Cap Psych Pod Episode 5: Sleep and Mental Health

Today we’re joined by Andrew Holmes, Owner and Founder of Sleep Efficiency. Andrew has over 15 years of experience in sleep diagnostics and PAP therapy. Andrew founded Sleep Efficiency here in Ottawa and has been providing individuals with take-home sleep testing since 2015.  Today, Andrew will be shedding some light on the affect sleep can have on mental health, different types of sleep disorders, and he will provide tips on how to improve sleep hygiene.

I think it’s fair to say that many people may not fully realize how much sleep can affect their mental health.  Can you walk us through some ways that sleep can either help or hinder a person’s mental wellness?

A:  Absolutely, sleep is really a new field of study, comparatively speaking; they didn’t really think much was going on up until maybe the 60’s or so where they actually realized there was a lot more brain function happening when we slept than what was once thought.  Prior to about 1959, sleep was looked upon as this sort of dormant period where it was involuntary- we know we had to do it but we didn’t really know why. We didn’t really know what the benefits were, although it was absolutely 100% necessary. Around 1958-1959, they started doing a couple of EEG tests, which are Electroencephalogram, and that’s where they realized that the brain is actually quite active during sleep and where sleep cycles kind of came from.

Sleep cycles are 90 minutes in duration where we go through the lightest stages sleep to the deepest stage of sleep and we close out with the REM period. That 90-minute cycle kind of repeats itself over and over and over again throughout the course of the night. Each one of those stages of sleep is really responsible in giving our body back something. Our slow-wave sleep is responsible for physical restoration; growth hormones release, muscle and tissue regeneration take place- so if you built a deck or went for a really long walk, or you’re coming from an operation, that’s when your body physically heals itself.

When we go into our REM sleep, that's responsible for our cognitive restoration, our mental horsepower where we have memory consolidation take place, so things that we’ve learned in the beginning of the week kind of consolidate into our long-term memory, so our memory recall this kind of impacted by that. So again, all of this different brain function that's happening while we're sleeping is necessary and it impacts our physical, emotional, and mental health on a great scale. What you want to consider is, you know, “Am I getting enough sleep?” “What is that kind of ‘magic hour’?” and “Is my sleep quality in nature?” There are a few different things that you want to examine there.

Something I was hoping you could touch on as well is sleep disorders.  Are there a lot of different types of sleep disorders, and how would a person go about receiving a diagnosis for one?

A: Yes! There is actually over 100 different types of sleep disorders and I know a little bit about all of them and a lot about most of them. Basically, there are some primary sleep disorders- things such as sleep apnea or restless leg syndrome, periodic leg movements then there's this whole subset of sleep disorders that are kind of categories into what they call parasomnias. Parasomnias are abnormal things that are happening throughout the course of the night, the most common one would be sleepwalking for instance. Another would be sleep eating; some people actually don't realize it but they’re fully asleep and they actually get up and then in an unconscious state make a full meal. They don't really understand why there's so much weight gain going on, but that's what's happening, they’re getting up in the middle of the night and preparing themselves a meal which can be quite dangerous, obviously. You can imagine somebody's actually cutting up vegetables or switching on a stove or something like that- it can be quite scary. So yeah, there's all these different types of sleep disorders.

With mental health it's really kind of a bidirectional relationship. People who have issues with mental health often have really poor sleep habits and people have poor sleep habits can potentially exacerbate any underlying health conditions, one of them being mental health. We really wanted to focus in on the amount of sleep; if we were to look at getting best optimal sleep for peak performance to make sure that you're well rested, to make sure they were able to handle anxiety levels next day, to be able to make sure you're able to handle the stress that’s thrown at you, seven hours is kind of the new research that just came out. I actually did the segment on 580CFRA last week and we talked about this. It used to be 7 to 9 hours to be optimal for peak performance (and that's talking about adult specifically, you want to make sure that we're capturing the right age group here, so if you are let's say a teenager early teens, you probably want to be somewhere between 9 to 11 hours of sleep) if you're an adult let's say over the age of 19 or 20, 7 hours seems to be that magic number now.

If you were to just do a simple Google search of what sleep hygiene is, that would be something that maybe some of the patients that would be listening to this could actually absorb some good takeaways and things that they could implement almost instantly; a lot of them are anyway. Sleep hygiene is kind of defined as best sleep practices. It doesn't mean having a shower before you go to bed to make sure you're nice and clean, it's those standard things that you do on a daily basis that will set you up for the most success when it comes to sleeping. One of the most important ones would be going to bed at the same time and getting up at the same time. We really want to keep that [consistent] and on the weekend, of course, allow yourself maybe an hour to sleep in or something like that. If we start shifting our bedtime and our rise time on a daily basis or even two or three times a week, what can happen is you can create a sleep debt for yourself. Bedtime and rise time is absolutely critical. Let's say you should make a strong decision that at 11:00 o'clock I'm going to go to bed and 7:00 o'clock every single morning you wake up and get your feet on the floor. If you end up sleeping in a little bit too much that day, then you’re going to impact your ability to fall asleep that night. if you go to bed too late and you have to get up early, maybe you're going to take a nap in the afternoon and now that's going to affect your sleep onset latency for that particular evening as well.

Just like when we were kids, sleep craves routine- it wants to be in that same kind of time frame. We talked briefly about sleep cycles and those are all kind of factored into this basic sleep hygiene tactic of same bedtime, same rise time. If we keep that consistent, our body will naturally wake us up and bring us out of a lighter stage of sleep because it's used to waking up and that sleep cycle will kind of exit itself naturally versus if you're going to bed and waking up at different times, you can wake up out of a slow wave sleep which is our deepest form and what you create there something called sleep inertia which is a sleep drunkenness, a sleep grogginess; you can actually wake up feeling exhausted and it can take two to three hours because you were ripped out of a sleep cycle that you weren’t actually able to finish. Again, one of the biggest things you want to look at is going to bed at the same time and getting up at the same time.

 Another good one for sleep hygiene best practices would be exposing yourself to daylight. This impacts our mental health as well- Seasonal Affective Disorder happens with the winter months -also called Winter Depression. Exposing yourself to daylight throughout the daytime is going to [help]. Light enters your eye via the retina, and it impacts we call your circadian rhythm. Your circadian rhythm is responsible for your sleep-wake cycle; it’s your body’s internal clock. The more exposure to natural light and daylight you can absorb through the daytime, it's going to put you in a position to be more tired in the evening. Alternatively, as well, you should be adjusting all the lights in your house maybe an hour two before bed you know.

Having a phone in your bedroom, or a TV is not a great sleep practice. It may be comfortable, and I know lots of people do it but a lot of studies show now that blue light actually delays the release of melatonin, which is a sleep inducing hormone. Your body is actually trying to fall asleep and try to release melatonin to your system to allow sleep onset to take place, but if you've got a phone staring in your eyes, it’s like shining a flashlight right into your eyes and that's going to delay the release melatonin, and in turn not allow you to fall asleep easily. National Sleep Foundation is a great source to go to, just type in sleep hygiene best practices. It all talks about the impact of caffeine, when we should eat our meals (not too close to bedtime), all of these different sleep practices, and again, a lot of them are things you can implement almost immediately, and they'll end up having a significant affect on your sleep in a very short period of time.

Just to touch on the technology a little bit, is there a specific time frame that you would recommend someone shutting off their phone or turning off the TV before they're trying to actually get to sleep?

A: The general rule of thumb would probably maybe an hour to two before bedtime. You almost want to kind of go with an old-school approach, maybe grab a book, turn down all the lights in your house or listen to some soft music, have a nice bath- routine is key. [You want to make sure] you're doing it consistently, nightly. You want to kind of set yourself up so that when it gets to the bedroom your body knows it's there to sleep; it's ready for it and you’ve done some steps that will allow your body to kind of unwind.

One other thing as well is we shouldn't be doing any of these types of things in the bedroom. If you want to read a chapter or something like that in bed, sure. But your bedroom should be used strictly for sleeping and sex, I suppose. All other activities should be really taking place outside of the bedroom. You don't want to associate any other activity like studying, any of your office work or anything like that with the bedroom. You want your body to know that when it arrives in that environment, it knows it's there to sleep and it's going to do that. With the pandemic over the last couple of years, a lot of people are working from home now and maybe they don't have the opportunity to work out of their basement and they have to make it work out of a one-bedroom apartment, so again these are guidelines, they’re not musts but it's what would set you up for optimal success for quality sleep.

Can you walk us through how Sleep Efficiency’s take-home testing differs from the traditional sleep clinic testing where you have to go in and stay overnight?

