primarily with inattention, or primarily with hyperactivity/impulsivity. Related to problems with inattention, people with ADHD often have difficulty following instructions, keeping things organized, and following through on tasks. Related to problems with hyperactivity and impulsivity, they also may tend to act without thinking, interrupt others, talk excessively, or feel fidgety or restless. ADHD begins in childhood and many individuals continue to show ADHD symptoms into adulthood. ADHD occurs in approximately 5-8% of school-aged children and adolescents, and is more common in males than females.

In addition to the problems with inattention, hyperactivity, and impulsivity, people with ADHD often have academic or employment problems and difficulties in their social interactions and relationships. ADHD often co-occurs with problems such as oppositional defiant or conduct disorder, learning disorders, and depression or anxiety disorders.

ADHD appears to have a biological basis, and for some people, it is an inherited condition. However, the specific cause of the disorder is not known and it may differ for different people; it is likely that multiple possible causes or contributing factors exist. The family environment does not cause ADHD, but it may affect the way that symptoms are expressed, as well as help people manage their ADHD.

There is no one test for ADHD that can determine whether someone has the disorder or not. Instead, assessment requires gathering information from several sources (e.g., parents, teachers, observations, testing), across multiple domains (e.g., home and school), and using standardized measures. Assessment should also carefully consider of other possible causes of ADHD symptoms, such as other disorders or stressors. A thorough assessment can be a complex process, and psychologists are well qualified to conduct such assessments.

What psychological treatments are used to treat ADHD?

For most school-aged children and adolescents, the best treatment for ADHD is a combination of behaviour therapy and medication. Behaviour therapy is particularly important in addressing family stress and social behaviour problems in individuals with ADHD, and may help to prevent or treat other problems that can occur with ADHD.

Behaviour therapy involves many techniques and focuses on establishing clear behavioural expectations for the individual and providing frequent and consistent feedback about behaviour, which could include rewards and consequences. Behaviour therapy can also include modeling, problem-solving, and skills training. For children, behaviour therapy is often conducted both in the classroom and at home, and parents and teachers are essential in implementing the therapy. For adolescents and adults, cognitive-behavioural therapy focused on the individual’s self-management of their own behaviours may be useful.

Where do I go for more information?

More information regarding ADHD and effective treatments (psychological and medication) can be found on a website developed by the US National Institute of Health at http://www.nimh.nih.gov/health/publications/adhd-listing.shtml

There is also a website of factsheets operated by Children and Adults with ADHD, an advocacy group, at https://chadd.org/understanding-adhd/adhd-fact-sheets/

Information about psychological interventions for ADHD can also be found in this article: Evans, S.W., Owens, J.S., Wymbs, B.T., & Ray, A.R. (2018) Evidence-based psychosocial treatments for children and adolescents with attention deficit/hyperactivity disorder, Journal of Clinical Child & Adolescent Psychology, 47:2, 157-198, DOI: 10.1080/15374416.2017.1390757

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. Amori Yee Mikami, Department of Psychology, University of British Columbia.

Revised: January 2021

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

Canadian Psychological Association
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: Chronic Pain Among Seniors

What is chronic pain?

Pain that does not go away and lasts for a few months or more is called chronic pain. Often chronic pain is the result of a known disease or injury and may last longer than the usual healing time associated with the disease or injury.

Sometimes medical tests cannot determine the cause of chronic pain. In most cases, the best way to assist a person with chronic pain is to help him or her learn how to manage it.

Pain can have different characteristics (e.g., burning, stabbing, and throbbing), tends to be accompanied by negative emotions (e.g., anger, fear) and can affect a person’s physical, mental, and emotional well-being. It can also affect a person’s physical functions making it harder for him or her to walk, bend, lift or sit. It can interfere with daily activities such as bathing, cooking, cleaning and working.

Pain can disturb sleep or appetite and decrease energy levels. It can interfere with roles and relationships with friends and family. Mentally, chronic pain can make it harder to concentrate or remember things. Emotionally, people with chronic pain can feel irritable, anxious and depressed. Psychologists play a central role in helping people manage chronic pain and the many consequences it has upon their well-being.

How common is pain among seniors?

Pain becomes more common as people get older. Research has shown that, during any one year, most seniors experience at least one significant pain problem, many of which are chronic. Common pain problems among seniors are:

  • pain from arthritis;
  • back pain;
  • leg pain;
  • pain following shingles;
  • pain following a stroke;
  • cancer pain;
  • post-polio syndrome; and
  • pain associated with other conditions such as chronic bronchitis, emphysema, stomach ulcers, fibromyalgia, and osteoporosis.

What are some common myths about pain and aging?

There are a number of myths about aging and pain. For example, many people (including some health professionals) sometimes say that “pain is a natural part of growing old”. This is not true. Pain is not caused by age. Pain is more common in older adults because the diseases or injuries that most often cause pain are more common in older adults.

It is important that the disease/injury and the pain be treated – no matter the person’s age. If we think of pain as a “natural part of growing old”, we may not treat a senior’s pain as seriously as we treat a younger adult’s pain.

Other common myths are that:

  • “older adults suffer less from pain than younger adults”;
  • “older adults can’t handle stronger painkillers or can easily become addicted to painkillers”; and
  • “pain medications always interfere with physical and mental functioning”.

Further, some older adults might feel less entitled than younger adults to ask questions of their health care providers and some health care providers might provide less information to them.

None of these myths and views about pain and aging are true or helpful and could prevent a senior from seeking and receiving the full range of pain treatment options available.

Is pain among seniors under-treated?

Perhaps because of some of the myths just described, pain among seniors is under-assessed and under-treated. Seniors are under-represented in clinics specializing in the treatment of pain. When a senior has another condition which affects his or her ability to communicate (e.g., Alzheimer disease), health professionals may not identify a pain problem.

Educating health professionals about how to evaluate pain in older adults is important and methods designed to identify and assess pain in people with severe dementia have been developed and are being evaluated in Canada and elsewhere. Older adults should seek treatment for their pain and ask questions about the range of medical and psychological treatments available.

Treating chronic pain among seniors

Similar to younger adults, seniors can benefit from treatments such as physiotherapy, occupational therapy, massage therapy, psychological therapy, and medications to manage their pain. However, research has shown that coordinated combinations of treatments for pain (e.g., psychological therapies combined with physiotherapy and medical management) show the best results.

The combination of different types of treatment is sometimes referred to as inter or multi-disciplinary treatment because it is delivered by a team of different health professionals such as physicians, psychologists, physiotherapists and occupational therapists.

Working with professionals who have special expertise in the treatment of pain among seniors is important. For example, because seniors’ bodies tend to process medication more slowly than those of younger adults, medications might have to be administered differently. Similarly, a pain management psychologist working with seniors must understand the problems unique to older age groups.

There are many benefits to treating chronic pain. These may include:

  • increased energy level;
  • improved physical functioning (e.g., sitting, walking, standing);
  • better sleep and appetite;
  • greater activity and independence;
  • more social involvement and better relationships with others;
  • better concentration; and
  • improved mood, self-esteem and sense of well-being.

What can psychologists do to help people with chronic pain? Is treatment effective?

Psychologists treating older adults for chronic pain often work within inter-disciplinary health care teams or coordinate treatment with the other health care services that the older adult might receive.

Because pain can be made better or worse by many factors, it is very important that the treating psychologist, or other pain specialist, communicate with the other health care professionals involved in the older adult’s care. Communication can only take place with the patient’s agreement (or in the case of persons with severe cognitive impairments, with the agreement of a close relative or legal guardian).

Psychological interventions focus on helping the older adult improve quality of life in spite of pain which, in turn, can decrease the burden of the pain experience. These interventions typically include cognitive-behavioural techniques which look at how physical sensations, feelings, thoughts and behaviours affect each other and our day-to-day functioning.

For example, a person with chronic pain may stop taking his or her regular walk to the community centre. Without the walks to the community centre, the person may become even less fit, may have a lower mood, and have fewer social contacts – all of which can worsen quality of life and the experience of pain. Psychological interventions can improve quality of life, and sometimes decrease pain, by helping the person with pain:

  • cope with depressed, anxious or irritable mood;
  • improve communication with others;
  • improve his or her social supports;
  • learn techniques and strategies to improve sleep and achieve relaxation; and
  • learn how to pace and organize activity.

Where do I go for more information?

The Canadian Psychological Association has a number of fact sheets that describe treatments for a number of conditions including chronic pain, depressioninsomnia, and generalized anxiety disorder. These treatments can be used and adapted to address some of the problems often seen in older adults with chronic pain.

For information about chronic pain, contact the Canadian Pain Coalition (http://www.canadianpaincoalition.ca/ ; 905-404-9545). The primary Canadian organisation dedicated to the study of pain is the Canadian Pain Society http://www.canadianpainsociety.ca.

For information on pain from arthritis, contact the Arthritis Society at http://www.arthritis.ca.

For information on pain from osteoporosis, contact the Osteoporosis Society of Canada at http://www.osteoporosis.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 Association, in cooperation with the Canadian Coalition for Seniors Mental Health, by Drs. Thomas Hadjistavropoulos and Sheryl Green, Department of Psychology, University of Regina.

Revised: February 2017

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: Depression

What is depression?

Almost everyone feels sad or “depressed” at certain times. Clinical depression (also called Major Depressive Disorder or MDD) is a more serious condition that is confirmed by the presence of at least five symptoms for at least a two week period.

The possible symptoms of Clinical depression include sadness, loss of interest in usual activities, changes in appetite, changes in sleep, changes in sexual desire, difficulties in concentration, a decrease in activities or social withdrawal, increased self-criticism or reproach, and thoughts of, or actual plans related to suicide.

Clinical depression may vary in its severity and its duration. In its extreme form Clinical depression can be life threatening and may require hospitalization.

Whereas Clinical depression is a more severe form of depression which can be fairly time-limited, Dysthymic Disorder (also called Dysthymia) is a less-severe, but more chronic type of depression.

Dysthymia is recognized when three of the symptoms listed above are present for at least two years. Some individuals also experience what is called “double depression”; when a person has ongoing Dysthymia, but from time to time also meets the criteria for Clinical depression.

Major Depressive Disorder is also distinguished from Manic Depression (also called Bipolar Disorder) in that in MDD the individual only experiences periods of depression, and potentially returns to normal functioning in between times. In Bipolar Disorder, however, the individual will cycle between depression and periods of hypomania or full manic problems (euphoria, high energy, lots of activity).

Approximately 1% of Canadian men and 2% of Canadian women are clinically depressed at any point in time and about 5% of men and 10% of women will experience clinical depression at some point in their life. Women are at about twice the risk of men to experience clinical depression. These rates of depression are fairly consistent in various countries around the world.

Depression is often a recurring condition, as a person who has had one episode of clinical depression is at high risk for repeated experiences, and this risk of recurrence increases with each subsequent episode. Prevention, early assessment and intervention are thus recognized as critical aspects of health care.

Although the causes of clinical depression are complex and vary from individual to individual,  a variety of factors increase the risk of a person experiencing clinical depression. Women may face an increased time of risk after childbirth.  Other risk factors include having a parent who has been clinically depressed, physical illness or ongoing disability, the death or separation of parents, major negative life events (in particular, events related to interpersonal loss or failure), pervasive negative thinking, physical or emotional deprivation, and previous episodes of depression. The most common framework is called the Biopsychosocial model, which incorporates biological, psychological and social categories of risk.

It is also increasingly recognized that some factors can increase resilience or reduce the risk of depression, such as regular activity, sound sleep, positive social relationships.  Models of clinical depression now often include both risk and resilience factors.

Some individuals experience depression in a regular seasonal pattern. Finally, some medical conditions and the effects of some medications can either look like, or induce, a depressive episode.

What psychological approaches are used to treat depression?

Given the large number of people who experience depression and its profound negative effects, psychologists have devoted considerable effort to study depression and develop effective treatments. These efforts have resulted in a number of treatments with evidence to support them. Many of these treatments emphasize one or more of the recognized risk factors discussed above.

Cognitive therapy is the most well-studied psychological treatment for depression and has the most consistent evidence to support its use.

Cognitive therapy involves the recognition of negative thinking patterns in depression and correcting these patterns though various “cognitive restructuring” exercises. Cognitive therapy also uses behaviour change strategies, and is also sometimes referred to as “cognitive- behavioral therapy”.

Cognitive therapy has been shown to successfully treat approximately 67% of individuals with clinical depression. The evidence suggests that cognitive therapy reduces the risk of having a subsequent episode of depression.

Behaviour therapy helps patients increase pleasant activities and overcome avoidance and withdrawal through efforts to become more engaged in the world.

Behaviour therapy also teaches strategies to cope with personal problems and new behaviour patterns and activities. Behaviour therapy is offered in individual or group therapy and has comparable success to cognitive therapy.

Interpersonal therapy is another treatment for depression, based on the idea that interpersonal stresses and dysfunctional relationship patterns are the major problems experienced in depression.

Interpersonal therapy teaches the individual to become aware of interpersonal patterns and to improve these patterns through a series of interventions. Interpersonal therapy has a success rate that is comparable to behaviour therapy and cognitive therapy.

Other psychological treatments exist in addition to the above treatments, and have promise in treating depression. These treatments have some evidence to support their use although they are not as well-established as the first three treatments.

Short-term psychodynamic therapy is a treatment which focuses on the identification of core conflictual themes in the way a person thinks about themselves or their interpersonal relations, some of which may be unconscious.

This treatment approach uses the therapeutic relationship as a model for other relationships and uses corrective experiences in therapy to lead to other changes in the depressed person’s life. Evidence suggests that the efficacy of this therapy approach is comparable to other established treatments for depression, although less research exists to make firm conclusions.

Reminiscence therapy is a treatment that has been developed for older adults with depression. It involves teaching people to remember times when the individual was younger and functioned at a higher level than as a depressed older adult.

Self-control therapy and Problem-solving therapy are treatments which combine some elements of cognitive and behaviour therapy for depression and teach better self-control and problem-solving behaviours in problem situations.

Scheduled exercise can also be used to treat depression.  Consistent evidence reveals that a regular routine (about 3 or more times a week, at about 30 minutes each time) of at least moderate aerobic exercise is associated with reductions in depression.

Biological treatments also exist for the treatment of clinical depression. These treatments are not offered by psychologists, but are typically provided by a family physician, psychiatrist or nurse practitioner. These treatments include drug therapies, electroconvulsive therapy and light therapy (the latter for people who suffer Winter-time Seasonal Depression, also called Seasonal Affective Disorder; SAD).

