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“Exercise is Medicine and Physicians Need to Prescribe It!”

We are what we doThat was the gist of a recent article in the Toronto Star’s Weekend Life section. It spoke about the growing list of scientific evidence showing that exercise “is the much needed vaccine to prevent chronic disease and premature death.” While you might say that doesn’t exactly qualify as ‘news’ (who among us didn’t already know that exercise was good for you?) it might be news to some. The article went on to cite the disturbing statistic that “only 15% of Canadian adults are meeting the recommended guideline of 150 minutes of exercise a week.”

Why is there a disconnect between what we actually do and what we know is good for us? The article suggests that a small part of the answer relates a cultural desire for quick fixes that makes it easier for patients and their doctors to focus on cures instead of disease prevention. The bigger reason, it said, has to do with the fact that simply telling someone to change existing habits doesn’t offer enough guidance or direction on how to actually do that. People tend to need support, and maybe even step-by-step instructions, on how to go about changing long-term habits.

Psychologists are experts at helping people change. It is a big part of what we do. We know all about tapping into motivation and willpower, and about how bad habits can persist when we don’t replace them with intentions to change and the actions required to bring that change about. In particular, psychologists know about our built-in habit mechanisms and how to tap into them to bring about lasting change.

Built-in habit mechanisms? Yes, we all possess a brain that frees up processing power by converting complicated behavioural actions into routines and habits that we can perform with barely any thought. Consider driving a car as an example. It’s a highly complex act that many of us are able to do almost automatically. The brain builds the routines and, when we sit behind the wheel those routines come up to the surface and we just drive. Knowing how to use that habit mechanism makes it easier to create new routines, like exercising regularly.

Say you want to walk for 30 minutes, three times a week. The habit mechanism is already in place to do the heavy lifting. All you really need to do with your conscious effort is to set the stage so the mechanism works for you instead of against you. This might take the form of setting the goal of walking by:

  • Scheduling a 30 minute ‘Walking’ appointment in your calendar, with a reminder, every Monday, Wednesday and Friday.
  • Writing “I want to walk for 30 minutes every Monday, Wednesday and Friday” on a piece of paper and placing that paper in a spot that you see every day.
  • Place your running shoes beside your front door.

Although none of these acts requires much effort on their own, the habit mechanism magnifies their impact by prompting you to take further actions toward walking every time you look at your note or see the shoes by the door. The act of scheduling the time to exercise also pushes you to follow through because it reminds you that walking is a priority in your day.

Multiplier

Because the work of prioritizing the activity, getting the shoes out and finding the time to walk has already been done, the only thing you have to do when your ‘Walking’ appointment arrives is to put your shoes on and step outside. Once you’re outside and walking, the physical and mental benefits of exercise make it easier to continue until you’ve hit your 30-minute goal.

The key to changing behaviour is creating new routines. We can increase our potential for change by mapping out the various steps that will lead us toward the desired routine AND by creating cues that minimize the effort needed to take each step.

“A journey of a thousand miles begins with a single step.” – Lao Tzu

 

www.shiftct.com
Shift Cognitive Therapy Oakville is a psychology practice that helps people learn to change habits and behaviour.

Dr. Kristina Wilder, Ph.D., C.Psych. (Supervised Practice)

dr-kristina-wilderDr. Kristina Wilder works with clients of all ages and backgrounds, including children, adolescents, adults, couples, and families. She brings enthusiasm, an energetic personality and a sense of fun to her work. Kristina believes in working transparently with clients, collaborating to meet their goals. She works with a variety of issues, including anxiety, trauma and abuse, depression, and relationship challenges.

Kristina received her Ph.D. in Psychology from St. John’s University in New York, an experience that helped her to be mindful of diverse client backgrounds.  She is skillful in Dialectical Behavior Therapy (DBT), Rational Emotive Behavior Therapy (REBT), and Cognitive Behavior Therapy (CBT). She is also experienced in Psychodynamic therapy.  With a wide range of tools, Kristina customizes her approach to client needs, helping each person reach their unique aims. She is a member of the Ontario Psychological Association and enjoys camping, Lego and quilting.

Siren Busch, M.A., C.Psych.Assoc.

siren-buschSiren Busch is a Psychological Associate registered with the College of Psychologists of Ontario to practice in Counseling, Clinical and Forensic Psychology. Siren is passionate about supporting adolescents and adults struggling with anxiety, stress, depression, anger, substance use, or a trauma history. She is fluent in both German and English.