A: There's been a bit of a shift in the way Healthcare is being delivered right now, and it needs to. The population is going through the roof and a lot of the hospitals, a lot of the outpatient testing and things like that kind of still operate in an analog style; you’ve got to go to the building to get it done, it's got to be on a very specific date, so “We're going to book you for a test six months from now on Wednesday at 9:00 o'clock at night” a lot of people have a hard time committing to that. What we offer is diagnostic take home sleep testing where this is all done from the comfort of your own bed. It's specifically looking for sleep apnea though, so if the indications are that maybe some of your symptoms are that you wake up gasping for air, you’re excessively tired through the daytime, morning headaches, these types of things would indicate that maybe sleep apnea is the culprit then that's what we specifically test for; any sort of respiratory related sleep disordered breathing. If you have issues like insomnia for instance, or you want to investigate any sort of those parasomnias that I talked about (e.g. REM behavior disorder) then your hospital is a lot more comprehensive and they still serve a wonderful purpose. However, the wait times for sleep tests (in hospitals) are in excess of six months, whereas with Sleep Efficiency, we're able to offer patients sometimes a next day appointment, and if not, definitely within a couple of days. It's the notion that they come to the office, they pick up one of our kits, they go home, they sleep with it in the comfort of their own bed, and it's all around their sleep schedule- whatever time they want to go to bed. You know, a lot of shift workers can't go to a sleep test at the hospital because their shift maybe starts at 10 or 11:00 o'clock at night and they work all through the night, so we kind of cater to a large group that would prefer that. A lot of patients with PTSD don't like the idea of sleeping in a hospital- I don't like the idea of sleeping in a hospital, to be honest, on a bed that's been slept on 1,000 times before with overhead pages going. It's not really conducive to a good night sleep.

Sleep Efficiency was kind of born about 4-5 years ago where I saw the need to offer a different type of service where we could offer a more timely service. You want to think about as well, if you're waiting for a sleep test and it's going to take six months, we can alleviate some of those people that don't need to be in that lineup. We can rule out a lot of people in a very short period of time so that will actually allow access to those who need hospital-based testing a lot sooner; we can kind of get rid of the ones that are there that don't need to be [tested at the hospital]. Of course, and it's an elective service, so they think maybe somethings wrong, but it's not as critical. The point I'm trying to make here is you shouldn’t maybe have the 70 or 75 year-old in the same lineup is the 19-year-old. If the 75-year-old has some serious cardiac disease and they have severe sleep apnea, it can put them in an increased risk of heart attack, stroke and congestive heart failure. If the 19-year-old has just got some sleep phase syndrome where they have problems regulating their bedtime and rise time and it's just simple behavior modifications, those two people shouldn't be in the same line up to get the same kind of testing done. We want to make sure that the people who truly need hospital-based sleep testing are getting it done, and then we can help out in that capacity- and we are, we’ve seen several thousand patients now over the last couple of years.

If anyone is interested in contacting you what would be the best way to go about doing that?

A: Our website is probably the best point of contact, all the information is there. It's www.sleepefficiency.ca. Patients can actually self-refer; we don't require a referral from the physician, although we do require a family physician involved for follow up. They can actually go directly to our website, www.sleepefficiency.ca, they can click the request sleep test, submit their own referral and we can offer them appointments as quickly as it just a couple of days later.

Thank you so much for joining us today Andrew!

Cap Psych Pod Episode 4: Grief and Loss

Today we’re joined by Selena Ladouceur. Selena is a Registered Psychotherapist (Qualifying) here at Capital Psychological. Selena received her Master of Arts Degree in Counselling & Spirituality from a joint program with the University of Ottawa and Saint Paul University. Her therapeutic intention is to focus on working with individuals and families to help them heal and process emotions in a supportive, non-judgmental, and safe environment. She typically takes an empathetic approach to treatment, concentrating on theoretic lenses best suited to Humanistic, Person-centered, and Emotion-focused therapy.

Today we’ll be chatting about something most everyone has experienced or will experience in their lives, grief and loss. Selena, thanks so much for joining us today.

S: Thank you Kristin for having me and taking the time to share this topic.

Many of us have likely heard of the stages of grief- can you walk us through them and how you would recommend coping with each stage?

S: Sure, so I think first it’s really important to discuss that losing someone or losing a pet, a relative, a loved one- it is never easy to lose someone or experience the grief that’s associated with a loss. So, it’s important to learn how to cope with it and eventually get to a place of being able to accept what has happened.  I’d like to start off by sharing a little bit about grief and what some definitions of grief and loss look like and can include. Grief is very much an emotion generated by an experience of loss and it’s not really stable- it’s not something that once you reach it, it just stays there. It’s something that can change, it’s something that can be felt stronger on specific days. It’s a process, and one that’s never ending. It’s continually manifesting. We can think of grief as a stranger living with us or as something that can be experienced and then accepted but not overcome.

I have a definition of grief and it states “it is the response to loss, particularly to the loss of someone or something that has passed away to which a bond or affection has been formed. Although conventionally focused on the emotional response to the loss, it also has physical, cognitive, behavioural, social, cultural, spiritual, and philosophical dimensions.” I took a grief workshop and that was something that was explained to us in that workshop, so I thought it was important to state that.

Some other definitions explain it as there’s a grief period, a mourning period, a bereavement and then the grief work. Grief Is the natural response to the loss. Mourning is the external or public expression of the loss or of the grief. Bereavement is the stage of having suffered it, and the grief work is the work of dealing with the loss. One thing that I think is really important to talk about is the Kubler-Ross model for grief: it’s the 5 stages of grief. It described 5 primary responses to the loss. These stages are not a linear process, nor do they require completion.  An individual can retreat backwards at any time, and they can also move forwards. It’s back and forth, it’s not kind of that one pathway. For example, a person may feel that they’ve fully moved past something and then the next moment it can jump right back at them. This occurs because grief is insidious and demands to be felt. These stages include denial, anger, bargaining, depression & acceptance.

Denial is the first stage and this stage the reality of the loss is questioned. A person may believe that there was some sort of mistake or mix up or an incorrect diagnosis; especially with cancer victims for example, this is when they’ll try to hold that hope that maybe it’s not as bad as it sounds, maybe there’s a way that with proper treatment we can cure it- kind of that stage.  They may cling to this false reality and prefer to kind of stay there.   

With anger, those who are grieving may begin to cast blame or ask questions like “why me?” They may become angry with the deceased person “they left me” or in the case of a suicide, they can say “it was selfish of them”. They can turn to that kind of resentment.

Bargaining is the next stage and this stage the individual will attempt to bargain away to avoid their cause of the grief. For example, after receiving a terminal diagnosis, they may plead to God “I’ll eat healthier, I’ll quit smoking, I’ll do anything and everything right just so I can get better.”

The fourth stage is depression. During this stage, they’re grieving enters a period of darkness and sadness. They may lose motivation for living, act like themselves and enter the mourning. So sad, why bother with anything.

The next stage would be acceptance. In this stage, they come to accept the loss, although there may still be pain, we like to refer to this as “open wounds” or “raw wounds, raw feelings”. During this stage, there’s a sense of calmness and a resumption of normal activities. It’s okay, going to be okay, things like that.

One thing I also wanted to mention was there’s a lot of myths vs realities around grief and loss. Some myths are things like we only grieve deaths, where in reality, we can grieve every loss. Another myth could be grief is an emotional reaction- grief is not that- it’s actually manifested in many ways. Another myth could be that we should grieve at home- in reality we cannot control where we grieve; it may hit us in a store, triggered by a memory, those kinds of things. It could be physical, spiritual, and emotional and it can occur at various times and places. You can kind of think of it like an ebb and flow.

K: Okay, that makes sense. I’m glad that you mentioned that it doesn’t have to be a death because I know a lot of people think of death when they think of grief and loss, but it could be like a job or anything really. 

How do you recommend helping a friend or family member who may be experiencing a loss?

S: So, mourning a loss like we had previously kind of said is not linear. It’s something that I would try to help them understand. I would share with them what the stages of grief are and how complicated they can be, and when we’re looking at the task associated with mourning, how can we observe that they may be revisited many times over before they’re able complete that mourning stage.  I think I would look at it almost like tasks; I would say the first task would be to accept the reality of the loss or get them to accept the reality of the loss. Often after death, survivors struggle to accept the reality of what’s happened. They also may deny the significance of the loss, accepting that the reality of the death means that coming to terms with the loss both emotionally and intellectually will be necessary.

 Another thing you could do would be to help them process their grief. This task would involve confronting emotions, even the painful ones, encouraging them to express it, recognizing when they are experiencing the pain, naming the emotion, and learning how to cope with [the emotions].

Another task could be to adjust to a world without the deceased. After a loss, many survivors face a world without their loved one and this can be where that wound hits you, you wake up in the morning and your partner’s not there or going into a room where a loved one used to sleep and they’re not there or seeing a dog bed on the floor where your dog used to sleep, anything like that.  This task would involve making internal, external, and sometimes spiritual adjustments to the loss. For internal adjustments, these are going to change one’s identity- survivors must ask themselves “who am I now without this loved one”. External adjustments can include taking on different roles and responsibilities, for example a spouse who was responsible for childcare may now have to seek employment outside of the home. Spiritual adjustments involve changes to a person’s world view, the beliefs, and assumptions. For example, someone who believes that the world is a fair and kind place may no longer feel this way after the loss, and they may start to resent everything around them and have that external blame.