Psychological treatments are effective and safe alternatives to drug therapy for depression when provided by a qualified professional psychologist.

The established psychological treatments for clinical depression are roughly as successful as pharmacotherapy for depression.  In fact, psychological treatments often have significantly lower drop-out rates than pharmacotherapy (approximately 10% in psychological therapies versus 25-30% in drug therapy) which may be related to the fact that drug therapies for depression often have unpleasant side-effects.  There is also evidence that cognitive therapy in particular reduces the risk of relapse relative to those individuals who are treated with drug therapy.

Although the evidence is somewhat inconsistent at present, it does not appear that combining drug and psychological treatments significantly enhances the success of either of these treatments alone. However, some of the drug therapies may be effectively combined with psychological treatments which provide for longer term change. Further research on the costs and benefits of combined treatments is needed.

It is also worth noting that psychological treatments that focus on relapse prevention have been developed and tested. One model in particular, called Mindfulness Based Cognitive Therapy, has demonstrated the ability to reduce the risk of relapse, relative to treatment as usual or medications alone, especially for individuals who experience recurrent depression.

In summary, depression is a disabling and potentially chronic disorder. There are a number of successful treatments, which include psychological and biological treatments. Unfortunately, there is no clear way to know in advance to which treatment any one person with depression will respond.

It is important to identify and treat depression as soon as possible, to prevent its development into a chronic problem. Further, long-term and more severe depression is associated with increased risk of suicide, so timely intervention from a qualified and professional health care provider is recommended.

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. Registered psychologists are regulated health professionals across Canada, and are required to meet educational, ethical and legal standards.  You can find a list of colleges and regulatory organizations at https://acpro-aocrp.ca.  Provincial and territorial associations of psychology also often maintain referral services; for this information go to https://cpa.ca/public/whatisapsychologist/ptassociations/. The Canadian Register of Health Service Providers in Psychology also has a list of providers and can be reached at http://www.crhspp.ca.

Other organizations in Canada also provide information abut depression.  Two notable sources include: Health Canada, at https://www.canada.ca/en/public-health/services/chronic-diseases/mental-illness/what-depression.html and The Canadian Network for Mood and Anxiety Treatments, at https://www.canmat.org/

This fact sheet was prepared for the Canadian Psychological Association by Dr. Keith Dobson, Department of Psychology, University of Calgary.

Revised: January 2021

Your opinion matters! Please contact us with any questions or comments about this or 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: Perinatal Anxiety

(Anxiety during pregnancy and baby’s first year)

What is perinatal anxiety?

Having a baby is typically a wonderful time in our lives. It is also a time of great change and uncertainty.  No wonder nearly all of us have an increase in worry and anxiety. Anxiety is a natural response we experience when we feel unsafe or threatened. We do not have to be in danger to experience anxiety. Even the idea of harm coming to ourselves or our loved ones —especially our baby— can make us feel anxious. During pregnancy, we may worry about the baby’s health and childbirth.  After birth, we may worry about the baby’s eating, sleeping, and safety.  Sometimes we don’t have specific worries.  Instead, we have a vague feeling of dread that something bad will happen. We may start avoiding situations, tasks, or even our own baby. We can also become extra careful and do more than is necessary (e.g., spend lots of time searching for information related to our worries). Although everyone experiences anxiety differently, changes in how we think, feel, and act are common.

Anxiety can affect our:

  • thoughts(e.g., worrying too much, imagining the worst, trouble concentrating and focusing)
  • actions or behaviours(e.g., avoiding, excessive planning, checking over and over again)
  • feelings (e.g., scared, on edge, irritable, numb, frozen)
  • bodies(e.g., upset stomach, racing heart, tense muscles, jumpy, not hungry, sleep trouble)

When is anxiety a problem?

Although anxiety can seem very scary, it is normal. It can even be helpful. Anxiety can help our body become stronger to deal with danger.  However, sometimes we have a lot of false alarms (we react as if there is danger when there is no real danger). When anxiety becomes upsetting and affects how we live our lives, it can become a problem or disorder. Approximately 20 percent of pregnant and new moms experience anxiety and related disorders. But perinatal anxiety does not only affect moms. Expecting and new parents of all genders, ages, and backgrounds can experience perinatal anxiety.

It is time to seek help when we…

  • feel anxious, on edge, or worried a lot, most days
  • notice anxiety is really upsetting us or getting in the way of daily life such as
    •  avoiding places, activities, people or situations that may bring anxiety
    •  doing too much of certain things (e.g., asking for a lot of reassurance)
    •  trouble carrying out routine activities
    •  difficulty enjoying the pregnancy or new baby
    •  more tension in close relationships

What helps people with perinatal anxiety get better?

People with perinatal anxiety may benefit from the following options (alone or in combination):

  • psychological therapy
  • pharmacological treatment
  • psychosocial support

The best ways to get better will depend on the severity of the symptoms of perinatal anxiety and personal preference. Decisions are best made with the support of a trained health professional.

What psychological approaches are proven to treat perinatal anxiety?

The primary psychological treatment that helps people with perinatal anxiety is Cognitive Behaviour Therapy (CBT). CBT involves learning new ways of thinking and behaving that can help reduce anxiety.

Scientific research shows that many people who receive CBT will experience improvements in anxiety.  CBT works for many anxiety problems including excessive worry, obsessions, panic, and post-traumatic stress. CBT can also help us feel more confident about our ability to cope with anxiety related to becoming a parent and caring for our baby.

What can psychologists do to help people with perinatal anxiety?

Psychologists help people take an active role in positive change. They can help us feel better and reduce how much anxiety is getting in the way of living our lives to the fullest.

A psychologist can help us to learn and practice skills to manage anxiety. Some examples are:

  • PSYCHOEDUCATION: Learning about anxiety is an important first step. It is often very comforting to know that we are not alone and it is not our fault.
  • SELF-CARE: If we are going to have the energy to take care of a new life, we need to take care of ourselves. This includes eating well, exercising, getting as much rest as we can, and taking time for ourselves (even if it is only a few minutes).
  • FLEXIBLE THINKING: When we are anxious, our thinking is sometimes unhelpful. The first step is to learn to recognize these unhelpful thoughts.  Next, we develop more helpful ways of looking at our situation and ourselves. This will often include learning to be kinder to ourselves.
  • FACING FEARS: Anxiety tends to change our behaviour in unhelpful ways (e.g., avoiding situations that trigger our anxiety). This makes us feel better in the short term but increases anxiety over time. Facing fears helps us learn that the things we fear are not as dangerous as we think.
  • RELAXATION & MINDFULNESS:. Learning skills such as calm breathing, muscle relaxation or mindfulness can help us reduce or better manage the bodily symptoms that are part of anxiety. Mindfulness techniques can also help us look at our thoughts differently. Mindfulness can help us notice and get untangled from our anxious thoughts so our thoughts have less power over us.

What is postpartum OCD?

Obsessive Compulsive Disorder (OCD) is an anxiety-related mental health problem. People with OCD experience thoughts that they don’t want to have and engage in behaviours they feel compelled to do.

The unwanted thoughts in postpartum OCD are often about harm to one’s baby. These thoughts can be frightening to ourselves and others. However, OCD thoughts are not associated with an increased risk of violence or harm to the baby. CBT can help improve the lives of mothers experiencing postpartum OCD.

Becoming a parent is a big change in our lives. Experiencing anxiety is often part of it. Fortunately, we can learn psychological strategies to help us manage our anxiety.

Psychology Works for Perinatal Anxiety!

Where can I go for more information?

You can consult with a registered psychologist to find out if psychological interventions may be helpful 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/.

A CBT expert can help us learn new skills to use in our daily life leading up to the birth and after the baby arrives. For the names of certified CBT Therapists in Canada, go to: https://cacbt.ca.

If you can’t find a trained CBT therapist in your community, you can use CBT self-management guides to help you learn these skills.  You can find free resources on anxiety for expecting and new parents at:

This fact sheet has been prepared for the Canadian Psychological Association, in cooperation with AnxietyBC, by Registered Psychologists Drs. Melanie Badali12, Martha Capreol3, Nichole Fairbrother4, Michelle Haring2, Sarah Newth2, and Adrienne Wang3.
1AnxietyBC, 2North Shore Stress and Anxiety Clinic. 3Changeways Clinic, 4University of British Columbia.

Date: March 23, 2018

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

Canadian Psychological Association
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: Cannabis Use

Cannabis is the most commonly used illegal drug in Canada (Canadian Centre of Substance Use and Addiction). In April 2017, the Government of Canada took steps to legalize cannabis for recreational purposes. It is currently legally available for medical purposes.

How does Cannabis affect young people?

Research suggests that regular or heavy use of cannabis in adolescence (ages 10-20 according to the World Health Organization) is related to difficulty in school, lower income, suicidality, greater welfare dependence and unemployment, as well as lower life satisfaction.

Our brains continue to develop up to the age of 24 years. Cannabis can change the way the brain develops, and medical imaging tests have shown differences between brains of cannabis users and non-cannabis users. Specifically, verbal learning, memory, and attention are negatively affected by acute and chronic use of cannabis. This effect can last even after someone stops using cannabis.

How does Cannabis affect mental health?

Cannabis use is related to mental health and mental illness. For example, research suggests that cannabis use is associated with psychosis, especially for those who use at an earlier age, who frequently use high potency cannabis, and who have a genetic predisposition for psychosis. There is also some research suggesting that cannabis use is associated with depression, bipolar disorder, and anxiety, though causality has not yet been clearly established for all such outcomes.

How does Cannabis affect judgement and decision making?

Executive functioning, which is our ability to plan, prioritize, and problem solve, is negatively affected by heavy or chronic cannabis use. This can lead to poor decision-making, planning, and organizing. Acute cannabis use is associated with an increased risk of motor vehicle collisions, especially fatal collisions.

What are the prevention and treatment options for dependence and abuse of Cannabis?

Research suggests that structured, school-based programs focused on making wise decisions about cannabis use, healthy coping, and substance use resistance skills offered in early adolescence can have strong effects on reducing cannabis use. Motivational Enhancement Therapy (MET) helps individuals resolve their ambivalence to get treatment and stop their drug use, and it has shown positive effects on reducing cannabis use in youth. Cognitive-behavioural therapy, motivational interviewing, and multi-dimensional family therapy are also shown to be helpful.

Where can I get more information?

Recommendations for the Legalization of Cannabis in Canada – provides further information regarding the research and recommendations for the legalization of cannabis in Canada: http://cpa.ca/docs/File/Position/Position_Paper_Recommendations_for_the_Legalization_of_Cannabis_in_Canada-September_2017.pdf

The Centre for Addiction and Mental Health – provides information about use and abuse of cannabis: http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/marijuana/Pages/about_marijuana.aspx

Government of Canada – general information about cannabis: https://www.canada.ca/en/health-canada/services/substance-abuse/controlled-illegal-drugs/about-marijuana.html

Here to Help – Cannabis Use and Youth: A parents’ guide: http://www.heretohelp.bc.ca/workbook/cannabis-use-and-youth-a-parents-guide

This fact sheet has been prepared for the Canadian Psychological Association (CPA) with information from the Recommendations for the Legalization Cannabis in Canada, a position paper prepared for the CPA by its Task Force on the Legalization of Cannabis.

Date: January 9, 2018

Your opinion matters! Please contact us with questions or comments about any of the Psychology Works Fact Sheets by sending an email to:  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: Pain in Children with Intellectual Disabilities who are Nonverbal

What is an intellectual disability?

According to the American Association on Intellectual and Developmental Disabilities, an intellectual disability:

  1. begins before age 18
  2. presents itself within different settings (e.g., at school, at home) through observable limitations in both
    • adaptive behaviour (e.g., personal hygiene, social skills), and
    • level of intellectual functioning (i.e., a child’s thinking ability).

These limitations cannot be explained by differences in one’s culture. Children may have these limitations but also have strengths in other areas. Children with intellectual disabilities are usually able to learn and improve in specific areas of functioning when their challenges are well-identified, and personalized supports are put into place.

There are a number of conditions and developmental periods in which a child is at risk for developing intellectual disabilities. First, chromosomal and genetic errors can lead to a number of syndromes associated with intellectual disabilities (e.g., Down Syndrome). Intellectual disabilities can also be caused by other factors during the pre, peri, and postnatal period (e.g., extremely low birth weight, infection, physical trauma). The degree of impairment can be determined, and classified into different categories:

  • Mild Intellectual Disability:
    • these children may experience difficulties in school, and can generally live independently
  • Moderate Intellectual Disability:
    • these children often remain at or below the level of a grade three student, and may be consistently dependent on others in some areas
  • Severe/Profound Intellectual Disability:
    • these children usually require support for the majority of daily activities, and many of these children do not have fully developed language skills.

What does it mean to be nonverbal?

In relation to this information sheet, nonverbal refers to children who have been diagnosed with an intellectual disability and do not communicate using spoken language. In other words, these children do not communicate with others using words or with a universally recognized form of sign language (e.g., American Sign Language). Children may occasionally be considered as nonverbal if they have a few words, but do not use them consistently or meaningfully.

What is pain?

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”. Pain experience (how a person perceives what they are feeling) is different from pain expression (how a person shows that they are in pain). Pain is subjective: both pain experience and pain expression vary from person to person.

As individuals may experience pain differently, self-report is a very common method of pain measurement. However, many children who have intellectual disabilities and are nonverbal may not be capable of providing accurate self-reports about their pain. For this reason, caregivers are often asked to estimate the severity of pain a child is experiencing through observing their behaviour/pain expression. In this way, social factors may also come into play and be particularly important in a context where caregivers are relied on more heavily.

How does having an intellectual disability and being nonverbal impact pain experience and expression?

In the past, it was thought that children with intellectual disabilities did not experience pain in the same way that those without intellectual disabilities do. The belief that children with intellectual disabilities do not feel pain, are less sensitive to pain or are indifferent to pain still exists among some individuals. These beliefs are contrary to the findings of more recent research studies. The reason some individuals with intellectual disabilities, particularly those who are nonverbal, may appear to be insensitive to pain could be because they may express pain differently than other children. There are many potential explanations for this difference in expression, one being due to difficulty communicating effectively.

In what ways do children with intellectual disabilities communicate their pain to others?