Graduating with a Master’s Degree in clinical psychology in 2000 from the University of Hamburg, Germany, Siren came to Canada in shortly thereafter to pursue her career in psychology. Her professional background includes positions with the Ontario Ministry of Children and Youth Services, the University Health Network and most recently with the Centre for Addiction and Mental Health. Siren is a member of both the Ontario and Canadian Psychological Associations and the services she provides are covered by most extended health benefits plans.

Managing Traumatic Stress Following a Mass Transportation Disaster

A mass transportation disaster involves the community as a whole, in addition to those who are directly involved. Families, friends, and residents of a community tied to a transportation disaster often experience a ripple effect of grief and sadness. Emotional responses following any traumatic event  may vary from person to person as each individual deals with death, serious injury, and loss differently.

Common reactions

There are many common reactions among those managing traumatic events. Below is a list of a few common reactions. It is important to keep in mind that these responses are normal and even expected by those impacted.

  • Recurring dreams or nightmares
  • Repetitive thoughts about the events surrounding the disaster
  • Difficulty concentrating
  • Repeated upsetting memories about the traumatic experience
  • Feelings of anger at the loss
  • Feelings of confusion and blaming of those associated with the event
  • Feeling emotionally numb and withdrawn
  • Loss of enjoyment in usually pleasurable activities
  • Becoming overprotective of family members
  • Social isolation
  • Trouble sleeping
  • Increased conflict with family members, close friends, or coworkers.

How you can cope

A mass transportation disaster can leave survivors feeling helpless, scared, overwhelmed, and unsettled. Below are some suggestions of how to cope with the aftermath of this kind of disaster.

  • Address problems one at a time, prioritizing for importance. This will help to minimize feeling overwhelmed.
  • Put off any major decisions. Allow yourself time to grieve and recover as you may not be able to make the best decisions when you are dealing with grief and loss.
  • Allow yourself to feel sad and grieve. When you have the chance, take time to reflect on what has occurred. Talking with others can be helpful and remind you that you are not alone with your stress or depression.
  • Practice healthy habits. Help yourself with self-care. This can include eating well and getting enough sleep. This is especially important in times of high stress.
  • Reestablish a routine. This can include regular meal times, exercising, or going to bed at a certain time. These will help you feel a sense of order as well as a sense of calm.
  • Anticipate that strong feelings may return on anniversaries. For example, one-month, six-month, or one-year anniversaries of the incident may bring up intense feelings once again. Try to spend this time with family and friends to support and care, rather than spend it alone. For more information about coping with disaster anniversaries, please visit the APA’s Help Center Article Anxiety and Sadness May Increase on Anniversary of Traumatic Event.

How family and friends can help

In the most troubling and uncertain of times, it is very helpful for family members and friends to support loved ones who may be struggling. Some tips for those close to a survivor of a mass transit disaster are listed below.

  • Encourage the survivor to seek out other survivors or others who have been in similar situations to find understanding and support.
  • Encourage the survivor to find a support group for disaster survivors to talk with one another and voluntarily share thoughts, anxieties, and fears resulting from their shared experience.
  • You and the survivor should avoid untimely, inaccurate, and ongoing media coverage of the accident. It can be unsettling for survivors to relive and witness the events they have been through.
  • Identify and consider what factors most troubling to the survivor or could remind them of their disaster experience and limit their exposure to it.

Recovery and the future

Recovery can take time. Life may feel different. It is possible to move on and find new meaning, purpose, and positive emotions. APA’s Road to Resilience brochure describes steps that you can take to build resilience – the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress. For more tips on how to manage stress after a mass transportation disaster, please visit the APA’s HelpCenter article How to Manage Traumatic Stress.

If you notice persistent feelings of distress or hopelessness or if you are struggling to attend to your daily responsibilities, consult with a licensed and experienced mental health professional. Psychologists and other mental health professionals are trained to help you successfully manage life’s hardships and pursue a plan for a more positive and meaningful future.

 

 

Thanks to psychologists Ester Cole, PhD and Denruth Lougeay, PhD for their assistance with this article. (Article adapted from original.)

Prepared July 2013.

Resources:

American Red Cross Guide for Families Affected by Transportation Disasters. http://www.tallyredcross.org/wp-content/uploads/2010/08/ GuideForFamiliesAffectedByTransportationDisasters.pdf

Raphael, B. A Primary Prevention Action Programme: Psychiatric Involvement Following a Major Rail Disaster. Omega Journal of Death and Dying, 10(3): pp. 211-226.