Task four I would say would be to find a way to remember the deceased while still moving forward in life. This means keeping a place in your heart for that person that you lost while being able and willing to move on with your own life. You know how when people always say “carry a piece of me in your heart” it’d be that sentiment- that person is always there with you. This may also mean allowing yourself to be happy and to love again which can be sometimes very difficult, especially after you know, you’ve had the same partner for 40+ years, it’s easier for people to say move on than it is to actually move on. So just holding the space of the person.

K: I know a lot of the time people feel a lot of guilt with that as well.

S: Yeah, so for the four types of loss, to explain too would be the anticipatory grief, delayed grief, disenfranchised or ambiguous grief or loss, and complicated loss. To explain these, the anticipatory grief is a grief that is experienced in advance or impending, so this would be for example a cancer patient finding out it’s inevitable that they’re going to pass or someone who was hit by a car and maybe there’s internal bleeding, etc. or there are complications due to this injury. There may be that anticipation that that could be the outcome. I think that the biggest difference there is knowing it could be coming vs not knowing, vs the sudden. Delayed grief- this emerges if not given time to process an emotion, so it’s expressed at a later time than maybe when the loss was experienced.  Disenfranchised or ambiguous grief can occur when others do not recognize of honor the loss. These terms can be used interchangeably, and it’s surrounding a loss [when] reason of the death is unknown.

Complicated grief can be debilitating, it can be intense, it could be an intense longing for the deceased, parental bereavement, risk factors along with support system not being there anymore. This grief refers to grief that is so severe and long lasting that it significantly impedes the persons ability to actually function. To help support someone through grief too, I think there’s’ a couple planes I could kind of touch on there:

Acknowledging what they’ve been through, so validating what they’ve been through, supporting them. Using terminology- “that sucks, that’s horrible, I can’t imagine how much that hurts”. You want to offer that solace but also that comfort of sitting with them and it’s uncomfortable- it’s hard. Allowing them time to mourn, but giving them space, and letting them mourn without judgement. There’s not a timeline that they have to meet, it’s okay to take 20 steps backwards if they need to, just give them that space to do that.

Creating an environment that facilitates openness. Being there, sitting with them even if it’s just in silence. And acting normal, maintaining a normal because a lot of the time the worse thing someone can do is treat someone differently.

K: right, like tiptoeing around them.

S: Exactly, yeah.  And then, you know check ins too. How are you doing? Do you need anything? Can I bring you food? Things like that. Check-ins that aren’t always considered a “check-in” if that makes sense. And then suggesting professional help I think is really important, you know. Losing someone can be incredibly difficult and there’s so many different types of loss. It can be the loss of a spouse through death, it can be maybe a heart attack or a stroke that can cause changes in the person, there’s so many different ways to lose that connection with someone. I think being able to reach out for help is something that’s really important.

So, obviously grief and loss is a difficult subject for anyone but how would you suggest speaking to a child about a loss?

S: When a loved one dies, children often do not know how to react to the news in the ways that we, as adults do. Their reactions can be very different than ours, and their emotions are not always understandable to them. Emotions are BIG and sometimes the children just don’t have the ability to kind of recognize or understand what it is that they’re feeling. This can often be due to barriers like I said, their age, maturity, understanding of what happened, the understanding of what death is, the fact that they have been sheltered by death possibly and having never experienced a loss before. This can be really difficult too especially if you think of it in the way of spirituality- do they have a belief? Do they believe that the person went to heaven? Can you talk about it in that way? Do they not have that belief? So, religion and spirituality will definitely kind of come into play there as well. 

I think younger children (preschool age) see death as temporary. Sometimes they still believe that it’s reversible, and that that person can come back. Once a child reaches the age of 5-10, then they start to think more like adults do, so they still have the belief that it will not happen to anyone they know, but when it does happen, they’re able to understand the severity of it; they kind of don’t have that belief that they can come back anymore.

Three key things to remember when explaining death to a child are being honest & encouraging questions, listening to them and keeping it age appropriate. I think those are the three key things to remember when you’re explaining this to your child. During your explanation, let the child know that it’s okay to ask questions, anything that comes to mind for them- be open, be supportive, be validating and then sharing it in a way that they can understand it. For example, explaining it to a five-year-old would be very different than explaining it to a twelve-year-old. Making it age appropriate, I think that’s going to be really important.

You can also let the child guide the conversation- how are YOU feeling? What do YOU understand about it? Being curious, asking them what they understand. Children who are having a serious problem with grief can start to show signs and that’s something I think is really important to watch for. If they have an extended period of depression in which they lose interest in daily activities or events or things that they would engage in previously could be concerning. Having a loss of appetite or a change in appetite, change in sleep patterns, a prolonged fear of being alone. They can also become anxiously attached, meaning that they don’t want the parent or loved one that’s left behind to be away from them for long periods of time, or even at times be out of their sight. That can be something that can cause a lot of stress to them. Acting much younger for an extended period can be another one, withdrawal from friends, not wanting to do things, not wanting to act out socially, and believing that they’re talking to someone or seeing he deceased family member for an extended period of time can be something to watch for as well.

One other thing to note is long-term affects of bereavement on children. Children who are bereaved early are more likely to develop psychiatric disorders in later childhood. This was found from a study by The National Library of Medicine in 1998. It found a fivefold increase in children’s psychiatric disorders in bereaved children compared to the general population. Something else to watch for too is denial of the death or avoidance of the grievance. Acting like nothing’s happened- that can be something that can be concerning as well.

You kind of touched on it a little bit but grief and depression can often go hand-in-hand. What are some signs that someone might be falling into a bout of depression and that they may need some professional help?

S: That’s a really good question because they do, they definitely go hand-in-hand and there are definitely some symptomologies that overlaps or cooccur. First, I think it’s going to be important to know some symptoms of depression. If you look at the DSM5, fatigue or loss of energy, feelings of worthlessness are all classed under depression. It diminishes an ability to think or concentrate, it can include indecisiveness, recurrent thoughts of death, suicidal ideation without a specific plan, or possibly even a suicide attempt or plan for committing it. Those are some things to really watch for in depression.

Grief is more the reaction to a loss and it’s more that natural sadness that occurs. When you’re experiencing depression on the other hand, it has a component of negative self focus- guilt, worthlessness, internal self negative talk, I guess you could say.  It tends to be accompanied by feelings of apathy and hopelessness. If a person feels that it’s hard to move, get up, motivate themselves, or they feel that their sadness is persistent or ongoing, never changing, depression is likely the cause. With grief, these moments of moving forward beyond those difficult ones will more ebb and flow so they become less frequent and will offer pleasantries with friends and family afterwards. Unfortunately, with depression, it will take away those pleasantries and this is usually caused because of loss of perspective. That indecisiveness comes up there, or that difficulty concentrating or thinking of anything but the sadness. Depression can sometimes advocate for permanent measures to be taken, as I said before, it talks about it in the DSM5, when there’s significant emotional pain and wanting to just end that pain, suicidation can occur so that’s something where if you’re talking to someone and see the signs and they start talking about “why am I here” or “maybe it would be better if I wasn’t here” that would be a really important time to encourage that person to seek immediate help before engaging in any type of self harm behaviour.

Something that people often talk about is survivor’s guilt.  Can you kind of explain what that is?

S: Yes, survivor’s guilt is huge. I worked with a client who was grieving a loss and it wasn’t until we hit this connection for her that it was like wow, that’s what I’m feeling.  A lot of people don’t know about it. Survivor’s guilt is a particular type of guilt. It may develop in people who survived a life-threatening situation or witnessed a traumatic or catastrophic event.  Even someone who had been the caregiver for a loved one with cancer- watching the disintegration of the person. They can go from being who they are to a very fragile state before impending death. That can be extremely traumatic to witness and to go through. Individuals believe that it’s unfair that they survived when the other person dies, and this can lead them to thinking that they did not do enough to save the life of that person. It’s going to be really important to talk to them about how they’re feeling, what they’re feeling, and explaining to them- especially when we’re talking about an impending death, there is nothing we can do.  The fact that they survived doesn’t make them a bad person. I think it’s important when you’re discussing that with someone to make that very clear to them. It’s okay that they survived, and they don’t have to feel that guilt.  Some symptoms of survivor’s guilt can include nightmares, difficulty sleeping, flashbacks to the traumatic events, and a lot of times too they’ll be almost a suppression of it, so when these triggering moments happen, it’s reliving it all over again because they’ve suppressed it, they’ve tried to forget it.  It can also include loss of motivation, irritability, a sense of numbness and thoughts about the meaning of life. They can start to question “what is the meaning” It’s important to know in times of that to rethink back to Viktor Frankl, what is the meaning of life? What is the purpose for you? What’s meaning making for you? It’s really important to explore what that person’s vision is for themselves moving forward. I think it’s important, kind of like when you’re helping a friend go through losing someone, it’s also important to talk about how to help someone going through survivor’s guilt. They’re much the same- acknowledging what they’ve been through, allowing time to mourn, being kind and patient, creating an environment that facilitates openness, normalization, checking in, and of course suggesting professional help as well.