As noted above, caregivers are often asked to report on these children’s pain. In some instances, caregivers may be able to see the source of pain (e.g., an open wound), however, in other cases, this may not be possible. Lack of a visible source of pain should not be interpreted as an absence of pain. Despite this, assessing the presence and severity of pain may be difficult for caregivers because children who have intellectual disabilities and are nonverbal do not always express pain very clearly. In some cases, even those caregivers who know the children very well still have difficulty assessing pain severity and location. Research suggests that parents are capable of identifying common behaviours expressed by their children who have intellectual disabilities and are nonverbal when they are in pain (see section below).

Studies seeking to create a list of common ways to express pain in this population have identified some general behaviours that may indicate a child is in pain. For example, the Non-Communicating Children’s Pain Checklist[1] [2] is a scale that has been used successfully by a variety of caregivers (e.g., health care providers, teachers, parents). A list of the behaviours on the NCCPC appears below. It is important to note that each individual may express pain differently and their baseline behaviour should be taken into consideration. Likewise, some of these behaviours may not always communicate pain; they may also express distress or frustration. Further, a child will not necessarily express all of these signals at once while in pain.

  • Vocal Behaviour: moaning/whining/whimpering (fairly soft), screaming (very loud), crying (moderately loud)
  • Social Behaviour: not cooperative/cranky/irritable/unhappy; less interaction with others/withdrawn, seeks comfort or physical closeness; difficult to distract/unable to satisfy
  • Facial Expression: furrowed brow; changes in eyes; not smiling; lips pucker up/tighten/pout/quiver; clenches or grinds teeth/thrusts tongue out
  • Activity: not moving/less active/quiet; jumping around/agitated/fidgety
  • Body and Limbs: stiff/spastic/tense/rigid; gesturing or touching part of body that hurts; protects/favours/guards what is hurting; sensitive to touch
  • Physical Signs: sweating; change in colour; tears; gasping

How can we ensure accurate pain assessment and management for children with intellectual disabilities who are nonverbal?

Effective pain assessment is critical for effective pain management.  These processes are challenging, due to many factors including differences in pain expression and cognitive limitations. Research has demonstrated that primary and secondary caregivers have varying pain-related beliefs, some of which may not be accurate. These beliefs may also influence care decisions. First, training programs may be an effective way to improve pain-related knowledge of those who care for children with intellectual disabilities. Second, further development and implementation of effective pain assessment tools for these caregivers could help to improve pain management in this population. Some medical settings have adopted the use of ‘tool kits’ for managing pain in children with disabilities, such as Holland Bloorview’s Chronic Pain Assessment Toolbox[3] for children with disabilities. Finally, ensuring that child-specific pain information is shared between a child’s various caregivers across settings is likely important. The Caregiver Pain Information Guide[4] is one example of a resource under development which aims to serve this purpose.

Where can I get more information?

To Access the Non-Communicating Children’s Pain Checklist[1],[2]:

To Access the Chronic Pain Toolbox[3]:

To Access the Caregiver Pain Information Guide[4] to be available at:

Additional Online Resources:

OUCH! How Understanding Pain can Lead to Gain when it Comes to Supporting Those with Developmental Disabilities *Not solely directed to children*:  https://www.porticonetwork.ca/documents/38160/99698/sss%2520vol%25206%2520issue%25205%2520-%2520ENGLISH.pdf/bf828358-15c9-48f6-a7d7-70812c0df146

Pain Assessment in the Nonverbal Patient: Position Statement with Clinical Practice Recommendations (MedScape) *Not solely directed to children with intellectual disabilities*: http://www.medscape.com/viewarticle/533939

Understanding Pain in Patients with Intellectual Disabilities (MedScape)*Not solely directed to children*:  http://www.medscape.com/viewarticle/752725

Cited References:

Breau, L.M., Camfield, C.S., McGrath, P.J., & Finley, G.A. (2003). The incidence of pain in children with severe cognitive impairments. Archives of Pediatric and Adolescent Medicine, 157, 1219-1226.Breau, L.M., Camfield, C., McGrath, P.J., Rosmus, C., & Finley, G.A. (2001). Measuring pain accurately in children with cognitive impairments: Refinement of a caregiver scale. Journal of Pediatrics, 138(5), 721-727.

Breau, L. M., Finley, G. A., McGrath, P. J., & Camfield, C. S. (2002). Validation of the non-communicating children’s pain checklist–postoperative version. Anesthesiology, 96(3), 528-535.

Breau, L.M., Lotan, M., & Koh, J.L. (2011). Pain in individuals with intellectual and developmental disabilities. In: Patel, D.R., Greydanus, D.E., Omar, H.A., & Merrick, J. (Eds.), Neurodevelopmental Disabilities: Clinical Care for Children and Young Adults (255 – 276). New York: Springer.

Drew, C.J. & Hardman, M.L. (2007). Intellectual disabilities across the lifespan. USA: Pearson Education Inc.

Genik, L. M., McMurtry, C. M., & Breau, L. M. (2017). Caring for children with intellectual disabilities part 1: Experience with the population, pain-related beliefs, and care decisions. Research in Developmental Disabilities, 62, 197-208.

Genik, L. M., McMurtry, M., Breau, L., & Lewis, S. P. (2018). Improving pain assessment and management knowledge of children’s respite workers: Development and preliminary effectiveness of the “Let’s Talk About Pain” training program. Journal on Developmental Disabilities, 23(2), 115-115.

Genik, L.M., Millett, G.E., & McMurtry, C.M. (under review). Facilitating respite: Preliminary evaluation of the Caregiver Pain Information Guide for children with disabilities.

Herr, K., Coyne, P.J., McCaffery, M., Manworren, R., & Merkel, S. (2011). Pain assessment in the patient unable to self-report: Position statement with clinical practice recommendations. Pain Management Nursing, 12(4), 230-250.

Hunt, K. A., & Franck, L. S. (2011). Special needs require special attention: A pilot project implementing the paediatric pain profile for children with profound neurological impairment in an in-patient setting following surgery. Journal of Child Health Care, 15(3), 210-220.

McGrath, P.J., Rosmus, C., Camfield, C., Campbell, M.A., & Hennigar, A. (1998). Behaviours caregivers use to determine pain in non-verbal, cognitively impaired individuals. Developmental Medicine & Child Neurology, 40(5), 340-343.

Oberlander, T.F. & Symons, F.J. (Eds.). (2006). Pain in children and adults with developmental disabilities. United States of America: Paul H. Brookes Publishing.

Orava, T., Provvidenza, C., Townley, A., & Kingsnorth, S. (2018). Screening and assessment of chronic pain among children with cerebral palsy: a process evaluation of a pain toolbox. Disability and rehabilitation, 1-9.

Symons, F.J., Shinde, S.K., & Gilles, E. (2008). Perspectives on pain and intellectual disability. Journal of Intellectual Disability Research, 52(4), 275 – 286.

Zabalia, M., Breau, L. M., Wood, C., Lévêque, C., Hennequin, M., Villeneuve, E., … & Breau, G. (2011). Validation of the French version of the non-communicating children’s pain checklist-postoperative version. Canadian Journal of Anaesthesia, 58(11), 1016-1023.

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 by Lara M. Genik (University of Guelph), Dr. C. Meghan McMurtry (University of Guelph) and Dr. Lynn Breau (Glenrose Rehabilitation Hospital). The current version was updated by Lara M. Genik (University of Guelph and Dr. C. Meghan McMurtry (University of Guelph).

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


[1] Breau, L. M., Finley, G. A., McGrath, P. J., & Camfield, C. S. (2002). Validation of the non-communicating children’s pain checklist–postoperative version. Anesthesiology, 96(3), 528-535.[2] Zabalia, M., Breau, L. M., Wood, C., Lévêque, C., Hennequin, M., Villeneuve, E., … & Breau, G. (2011). Validation of the French version of the non-communicating children’s pain checklist-postoperative version. Canadian Journal of Anaesthesia, 58(11), 1016-1023.

[3] Orava, T., Provvidenza, C., Townley, A., & Kingsnorth, S. (2018). Screening and assessment of chronic pain among children with cerebral palsy: a process evaluation of a pain toolbox. Disability and rehabilitation, 1-9.

[4] Genik, L.M., Millett, G.E., & McMurtry, C.M. (under review). Facilitating respite: Preliminary evaluation of the Caregiver Pain Information Guide for children with disabilities.

“Psychology Works” Fact Sheet: Behavioral and Psychological Symptoms of Neurocognitive Disorders in Seniors

What are Neurocognitive Disorders (NCD)?

Neurocognitive Disorders are characterised by a cognitive decline which affect one or more cognitive domains such as memory and learning, executive functions, perceptivomotor activities, attention, language and social cognition. The decline must be significant in comparison with the person’s prior functioning, can be reported by the person or a family member, and objectified by a clinical assessment (e.g. neuropsychological evaluation). When cognitive decline does not affect the functional autonomy, about it is considered as a mild cognitive disorder. However, when deficits have more impact on functional autonomy, a diagnosis of major cognitive disorder can be made Neurocognitive disorders have many etiologies such as Alzheimer disease, Vascular disease, Lewy Body disease, Frontotemporal Disorders, etc.

What are the behavioural and psychological symptoms of dementia (BPSD)?

People who suffer from a neurocognitive disorder, such as Alzheimer’s disease, can have a number of difficulties related to:

  • thinking (e.g., paranoid beliefs, delusions, , hallucinations);
  • mood (e.g., anxiety, depression, apathy); and
  • behaviour (e.g., aggressiveness, yelling, wandering, manipulating objects and inappropriate sexual conduct).

80 to 97% of older people with Alzheimer disorders may present BPSD during their disease (Gauthier S, Cummings J, Ballard C, Brodaty H, Grossberg G, Robert P, et al. Management of behavioral problems in Alzheimer’s disease. Int Psychogeriatr. 2010;22(3):346-72.)

What causes BPSD?

BPSD can be caused by a number of factors. These include:

  • brain changes associated with the neurocognitive disorder;
  • environmental factors such as , excessive demands, sensory overstimulation (e.g. too much noise or agitation in the environment), the absence of visual cues to help the person remain oriented (e.g., the green tagged door is the kitchen, the door with the picture of trees is the person’s bedroom), too few activities or pastimes;
  • social factors such as challenging interpersonal or social relationships or situations (e.g., non adaptative communication);
  • individual factors related to the person’s physical or emotional state such as pain, fatigue, stress, fear, boredom, or other unmet basic needs.

What are the effects of BPSD?

The distressing nature of BPSD can affect the quality of life of the person. He/she can feel left aside, can be frustrated or angry, feel lonely or hurt. The presence of BPSD also increases the risk of physical and chemical contention. But BPSD also affect relationships with family and caregivers, as well as treatment. Family caregivers may see a decrease of their quality of life and feel more psychological distress as anxiety and depression symptoms, culpability, hopelessness as well as difficulties to cope with BPSD. This context may precipitate the decision by the family to place the patient in residential care. The staff of residential care center can also find it difficult to care for a person with BPSD (e.g. resistance and physical agitation can make hygiene care more challenging).  They may report stress, anxiety, fear, helplessness, distress, burnout and they are more at risk of work-related accident.

What can psychologists do to help people with BPSD?

Studies have shown that psychological approaches are effective for reducing disruptive BPSD in individuals with neurocognitive disorder.

It is generally recommended that BPSD be treated first with nonpharmacological approaches, which are effective for many psychological and behavioral symptoms in individuals with neurocognitive disorders. However, when the situation is urgent or severe (i.e., there is a risk for the safety of the person or to others), pharmacological intervention might be added to non pharmacological approaches. Although some medications may help in treating BPSD, the risks and side-effects of the medication need to be carefully considered against their usefulness.

The implication of the psychologist in BPSD management is important. The psychologist’s mandate is quite diverse, and he/she can play an important part both with the person with BPSD and with the caregivers (family and staff members).

ASSESSMENT

The psychologist does a thorough assessment of symptoms – what they are and what makes them better or worse. Some psychosocial models have been developed for BPSD. One of the most popular is the Cohen Mansfield unmeet needs models (Cohen-Mansfield, 2000) who address BPSD as the result of unmeet needs. Another interesting model is the Newcastle Model developed by James (2011).  This model integrated elements of the experience of the person with neurocognitive disorder, the Cohen-Mansfield need model and cognitive behavioural model. With this model, clinicians work with caregivers to develop a hypothesis about the BPSD and take into account many contextual factors as personality traits, mental health, life story, social environment, etc. Second, the psychologist uses the findings from the assessment to develop a plan for intervention in collaboration with the caregiver and, in specific case, with the nursing team.

PSYCHOLOGICAL INTERVENTION

Psychological intervention as psychotherapy with patient with mild cognitive disorder may help decrease anxiety and depression symptoms (e.g. adaptation of CBT). The psychologist can also be involved to provide psychological support to the person and/or the family after a diagnosis of major neurocognitive disorder (e.g. understanding the illness, acceptance), or during life transitions associated with the illness (e.g. placement in a long-term care facility). Throughout the illness, psychological interventions can help reduce the person’s distress (e.g. reminiscence therapy, validation techniques).

BEHAVIOURAL INTERVENTION

Behavioural interventions can help by structuring routines and the environment in order to eliminate the factors that trigger or maintain symptoms.

For example, some patients manifest aggressive behaviour during personal hygiene activities, such as bathing. In this situation, the discomfort associated with bathing may be the trigger and avoiding the activity is the reinforcer. Rather than reducing the time devoted to bathing, it may be more useful to divert the patient’s attention away from the activity using conversation, music, etc. At the same time, it is necessary to reinforce appropriate behaviour that occurs during bathing. Similarly, lack of activity during the day may contribute to apathy and depressive symptoms. Scheduling pleasant activities may be a useful approach in this case.

Structuring activities in such a way to reduce stress is another approach. For example, a patient may present symptoms that are worse at a period of the day when he is very much involved in an activity. For this individual, it may be useful to provide rest and relaxation rather than activation during this specific time of day.

For another patient, symptoms may be worse during a period of the day when he is by himself and not doing anything. If the assessment reveals that symptoms are not usually present when the patient is engaged in activity, this might be the time to schedule visitors or arts and crafts.

Interventions such as sensory stimulation can also be of help. These include giving the patient fabric or a foam ball to handle, pictures in a book or magazine to look at, music to listen to, scents to smell, etc. Sometimes, if a particular person cannot be present to provide social interaction, listening to him or her on tape or watching him or her on video can be a good alternative.