 

www.shiftct.com
Call Shift Cognitive Therapy for help with depression and anxiety in Oakville.

Make Your Choices, Whatever They Might Be

On the cusp of the Canada Day long weekend it’s hard not to tFlaghink about perspective – you might view this as the second long weekend of the summer or the second-last; if the weather is hot and sunny you might say it will have been a “good” weekend or a “bad” one if the weather is wet. Regardless of the way you choose to see it, the choice is ultimately yours.

People often wonder about that, whether they truly have any choice about how they view things, because thoughts occur so quickly – almost automatically. This is true. As our sense organs perceive elements of the environment around us, the brain is constantly labeling, judging and understanding everything that’s coming in. Look around you right now and you might be able to appreciate that somewhere, deep inside your head, your brain is quietly rhyming off the names of everything it’s seeing and hearing. But even as it’s doing that, you can also purposely cause certain thoughts to come to mind. For example, think right now about what you did on last year’s Canada Day long weekend. Now think about a summer weekend from your childhood. You have just taken control over your brain!

Because thoughts and feelings are so closely connected (see earlier articles on Reacting AND Responding, Anxiety – Automatic Protection) our emotions and physiology often react to sensory information before we’re aware of it consciously. This can have the effect of leaving us feeling hijacked and out of control. But when you remember that you always have a choice about how you want to view things you can reframe those instantaneous reactions into something that feels more empowering.

A client recently provided a good example of this when he worried that his vacation might be ruined because he had to take his computer and work phone away with him on holidays. Knowing that he absolutely had to stay in touch over the break, he felt better by focusing instead on the fact that technology made it easy for him to be away on vacation AND periodically remain connected with important tasks back at work.

Choose to have a good holiday.

 

 

www.shiftct.com
Shift Cognitive Therapy Oakville is a psychology practice that helps people learn to manage anxiety, stress and depression.

Spring 2013 Fear of Flying Seminar

At the end of May Dr. Ian Shulman and Capt. Marc-Antoine Plourde led a group of 10 people who were afraid to fly on a two-day workshop to help them with their phobia. We met at a small facility on the grounds of Toronto’s Pearson International Airport and spent two full days working on helping the seminar participants to cope with their fear and understand its origins. Most people believe that their fear of flying occurs because flying is dangerous. In fact, with all the safety mechanisms, regulations, standards and the double- and triple safeguards built into modern aircraft, being a passenger on a commercial aircraft is actually safer than driving on the highway. What we help our flight seminar participants to appreciate is that the fear of flying is actually more related to the fear of not having control.

Boarding Air Georgian's Beech 1900

In our experience, the one thing most fearful fliers have in common is a history of feeling truly alone or afraid at some time in their lives, usually in childhood or early adolescence. Some felt it because their parents were alcoholics or abusive; other parents were otherwise unavailable because of illness, depression, poverty, work, or when they had others in the family who demanded more of their attention. Some fearful fliers felt alone growing up in families that never talked about feelings, leaving them confused about how to make sense of their own emotions. Still, others felt alone or afraid when they were trapped in places or situations that they couldn’t escape from, like small spaces, near-drownings, or being too small to stop others from bullying or tormenting them. Those kinds of early-life experiences taught fearful fliers a powerful lesson: Remaining in emotionally intense situations is painful and to be avoided.

First Officer Andrew gives the safety briefing; Marc-Antoine Plourde listens in.

The 10 adults in our latest group were no different; all were able to identify challenges in their pre-adult years. Almost the entire group had flown before and only one had experienced a flight-related incident (like bad turbulence or a sudden loss of altitude) when on a plane. Instead, the most common story people told was of feeling anxious on and off over the course of their lives and using avoidance to manage it.

They all spoke of avoiding airplanes because they feared they would be unable to escape or do anything to manage their feelings if they began to feel afraid during the flight. When anxious in cars they would open windows, pull over or insist that they always drive; in elevators, they would get off at the next floor or take the stairs; or in crowded rooms they would sit by the door and ensure they knew all the exits – just in case. But on airplanes, they said, once they were in the air, they felt they couldn’t do anything to maintain that sense of control over their fears and feelings.