Some coping strategies for dealing with survivor’s guilt can include things like seeking help, talking to someone, getting that professional perspective, self-care routines are also considered to be a very important part of emotional healing, and that goes for any type of grief or loss- making sure you’re taking care of YOU- you’re taking care of yourself.

Grief can lead to both physical and emotional symptoms, as well as spiritual insights and confusion. While grief is a very natural an inevitable part of life, it’s also one for the most part that can be neglected and misunderstood. Having this experience, it’s really important to allow yourself the time to grieve. Allow yourself to go through that loss, allow yourself to experience the feelings. And then you get to a place of acceptance, and like we said before it’s not linear- it’s going to be something that’s continual, it’s going to be a process. It’s something that you’re going to take 20 steps forward and then 20 steps back and that’s okay. I think it’s important to say that.

Thank you, Kristin, for having me, I hope I was able to shed some light on the grief process, and what affects and impacts it may cause on the individuals who have lost a loved one. I think it’s also important to remember that our job as therapists is to hold space and provide validation and support for our clients as they go through the stages and ultimately just help them get back to what an everyday life can look like for them.

K: Absolutely, thank you for joining. Grief isn’t something that people tend to talk about very openly, so I think it’s important that we open the doors to this conversation and get people talking about it, because it definitely can be very helpful.

S: Absolutely, I have some resources too that I wanted to share.  One of them was the Bereaved Families of Ottawa Group It’s a volunteer-run group and it offers drop-in sessions and also sign-up sessions, so you can do smaller groups if you prefer and it depends on what your needs and preferences are, they kind of cater to that which is good.

Also, there’s another group called Grief Shares it’s a grief recovery support group where you can find help and healing for the hurt after the loss of a loved one.

Thank you so much again to Selena.  If anyone would like to book an appointment with Selena or any of our other therapists, please call the office of visit www.capitalpsychological.com

Cap Psych Pod Episode 3: Alcoholism and Addiction

Today we're joined by Matthew Champ, Registered Psychotherapist. Matthew studied criminology and psychology in university with a focus on addictions and substance abuse. He has been involved in the mental health counseling field since 2010 and has been at our clinic for just about two years now. Matthew has worked with people from all walks of lives, ages, and backgrounds including both institutional and private settings. Today we'll be covering some specific questions on the topic of addiction, including the stages of addiction as well as the 5 D’s of alcoholism. Matthew thanks so much for joining us today!

M: Thanks for having me.

K: No problem! So, just before we jump into some specifics, can you tell us what exactly addiction is?

M: Yeah, that's a big question- what is addiction, right? Because there's so much that goes into addiction. Addiction for the most part is a chronic relapsing disorder characterized by compulsive drug seeking; its continued drug use despite harmful consequences, and it has long lasting changes in the brain. So it’s a little bit of a brain disorder as well as a mental illness at the same time. We have these intense cravings but we lose our control over our ability to moderate how much we're using. That's the textbook definition of addiction, but there's so much more that can go into addiction.

There's a journalist by the name of Johann Hari and he did this amazing Ted talk called  “Everything you think you know about addiction is wrong.” Have you heard of that Ted Talk, Kristin?

K: I haven't, no, but that's definitely something that I can link if anyone’s interested.

M: Perfect, because it's fantastic. He talks about addiction being a lack of community, a lack of support, a lack of resource because addiction often times is steeped in shame; it's steeped in stigma, avoidance and isolation so ultimately whether we're talking about addiction to substances like cocaine, alcohol or indamines, he would be looking at this [and] going “well let's talk about addictions to things like sex or screen time on our phones.” You know, for some people it's addiction to food or to working out and exercise 'cause we can technically become addicted to almost anything. Ultimately, addiction is when we separate ourselves from our community so it's a really interesting concept that he talks about there. He kind of takes the textbook definition of addiction and he expands on it by bringing community and our need as a society to really help each other out into the the picture and it's a really interesting Ted Talk to explore what addiction is past that textbook [definition].

K: It's interesting, whenever I hear addiction I never think of phones or anything like that. In my head, it's always drugs or alcohol- so it's interesting that you bring that up. I'm sure a lot of people probably feel the same way.

M: Absolutely, you know, we live in a world now [where] our phones are so important to us, right? We go everywhere with them- when I leave the house it’s always like “OK, I’ve got my phone, I’ve got my keys, I’ve got my wallet.” Ten years ago it was like “I’ve got my wallet and my keys.” In the last ten years even, we've gotten to the point where we're so dependent on having our phones where when we get into situations where we're bored, we pull out our phones. We will sit on a bus and we'll sit there on our phones rather than engage with the world around us. You go to the mall (well, not in the last two years obviously with Covid), you go to the mall and go to a food court and you see people off in their little corners at their tables and they just all on their phones. So yeah, addiction ends up becoming that compulsive seeking for that dopamine release, and we can get that through any time phone goes off, we get that through that burn that we get at the gym, we get that through anything really that's not just alcohol or drugs. I'm glad we were able to actually touch on that because it wasn't really until the last 10 years that we started seeing people being flagged as having screen addictions and phone addictions. Even over the last 20 years, pornography addictions with the access of the screen and the internet, that's made those types of addictions even more prominent in our day-to-day society.

K: Definitely! So, can you walk us through the different stages of addiction?

M: Yeah, absolutely. Let's not actually call it the stages of addiction- let's call the stages of use because addiction is only one stage in the stages of use. If you were to Google “what are the stages of of use” or “stages of addiction,” you're going to find people will often say that there are four stages. They'll say experimentation, regular use, high risk use, then addiction. I think that we should actually be breaking it down into about 6 steps.

There are six stages, really, I think that are out there because we have to recognize that not everybody is a user, right? So, for talking about stages of use we have to start with the first stage: non-use. Some people don't drink alcohol, some people don't smoke marijuana, lots of people don't smoke cigarettes or use cocaine, so we do have to start off with that non-use stage because that is number one. From there, the first reason that people typically start to use is they experiment with something, right? So, you know, they either hear about it from a friend or they see it whether it's in media or with marijuana recently being legalized in Canada suddenly it's like oh, well there are now stores on every single block that I can go and try this.

K: Multiple stores on every single block.

M: Not everybody here might be living in the Ottawa area but it’s so funny if you go down Richmond St through Westboro, there is literally a block where there are four pot shops within a block and a shop where you can go get your bongs, rolling papers and vape stuff across the street. How do you all stay in business when you're in direct competition with each other?

K: Yeah, even close to our office, on Hazeldean Road there are three strip malls in a row that have a shop in them.

M: It’s funny because you’re now driving past more pot shops than you are beer stores or liquor stores. But, seeing all those pot shops leads to that curiosity, right? So, why do people start to use? They start to use because they’re curious. No one ever picks up a substance or a drug and says  “I can't wait to be addicted to this,” right? So we start with that idea, “I’m just going to try and see how it makes me feel.” Usually experimentation then, before even leading into regular use, it goes into social use. A lot of times, you go and you try a substance; maybe for a teenager it’s trying alcohol, maybe for someone else it's trying pot, or you know, maybe even trying MDMA or cocaine or speed or another street drug. At first, it starts off as kind of a ‘fun’ thing to do. When is it fun to do? When we’re being social, so drinks at parties, smoking weed with your buddies, when you're at a party, cocaine is sometimes that bump that people use just to get them through the next hump of “I can now go and have five more beers.”  and so well that might be a binge, someone might actually just put that binge into social use. They're only using or only bingeing when they go to parties, and that might be very rare.

There are some people that I’ll work with who go to parties every single week, and that's where their main drug use is, so it’s no longer “social” as much as it is the next stage of habitual use. Now it's “anytime I go to a party I'm using it, and I'm going to parties all the time,” or “I'm having a drink every single night with dinner,” or “I'm smoking weed every single night before I go to bed.” Habitual use doesn't necessarily mean that we're using it to get intoxicated. A glass of wine at dinner or a beer at dinner is not going to lead to intoxication for the average person. Smoking a joint before going to bed may be more medical than it is drug seeking. We can look at that habit and [see] that there's a habit, but that habit doesn't necessarily mean that we are over using or indulging to do damage. Once we realize that there is a habit forming, we have to be very wary of it because it's very easy for habit to slip into abuse.

Abusive use is our next stage. Abusive use is ultimately “I am using to get intoxicated.” I may not necessarily be chemically dependent on this substance, but I'm now drinking three or four beers every single night to get a buzz, or I am now smoking weed to be high, or I am using to feel that rush- to get that dopamine release. This is also an interesting stage because you can be in abuse stage while you are experimenting, while you're in a social stage, or while you're in the habitual stage because of binges. If we're saying that someone is a social user and they only go out to a party once every two or three months, and they use then; but when they do use, they get rip roaring drunk or high out of their minds, we would then say in this moment of use, you are in the abusive stage because you're doing this to be intoxicated.