It is not always necessary to stop patients from wandering. Organizing the environment to allow the patient to be physically active can be very helpful. For example, create specific areas in the residence where the patient can move about safely. Concealing outside doors and emergency exits can deter patients from exiting unsafely.

CAREGIVERS and NURSING TEAMS

Psychologists can have an important role to address distress and resistance of caregivers and nursing teams who work with people with BPSD. As a member (or partner) of the treating team, they can help identify the team’s difficulties, provide a space to vent their frustrations or express their concerns (debriefing), and help maintain motivation and bell-being within the team. They can also help the team in reaching a better understanding of the illness and the BPSD and help implement nonpharmacological interventions through formal teaching or coaching, in order to increase the team’s ability to manage BPSD.

At last, the psychologist can work with the family members in individual or group setting. The intervention could focus on increasing the caregiver’s knowledge of neurocognitive disorders and BPSD or coaching the caregiver on BPSD management techniques. The psychologist also plays a key role in assessing and addressing caregivers’ burnout and psychological distress. Psychotherapy can be necessary to address issues such as guilt and acceptance.

Where do I go for more information?

For more information visit the Alzheimer Society of Canada at http://www.alzheimer.ca.

http://capsulesscpd.ca/ (in French)

https://www.baycrest.org/Baycrest/Education-Training/Educational-Resources/Responsive-Behaviours

https://www.msss.gouv.qc.ca/professionnels/maladies-chroniques/alzheimer-et-autres-troubles-neurocognitifs-majeurs/processus-cliniques-et-outils/ (in French)

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


This fact sheet has been prepared for the Canadian Psychological Association by Dr. Philippe Landreville, Université Laval.

Revised: September 2020 by Caroline Ménard and Laurence Villeneuve, psychologists at the Institut Universitaire de Gériatrie de Montréal (IUGM)

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: Sexual Health After a Heart Attack

Sexual activity is an important part of quality of life and is often a great concern for both patients and their partners after a cardiac event. Fears and concerns may temporarily interfere with sexual spontaneity and response.

A few factors may interfere with your sexual health after your discharge from the hospital. You might temporarily suffer from mild depression, which will affect your sexual desire. Some medications may also impact sexual function. You might fear that sexual activity will cause another heart attack or your spouse might silently think the same. For the majority of patients, this will last a short period of time and life will pick up where it left off before you had a cardiac event.

There are also some unique difficulties that men and women may face. For example, erectile dysfunction (ED) is often associated with heart disease in men. The same factors that contributed to blocking the arteries of your heart can block arteries elsewhere in your body. Some medications may also contribute to ED. A healthy lifestyle that incorporates a heart healthy diet, exercise and reaching a healthy weight has been shown to correct ED in 30% of obese patients.

Women may face difficulties with several aspects of the sexual response cycle, including desire, arousal, and orgasm. Women may avoid intercourse due to pain caused by decreased blood flow or friction resulting from not enough lubrication. Over-the-counter lubricants can often address this concern and prevent further problems in the sexual and interpersonal relationship from developing.

Many of the sexual difficulties that people face after a heart attack, however, stem from just not knowing enough about whether they can safely have sex again.

When is it safe to engage in sexual activity after a heart attack?

If you have recently had a heart attack, your doctor will likely recommend that you wait one week or more (several months if you experienced complications) before resuming sexual activity. After this healing period, the risk of having a heart attack during sex is actually quite low. The risk is comparable to that of getting angry and is reduced if you exercise regularly and take your medication.

From a cardiac standpoint, sexual intercourse is like any other physical activity; your heart rate and your blood pressure increase. The effort on your heart is about the same regardless of your position. The activity is often compared to walking at three to six kilometers per hour on a level surface, or climbing 20 stairs in 10 seconds. However, each individual may have different physical factors to consider. It is important to always talk to your cardiologist/family physician before resuming sexual activity.

How can psychological strategies help to maintain my sex life after a heart attack?

  • Start slowly and have realistic expectations. The first few weeks after a heart attack can be very stressful on your partner and yourself. Both of you might still be tired. Plan sexual activity for the time of day when you have the most energy and are least bothered by other health issues. You might also want to avoid having sex after a large meal. Give yourself a few hours to digest. Similarly, limit the amount of alcohol you drink and avoid using tobacco as both of these may affect sexual function. If you have chest pain or shortness of breath, speak to your doctor.
  • Physical affection without sex is just as important. Explore your senses: hold hands, hug, and touch your partner. Create a bit of romance with music, candles, and special scents. You can also maintain emotional closeness by doing things like having regular date nights.
  • For anyone,communication is key to an enjoyable sex life, and this is especially true after a heart attack. Agree to have honest discussions. Tell each other what you like and don’t like. If you are experiencing some communication difficulties in your relationship, meeting with a psychologist can help to improve communication skills.
  • There aremany factors that can affect desire, including fatigue, fear/anxiety, depression, pain/physical discomfort, and drug-related sexual side effects. If you are experiencing any of these additional issues, it can be helpful to meet with a psychologist to specifically address these difficulties.

Where can I get more information?

Thriving with Heart Disease: A Unique Program for You and Your Family. Live Happier, Healthier, Longer – by Sotile & Cantor-Cooke (includes a chapter specifically on sexual functioning)

Heart and Stroke Foundation of Canada:  www.heartandstroke.com

Canadian Association of Cardiovascular Prevention and Rehabilitation:  www.cacpr.ca

Sex Information and Education Council of Canada (SIECCAN):  www.sieccan.org

The Society of Obstetricians & Gynaecologists of Canada:  www.sexualityandu.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, please visit: https://cpa.ca/public/whatisapsychologist/ptassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Heather Tulloch, University of Ottawa Heart Institute, Dr. Hannah Marchand, Kingston Orthopaedic and Pain Institute, and Dr. Michele de Margerie (physician), University of Ottawa Heart Institute.

Revised: September 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 Risk Factors and Heart Disease

What is heart disease?

Heart disease, also known as cardiovascular disease, is a general term for a variety of conditions that affect the heart and blood vessels. It is a chronic disease that can lead to serious events including heart attack and death. Heart disease is one of the leading causes of death in Canada and worldwide.

What are the risk factors for heart disease?

There are many risk factors for heart disease. There are “uncontrollable risk factors” including age, sex, heredity, and ethnicity. There are also “modifiable risk factors” that can be controlled or impacted by changes that you make in your lifestyle. These risk factors include smoking, excessive alcohol intake, excess body weight, high blood pressure, abnormal blood cholesterol levels, sedentary behaviour or limited exercise, diabetes, and excessive stress, anxiety, and depression.

Stress and anxiety and heart disease

Everyone experiences stress at some point in life. In these situations, your body reacts by releasing stress hormones, which in turn increases sweating, breathing, heart rate and blood pressure, as your body revs up into high gear to deal with the perceived stress. In the short term, these reactions may be helpful. However, in the long-term stress can be damaging. When individuals experience constant stress over a long period of time, fat cells may be converted into cholesterol, platelets can become more “sticky,” and patterns of daily life may change (decreased amount of healthy eating, regular exercise, and rest).

It is common for cardiac patients to experience varying degrees of fear or nervousness related to their health condition. About one in five (20%) cardiac patients experience significant anxiety symptoms that interfere with daily functioning including: uncontrollable worry, restlessness, irritability, muscle tension, headaches, sleep disturbances, increased fatigue, sweating, and/or gastrointestinal/stomach problems.

Depression and heart disease

Depression is also common in people with heart problems. Similar to anxiety, about one in five patients experience clinical (or major) depression that significantly interferes with daily functioning. Symptoms include feelings of sadness, loss of interest in pleasurable activities, changes in weight and/or appetite, sleep disturbances, decreased energy, difficulties with concentration/memory, feelings of worthlessness, helplessness, or hopelessness, and/or thoughts about suicide/death. Depression can contribute to both the onset of heart disease, and to poorer outcomes following a diagnosis of heart disease.

How can psychological treatments help to manage heart disease?

Psychologists play an important role in helping people to prevent and manage chronic diseases like heart disease. In addition to general training in the treatment of depression and anxiety, many psychologists are also specifically trained to help people cope with chronic diseases. In fact, some cardiac rehabilitation programs have a psychologist on their team.

Here are some ways that psychological approaches can help to prevent and manage heart disease:

  • Stress and anxiety management – How you perceive stress in your life affects the level of stress or anxiety that you experience. It is important to learn how to recognize and identify your own “stress triggers” and how stress impacts you on a daily basis. To begin managing anxiety, it is important to develop healthy coping strategies including becoming aware of emotions which can trigger anxiety, learning relaxation and deep breathing techniques, distracting yourself from thoughts or physical symptoms, doing something pleasurable, sharing fears and worries with someone you trust, and focusing on what you can control rather than on the things you cannot. Additionally, positive social support networks (e.g., friends and family) and daily physical activity help reduce the effects of stress and anxiety.
  • Depression management – Negative thinking, low activity levels, and difficulty handling strong emotions are often involved in depression. Many people with heart disease may also have unresolved issues of loss, grief, and anger, which may be weighing them down and draining their energy. Getting help to learn new ways of thinking and learning to better manage negative thoughts and strong emotions can be beneficial. Additionally, it is important to set realistic goals and engage in self-care activities such as regular exercise and doing pleasurable activities, even if you do not feel like doing so.
  • Making and maintaining lifestyle changes – Psychologists and psychological strategies can also help people to make and maintain changes in their diet and exercise routines, which are important parts of managing heart disease. Psychologists can assist with issues such as identifying and enhancing your motivation for change, setting realistic and achievable goals, and building on success in making lifestyle changes.

Where can I get more information?

Thriving with Heart Disease: A Unique Program for You and Your Family. Live Happier, Healthier, Longer – by Sotile & Cantor-Cooke

Mind Over Mood: Change How You Feel by Changing the Way You Think – by Greenberger & Padesky

It’s Not All in Your Head: How Worrying about Your Health Could Be Making You Sick – and What You Can Do About It – by Asmundson & Taylor

Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness – by J. Kabat-Zinn

Heart and Stroke Foundation of Canada: http://www.heartandstroke.com

Canadian Association of Cardiovascular Prevention and Rehabilitation: http://www.cacpr.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, please visit: https://cpa.ca/public/whatisapsychologist/ptassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Hannah Marchand, Kingston Orthopaedic and Pain Institute, and Dr. Heather Tulloch, University of Ottawa Heart Institute.

Revised: September 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: Panic Disorder

Imagine yourself relaxing by the pool. Suddenly, for no apparent reason, you feel faint, your chest hurts, you can’t breathe, your legs tremble, you think you’re having a heart attack and you’re dying. You may be having a heart attack or you could be one of several thousand Canadians suffering from panic disorder.

What is panic disorder?

Panic Disorder (PD) is marked by repeated attacks of panic that occur unexpectedly in the absence of any situational threat (i.e., they occur “out of the blue” and without any warning). These attacks begin quickly and build to a peak rapidly (usually in 10 minutes or less). They are often accompanied by a sense of imminent danger or impending death and an urge to escape. Panic attacks are often described as “the most terrifying experience I’ve ever had”. They leave the individual emotionally drained, frightened, feeling vulnerable and anxious about their health.

PD sufferers often live in fear of having another panic attack. Some fear that the attacks indicate the presence of an undiagnosed, life-threatening illness (e.g., cardiac disease). Others fear that the attacks are an indication that they are “going crazy” or losing control. Some individuals significantly change their behaviour (e.g., quit a job) in response to the attacks.

Individuals with PD often develop agoraphobia. The essential feature of PD with agoraphobia is anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a panic attack. Agoraphobic fears typically involve situations such as being alone outside the home or being home alone; being in a crowd or standing in line; being on a bridge or in an elevator; and travelling in a bus, train or car. The situations are avoided or endured with considerable dread, or confronted only when accompanied by a trusted companion.

Untreated, PD may lead to both chronic debilitating anxiety and excessive visits to health care facilities. PD often is compounded by other problems. Depression occurs in 50%-65% of individuals with PD. It is also common for them to develop other anxiety disorders. It is estimated that 36% of people with PD have substance abuse problems (drugs and/or alcohol).

Who gets panic disorder?

PD is found more often in women than men. PD can appear at any age but it begins most often in young adults. The onset of PD is often preceded by a period of considerable stress (e.g., from an overload of work, the loss of a loved one, a move to a new city, a serious accident, a surgery, a divorce) or the anticipation of a stressful life event. It can also start right out of the blue. Studies throughout the world indicate that three out of every 100 individuals will suffer from PD at some point in their lives. It rarely goes away by itself.

What causes panic disorder?

Many individuals attribute PD to a lack of “strength” or “character”. Nothing could be further from the truth. Although no one knows the exact causes of PD, most experts believe that PD is caused by a combination of biological and psychological factors. For example, PD appears to run in families. This suggests that a genetic predisposition toward PD may exist. Another line of research shows that people with PD may have abnormalities in brain activity and biochemistry. Still another line of evidence suggests that there is a strong psychological component to PD. For example, scientists have found that people prone to panic attacks are much less likely to panic when they are told in advance about the sensations that some situations (e.g., hyperventilation) or substances (e.g., caffeine) will cause.

Can panic disorder be treated?

The vast majority of people with PD can be helped with the right professional care. Furthermore, they can almost always be treated without being admitted to a hospital. Recovery may occur in a matter of months but can take longer depending on individual circumstances. People with PD often have more than one disorder, which can complicate treatment. A successful treatment program must address all of an individual’s related problems including any depression or substance abuse that might accompany the underlying PD.

Can psychology help?

The most successful treatment approaches to PD include behavioural and cognitive therapies as well as medication. Results from numerous studies suggest that the best psychological approaches are as effective as the best pharmacological approaches in the short term and more durable over the long term.

However, there is no single correct approach: there are individuals who do not respond to cognitive-behavioural treatments and who may respond positively to medication; conversely, there are individuals who are resistant to pharmacotherapy and who may benefit from cognitive-behavioural therapy; finally, there are patients who may benefit more from a combination of both treatment approaches.

Behaviour therapy helps individuals reduce their fears and gain more control over difficult situations. It focuses on exposure to the actual physical sensations that someone experiences during a panic attack, as well as the situations that the individual fears and avoids.

Cognitive therapy attempts to change people’s thought patterns by helping them identify and criticize their unrealistic thoughts and helping them replace those thoughts with more realistic, positive ways of viewing the attacks. Psychologists developed behavioural and cognitive therapies and most often use a combination of both to treat PD. Patients have fewer and less severe panic attacks, actively participate in their own recovery and learn skills they will continue to use in many situations after the therapy ends.