The keys to the success of our fear of flying workshop was that we helped the group to (a) develop realistic expectations of what would happen on an actual flight and (b) improve their ability to tolerate the anxious thoughts and feelings we knew they would experience when they took the chance of giving up their usual controls. Using group discussions, mindfulness meditation practice on board the aircraft, and showing our adult fliers that they had it in their ability to ask for the care and comfort they needed, we readied the group for the confirmation flight, a tour of the skies over Toronto.

Dr. Ian Shulman, after the flight.

In the end, 7 of the 10 decided to fly. All were nervous, but all found ways to cope that didn’t involve avoiding or procrastinating. It wasn’t easy, a few members of the group felt quite scared and needed reassurance, but Dr. Shulman, Capt. Plourde and the other members of the group were all there to provide it. The worst part for most, they said in the post-flight debriefing, was right before they stopped trying to control everything and gave in to their feelings. The best part was about 5 minutes after that, when they realized their fears were unwarranted and found themselves able to cope with whatever the experience gave them.

Let us know if you’re afraid to fly too, there are things we can do to help.

Genetic Testing for Postpartum Depression

Postpartum DepressionThe Toronto Star recently reported that “a simple blood test” done early in a woman’s pregnancy may soon be able to detect DNA changes that predict postpartum depression. According to the article, a study recently published in the journal Molecular Psychiatry examined blood samples of 93 pregnant women and found that approximately 80% of those who would later go on to develop postpartum depression shared a sensitivity to changes in estrogen at the level of their genes (that is, in their DNA). Estrogen, labeled by some as “the big kahuna” of the female hormones, is produced by both the ovaries and the placenta and is vital to pregnancy – basically, no estrogen means no pregnancy. The obvious implications of the research are that help for depression can be provided to women who are at risk before it settles in.

Postpartum depression is more serious than the typical “baby blues” that can occur within hours of delivering a baby, but requires no treatment and usually resolves within hours or days. Symptoms of postpartum depression can last longer and be more severe. It can also develop into a full-blown, major depression, which raises the risk of other depressive episodes throughout the lifespan.

The US National Institute of Health estimates that 1 in every 10 women may develop symptoms of postpartum depression in the year after childbirth.

 

 

www.shiftct.com
Call Shift Cognitive Therapy for non-medication help with depression in Oakville.

Canadian Economists Support Greater Access to Psychologists

The Canadian Psychological Association released a report today that it commissioned by an independent group of health service economists and health policy analysts. The report was critical of Canada’s current approach to mental health care, calling the lack of support for effective psychological services “a silent crisis.” It urges Canadian health policy makers to consider adopting strategies currently in place in other nations. One strategy involves working with insurers and employers to provide more realistic amounts of insurance coverage for psychological services, especially since insurers and employers both gain dramatically from having a healthy, well-functioning workforce.

Read the press release and access the full report here.

 

 

 

www.shiftct.com
Call Shift Cognitive Therapy for help with depression and anxiety in Oakville.

Rethinking Depression

This month, CBC Radio One has been airing a thought-provoking, 3-part series entitled “Rethinking Depression” on its program Ideas. With the help of a number of local and world-renowned experts in the field, producer Mary O’Connell explores what we know – and what we think we know – about depression and the medications we use so often to treat it. The patient and interested listener (the entire series runs for three hours) will be rewarded with some really fascinating but often not well-publicized facts about the social, commercial and political factors that are conspiring to make psychotropic medications “a $20billion per year industry worldwide” and have led the World Health Organization to predict that depression will be the second leading caused of global disability by 2020. This series is well worth the time to listen to!

Listen to part 1 here.

Listen to part 2 here.

Listen to part 3 here.

 

Some tidbits from the series…

Up until the 1950s, depression affected only about 1% of the population, and that was mostly middle-aged women. Back then, the term was used almost exclusively to refer to the serious condition that left sufferers barely able to function and often suicidal. However, in 1963, when pharmaceutical giant Hoffman-La Roche introduced its minor tranquilizer Valium, huge numbers of people began to use it to address their own ‘symptoms’ of feeling blue and overwhelmed. Whereas previous psychiatric drugs had mostly been reserved for use with the seriously mentally ill, Valium was seen as something any adult could use, just to ‘take the edge off’ everyday life. In 1966, The Rolling Stones wrote about its widespread acceptance in “Mother’s little helper” and its cultural relevance grew as it increasingly found its way into popular movies and television.