Now, there comes a fine line of abuse leading potentially to addiction. Not for everybody, but it can for some people because the biggest difference between abuse and addiction is the need. The abuse is the the want.  “I want to be intoxicated” versus addiction becomes that need. “I need to be intoxicated; I work more at my baseline when I am high or when I am drunk” and it becomes that idea of abuse may be impacting our lives with harmful consequences because of hangovers, but addiction would be “I need to get through my day by being drunk,” or “I can't go to work without being drunk,” “I can't sit with a family without being drunk,” “I can't take care of my kid without being drunk.” It starts to take over that person's life and it's no longer a choice. It becomes that necessity and that dependence part.

The biggest thing here is acknowledging that when we're in an abusive stage of alcohol use or substance abuse, we really want to be checking in to make sure that “I don't actually need this.” Once we hit that need, well then it becomes hard to stop; now our brain has started to change, our body has started to change physiologically to that response, and now we're only getting our big dopamine or serotonin releases when we use our substances and not when we are doing the things that would normally release dopamine for the average person.

 I used to do these prevention presentations and I built a curriculum a few years ago that was working with a lot of grade seven and eight students and when I was explaining the difference between substance abuse and addiction to them, I would often talk about things that normally produce dopamine. If we go back in evolution days to caveman days, dopamine was released when we did something to survive. You drink some water, you survive. You eat some food, you survive. You have a good sleep, you survive. That’s what allowed our brains to release dopamine to make us feel good, like “Hey, you're surviving! Have some of this ‘feel good juice’ and feel good.” But as our brains have evolved and as our world has become a world of stimulation, everything kind of releases dopamine- just different levels of it. Living in Ottawa, we've got a lot of Ottawa Senators fans here and if you're watching a Senators game and they score, your dopamine gets released and you feel good. If the Senators win, you feel even better because you get a lot more dopamine. We have so many more food options; we don't have to eat the same thing over and over again so if pizza is your favorite food and you sit down and have pizza your brain explodes with dopamine and it feels fantastic. Maybe you love to travel, so going to a new place you've never been before, your brain explodes with dopamine and we feel good. Where addiction comes in is addiction takes down that dopamine release for everyday things and ultimately makes us dependent on getting our dopamine from our substance use or abuse. It's a really kind of interesting thing that our brain does there, when we hit that addiction stage.

I know that I've already thrown one YouTube video at at y'all to take a look at, but if you want a really good picture as to the stages of use that lead up to addiction, I would highly encourage you to watch this video by Film Bilder. It's a very sad, depressing little cartoon but it's so fascinating in its simplicity that I encourage pretty much anybody to watch it if they want to have a good understanding of what addiction looks like.

K: I've heard you talk about the 5 D’s of alcoholism- can you walk us through what those are?

M: Yeah, absolutely. I’ve talked about the 5 D’s lot with clients because the 5 D’s are simple. A lot of times when we're doing recovery work with addicts, it seems very complicated and complex, because ultimately the emotions are complicated and complex, the state of mental wellness is complicated and complex, so I like to do something very simple to start which is to acknowledged five different ways to manage cravings without it being too hard. Having them all start with D is fantastic because it makes it a little bit easier to remember. If you're a client of mine,  I'm sure you've heard me mention the 5 D’s before.

The first one I actually want to focus on is not usually the first one I talk about with clients but it’s deep breathing. The reason that I bring up deep breathing first is [because] I believe that therapy is a huge piece of learning mindfulness for oneself, and I think that mindfulness is probably one of the biggest things that our society has kind of thrown behind because we're all either future oriented or past focused. Mindfulness is ultimately bringing ourselves back into present; bringing ourselves back into the “now.” When it comes to addiction, a lot of times there's a lot of shame built around it and there's a lot of stigma and taboo around it where people automatically assume the worst thing about someone when they hear the word addiction. By deep breathing, it allows the person not to be focusing on the past or the future but to be focusing on the present. It helps us slow down our hearts, and when we slow down our heart what we're doing is we're slowing down how fast the blood is rushing through our body; we’re slowing down our stress response. Taking the time to sit down, close your eyes, do that deep breath in through your nose for 5-6 seconds, hold it for a couple of beats, and then exhale through your mouth for about 5 seconds as well, and then a hold before repeating is going to allow us to focus the mind, focus our energy for actually managing the cravings. Deep breathing is very important.

 The second D that we need to kind of then put into play is delay; can we delay our craving? Perhaps you're someone who is what we call a “functional alcoholic.” A functional alcoholic would be someone who can go to work; they have a job, they have a family, they've got other things going on, but when they're not doing those priorities they are drinking and drinking to a state of intoxication. Maybe it's that they get home from work everyday at 4:00 PM and their first beer is cracked at 4:05 PM. The big thing is the delay- how long can I delay the start of my use, because by delaying the start of our use we actually do reduce the amount of harm that we're ingesting in that day. Maybe it’s a reduction of a grand total of 1 beer in the long run, or one use. Maybe it becomes a reduction of two or three, and if that still leads to intoxication, that tipsy feeling or that buzzed feeling that the individual is looking for, we do know that simply reducing the amount that we ingest means that we've reduced the amount of harm that we are potentially facing. I always encourage people to start with 5 minutes or 10 minutes. If you get that craving right away, you say “I'm going to wait 10 minutes.”

That's where we can throw in our third D which is distraction; what can I do to distract myself for the next 10 minutes or 15 minutes? The hope is that come the end of 10 minutes, the cravings have dropped a little bit and maybe the distraction has kicked in so that way we're not necessarily as tempted to go straight to the fridge and crack open the drink or it allows us to reset that delay for another 10 minutes. I encourage people to find useful and productive things as distractions- for some people it might simply be sitting down and watching something on Netflix- if we sit down and watch something for 25 minutes, hey, we’ve delayed that use for 25 minutes and we’ve distracted our mind for that time. Perhaps it’s distracting ourself by going for a walk, maybe we’ve got a kid in the house so we’re going to do some colouring with the kid and distract ourself with our other priorities. Maybe it’s distraction through music or taking a hot shower or a hot bath and pampering yourself a little bit. Maybe it’s simply going upstairs and reading for a little bit or doing a workout or an exercise; anything that’s going to allow you to get a little bit of a dopamine release without necessarily feeling like you need to continue using.

From there, we go into drinking water- drinking cold water. That's going to help calm down our heart as well. It's going to kind of come back into us and go ‘we are consuming something.’ For some people that I work with, I’ll tell them to keep a tub of vanilla ice cream in the freezer and anytime they get a craving, going take a scoop of vanilla ice cream and let that cold, sweet ice cream kind of trickle down the back their throat. It's going to help slow down the heart rate with how cool it is, it's going to slow down our thoughts, and it's also going to just allow us to feel a little bit better. It’s a nice way of having another distraction or delay in play.

The fifth D, which is probably the most important D is discussion. This allows us to have some semblance of accountability and community. If we go back to that “what is addiction” [question], and we say “well, addiction is the absence of community.” How do we combat addiction then? It’s when we build ourselves up with a support network, we build ourselves up with people who aren't going to judge us for having a substance abuse problem or an addiction issue . We have a support network [for when you say] “I've got a big craving I've just tried distraction, delay, deep breathing and drinking water or eating a little bit of ice cream and I'm still feeling this intense urge or this craving” Who do I have that I can call? Who do I have that I can send a text message, or send an email to and say “Hey, I'm struggling right now and I could just use an ear or use someone just to know what I'm going through”? That gives us that little piece of accountability so that other people are invested in our wellness as well. This is why, if you think about resources like Alcoholics Anonymous for example, the sponsor program is such a huge part of that program because it's about “hey- you have a craving, it's hard to deal with this on your own, you've now got someone you can call, you’ve now got someone who can help talk you off the ledge and you’ve got someone with that lived experience to be able to help talk you off the ledge.”

 Very simply put, we do deep breathing, we delay, we distract, we drink cold water and we have discussion. Those are the first really simple steps in managing our cravings when it comes to substance abuse and addiction.

K: That's a great start -I'm sure we could circle back and talk about this for hours.

M: Absolutely. I know that that was the big last question you had for me, but I do want to give some resources around addiction or substance abuse issues.

You can obviously reach out to Capital Psychological- I'm not the only person here that has a background in working with people who are living with addictions. There are some therapists that can take people on pretty soon.

 We also have to recognize that therapy is expensive and usually going hand in hand with addiction is financial issues as well. Actually, side note- when we were talking about all the different things that people can become addicted to, we totally forgot gambling which is huge. It's hard for someone who might be living with a gambling addiction to be able to go “well, can I afford therapy?” [or] to focus on therapy when all of their money has gone into their gambling addiction, so there are a lot of other resources that I want to give that are out there. I believe that our duty as therapists or mental health workers is to ensure that our clients are better off after we've talked to them than before we talked to them, and part of that also means understanding the financial pressures.

Ottawa has a number really great resources for people who are living with addictions. Outside of Alcoholics Anonymous or Smart Recovery, which are both support groups. AA does the 12 step program, which is highly steamed in Evangelical Christianity, so that really pushes some people away from wanting to get into it. Smart Recovery has become a very good alternative to that.  I always joke that Alcoholics Anonymous was made by middle class, middle aged white dudes for other middle class, middle age white dudes (that’s a generalization of AA). Smart Recovery has been a really good diverse counter to AA for a lot of people and I've seen a lot of good success with Smart Recovery groups. I believe that there's a good one that's being run out of the Royal Ottawa right now.