Antidepressant and anti-anxiety medications can ease symptoms. Anti-anxiety medications (e.g., benzodiazepines) are fast-acting and may be used as a short-term solution to decrease acute anxiety. Antidepressants may be used in the longer term treatment of PD, but can take weeks to produce noticeable therapeutic benefits.

Both online and in-person support groups may be useful. Many people learn from others, use the support offered by group members and need the reassurance that they are not the only ones with PD.

Well-conceived smartphone applications (apps) using behavioural and cognitive strategies for the management of anxiety and panic attacks may be helpful. They can provide valuable support in daily life.

Effective treatment can bring significant relief to 70 to 90 percent of people with PD.

Where do I go for more information?

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

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Janel Gauthier, Université Laval, Québec.

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: Obsessive Compulsive Disorder

What is obsessive-compulsive disorder?

Have you ever had a strange or unusual thought just pop into your mind that is entirely out of character for you? Maybe you’ve had the thought of suddenly blurting out an embarrassing or rude comment, or of causing harm or injury to another person, or of doubting whether you acted correctly in a particular situation.

Have you had an irresistible urge to do something that you know is entirely senseless, like checking the door even though you know it is locked, or washing your hands even though they are clean?

Most people experience unwanted, even somewhat bizarre or disgusting thoughts, images and impulses from time to time. We don’t feel upset by these thoughts and urges, even though they seem pretty unusual for our personality and our experience.

Some individuals, however, suffer with a special type of unwanted thought intrusion called obsessions. Obsessions are recurrent and persistent intrusive thoughts, images or impulses that are unwanted, personally unacceptable and cause significant distress.

Even though a person tries very hard to suppress the obsession or cancel out its negative effects, it continues to reoccur in an uncontrollable fashion.

Obsessions usually involve upsetting themes that are not simply excessive worries about real-life problems but instead are irrational concerns that the person often recognizes as highly unlikely, even nonsensical.

The most common obsessive content involve (a) contamination by dirt or germs, (b) losing control and harming oneself or other people, (c) doubts about one’s verbal or behavioural responses, (d) repugnant thoughts of sex or blasphemy, (e) or deviations from orderliness or symmetry.

Compulsions are repetitive, somewhat stereotypic behaviours or mental acts that the person performs in order to prevent or reduce the distress or negative consequences represented by the obsession. Individuals may feel driven to perform the compulsive ritual even though they try to resist it.

Typical compulsions include repetitive and prolonged washing in response to fears of contamination, repeated checking to ensure a correct response, counting to a certain number or repeating a certain phrase in order to cancel out the disturbing effects of the obsession.

People with clinical OCD typically have both obsessions and compulsions (although some may be more aware of struggling mainly with either obsessions or compulsions), with the majority (81%) experiencing more than just one kind of obsession or compulsion.

Approximately 1% of the Canadian population will have an episode of OCD, with the possibility that slightly more women experience the disorder than men. The majority of individuals report onset in late adolescence or early adulthood, with very few individuals experiencing a first onset after 40 years of age.

OCD is also seen in childhood and adolescence where it is a similar symptom pattern to that seen in adults. OCD tends to be a chronic condition with symptoms waxing and waning in response to life stresses and other critical experiences. It is uncommon for individuals to spontaneously recover from OCD without some form of treatment.

Depending on the severity of the symptoms, OCD can have a profound negative impact on functioning. In severe cases, obsessive thoughts and repetitive, compulsive rituals can consume one’s entire day. Like other chronic anxiety disorders, OCD often interferes with jobs and schooling. Social functioning may be impaired and relationships can be strained as family and close friends get drawn into the individual’s OCD concerns.

The actual cause of this disorder is not well known. Genetic factors may play a role but to date there is little evidence of a specific inheritance of OCD.

Studies have suggested there may be some abnormalities in specific regions or pathways of the brain. Other research indicates that critical experiences or personality predispositions might be related to increased susceptibility for OCD.

However, there is no known single cause to OCD. Instead, most of the genetic, biological and psychological causes probably increase susceptibility to anxiety in general rather than to OCD in particular.

What psychological approaches are used to treat OCD?

Since the early 1970s research has shown that behaviour therapy is the most effective treatment for most types of OCD. It involves experiencing the fearful situations that trigger the obsession (exposure) and taking steps to prevent the compulsive behaviours or rituals (response prevention).

These studies have shown that 76% of individuals who complete treatment (13-20 sessions) will show significant and lasting reductions in their obsessive and compulsive symptoms.

When measured against other treatment approaches such as medication, behaviour therapy most often produces stronger and more lasting improvement. In fact, there may be little advantage to combining behaviour therapy and medication given the strong effects of the psychological treatment.

However, up to 20% of people with OCD will refuse behaviour therapy or drop out of treatment prematurely. One of the main reasons for this is a reluctance to endure some discomfort that is involved in exposure to fearful situations.

More recently, psychologists have been adding cognitive interventions to the behaviour therapy treatments involving exposure and response prevention. Referred to as cognitive behaviour therapy (CBT), this approach helps people change their thoughts and beliefs that may be reinforcing obsessive and compulsive symptoms and can help individuals feel less fearful of exposure and response prevention exercises. Also, the cognitive interventions can be particularly helpful if you are mainly struggling with obsessions, rather than compulsions.

Together with exposure and response prevention, the CBT approach has been shown to be effective in offering hope to individuals suffering from OCD.

What are the symptoms of OCD1?

  • presence of obsessions and/or compulsions;
  • obsessions and compulsions cause marked distress, are time consuming, or significantly interfere in daily activities;
  • the content of the obsessions and compulsions is not restricted to concerns associated with another psychological disturbance such as the preoccupation with food in an eating disorder or guilty ruminations in major depression, nor are the symptoms directly caused by the effects of a substance or general medical conditions.

1 Based on the diagnostic criteria of OCD as found in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) of the American Psychiatric Association (2013).

Where do I go for more information?

The following websites provide useful information on OCD:

Other helpful resources include:

  • Purdon, C., & Clark, D.A. (2005). Overcoming Obsessive Thoughts: How to Gain Control of your OCD. New Harbinger Publications.
  • Baer, L. (2012). Getting control: Overcoming your obsessions and compulsions (3rd ed.). Plume.De Silva, P. & Rachman, S. (1992). Obsessive-Compulsive Disorder: The Facts. Oxford University Press.
  • Foa, E. B., Yadin, E., & Lichner, T. K. (2012). Exposure and Response (Ritual) Prevention for Obsessive-Compulsive Disorder: Therapist Guide (2nd).Oxford University Press
  • Steketee, G., & White, K. (1990). When Once is not Enough: Help for Obsessive Compulsives. New Harbinger Publications.
  • Munford, P.R. (2004). Overcoming compulsive checking: Free your mind from OCD. New Harbinger Publications.
  • Munford, P.R. (2005). Overcoming compulsive washing: Free your mind from OCD. New Harbinger Publications.
  • Abramowitz, J.S. (2009). Getting over OCD: A 10-step workbook for taking back your life. Guilford Press.
  • Challacombe, F., Oldfield, V.B., & Salkovskis, P. (2011). Break free from OCD: Overcoming obsessive compulsive disorder with CBT.
  • Grayson, J. (2014). Freedom from obsessive-compulsive disorder:  A personalized recovery program for living with uncertainty (updated edition).  Berkley Publishing Group.
  • Winston, S. M., & Seif, M. N. (2017). Overcoming Unwanted Intrusive Thoughts: A CBT-Based Guide to Getting Over Frightening, Obsessive, or Disturbing Thoughts. New Harbinger Publications.

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

 This fact sheet has been prepared for the Canadian Psychological Association by Dr. David A. Clark, University of New Brunswick. It was revised most recently in 2020 by Dr. Gillian Alcolado, University of Manitoba.

Revised: July 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: Generalized Anxiety Disorder

What is generalized anxiety disorder (GAD)?

If you have Generalized Anxiety Disorder you will experience chronic, excessive, and uncontrollable worry. You may also be on edge, be easily fatigued, have difficulty concentrating, feel irritable, experience muscle tension, and have problems sleeping.

GAD is one of the most common anxiety disorders. Canadian data suggest that one out of every 12 individuals will suffer from GAD at some time in their life. It can be mild or it can contribute to unemployment and serious family and social problems.

GAD can lead to other problems such as fear of meeting people (social anxiety disorder), severe panic attacks (panic disorder), and depression. If left untreated, those with GAD are at greater risk of developing medical problems such as heart disease, diabetes, and cancer.

Proven psychological approaches to treat GAD

There are a number of proven psychological therapies for GAD. They will help you gain control over your worries, decrease your anxiety, and improve your quality of life. The therapies that have been shown to be most helpful are:

  • cognitive re-evaluation to help you correct thinking patterns that increase worry;
  • behavioural experiments to help you cope with uncertainty;
  • imaginal exposure to help you confront rather than avoid your fears;
  • problem-solving training to help you learn better ways to solve everyday problems; and
  • progressive relaxation to decrease your physical symptoms of anxiety such as rapid breathing and sore muscles.

Research shows that psychological treatments are effective in treating GAD

Psychological therapy is very effective in the treatment of GAD. In a Canadian study, 77% of those receiving short-term psychotherapy (16 sessions of cognitive re-evaluation, problem-solving training, and exposure) remained GAD-free one year after treatment.

The fact that you get better and stay better after psychological therapy is certainly an important consideration for those seeking help for anxiety-related problems.

Where do I go for more information?

For more information visit the following website:

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. Michel J. Dugas, Université du Québec en Outaouais.

Revised: October 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: Gambling

What are gambling and gambling problems?

Most Canadians play games of chance for money or other prizes. Popular gambling activities include lottery and raffle tickets, scratch tickets, casino games, slot machines, video lottery terminals (VLTs), bingo, sports betting and informal card games. In Canada and around the world, people have had more and more opportunities to gamble over the past 30 years.

Although most Canadians are recreational gamblers, about 5% of the adult population develops gambling-related problems. These problems can range from the person who over spends on one occasion to the person who has a longer-term problem controlling his or her gambling activity.

At the extreme end of the scale is Gambling Disorder which is continued and extreme gambling that is maladaptive because of its negative effects on family, personal and work life (APA, 2013). About 1% of adults experience this severe form of the disorder.

Indicators[1] may include: repeated unsuccessful attempts to control, cutback or stop gambling, restlessness or irritability when making these attempts, needing to gamble with increasing amounts of money to achieve the desired excitement, preoccupation with gambling, gambling to escape from problems or emotions such as depression or anxiety, lying to family members or others about the extent of gambling,  jeopardizing relationships, jobs or career opportunities because of gambling, and relying on others to provide money to relieve the financial consequences of gambling. Chasing losses (returning to gamble on another day to win back lost money) is considered a key feature.

There is no one cause of gambling problems and it is clear that biological, psychological and social factors all play a role. Gambling problems tend to run in families and people who have or have had problems with other addictions such as alcohol are at an increased risk of developing a gambling problem.

Gambling problems can also be related to clinical depression but we do not yet fully understand whether gambling problems lead to depression, whether depression contributes to gambling problems, or both. People who are impulsive (for example, people who make decisions without thinking about consequences) are also more likely to have gambling problems. Most gambling also occurs in a social context. People gamble because their friends and family are gambling.

What can psychologists do to help people who have gambling problems?

Researchers have been active in examining k how successful we are at treating people with gambling problems. In most areas of the country, programs and counsellors use treatment approaches that are similar to those used for drug and alcohol problems. These approaches can be provided individually or in groups and for inpatients and outpatients. Most cities have chapters of Gamblers Anonymous which offer mutual support groups that operate on a twelve-step, spiritual model.

Research supports psychologists’ use of cognitive and behavioural treatments with problems gamblers. Cognitive treatments help people understand and change thinking that maintains maladaptive gambling.

For example, problem gamblers try to predict the outcome of their next bet by considering the outcomes of earlier bets.

This kind of thinking is false and risky. A certain outcome is not more likely because it has or has not occurred on earlier bets – the chance of a certain outcome remains the same for each bet. With behavioural treatments, people change their behaviours and environment in order to make it harder for them to gamble. For example, people will often limit their access to cash.

Research also highlights the importance of motivation in overcoming gambling problems. Motivational enhancement techniques help people to understand how gambling effects their lives and the mixed feelings they might have about stopping gambling.

To date, there are no medications which have been proven to be effective in treating problem gambling.

Where do I go for more information?

The website for the Responsible Gambling Council, http://www.responsiblegambling.org has a comprehensive list of links to Canadian treatment programs, Gamblers Anonymous and provincial help lines.

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. David Hodgins, a faculty member in the Clinical Psychology Program at the University of Calgary, Calgary, Alberta. He is affiliated with the Alberta Gaming Research Institute http://www.addiction.ucalgary.ca.

Revised: October 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] Based on the diagnostic criteria of gambling disorder as found in the Diagnostic and Statistical Manual of Mental Disorders (5th Ed.) of the American Psychiatric Association (2013).

“Psychology Works” Fact Sheet: Needle Pain

Why does pain from needle procedures matter?

Needle procedures are used to prevent, diagnose, monitor, and treat various health conditions. For example, insulin injections and finger pokes are a common experience for people with diabetes while bone marrow aspirations and lumbar punctures are experienced by people with cancer. Immunizations/vaccinations are the most common source of needle pain in childhood. For example, the Canadian Immunization Schedule recommends over 20 needles, not including yearly flu vaccinations, before a child reaches the age of 18. While vaccinations are a critical part of health care that have made a major difference in the prevention of infectious diseases, pain can be a consequence of these procedures. If the pain from needle procedures is not properly managed, there are short and long term consequences including longer procedure times, increased risk of fainting and injuries, negative memories, fear and avoidance of future procedures.

Why does pain from needle procedures matter?

The good news is that there are many ways that pain and distress during needle procedures can be managed. Types of strategies include:

  • procedural – how the clinician performs the procedure (e.g., no aspiration for immunizations)
  • physical – across ages, sitting upright is usually helpful unless the person has a history of fainting. If there is a history of fainting, a technique called muscle tension can be helpful.
  • pharmacological – topical anesthetics or other medications for more invasive procedures.
  • psychological strategies. More on these below for preschoolers and older.

The recommended strategies can change depending on the age of the person getting the needle. For example, infants benefit from kangaroo care (<1 month) or being closely held by the caregiver, breastfeeding, and/or sugar water for more minor procedures such as immunizations or venipunctures.