A second major societal shift that further increased the appearance of higher rates of depression occurred in 1980, with the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the so-called ‘bible’ every North American mental health provider relies on to distinguish what is and isn’t a psychiatric condition. Political infighting between the various high-powered authors resulted in the decision to lump into a single category both the major depression that truly incapacitated its sufferers and the milder, ‘reactive depression’ that resulted when people struggled to manage difficult life events and felt distressed, but were still able to go to work every day and function reasonably well. Suddenly, the size of the market for a medication that took away distress increased dramatically.

Newsweek: "A breakthrough drug for depression"While effective as a sedative, Valium wasn’t a great option for elevating low mood and it had some undesirable side effects as well. Pharmaceutical giant Eli Lilly resolved those problems when they brought Prozac to market in 1988. Compared to Valium, Prozac was easy for physicians to prescribe and monitor, and it was easy for consumers to take. It was quickly hailed as a breakthrough and a ‘magic bullet’ for depression. Prozac worked specifically on the neurotransmitter serotonin, and the pharmaceutical industry and its marketing partners insinuated and gradually solidified the idea that depression was the result of a chemical imbalance in the brain. Even though that idea has little empirical support it is still widely held to be true. It may be that the so-called Serotonin Hypothesis of depression is more a marketing coup than a scientific fact.

Some estimate that 75% – 80% of the effects of antidepressant medications may be due to placebo, meaning that the belief that the medication is helping to reduce symptoms may be more powerful than the medication itself. Noticeable impacts on other serotonin-related systems within the body (eg, sexual function, bowel function, and attention) may give the appearance that the drug is doing something, but scientists are still actively struggling to understand what the SSRI class of medications (that includes Prozac, Paxil, Celexa, Cipralex, Luvox and Zoloft) actually do. What is not under debate is the fact that huge amounts of money are available to be made as rates of depression continue to rise and as categories of users continue to expand. According to the series, senior citizens, children and teens are in the fastest growing group of antidepressant users in the past 10 years and manufacturers are now re-working their formulas for use with animal populations as well (see www.reconcile.com).

www.reconcile.com

One of the more challenging aspects of the series is the realization that as a society, we have medicalized unhappiness and other normal emotions. It invites us to question whether we’re better off for it, or if we might be shortchanging ourselves over the long-term by stepping away from the opportunities for positive growth that can come from personal struggle. What if depression and rumination can teach us how to function more effectively the next time a problem arises, much in the same way that we voluntarily expose ourselves to the flu viruses in the fall to inoculate ourselves against them over the winter? What if suffering can lead us to change dysfunctional aspects of our lives, perhaps through treatments like cognitive therapy, which is effective and has lower relapse rates than medication.

Rethinking Depression is an excellent documentary series and well worth the time.

Click here for other information on managing depression.

 

www.shiftct.com
Call Shift Cognitive Therapy for non-medication depression help in Oakville.

Students Highly Stressed: TDSB Survey

The Toronto District School Board recently released the findings of their 2011-12 Student Census (click here to download the survey) and the results suggest that a majority of students may be struggling with anxiety and depression. Believed to be the largest survey of its kind in Canada, the census explored how students feel about their in- and out-of school experiences and their general well-being. Almost 90% of all Toronto students in grades 7 through 12 (103,000 students) participated in the survey.

The study revealed that 63% of grade 7 and 8 students and 72% of those in high school felt nervous or anxious often or all of the time. Fully one-third of Toronto high schoolers reported feeling under a lot of stress and about three-quarters said they felt tired for no reason and struggled to concentrate and make decisions (see the table below). A significant source of their worry was how things might be in the future.

 

Student Experience Grades 7 – 8 Grades 9 – 12
Tired for no reason

58%

76%

Difficulty concentrating

56%

76%

Difficulty making decisions

56%

72%

Nervous/anxious

63%

72%

Under a lot of stress

40%

66%

% reporting All The Time/Often

These symptoms our teens and tweens are reporting are some of the same symptoms present in depression (follow this link for a complete list from the Canadian Mental Health Association), a debilitating condition that can develop when we feel unable to cope with prolonged stress. The results are upsetting because they suggest that while we’re giving our kids so many opportunities, we’re not teaching them enough about how to manage with the challenges and demands of everyday life.

Cognitive behaviour therapy is an important and effective tool in the fight against depression.

 

www.shiftct.com
Call Shift Cognitive Therapy for depression help in Oakville.

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