Speaking of the Royal Ottawa Hospital, they have an amazing concurrent disorders program that is 100% free- all you need to do is call up the Royal Ottawa, ask to be transferred to the concurrent disorders program and they will have you go in, do an intake and you can either do inpatient or outpatient there, but it is an intensive program- it's usually four to six weeks and it's every day all day.

We in Ottawa have as well OARS, I guess it's now called SAR which is the you know Ottawa Addiction Referral Services, so if you don't know where to go, you can call up SAR- they’re attached the Ottawa Withdrawal Management Clinic down on Montreal Rd. What they'll do is they'll do a long assessment with you. After that assessment, they will provide you with options that fit within your budget or fit within where your addiction actually currently lies.

They might recommend something like Rideauwood Addiction and Family Services, which have programs for pretty much anyone between the ages of 8 and 98. They've got programs for family, for children, teenagers, they've got a school based program, they've got an adult program, they've got a drug treatment court. They also have a gambling program, which is why I wanted to bring them up because there aren't a lot of gambling programs in Ottawa, but they are one of the few gambling programs that is completely covered by the government.

They might refer someone under the age of 24 to the Dave Smith Treatment Centre. That's an inpatient treatment centre for youth and young adults who are struggling.

We also have the Mental Health Crisis Line. The Mental Health Crisis Line (613-238-3311) is a 24/7 line and they will be able to connect you with other resources as well.

If you're looking at going into actual in-person treatment rehabilitation, Merrickville has an amazing program called Newgate 180. That one is not free, unfortunately, but it's just a spectrum of different resources available.

A big one for parents who might have youth or young adults in the family who are living or struggling with substance abuse is  The Parent’s Lifeline of Eastern Ontario. This is such a fantastic organization; it is run by other parents who have had children with either serious mental health issues or serious addiction and substance abuse issues. They have a 24/7 crisis line- I believe the number is 613-321-3211. They also have a youth group for these youth who might be suffering from substance abuse issues or mental health and mental wellness issues. They have one-on-one counseling available as well. A lot of great resources there at PLEO.on.ca.

That's just a start of some resources that are available. If anybody doesn't see their demographic being met in any of those resources, feel free to reach out to Capital Psychological and let us know and I will always be able to provide you with more resources along that path as well.

K: Perfect, that's awesome. Thank you for sharing those. I'm sure that's going to be super helpful.

M: I hope so. And if you're listening to listen you're like “I don't have a problem with substance use or abuse or or addiction” that's fantastic, my one big take away for you would be don't judge those that are living with it. Like I said off the top, nobody wakes up one day it goes “I can't wait to become an addict.” Addiction takes time to formulate. We look at the criminalization of drugs and the war on drugs and there are a lot of political reasons as to why drugs have been criminalized, and not a lot of good health reasons as to why drugs have been criminalized.

It's really important to remember that these are people who are living with health issues. It's interesting, I've used the word “addiction” and “addict” a lot today, but I'm usually very hesitant to use that word because of the stigma that comes with it. I don't like using the word relapse either, because relapse is a word that ultimately means “okay, well we're back to zero.” When I think about addiction or life as a race, I think of it like a marathon; if you're running a marathon and you happen to stumble at mile 11, you don't go back to the beginning and start over again- you stand up, you pick yourself up, you dust yourself off, and you keep running. When you finish the marathon, you go “Hey, I ran an entire marathon and I only fell one time” or “I only fell four times.” Even if you fell 10 times, you still completed that marathon and that's a huge thing to be supportive of rather than going “Oh, well you've just thrown away a year sobriety by making a mistake.” I try to be very careful around my language when I'm working with clients one-on-one. I used the words “addiction” and “addict” today because we are talking about addiction as a whole but it is something to kind of check ourselves around how we speak and the words we use. The words we use really do have a lot of power when it comes to managing the stigma of substance abuse.

Thank you so much again to Matthew for all of the information on alcoholism and substance use/ abuse. Like Matthew said, if anybody needs any more information, they can definitely reach out to our office through the “CONTACT US” page on our website. There, you can also reach out if you would like to book an appointment with Matthew or any of our other therapists.

Cap Psych Pod Episode 2: Self and Co-Regulation in Parenting

Today we’re joined by Sandra LeBlanc. Sandra is a Registered Social Worker with 25 years experience and has been with our clinic for just over a year now. Sandra works with children, adolescents, adults and families to navigate through a wide range of mental health issues such as anxiety, depression, attachment issues, trauma and grief.

Today we're going to dive into a topic that many people can relate to: parenting. Sandra is going to provide some guidance on self and co-regulation, specifically utilizing the P.A.C.E approach.

First, let's talk about self regulation and co-regulation. What does self regulation mean?
S: So very often, parents will come in and ask me if I can teach their child self regulation skills, or the teachers want them to have self regulation skills in the classroom. What self regulation means: it's the ability to manage your big feelings, your impulses, to think before you act, using self control, managing yourself, managing your anger and impulse control so that you're not bopping Johnny on the head in the classroom or doing things that parents or teachers don't like our kids to do.
However, the problem with self regulation is that it can be really really hard for children when they are young and their brains are not fully developed. That's one thing we're really becoming a lot more aware of; their brains are still quite young, so they need our help- so that's where the co-regulation comes in.

Perfect, so what is co-regulation? How would you describe that?
S: So because our brain is already fully developed, or at least we hope it is- most of the time it is but sometimes we have our off days too, and our off moments- so we need to help the child to regulate and calm what we call their fight/flight/freeze responses which is kind of like the bottom half of the brain where we don't think rationally. If a child is not thinking clearly, the bottom half of their brain is going into that fight/flight/freeze response so then they can't access the thinking part of their brain (the frontal cortex)- that's where maybe they know that they should be using their words, not hitting or not throwing, those kinds of things, but they forget in that moment because they're in that fight/ flight/freeze response and the bottom half of their brain is activated.
What we need to do is to engage and nurture them first through emotional co-regulation. So for example, being with a child comes first before we teach them.

Okay, that makes sense. So what is the P.A.C.E approach? Can you explain that?
S: Sure! P.A.C.E was first developed by Psychologist Dan Hughes who developed dyadic developmental psychotherapy. P stands for playfulness, A stands for acceptance, C stands for curiosity, and E stands for empathy. If you'd like, I can go into them in a little bit more detail for you.
K: Yeah, sure that would be great.
S: P, being playful- play is really the key to a child's world and their way of learning about the world. When we engage in playfulness with them, we are showing them an interest in them, or showing that we care about them and that we want to have fun with them. We also have to make sure that we're not totally plugged into our devices like out phones or electronics when we're playing with them- we need to be there with them.
K: That's very hard nowadays.
S: Yes, exactly- we get very distracted by all those things. If we can also use humour with them, that can help us go a long way as parents- we just have to make sure that we're not using sarcasm instead of humour because sarcasm could certainly have an impact on them and they could find that hurtful.
A stands for acceptance, which is one of the harder ones, I find, to use. What we're doing here is we're accepting the child's feelings and behaviours, and we're just accepting them in that moment. So the parent can accept the feelings, but not necessarily agree with them or condone the behaviour. For example, they may be super angry and throwing something or a toy or maybe even calling us names- that's hard as a parent to sit there and listen to that, but the acceptance part is saying "okay, wow I can really see that you're really really angry right now" or "you're super frustrated" or "you're really angry with mom/dad."
It's not to be confused with accepting that it's okay to throw that toy, or it's okay to call me names- that's not what we're saying here. We're just really validating their feelings in that moment.
C is where we're using curiosity. At this point, we're not trying to assume that we know what they're feeling or why they're doing something. An example might be if you see your child laying on the couch and you think "oh, they're just being lazy." What we need to do here is just be curious and ask questions like "oh, I see you've been on the couch more often than usual- I wonder if you're feeling lonely, or your sad- what's going on?" Just be curious, and don't assume that it's laziness. Even going further such as "with this pandemic, I wonder if you're missing your friends and maybe you're just really bored, what's that like for you that you can't see your friends right now?"
K: Right, I feel like for a lot of parents it's hard to remember that yes- they're a kid, but also they're just a small human. Kids have the same thoughts that we do.
S: Yeah, exactly. They don't always want to tell us what they're feeling, because sometimes they don't know what they're feeling either- maybe they have a feeling in their stomach but they're not really sure what's going on.
The last one is empathy- this is where we're trying to understand and be sensitive to what they're feeling and experiencing and trying to understand their thoughts; basically putting ourselves in their shoes. So "oh, wow that sounds really hard for you- of course you're bored, of course you're missing your friends, I totally get that. It's okay for you to feel sad and lonely and like you're missing out, especially during Covid." It's been so hard for all of these kids who have been home for longer periods of time or maybe they're not able to play with friends or peers because they have an immuno-compromised family member so they have to be really careful about socializing, so that could be really tough for them.