Research shows that the psychological techniques listed below help to reduce immunization pain, and can help for other needle pain in children as well as adults. They are all relatively easy to use and low in cost, if not free. Each technique can be adjusted as needed, depending on a person’s age and the specific procedure they are having.

  • Education and Preparation – everyone deserves to know what procedure they are getting, why, and what will be done to make it comfortable (what they can do and what others will do). Provide choice when possible: for example, do they want to look at or away from the needle? What coping strategies will they use? Do they want a caregiver or other trusted individual to be present?

    Before a needle procedure:

    • Answer any questions people have in a way that is honest but appropriate for their age
    • Tell very young children about the needle only a little while before the procedure
    • Tell older children, adolescents, and adults about their procedure before the day in question so they can prepare coping strategies
  • Communication to the individual immediately before and during the procedure. For all ages:
    • Speak calmly, clearly, with simple wording.
    • Signal the start of the procedure in a neutral way (e.g., “1, 2, 3, here we go”).
    • Do not say “it won’t hurt”. That does not help and it is not necessarily true so could led to mistrust.
    • Do not reassure (e.g., say “it’s okay” or “almost done”) over and over again. It does not help.
  • Distraction – these are strategies that involve taking a person’s attention away from the procedure. Use age-appropriate distraction techniques such as:
    • Talking about things other than the procedure (e.g., holidays, favourite movie)
    • Toys
    • Videos (with adult coaching to engage for younger children)
    • Singing
    • Video games
    • Books
  • Deep breathing or blowing – this strategy involves the person taking slow, deep, regular breaths, which can help with feeling relaxed. Using a toy is recommended for school-aged children and adolescents (e.g., pinwheel or bubble wand) which then also includes distraction. Children (and adults) can be instructed to take a calm and slow breath from their diaphragm (e.g., “take a deep breath in from your tummy. When you breathe in, your tummy should fill up like a balloon. Then breathe out pushing out all the air.”). Adults may also find coughing or taking a deep breath in and holding it (for brief injections such as immunizations) helpful.

What if a high level of needle fear is present?

Needle fear is present in about 2/3 of children and 1/4 of adults and can range from mild to severe levels. The strategies listed above are helpful for people with low to moderate needle fear. Across the lifespan, about 10% of individuals have high levels of needle fear that can interfere with their willingness to undergo needed medical procedures. At the most severe end of the spectrum, ~4-5% of individuals have a phobia related to needles which is characterized by extreme fear and anxiety and called blood injection injury phobia. People who have high levels of needle fear require different strategies than are listed above – they need to undergo exposure-based therapy in which they face their fear in a controlled, hierarchical manner. After their fear reduces, they can then benefit from the traditional pain and distress management strategies.

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. C. Meghan McMurtry, University of Guelph. The current version is based on the 2011 version written by Dr. C. Meghan McMurtry, Dr. Christine T. Chambers, Dalhousie University, and Dr. Anna Taddio, University of Toronto.  

Updated: 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: Seasonal Affective Disorder (Depression with Seasonal Pattern)

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

What is Seasonal Affective Disorder?

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

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

Who is at risk of developing SAD?

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

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

What are the symptoms of Seasonal Affective Disorder?

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

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

Can Psychology Help Seasonal Affective Disorder?

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

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

Are there other treatments for Seasonal Affective Disorder?

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

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

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

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

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

Where can I get more information?

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

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

Date: July 2018

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

Canadian Psychological Association
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: Social Anxiety  

What is Social Anxiety?

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

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

When does social anxiety become a problem?

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

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

Who has problems with social anxiety?

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

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

What treatments help people with social anxiety?

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

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

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

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

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

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

How can psychologists help people with social anxiety?

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

For more information:

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

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

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

Date: June 29, 2018

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

Canadian Psychological Association
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: Caregiver Stress

Caregiving can be a positive experience, but without proper support the stress associated with caregiving responsibilities can compromise the well-being of both the caregiver and the care recipient.

What does it mean to be a caregiver?

Carers (also called family caregivers or natural support) are those in the circle of care, including family members and other significant people who provide unpaid support to a person in need. It is estimated that 8.1 million Canadians (1 in 4) provide some level of care to a family member or friend with a chronic mental or physical illness or disability (Statistic Canada, 2013). Carers contribute $25 billion in unpaid labour to our health system (Hollander et al, 2009).

The degree of the unpaid carer’s involvement can vary over time and is dependent on the availability of external resources, on the needs of the care recipient, and on the caregiver him/herself (their needs and own capacity to help). Some care recipients may require assistance with only a few tasks, while others with more pronounced impairments may require continuous care and supervision for most or all activities of daily living. For example, the intensity of caring for elderly parents is often lower than caring for an ill child or spouse (Statistics Canada, 2012). Care needs can also fluctuate over time. Some conditions are time-limited and happen later in life (e.g., Alzheimer’s) while others can be life-long (e.g., mental illness, children with developmental challenges).

You may be caring for a loved one who has reduced physical, mental, emotional, social and/or cognitive ability due to age, accident, physical and/or serious mental illness.  Although most caregivers report providing care for one individual at a time, it is not uncommon to care for multiple friends or family members.  More than 1 in 5 (22%) Canadians reported more than one family member with a mental health problem in 2012 (Pearson, 2015).

As a carer, you may be expected to execute a variety of tasks such as:

  • Transportation and/or running errands
  • Feeding and/or preparing meals
  • Clothing, bathing/grooming
  • Managing toileting/Incontinence
  • Transferring/lifting
  • Managing difficult behaviours
  • Administering medication, assisting with medical treatments/therapies
  • Liaising with health providers
  • Assisting with indoor/outdoor property maintenance and household chores
  • Providing emotional support and coping strategies
  • Socialization
  • Monitoring safety of loved one
  • Monitoring comfort of others

These tasks may present themselves uniquely or jointly, and each has unique impact on your stress.

What are the causes and symptoms of caregiver stress?

As you provide care, you may experience symptoms of stress. If not properly addressed, stress may become chronic. This is especially true for long-term caregiving, such as for children with developmental disabilities or chronic illness, or for loved ones of any age with serious mental or chronic physical illness. The unpredictability of certain conditions can have a strong impact on the experience of stress; caregivers are not always able to control or predict the challenges associated with their caregiving responsibilities. This can be especially difficult for carers who do not adapt easily to unexpected situations.

Stress related to caregiving can be direct or indirect. It can result from the number, duration and intensity of the tasks associated with caregiving, as well as the loss or grief that are often associated with having a family member or friend with a chronic mental or physical illness or disability. Stress can also be associated with financial strain due to work disruption or costly treatment, conflicts in interpersonal relationships, poor health, and compromised social relationships. Indirect stress is not less important but may not be easily recognized at the outset of a caregiving cycle.

It is estimated that 6.1 million carers are juggling work and caregiving responsibilities. Fifty-percent of carers are between the ages of 45-65, their peak earning years (Statistics Canada, 2013). You may experience disruptions in work, such as unpaid time away or temporary absence from your career.

In certain caregiving situations, the illness or disability may impact the carer’s own physical or mental health as well as their emotional stability. Many caregivers report they neglect their own health needs, such as booking personal health appointments, skipping meals or eating a poor diet, not getting enough sleep, smoking, abusing substances, and not tending to psychological or emotional distress. Further, caregivers who are older, are of lower socioeconomic status, or have limited support networks appear to be at higher risk.

Other symptoms of caregiver stress may include:

  • Depression, anxiety, and/or irritability
  • Trouble concentrating
  • Disturbed sleep
  • Feeling exhausted despite adequate rest
  • A weakened immune system
  • Loss of interest in personal needs, desires, and pastimes
  • Increased feeling of resentment towards the care recipient and/or family/friends
  • Loss in satisfaction of being a caregiver
  • Feeling helpless, hopeless and isolated

Each of these factors, individually and collectively, can have a significant impact on the stress experienced by the caregiver.

However, caregiving can be a satisfying experience and most caregivers report some positive consequences for both the family and themselves (National Opinion Research Center, 2014). This includes stronger bonds and commitments, resourcefulness, pride and satisfaction, as well as growth and adaptation. Additionally, caregivers report a stronger sense of purpose in life, increased tolerance, empathy and compassion. Providing caregivers with information and support can help to enhance the positive aspects of caregiving experience and to reduce the stress associated with it

How can I reduce my caregiving stress?

Counselling, therapy, Mindful meditation, yoga, journaling, and/or having a pet, are some ways that can reduce caregiver stress.

Communicate your concerns and needs with others. Consider seeking out local organizations, support groups, and associations that assist with caregiving. They may be able to connect you with resources, allowing you to share responsibilities.  Meeting with other caregivers with similar situations may help to break isolation and share difficult experiences. Social media platforms can be an important way to connect with others, especially when the caregiver cannot get out of the house or is isolated.

By sharing your concerns and needs you are less likely to feel that you are isolated in providing care. This will give you an opportunity to assess your emotional wellness. It will also give you an opportunity to assess how you feel concerning your caregiving responsibilities. While under certain circumstances you have no choice but to fulfil your caregiving responsibilities, you may like to learn that it is okay to say “no” when you are feeling overwhelmed. Accept that your feelings and needs are legitimate; they affect your health and your ability to provide needed care.

Ask for and accept help from family or friends. If help is not actively offered, talk with family or friends who would be able to help. You may find it less stressful if a few people participate in dedicated responsibilities. It is important to share responsibilities when other people are involved in caregiving. This ensures that everyone involved feels comfortable and competent to carry their responsibilities.

Be mindful of your physical and mental health. Keep up with personal health appointments, eat a balanced diet, and ensure that you are getting enough sleep. It is recommended to set aside at least 30 minutes four times a week for exercise. It is important to take a break from your responsibilities to reduce physical and mental exhaustion. Arrange some time each week to socialise or engage in hobbies/leisure activities. Focus on the things that are within your control and approach your responsibilities with a positive and self-compassionate attitude. Self-compassion and positive thinking have been found to be effective defenses against chronic stress and burnout.

How can psychologists help with caregiver stress?

Caregivers are often engaged with many healthcare providers, including physicians, psychologists, nurses, physiotherapists, social workers and home support workers, among others. They can also help with stress reduction strategies.

A psychologist can assist you in the process of recognizing the loss and grief that are often associated with caregiving. Proactive stress reduction is important so that you can sustain your own well-being and better fulfill your caregiving duties.  This, along with support and education about your loved one’s illness and its course can ease some of the negative consequences of caregiving.

Therapy can also help you find positive aspects of caregiving, both for the family and for yourself. At times in caregiving, some difficult relationship dynamics can develop.  A psychologist can assist carers and the person needing care to have conversations that lead to greater understanding and awareness of both people’s needs, thus reducing stress.

You may benefit from psychotherapy such as cognitive behavioural therapy (CBT), interpersonal therapy, or psychodynamic therapy. All forms of psychotherapy allow you to deal with your stress, concerns, worries and other symptoms with a therapist, in a secure environment.

  • In CBT, your therapist will guide you through thoughts and behaviours that are self-defeating and pose a negative influence on your life. The goal of CBT is to provide you with the skills to challenge these negative thoughts and maladaptive behaviours. By minimizing the influence of negative thoughts and behaviours, you will be able to develop a balanced perspective on the events that occur every day in your life and surrounding environment.
  • Through interpersonal therapy, you will learn to self-evaluate any challenges that you may have in communicating your needs with others. The goal is to improve communication skills so that your intentions are understood, and your needs are met. This can help reduce certain burdening feelings associated with caregiving. It will also help to strengthen your relationships with family, friends, the care recipient and any supporting resources that can assist you with caregiving.
  • Through psychodynamic therapy, you can uncover unconscious feelings that are negatively influencing your mood and attitude. The goal of this therapy is to allow you to recognize, understand, and manage these unconscious feelings. This therapy has been found to be less effective than CBT and Interpersonal therapy in treating caregiver stress and depression.

Some carers experience symptoms severe enough to consider medication. Selective serotonin reuptake inhibitors (SSRIs) are the preferred antidepressant for treating depression resulting from caregiver stress. SSRIs influence the balance of serotonin in the brain, which helps with mood regulation; common side effects of SSRIs include agitation, dry mouth, drowsiness, nausea, and dizziness to name a few. Medication prescribed by a physician may be combined with any of the psychotherapies mentioned.

Where can I get more information?

The Canadian Mental Health Association – provides helpful information and resources to people caring for a loved one with a mental illness:
https://cmha.ca/mental-health/finding-help/family-caregiver-support

The Canadian Home Care Association – provides helpful information and resources for caregivers:
http://www.cdnhomecare.ca/content.php?doc=223

American Psychological Association (APA) – provides helpful information and resources for caregivers:
http://www.apa.org/search.aspx?query=caregiver
http://www.apa.org/search.aspx?query=caregiving

Provincial associations of psychology – provides access to information from psychological associations for each province or territory:
https://cpa.ca/public/whatisapsychologist/ptassociations/

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/

References

Pearson, C. (October, 2015). “The Impact of Mental Health Problems on Family Members,” Health at a Glance, Statistics Canada catalogue no. 82-624-x, http://www.statcan.gc.ca/pub/82-624-x/2015001/article/14214-eng.pdf.

Hollander, M. J., Lui, G., Chapell, N. L. (2009). Who Cares and How Much? The Imputed Economic Contribution to the Canadian Healthcare System of Middle-Aged and Older Unpaid Caregivers Providing Care to The Elderly, Law & Governance, 12(2): 42-49 /a

National Opinion Research Center. (May, 2014). Long term care in America: Expectations and realities. Retrieved from http://www.longtermcarepoll.org/PDFs/LTC%202014/AP-NORC-Long-Term%20Care%20in%20America_FINAL%20WEB.pdf

Portrait of caregivers, 2012 – Statistics Canada. https://www150.statcan.gc.ca/n1/pub/89-652-x/89-652-x2013001-eng.htm

Turcotte, M. (2013). Family caregiving: What are the consequences? Ottawa: Statistics Canada. Retrieved from: http://www.statcan.gc.ca/pub/75-006-x/2013001/article/11858-eng.pdf

This fact sheet has been prepared for the Canadian Psychological Association by Anna Beth Doyle, Concordia University and Ella Amir, AMI-Quebec.

Date: July 2018

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

Canadian Psychological Association
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: Enuresis and Encopresis in Children

What are enuresis and encopresis?

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

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

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

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

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

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

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

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

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

Why are enuresis and encopresis a problem?