For sure! Can you tell us a little bit about the ideal outcome of adopting the P.A.C.E approach with regards to parenting?
S: The idea of using the P.A.C.Eful approach is to build a safe, trusting and meaningful relationship with children and for young people who have experienced trauma. This is what Dan Hughes was doing when he developed it, and I've found that you can use this approach with any child whether they've experienced trauma or not, or even with yourself. That's one thing I encourage parents to do is to try to be accepting of their own feelings and be empathic towards themselves. I encourage teachers to use it with their students at school, and hey- you can even use it on your husband if you want.
K: It's always good to improve any kind of relationship.

Can you walk us through a scenario when this might be applicable?
S: Yeah, so one example I can give you is this: let's pretend there are two children who are stuck at home, isolated with their parents because of Covid and one of them starts to express some anger, throwing a toy and says something like "I'm really tired of playing with these toys all the time, I'm so sick of being with my brother all the time, I don't like this anymore." As a parent, you might be feeling like "wow, my child's really ungrateful- she has all these toys, and a roof over her head, a brother to play with, why is she being so [ungrateful]." I need to check myself, I need to take a moment and breathe and try to not pass my judgement on them. This is where I use the A in P.A.C.E. being accepting- so "oh my, you seem so angry right now." "I wonder if it's really hard for you not to be able to see your friends right now." (That's the Curiosity) "here you are, you're stuck at home with mom and dad and your little brother, wow that must be so hard for you."
Then it's kind of wrapped up- I didn't really use the P in there- there's no Playfulness in that scenario exactly, but I really tried to use Acceptance and Curiosity and really try to figure out what it is [that was bothering them]. Your child might say "Yes! Yes! I miss all my friends, I don't get to see them anymore and I'm tired of playing with my brother." In this situation, the child might still yell, they might still cry, they still might have a temper tantrum, and it might still last for a while, but the hope is that the child's feelings are being heard and they're feeling validated. As a result of that meltdown, the child will diffuse in a more timely manner. If the parent is able to come alongside them and offer them support in using this approach vs something like a time out where they get sent to their room or sit in the corner, which is more of a punitive nature, this will help them become more regulated and calm down faster. It doesn't change the outcome, because they still can't play with their friends, but at least they're feeling heard and validated by their parents and they're learning how to manage big feelings.

Okay, so is it beneficial for parents to learn how to utilize P.A.C.E on themselves before applying that technique when dealing with their kids?
S: I think so, because again, like I said in that scenario- you might be thinking "wow, my child is so ungrateful and not using the toys that they have." So we really have to accept our own views and our own values and feelings and this way if we're accepting "this is what I'm feeling right now, I'm feeling really triggered by their reaction" then it's going to help me stay calm, and I'm going to use a little self-compassion on myself, or Empathy on myself. Maybe later on, I might be curious as to why I'm so upset about them with that [situation]. It might be something that goes back to when I was younger about when my parents told me I really need to be grateful for toys because we only got one toy for Christmas- that kind of thing. So it's good to use it on yourself, and to be empathic with yourself, as well as your spouse too if you're finding that you're upset with how they've dealt with a situation with the child.

What benefits do you see in using P.A.C.E vs other parenting approaches?
S: I think the biggest benefit of this approach is that you're not trying to change or negate the child's feelings. By using the acceptance, the child feels heard and understood. It doesn't mean that you're condoning the behaviour, and the temper tantrum may still happen but it will not last as long.

In what ways does the coronavirus affect the use of P.A.C.E? Do you think it makes it more relevant given all the changes that everybody has experienced over the last 2 years?
S: Definitely, as in the example I used earlier- I think that because of this global crisis, parents need to be more accepting and empathic towards themselves and to each family member, and accepting that it's really hard for us to be isolated, for us to work online, to miss friends, to feel anxious about going in public again which is something that some people might be dealing with as well, especially as mandates or restrictions start to lift. By being able to use curiosity to wonder aloud "Gee, I wonder what you guys are feeling right now- are you missing your friends? Is there anything you're worried about at school right now? Are you worried about the masks or not wearing masks?" Each child deals with the situation in a different way; we just need to figure out how they're feeling. I find using P.A.C.E very helpful for any scenario, really.

Right, perfect. Okay, so switching gears a little bit- let's talk about meltdowns, which is literally every parent's nightmare. Something you talk about is looking for signs of stress in children. Can you walk us through some potential behaviours to look out for?
S: Yes, so some things you want to look out for is things like toileting accidents, aggressive behaviour, defiance, when they're seeking power in other ways- so some children right now may be seeking control in a lot of different ways because of all the uncertainty that we've been experiencing due to the coronavirus. Another one you might see is baby talk and asking to be dressed, even though they already know how- they already have that skill, so they're kind of regressing in their behaviours. In this case, it's really important to provide the child with a connection if they're looking for that at that time. If they want to be dressed and it's just once in a while that you need to help them with that, then you're meeting their emotional needs and they're feeling safe. Once they feel safe again, then you will probably see the baby talk disappear. But if you use comments like "use your big boy/ girl words" then you might be shaming them and you won't be meeting their emotional needs.

That makes sense. What advice can you provide to calm a child when they seen inconsolable?
S: One thing I often suggest is just seeing if you can offer them a hug or a touch or to help regulate them in that moment and just listen to their cues of what they need at that time. Other things that might be helpful are providing them with space, distraction, or with sensory activities- some kind of physical activity that is obviously safe such as jumping on a trampoline if you have a small trampoline in the house, playing with a ball. And then finding things that they find soothing and calming for themselves like fidgets or bouncy balls, or a rocking chair- lots of kids find that soothing, colouring books, puzzles, bubbles. Doing deep breathing with bubbles can be really helpful.

How do you suggest a parent close out a meltdown? Is there an approach that you've found useful to reconnect with a child after the fact?
S: Definitely I would suggest going back later and talking to the child once they're calm. We want to be looking for the teachable moments once you're both calm. So together, you can also discuss what they might want or need when they're feeling upset. This is going to help you with that calming down space or calming down basket, so you might ask them "do you need space?" or "do you need a hug?" or "what would you like in your calming area or basket?"
K: That makes sense. I feel like almost everybody's been in the position whether they have a child or niece or nephew and they're just like "ahh, I can't talk to you right now" because you get so flustered and upset, it's hard to be the parent in that situation.
S: Mmhmm, and sometimes if you need to walk away yourself, that's okay. You can tag team somebody else in that might be around- hopefully someone else is around that could take over for you so you can go and become calm and collected.
Lastly, parenting's not an easy task and we all make mistakes. I'm a parent myself and I've made lots of mistakes. We need to practice self care and we need to try and stay regulated ourselves when we are dealing with our children's big emotions. Let's say we don't stay cool, then it's okay for us to go back later on and repair the relationship. Just say "Hey, I'm really sorry mommy yelled" or "I didn't handle that situation as best as I could have and I'm really sorry and I love you." Making sure that the child knows they're still loved and cared for, and the fact that you're able to apologize and show that you're human is really really helpful.
K: Right, and that too, maybe not if they're super young, but it also shows them that they're allowed to have emotions because even their mom, dad or parent does, so that's good.
S: Yeah, and I think because of Covid, everybody's emotions are running high right now so even parents are struggling a lot lately, so it's is even harder for us to self regulate and help to co-regulate our children.

Thanks so much to Sandra Leblanc for taking the time to provide some information on self and co-regulating in parenting. If anyone is interested in speaking with Sandra, please feel free to reach out to the clinic at www.capitalpsychological.com

Cap Psych Pod Episode 1: Starting Your Therapy Journey

Today we’re joined by Brenda Weaver, our Practice Manager. Brenda has been with the clinic since 2015 and manages everything from intakes and payment to keeping the office running day to day. Today we’ll be covering some FAQs pertaining to taking the first steps in finding a therapist, information you may need to research before reaching out to a clinic of a therapist and how to go about getting that first appointment booked.
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How do you suggest someone begins their journey to finding a therapist?
B: The first step is probably to talk to your GP; let them know your concerns, let them know what’s going on with you. They may have a referral source for you. If they don’t, just start doing your own research on therapists in your area, ask friends and family if they have any recommendations. A good resource that I sometimes recommend is the Psychology Today website- there you can filter by location [and] specialty in order to find a therapist that might be able to help. Some will note if they’re accepting new clients or not.

K: Oh, that’s good- that’s helpful so you don’t just randomly reach out to a bunch of people and if they’re not taking any new people, it’s not just wasting your time.

B: Exactly. It’s hard enough to take the first step without being turned down 100 times… maybe not 100, but you know what I mean.