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

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

How can psychologists help children with enuresis and encopresis?

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

Psychologists can:

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

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

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

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

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

Are there other professionals we should see?

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

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

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

Where do I go for more information?

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

 

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

Date: February 7, 2019

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

Canadian Psychological Association
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: Health Anxiety

What is health anxiety?

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

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

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

How prevalent is health anxiety?

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

What are the main causes of health anxiety?

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

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

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

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

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

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

What psychological treatments are used to treat health anxiety?

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

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

How effective are psychological methods of treating health anxiety?

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

Where do I go for more information?

For the public:

For the professional:

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

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

 

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

Revised: June 2020

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

Canadian Psychological Association
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: Post-Traumatic Stress Disorder

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

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

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

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

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

What are the symptoms of PTSD?

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

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

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

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

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

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

Where do I go for more information?

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,

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

Where can I get more information about psychology/psychologists?

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

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

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

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

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

Date: August 2020

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

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


[1] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders. (5th ed.). Author: Washington, DC.

[2]Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults American Psychological Association. Guideline Development Panel for the Treatment of PTSD in Adults. Adopted as APA Policy February 24, 2017 https://www.apa.org/ptsd-guideline


“Psychology Works” Fact Sheet: Climate Change and Anxiety

Experiencing Anxiety Related to Climate Change

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

What Contributes to Anxiety Related to Climate Change?

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

Before a Climate-related Event

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

During a Climate-related Event

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

After a Climate-related Event

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

Who is Most Vulnerable?

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

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

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

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

Psychological Practice and Services

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

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

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

Psychological Science

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

Advocacy

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

Knowledge Mobilization

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

For More Information:

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

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

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

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

Date: December 1st, 2020

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

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


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

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

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

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

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

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

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

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

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

“Psychology Works” Fact Sheet: Depression Among Seniors

What are the symptoms of depression in older adulthood?

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

Who is affected?

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

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

What are the other problems associated with depression?

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

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

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

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

What are the causes of depression in later life?

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

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

What psychological approaches are useful to treat depression among seniors?

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

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

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

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

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

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

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

Where do I go for more information?

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

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

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Philippe Cappeliez, Emeritus Professor, School of Psychology, University of Ottawa.

Revised: March 2020

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

Canadian Psychological Association
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 Interventions for Acute Pain Management in Children

What is acute pain?

Acute pain is typically described as a mild to intense sharp pain. It comes on quickly and lasts for a short period of time, usually providing a signal to the body that something is wrong. Experiencing acute pain is important because it is a part of our body’s built-in warning system. The experience of pain varies across individuals, which means that the same painful event can be felt very differently among children.

Pain is like a puzzle that is made up of different pieces. There is a biological piece (e.g., previous injuries can make a person more sensitive to pain), a psychological piece (e.g., memories of past pain experiences can impact future pain experiences) and a social experience piece (e.g., the people who are in the room with you can impact how much pain you feel and how much pain you actually express). Even within the same person, the impact each piece has can change from situation to situation or as someone matures over their life. So even the same painful event can be experienced by the same person differently at different points in time!

Common causes of acute pain in children include everyday bumps and bruises (e.g., when a child falls off a bike), routine medical procedures (e.g., getting a needle at the doctor’s office), and post-surgical pain (e.g., the pain following tonsil removal that often lasts days). A person’s report of pain must be respected and paid attention to, no matter how old the person is. Sometimes a child cannot tell us they are in pain because they are too young or have intellectual or developmental disabilities. However, a good rule of thumb is that anything that causes pain in adults will also cause pain in children. There are well-validated ways to help assess and understand the pain of infants, children, and teens.  

Assessment of acute pain in children

Scientists and clinicians know that pain is tricky to assess even in adults, so a lot of work has gone into trying to understand the best ways to measure pain in children. With infants, toddlers, and preschoolers, watching body language is often the best way. For example, the FLACC (Face, Legs, Activity, Cry, Consolability) scale instructs caregivers to focus on the infant/child’s grimacing face, flailing legs, arched body or squirming, if they are crying, and how easily they are consoled. If children are hospitalized, it’s possible to use physiological measures like heart rate or how much oxygen is circulating in the blood. The higher the heart rate or the lower the oxygen saturation in the blood, the more stress the child is in and the more pain we assume the child is experiencing. Some pain assessment tools used in the hospital, such as the PIPP-R (Premature Infant Pain Profile-Revised), incorporate both behaviours and physiology measures. Sometime around the age of 6 or 7 years, children are able to self-report their pain more reliably, so parents and health professionals should try to ask them about their pain. For example, the Faces Pain Scale – Revised[1] (see below) is a great way to ask early school-aged children about how much something hurts. For older children and teens, who may have a good understanding of how rating scales work, you can just use a numeric rating scale without any aids. For example, you could ask an older child or teen, “On a scale of 0 to 10, where 0 is no pain and 10 is the worst pain you can imagine, how much pain are you experiencing right now?”.

Why is acute pain a priority in children?

Acute pain occurs frequently in both healthy children and those with chronic illnesses. Although pain serves an adaptive role, it may have adverse effects on the body, mind and social wellbeing of children if left unmanaged. Through experience, children learn the concept of pain, and previous experiences of pain influence how they experience pain in the future. Without appropriate assessment and treatment, acute pain can change how a child processes pain. A fear of needle-related procedures and avoidance of medical appointments may also develop if pain is not properly managed. Sometimes, acute pain can even lead to longer-term pain (i.e., pain that lasts more than 3 months). For example, research has suggested that anaesthesia and analgesia during surgery is important as it may protect a child from longer term pain.

Psychological strategies for managing acute pain in infants, children, and teens

Whether you are the parent (or caregiver) of an infant, child, or teenager, research shows that you play a major role in helping your child prepare for and cope with acute pain experiences. The way your child depends on you for support might look different depending on how old your child is.

Managing pain in infants and toddlers

Since infants (< 2 years old) haven’t yet developed the abilities needed to understand why they are in pain or what they can do to feel better, they rely on their caregivers more than ever to help them make sense of and cope with the experience. Parents can help reduce acute pain in infants and toddlers. One strategy parents can use with their infants that does not require any preparation is as easy as ABCD! The ABCD approach requires parents to calm themselves to help them calm their child. The ABCD’s are:

  1. Assess your own anxiety. Your infant looks for hints from you to help them make sense of what’s happening. When you are calm, your infant is more likely to feel calm, too. If you have your child in your arms, your slow heartbeat will help you keep your child calm.
  2. Belly breathe if you are stressed. Take some slow deep breaths in through your nose and into your belly. Slowing your breathing will slow your heart rate which can help slow your infant’s breathing and heart rate.
  3. Use a calm, close cuddle with your infant. Your cuddle is extremely comforting to your infant, especially when used before, during, and after painful experiences. Depending on how old and active your infant is, this might involve skin-to-skin contact (holding your infant, dressed only in a diaper, against your bare chest, breastfeeding your child) or hugging your child while they sit in your lap or stand between your legs or while in your arms.
  4. Distract your infant at the right moment. Distracting your infant using a toy, book, bubbles, or song, or by talking to them about something unrelated to the pain can help him or her calm down, but you should wait 30-45 seconds for their crying to slow down and their eyes to open before you start the distraction. Infants might show you that they are not ready for distraction yet (by becoming more upset, pushing the toy away, or looking away in response to the distraction). If this happens, go back to cuddling.

Managing pain in younger children (3-10 years)

Between the ages of about 3 and 10, children are gradually learning what they can do to get themselves through painful experiences, but still rely heavily on their parent or caregiver taking charge of the situation. During this broad age stage, successful coping with pain will usually involves a combination of child-led and parent-led strategies, with a greater emphasis on the parent the younger the child is.

While there are strategies that will work at any age from about 3 to adolescence (described later on), children in this stage have some unique psychological considerations. Children in this stage might experience some anticipatory worries when they know a painful procedure is coming. To help prepare their child for a painful experience, parents can take some extra steps in advance of a planned painful procedure:

  • Decide when and how to share information with your child about an upcoming painful procedure. Younger children can be told the day of the procedure. Older children and teens should be told at least the day before, so that they can prepare coping strategies ahead of time and might benefit from learning about and practicing the steps involved in the procedure.
  • Answer your child’s questions honestly. For example, if your child asks if a needle will hurt, you might say “It might hurt a small or medium amount, but it will be over soon”.
  • Consider offering your child some choice in how their pain is managed, such as how they want to be distracted during the procedure, whether they want to hold your hand, and what they would like to do after the procedure. Offering choices to a young child is usually not helpful and might overwhelm the child. For older children, offering choices in advance (such as before you leave the house) helps them know what to expect and can help them feel more in control of the situation. They can also be motivated to get through the unpleasantness for a reward immediately after the painful procedure (e.g., lollipop) or in the near future (e.g., ice cream stop on the way home). In the below section are strategies that will work with children across childhood.

Managing pain in older children and teens (10+ years)

As children progress through the tween and teen years, they often take on an increasingly independent role in managing their pain. Although the preparatory strategies described above can help reduce the stress your child experiences before a procedure, they should always be used in combination with strategies for managing the pain while and/or after it occurs.

The following strategies can help reduce pain in children and teens during and after a painful experience:

  • Effective strategies for distracting your child will vary depending on their age, abilities, and interests, and might include blowing bubbles or pinwheels, playing with a toy or video game, watching a movie, listening to music, or using virtual reality technology. Generally speaking, the more actively the child is involved in the distraction activity, the more powerful the distraction will be.
  • Guided imagery. Through guided imagery, you can help your child use their imagination and senses to picture themselves in a different, more calming place. Guided imagery scripts for children of all ages are available online.
  • Belly breathing. Breathing exercises that involve diaphragmatic (or “belly”) breathing can be used with children to help them feel calmer during and after painful experiences. Children can be instructed to breathe in through their nose and into their belly (keeping a hand on their belly to check that it rises with each breath) and breathe out through their mouth.
  • Coping statements. Teaching children to use coping statements can help them think more positively and feel less negatively about the painful event. Having children repeat statements such as “I can get through this” or “I know the pain will go away”, aloud or in their head, can help them feel better. Reminding them after the painful experience about how well they did, how short the pain was, or how “worth it” the reward was will also help them build better pain memories for the future.

Parent behaviours to avoid

Sometimes despite the best intentions, parents overuse behaviours that have been linked to higher pain-related distress. Parents and caregivers should try to notice and limit their use of these behaviours:

  • Reassuring your child by saying things like “it’s ok” or “you’re fine” when your child is visibly distressed or before they are distressed. It can cause them to feel confused, increasing their distress, or it can signal to them that something scary is coming, because parents don’t usually reassure their child when things are fine.
  • Criticizing your child’s response to pain. Saying things like “your brother didn’t cry after his needle” or “big girls don’t cry” may teach a child that it is not okay to express pain when they are feeling it, increasing future distress and pain.
  • Apologizing for your child’s pain. Apologizing for your child’s pain when you are not the one who caused it can confuse your child. It can also suggest to him or her that their pain has caused distress for you, which can further increase their distress.

Where can I get more information?

Learn more about assessing and treating acute pain at the AboutKidsHealth Pain Hub, a health education resource for children, youth, and caregivers approved by The Hospital for Sick Children (https://www.aboutkidshealth.ca/pain). In addition to describing psychological strategies we mention in this sheet, this resource provides parent- and patient-friendly information sheets that describe important physical (such as using smells and sounds or massage) and pharmacological strategies (such as acetaminophen, sugar water, or numbing cream) that often add to the success of psychological strategies.

You can also 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 websites 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 Miranda Di Lorenzo, Shaylea Badovinac, and Dr. Rebecca Pillai Riddell, York University.

Date: November 24, 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] Faces Pain Scale – Revised. Copyright ©2001, International Association for the Study of Pain.

“Psychology Works” Fact Sheet: Schizophrenia

What is schizophrenia?

Schizophrenia is a serious disorder that is related to a range of behavioural and thinking problems. Despite common myths, schizophrenia does not refer to ‘multiple personalities’, but rather a loss of contact with reality. The symptoms of schizophrenia are different from person to person, and symptoms, at least in a milder form, tend to last for a long time and long-term treatment is usually necessary. However, there is hope for improvement and a return to normal life for many people. With a combination of medication, psychological therapy, and family/social support, people with schizophrenia can function well in their community.   

What are some of the problems faced by people with schizophrenia?

  • Difficulties with perception of reality, such as hallucinations (for example, seeing or hearing things that are not real), delusions (for example, believing an organization is plotting to harm you; thinking that special messages are contained in advertisements), and bizarre behaviours (for example, peculiar speech). These are the kinds of symptoms that people often think of when they say someone is suffering from a “psychotic episode”. These symptoms are also sometimes called “positive” symptoms, referring to the presence of the unusual sensory experiences that are in excess of typical human experience.  
     
  • Difficulties with behaviours and emotions, such as reduced experience and expression of emotions, avoiding other people, lack of motivation, and a decrease in amount of speech. These symptoms are sometimes called “negative” symptoms, referring to the reduction or absence of usual social and emotional experiences.
     
  • Difficulties with thought processes (called cognitive abilities), such as attention, memory, speed of processing information, planning, and problem solving. This means that many daily activities like grocery shopping, learning new skills at work, or following a conversation might be very difficult for people who have schizophrenia.
     
  • Difficulties with social functioning, such as forming and maintaining relationships, or doing well at school or work. 

Schizophrenia is not the only disorder associated with psychosis. For example, some people may have symptoms of both a mood disorder (like depression or bipolar disorder) and schizophrenia, or others may have just some psychotic symptoms (e.g., hallucinations). Those experiencing psychosis might be at risk for a more severe form of their disorder and should be encouraged to seek mental health treatment.

How common is schizophrenia?

  • Approximately 1% of the world’s population meet the criteria for a diagnosis of schizophrenia
  • Men are more likely to be diagnosed with schizophrenia – the ratio of men to women is 1.4 to 1
  • Symptoms often start in late adolescence or young adulthood, and may occur for many years before diagnosis; on average, men are usually diagnosed at a younger age – 22 years old for men versus 27 years for women

What are the risk factors for schizophrenia?

There are several different causes of schizophrenia, which often act in combination:

  • Heredity– Having a parent, sister, or brother with schizophrenia is a risk factor for developing the disorder. However, this does not mean that one is guaranteed to have schizophrenia, it just increases the likelihood  to a higher degree than people who do not have a family member with this diagnosis.
     