So, when you do go about reach out to someone, what is some information should you include in your initial message for them?
B: So, we need to know if you’re looking for an assessment or if you’re looking for therapy- we can touch on that a little bit more later. We need to know if you’re looking for yourself or if it’s for a family member; if it’s for a child, we need to know the custody arrangements- if parents are together or not. If they are together, great! If not, then we need to know who has decision making [authority]. It’s a good idea to come into this open book so everybody is on the same page. We need to know if you’re looking for a certain type of therapist: Registered Psychotherapist, Psychologist, Social Workers- there are so many different kinds. It’s important to let us know if you are looking for a specific modality- CBT, DBT, something like that. And of course, we want to know the reasons that you want therapy. Give us as much information as possible so we can find the best therapist to suit your needs. We have to speak to the therapist to be sure that they can work with you on your concerns, but everything is confidential to the office, so you don’t have to worry about that at all.

K: Right, that’s good. So, just about the different modalities, typically, do you think that a GP, if they’re referring you to a therapist, would specify “I think EMDR would be helpful” or “CBT would be helpful” or anything like that?

B: Sometimes they do, but sometimes they just say “you need talk therapy” or whatever, which could be a bunch of different ones. Kind of depends.

K: And I guess you could just ask your therapist too, once you are set up with someone.
B: Exactly.

Touching on the therapy and assessment aspect, what’s the difference between therapy (or treatment) and an assessment?
B: Okay, so a lot of people think that you need to have an assessment before you can have therapy- that’s not the case. The definition of therapy is a treatment intended to relieve or to heal a disorder. It’s generally an hour-long session where you speak with your therapist about your mental health concerns or issues in your life and they can help you through. An assessment is an evaluation using testing measures to determine a diagnosis and to give recommendations. Assessments have to be done with a Psychologist and a Psychometrist (in our office anyway) to do the testing for them. Once the testing is completed, scoring and data interpretation is done, a draft report is written, and we set a feedback appointment at which time you’ll get a diagnosis and recommendations. Often times, the recommendation is to seek out therapy, but it all depends on what is found in the scoring and data interpretation.

K: Right, and I’m sure a lot of people don’t know about the fees too, so that’s probably something that they need to check in on before they go ahead and book.

B: Fees are definitely something that you need to discuss with your therapist or admin before you go in to do an assessment.

K: Never good to have surprises like that.

B: No, definitely not, and I mean they can be pricey so you definitely wan to make sure that if you have coverage, that the coverage will cover specifically the assessment as well.

Can you explain the difference between a Registered Psychotherapist, Registered Psychotherapist Qualifying, Registered Social Worker, Psychologist and Psychiatrist?
B: Well, there’s a lot of different types out there. Psychotherapy is kind of like an umbrella term for anyone who does therapy. A Registered Psychotherapist belongs to their own college, they can work with individuals and/or families depending on their training.

Qualifying Psychotherapists are in the process of completing their clinical hours, and still have to write their final exam to become *autonomous. They are able to provide counselling services while under supervision.

Social Workers often times have a master’s or a bachelor’s degree. They provide support to people with mental health issues as well. Depression, anxiety and PTSD are some of the issues that RSWs can offer support with. They also belong to their own college, and they can work with different age groups depending on their training. At our office, everybody is under the supervision of a psychologist.

Psychologists have a doctoral degree; they focus on emotional and behavioural aspects of mental illness using different techniques of psychotherapy. They can treat, as well as complete testing to see if a psychological diagnosis is present. They are governed by the College of Psychologists.

Psychiatrists also have a doctoral degree, and they have the ability to diagnose patients through testing. Psychiatrists are also medical doctors, so they have the ability to prescribe medication to their patients. Essentially, if you need medication for depression, for example, you’d need to see a psychiatrist, however you could see a psychologist or a psychotherapist for treatment and they can refer you to a doctor for medication, or back to your GP for medication if needed.

How do you suggest someone finds a therapist whose background aligns with their specific concerns?
B: Well, connecting with your therapist is really important- I would say to read the therapists’ bio from all the clinics around you. Be sure to read them and choose a few possible ones, then you can kind of narrow it down. Also, in an office where there’s an admin, when you give your information, they can often match you up with the best therapist to fit your needs.

K: Okay, that might kind of just speed things up a little bit if there is [an admin].

B: It does, yeah. And once you’re talking to somebody you can get more of a feel as to what they need, and kind of match up personalities too with the therapist which is kind of nice.

In that regard, what would happen if a client isn’t connecting with their therapist? Would it hurt the therapist’s feelings if they try to find someone new?
B: That’s a really good question. Your therapist is going to have your best interest at heart. If there isn’t a good connection for you, there probably isn’t a good one for them either so they would definitely want you to move on to someone else that would be able to help you. Just be honest with yourself if things aren’t working out and start looking for someone new. It isn’t beneficial to anyone if you continue seeing a therapist and you aren’t getting anything from the appointments. It’s best to just move on if the services aren’t quite for you.

K: Right, and if you do have coverage, it’s just kind of a waste of your coverage if you aren’t actually getting anything out of it.

B: It absolutely is, yeah, for sure.

What would happen if you share custody of a child who needs to meet with someone? What’s that process like?
B: So, this can be tricky sometimes. In cases of shared custody, it’s preferred that both parents are on board for therapy for the child. Often in the case of younger children and adolescents, the therapist will meet with parents to get some background and to discuss possible treatment. Having both opinions is really helpful. If the parents prefer not to be together for the session, a split session or two totally separate sessions can be arranged. Fees would be charged for both sessions though.

K: So, it’s best just to be honest if you don’t get along with an ex and you don’t think it’s going to be beneficial, then just do it on your own.

B: Absolutely. The majority of people try to put the best interest of the child first, but sometimes there’s so many hurt feelings that parents just cannot be in the same room or on the same computer screen together, and we understand that. We’ll do our best to make everybody comfortable.

K: And then it would be in the kids’ best interest too, if they know that and they can just do things separately.

B: Absolutely. The other thing that I should mention too is quite often adolescents aren’t on board with therapy, so make sure if you’re seeking out a therapist for your child/ teen that they really are on board. I usually tell people to have them read the bio with you to make sure that they think that they can connect with the therapist.

K: Right, they need to be open to actually talking to someone because if you just put a kid in a room, they’re not going to just start talking to someone with no desire to.
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B: For sure. [If they] go in cold and “I don’t really want to talk to you” it’s hard for the therapist as well- it’s like pulling teeth to get them to talk. Obviously, they’re not in a place where they’re ready to talk.

Can you explain the consent process for if a child comes to see a therapist?
B: So, legally a child 12 years old and above can sign for consent for therapy. What we do in our office is we have both the child and a parent sign consent in order to rule out any issues when it comes to confidentiality and to billing; I mean, let’s face it, these sessions cost money- you need to know the prices. The best thing to do is to ask your clinic or your therapist about procedures.

Also with billing, can you explain the insurance process? How to tell if you’re covered for a specific therapist, etc?
B: The best thing to do, obviously if you have a handbook, look it up. If not, you can call your extended health benefit company to find out if they will cover [and] what type of therapist they will cover. We usually send out the wording, so it’s whichever type of therapist “Under Direct Supervision of Dr. Garcia” in our case. Some will cover Registered Social Workers, some won’t. Some will cover Psychotherapists, some won’t. It’s definitely best to have a little conversation with them first just to make sure they will cover.

What is the difference between direct billing and submitting a claim to your insurance company?
B: Direct billing is when the office bills the insurance company directly. Not all offices do this- we don’t, so basically, you pay us after the session and then you submit the claim yourself. Quite often you can do it online- we’ll send you a receipt and you can just upload it directly to your insurance portal.

You had mentioned that the therapists in our office are supervised by Dr. Garcia- can you explain what that means?
So, the supervision is for insurance purposes, so extended health benefits cover [sessions]. The other reason is so the therapists have someone to discuss a case with; find additional ideas, additional resources to help their client. It’s always kind of nice to have somebody that you can bounce some ideas off and to get some advice in helping with their treatment. It’s also possible that they need a signature of the supervising psychologist for a form or a letter; quite often it would have to be from a doctor, so the psychologist, then, would be the one to do as well as the treating therapist. So, the supervisor needs to know at least parts of the case before signing.

Thanks so much to Brenda Weaver for answering some of out FAQs about starting a therapy journey. If anyone has additional questions about seeing a therapist at our office specifically, they can give the office a call or they can submit a form through our website.

Neighbours of Kanata Lakes

Dr. Diana Garcia of Capital Psychological was featured in the most recent edition of the Neighbours of Kanata Lakes magazine. Dr. Garcia discusses way to prepare your children for back to school routines to make the transition easier for everyone involved. 

Too much screen-time for youth→

Following a children's play area at a mall in B.C being replaced with iPads, child psychologist Diana Garcia discusses the risks involved in too much screen-time in small children. 

Back to School Anxiety →

In this second CTV News Channel segment, Child psychologist Diana Garcia shares tips on how parents can transition their children from summer vacation to a back-to-school routine.

https://www.ctvnews.ca/lifestyle/how-to-help-your-kids-overcome-back-to-school-anxiety-1.1978809

Back to School→

In this August 2014 CTV News Channel segment, Child psychologist Dr. Diana Garcia gives suggestions on how to get the kids out of vacation mode and ready for school.

https://www.ctvnews.ca/video?clipId=425986