  • Environment – Many factors unrelated to family history can affect brain development and the risk for schizophrenia. Examples include a mother having a serious illness or a long period of malnutrition while pregnant, low birth weight, oxygen deprivation during birth, and serious illness during early infancy. Additionally, there are experiences in a person’s environment that may increase their likelihood of developing psychotic symptoms (especially if they are already at a higher risk because of hereditary or developmental factors). Examples of this include childhood abuse, war zone exposure, and poverty. 

What psychological treatments are available to help manage schizophrenia?

Historically, treatment took place in large hospitals where patients were completely removed from society. With the use of medications since the 1950’s, many people with schizophrenia are able to live in the community and do not need to be in hospital settings for long periods. While antipsychotic medications can be effective at targeting “positive” symptoms (i.e., hallucinations and delusions), they often have limited effects on “negative” symptoms (i.e., emotional experiences and motivation), and cognitive difficulties. As well, many people have trouble staying on their medication, due to multiple negative side effects. As a result, they are likely to start experiencing symptoms again if they stop their medication.

Research suggests that the most effective treatment plan is a combination of antipsychotic medication and psychological therapies that help people make changes in real-world behaviour. As we develop more effective treatments, people with schizophrenia are better able than ever before to function in society, even though some may continue to have symptoms.   

  • Cognitive Behavioural Therapy (CBT)– An active, collaborative type of therapy that focuses on a person’s thoughts and core beliefs, and the behaviours that are related to these thoughts. In CBT-P (a form of CBT for psychosis), a person learns to question and re-evaluate the source and meaning of their hallucinations and delusions. 
     
  • Cognitive Remediation – Focuses on training people to improve their thinking abilities such as attention, memory, reasoning, and information processing. New problem solving strategies are learned and there is a focus on helping the person be more engaged with cognitively challenging and stimulating tasks in daily life. Therapists play a large role in supporting the development of new skills and strategies as well as addressing negative core beliefs about cognitive abilities. 
  • Family Support– Provides information, support, and new interaction skills to people affected by schizophrenia and their family members, so that the whole family can learn to best manage the disorder.
     
  • Social Skills Training– Focuses on teaching people more adaptive skills to use in interpersonal relationships, and allows practice of these skills in a group, and in one’s daily life. 

An important note on stigma

Schizophrenia is often misunderstood by the public. The disorder often receives media attention, but, as with many news stories related to mental illness, many facts are taken out of context for entertainment or shock value. In particular, popular stories and media reports about people with schizophrenia sometimes make it seem like these individuals are dangerous or violent. In fact, people with schizophrenia are generally not dangerous, and usually pose a higher risk of harm to themselves (due to suicide) than to other people. As well, people with a psychotic disorder are more likely to be victims of violent crime than to be violent.  

Where can I get more information?

  • Surviving Schizophrenia: A Manual for Families, Patients, and Providers– by Torrey
  • The Family Intervention Guide to Mental Illness: Recognizing Symptoms and Getting Treatment– by Mueser & Morey
  • Schizophrenia Society of Canada:  schizophrenia.ca 
  • Canadian Mental Health Association: cmha.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 Association by Dr.. Katherine Holshausen, St. Joseph’s Healthcare Hamilton, & Department of Psychiatry and Behavioural Neuroscience, McMaster University and Dr. Christopher R. Bowie, Head’s Up Early Psychosis Intervention Program – Kingston, & Department of Psychology, Queen’s 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: Suicide

What Every Canadian Needs to Know about Suicide

Some Facts.  Although death by suicide is relatively uncommon, on average there are more than 10 deaths by suicide daily in Canada.  Thinking about suicide and engaging in self-harm and in suicidal behaviour are much more common.  When feeling overwhelmed or in psychological pain, people might contemplate suicide to varying degrees.  Sometimes people have passive suicidal thoughts such as wishing they wouldn’t wake up in the morning or wishing something fatal would happen.  Sometimes suicidal thoughts are more active, and people think about how to actively end their lives.  Although having suicidal thoughts does not necessarily mean that someone is on the verge of killing themselves, both active and passive thoughts need to be taken seriously because they suggest that something is not right at that moment in the person’s life.  Approximately 4,000 people die by suicide in Canada each year[i].  This figure may be an underestimation since death by suicide may be misclassified[ii] as an unintentional injury or as the result of a chronic health condition. In addition, this figure does not include the deaths of people who are terminally ill and obtain medical assistance in dying (MAiD).

Risk for death by suicide differs by as age (older), sex (male) and cultural group.  Three-quarters of those who die by suicide are men.  Most men and women who die by suicide are middle-aged.  Middle-aged and older men have Canada’s highest rates of suicide.  Suicide is the second leading cause of death for people between the ages of 15 and 34[iii].     Suicide rates do not take into account non-fatal suicidal behaviour; statistics estimate that suicide attempts outnumber deaths by suicide by somewhere between 10 and 20:1[iv]

Who is at risk for suicide?  There are many factors that contribute to suicide.  Commonly, people who think about or die by suicide may feel overwhelmed with psychological pain[v], which can be experienced as hopelessness, helplessness, loneliness sadness, anger, guilt or shame, or meaninglessness[vi].  Past behaviour tends to predict future behaviour; one of the strongest risk factors for death by suicide is having tried to end one’s life in the past. Studies show that suicide tends to be more common among people with one or more mental disorders, primarily mood disorders (like Major Depressive Disorder or Bipolar Disorder), psychotic disorders (like Schizophrenia), a substance use disorder, and personality disorders[vii]. Suicide risk may be elevated among people in pain and whose chronic illnesses restrict their daily functioning[viii], although this typically occurs when a mood or other mental disorder is also present.  It has been estimated that about 90% of those who die by suicide have a mental disorder, but most people with mental disorders do not die by suicide.[ix]  Additionally, although depression and suicide risk often go hand in hand, not everyone who dies by suicide is depressed, and not everyone who is depressed thinks about suicide. Nevertheless, when someone is depressed, it is important to find out if they are having suicidal thoughts. To find out more about mental disorders go to https://cpa.ca/psychologyfactsheets/.

What are some of the signs to look for if you are concerned that someone is considering suicide?  Specific signs of suicide risk include talking about suicide and death, talking about or collecting implements for self-harm or for suicide, preparing for death by writing a will or giving away prized personal possessions, previous suicide attempts, and recent experience or anticipation of serious personal losses. Some of the other signs that someone might be considering suicide are similar to signs of depression.  These include changes in eating or sleeping habits, withdrawal from others, extreme emotional changes, a blunting of emotional expression or loss of interest in usual activities particularly those usually enjoyed, and neglect of personal appearance.  There can also be increased use of alcohol or other drugs and increase in strange or risky behaviours.  As mentioned, although depression is a risk factor for suicide, the majority of people with depression do not die by suicide. Sometimes people are most at-risk for suicide when their depression lessens, and they appear to be doing better.  Suicide risk can be extremely high when someone is initially emerging from an episode of depression, especially if their energy returns but their thoughts of suicide remain strong. Some people are quite good at presenting themselves as being well put together even when they are not; support and the opportunity to explore their thoughts and feelings about life can be critical.

How do talk to someone about suicide?  Asking a person about suicide will not make them suicidal.  It is best to come right out and say that you have noticed some changes or signs that they may be hurting or in need of help, that you are worried or concerned and that you want to help.  If the person admits to feeling sad or hopeless, ask directly if they have thought about hurting or killing themselves.  Listen, don’t judge, and don’t try to solve their problems.  You may not understand how or why someone feels the way they do but accept that they are in pain and in need of help.  Don’t try to convince them that their way of seeing the world, or the actions they are considering, are bad or wrong.  If someone is thinking about suicide and discloses it to you, never promise to keep this information confidential.  A person feeling suicidal is a person who needs help and you may need to talk to others to help them get it[x].

How do I get help if I or a loved one is thinking about suicide?  There are supports and services that are effective in helping people deal with their psychological distress and recover from mental disorders.  Helping someone in need get help can be very important since less than half of people who have psychological problems actually get the help they need. Sometimes it is the stigma of mental disorders that gets in the way of people asking for and receiving help.  Mental healthcare services are not always funded by public health insurance, which can also make it harder for people to get the help that they need.  Keep in mind that helping loved ones doesn’t mean you can or should solve their problems, treat their illness or take away their pain.  Helping doesn’t mean that you should assume personal responsibility for someone else’s safety or for stopping their suicidal thoughts or actions.  It means listening, caring, supporting, and helping the person get the professional mental health help they need, when and where they need it.  It may also mean advocating for them. Navigating a complex health system can be daunting, especially when someone is in distress.  Helping to make calls and appointments, and acting as their advocate, can be very important to getting someone help in a timely manner. 

Where do I turn if the situation is urgent? Thinking about suicide can be a health emergency and needs to be treated the same way as any other crisis.  Don’t assume that people who think about or talk about suicide are not serious, are being dramatic, or that their suicidal thoughts will simply go away on their own – they often don’t.  This is no time for “cautious waiting.” If you or someone you know is thinking about suicide, cannot make the thoughts go away, feels like acting on the thoughts, have a plan for how to die by suicide, or have access to the means with which to end life, you need to get help immediately!  Call 911, go to the nearest hospital emergency room or urgent care clinic, or call a crisis line or distress centre.  Crisis Services Canada can be reached at 1-833-456-4566.  The Canadian Association for Suicide Prevention has a directory of crisis lines across Canada http://suicideprevention.ca/thinking-about-suicide/find-a-crisis-centre.

Where can I get mental health help? If the situation isn’t urgent but you or the person you are concerned about is distressed, help is available.  Research shows that psychological treatments are effective for mental disorders and can reduce or resolve thoughts of suicide, or prevent suicide behaviour.  Provincial and territorial associations of psychology maintain referral services so that you can find a psychologist in your area https://cpa.ca/public/findingapsychologist/.   To find out what to expect when seeing a psychologist, see https://cpa.ca/public/.

Other avenues to get help include bringing your concerns to your family physician, primary health care team or community health centre. Some primary health providers like family physicians may be able to offer help directly or refer you to a health care provider or program that specializes in mental health treatment.  If the person in crisis is a student, the school or university may have mental health providers on staff.  The Canadian Mental Health Association can also be a helpful source of information and support. When choosing mental health help, it is always a good idea to seek the services of a regulated and specialized mental health care provider (like a psychologist or psychiatrist) to make sure that mental health problems are accurately assessed and diagnosed.  Not all mental health issues, disorders or treatments are the same.  Not all healthcare providers have expertise in assessing and treating mental disorders.  An accurate assessment and diagnosis is critical to making sure that you receive the right care.

Additional resources include:

CANADIAN RESOURCES:

Mental Health Commission of Canada
https://www.mentalhealthcommission.ca/English/what-we-do/suicide-prevention

Indigenous Services Canada 
https://www.sac-isc.gc.ca/eng/1576089278958/1576089333975

Veterans Affairs Canada
https://www.veterans.gc.ca/eng/health-support/mental-health-and-wellness

Mood Disorders Society of Canada (MDSC)  
http://www.mooddisorderscanada.ca/

The Canadian Association for Suicide Prevention (CASP) http://www.mentalhealthcommission.ca/English/issues/suicide-prevention 
Video: Let’s Talk about Suicide — http://vimeo.com/98177990

The Canadian Coalition for Seniors’ Mental Health (CCSMH)
http://www.ccsmh.ca/en/projects/suicideAssessment.cfm
http://www.ccsmh.ca/en/booklet/index.cfm

The Canadian Mental Health Association (CMHA)
http://www.cmha.ca/mental-health/understanding-mental-illness/suicide/

The Centre for Suicide Prevention 
http://suicideinfo.ca/

AMERICAN RESOURCES:

Suicide Prevention Resource Center
http://www.sprc.org/

The American Association of Suicidology (AAS)
http://www.suicidology.org/home

The American Foundation for Suicide Prevention (AFSP) http://afsp.org

The American Psychological Association (APA)
 http://www.apa.org/topics/suicide/index.aspx  

U.S. Substance Abuse and Mental Health Services Administration (SAMHSA)
http://www.samhsa.gov/prevention/suicide.aspx

INTERNATIONAL RESOURCES:

The International Association for Suicide Prevention (IASP)
http://www.iasp.info/

The World Health Organization (WHO)
http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/

 

Where can I get more information?

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

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

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

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

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Karen R. Cohen (Canadian Psychological Association) and Dr. Marnin J. Heisel (Western University)

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


[i] http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/hlth66a-eng.htm

[ii] http://www.med.uottawa.ca/sim/data/Suicide_e.htm, http://www.apa.org/monitor/2012/12/suicide.aspx

[iii] http://www.phac-aspc.gc.ca/publicat/lcd-pcd97/table1-eng.php

[v] Shneidman, E.S. (1993).  Suicide as psychache (commentary). The Journal of Nervous and Mental Disease, 181 (3), 145-147.

[vi] http://suicideprevention.ca/understanding/why-do-people-suicide/

[vii] Bertolote JM, Fleischmann A, De Leo D, Wasserman D. Psychiatric diagnoses and suicide: revisiting the evidence. Crisis. 2004; (25(4): 147-155.

[viii] Kaplan, M.S., McFarland, B. H., Huguet, M.S., & Newsom, J.T. (2007).  Physical Illness, Functional Limitations, and Suicide Risk:  A Population-Based Study.  American Journal of Orthopsychiatry.  77(1), 56-60.

[ix] http://depts.washington.edu/mhreport/facts_suicide.php

[x] More information about suicide prevention and about talking about suicide can be found at http://www.helpguide.org/mental/suicide_prevention.htm

 

“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) Freeing 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
Toll free (in Canada):  1-888-472-0657

“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 create 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) due to systemic racism. 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, also known as microaggressions.

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. A few of the many 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

  • Negative stereotypes of a category of people are accompanied by negative attitudes and emotions such as anger, hate, irritability, and fear.
  • Prejudice can also appear to be “positive,” but these attitudes are 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”.
  • 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.
  • 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 impacts the receiver negatively and may lead to reciprocal feelings and actions. 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 react 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 is likely to be offered a lower start-up salary, contributing to pay gap discrepancies which combines with accumulated wealth disparities to maintain White supremacy. 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. Rather, majority members who have inherited, and therefore benefit from the systems of racial power have the responsibility to repair harm and establish justice. They must step forward to becoming true 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 in combination with repairing past discrimination. 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
Updated: October 12, 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: 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 PsychNet® Gold 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