Think You Might Have a Case of the Winter Blues?

CFIR Toronto's Clinic Director, Dr. Lila Z. Hakim, C. Psych., offers a few helpful tips below to start feeling good again **:

Nourish Your Body

Many of us experience cravings for certain foods when the winter season blows in and our bodies develop a yen for carbohydrates. Carbohydrates are directly linked to the production of the neurotransmitter serotonin, an emotion regulator that helps you feel emotionally stable, less anxious, calmer, more focused and energetic.

When that 3 p.m. craving for a savoury or sweet snack hits, it’s your body’s way of self-medicating, seeking to improve your mood by boosting your serotonin levels. Listen to your body and give yourself that much-needed serotonin lift.

Instead of calorie-dense, sugary pieces of bread and sweets that offer a quick mood-boost and then a crash, consider healthier alternatives such as fruits, nuts, and yogurt.

Get Active!

Physical activity increases not only the calming neurotransmitter serotonin, but also increases dopamine, the emotion and pleasure neurotransmitter, and endorphins, your pain-relief and pleasure neurotransmitters. Incorporating movement into your day (climbing stairs, going for a walk, etc.) gives your body the activity it needs to keep your mood up throughout the day.

Make Sleep a Priority

Sleeping excessively (or hibernating) is normal in the winter and is often a reaction to the cold, but for some, ongoing insomnia or difficulties falling or staying asleep create difficulties that can lead to the blues. Provide yourself with a space at home that includes comforting objects (such as a warm blanket, beautiful objects, etc.) to calm your stress hormones. Aim to get exactly the amount of sleep you need to feel fully rested and ask a professional if you are unsure about how much rest is the ideal amount.

Do Things that Light You Up

Find activities in your life that give you a sense of pleasure and meaning, that involve curiosity, exploration, and interest­–this could be collecting or building things, researching something you love like traveling, or caring for other people. Artistic endeavours like creating and listening to remarkable music are also great options. Pleasure, curiosity, exploration, and interest all stimulate dopamine, which makes you feel exhilarated and alive!

(**Note: If you or a person you know is experiencing regular symptoms of depression, it is important to seek medical attention from a physician. If you don’t have a family doctor, click here for additional information and options via Ontario.ca.)

Weathering the Grief Storm Well: What is grief, and when will it pass?

by: Reesa Packard, M.A., Ph.D., R.P.

What is grief? 

Grief is the emotional, bodily, cognitive, spiritual, and/or relational impacts of any important loss. The loss can be obvious, like the death of a loved one, or subtler, like a small or big shift in life circumstances.

Lots of people find grief to be very difficult – if you feel unable to function normally in the aftermath of losing someone or something that you cherish, or are very used to, know that this is a common feeling. Some people react to the intense emotions of grief by trying to ignore them or push them away. This strategy rarely works in the long-term though, since grief is a process that we just cannot run from – like a storm, it cannot be derailed, but instead, has to run its course.

Why is grief so hard? 

Grief can be like a storm also in the sense that it rushes in – sometimes by great surprise – and ravages some or all of what we had previously known as ‘normal’. The grief storm can bring crashing waves of anger, sadness, and guilt. These emotional waves can be big, and frequent, and unpredictable. During and after the storm, it is easy to feel overwhelmed and disoriented.

To get through the grief storm, we have to actively care for ourselves in it, which takes work. There is a decent payout for this work, though: if we can manage to do this, then those big, crashing waves of emotion can gradually become less intense, less frequent, and more predictable. While the loss itself never goes away, the pain it brings can become easier to tolerate. Over time, we can begin to find ways to re-build a new normal.

So, how can we weather the storm well? 

Striking the right balance between connecting to difficult emotions and also taking regular breaks from them, is key.

To connect with the difficult emotions, you can try any strategy that will help you feel and release the emotions, such as taking in a moment of silence with yourself either in stillness or while moving, journaling or drawing about the feelings, or sharing the feelings by talking to a good friend or a therapist; find ways to let it out.

To take a break from the emotions, you can try any strategy that can re-resource you, remind you of a different perspective, or shift your experience, such as engaging in hobbies or activities that you typically enjoy. This might include social, creative, active, spiritual, or deep experiences; find ways to be a bit more okay, even just for a minute or two.

Remember that everyone grieves differently and that your needs are likely to vary from moment to moment, and situation to situation. The process of learning to weather the grief storm well is less about doing any one specific thing, and more about exploring, and learning about yourself and what you might need. While the balancing of feeling emotions and taking breaks from them can be important, how you go about balancing these will be specific to you. Grief storms can be hard, and anything you do to get through them, that also supports your overall wellness (or doesn’t take too much away from it), can be absolutely okay.

Take good care.

Reesa Packard is an Associate at CFIR. She has a doctoral degree from the Saint Paul School of Psychotherapy & Spirituality and works in private practice as a registered psychotherapist. She works with clients hoping to develop a more integrated sense of self as a means to well-being and meaningful, lasting transformation. Reesa is also involved in the teaching and supervision of psychotherapists-in-training and advanced knowledge through research in her specialty fields.

Depression: Two Types, Two Treatments

by: Dr. Alexander Vasilovsky, C.Psych. (Supervised Practice)

We’re used to thinking about depression in terms of its symptoms: for example, depressed mood, inability to feel pleasure, sleep disruption, and loss of appetite, weight, and/or sexual desire, among others.

But, have you ever thought about there being two types of depression?

Some mental health professionals have begun to focus not just on symptoms, but also on the everyday life experiences associated with depression: feelings of loss and of being abandoned and unloved on the one hand, and feelings of worthlessness, failure, and guilt on the other.

Based on these two different experiences related to depression, Sidney J. Blatt, a professor emeritus of psychiatry and psychology at Yale University’s Department of psychiatry, along with his colleagues, distinguished two types of depression.

One type of depression is the “relational” type, sometimes called the “anaclitic” version, from the Greek word for “to lean on.” Typically, this depression is characterized by feelings of loneliness, helplessness, and weakness, as well as intense and chronic fears of being abandoned and left unprotected and uncared for.

The other type of depression is the “self-critical” type, sometimes called the “introjective” type. Typically, it’s characterized by feelings of unworthiness, inferiority, failure, and guilt. Introjectively depressed individuals engage in harsh in scrutinizing and evaluating themselves. They have a persistent fear of criticism and of losing the approval of others.

Not only do these two types of depression reflect two different internal experiences of depression – “I’m empty, I’m hungry, I’m lonely, I need a connection” (relational) versus “I’m not good enough, I’m flawed, I’m self-indulgent, I’m evil” (self-critical) – they also indicate different therapeutic needs.

Research shows that those who are relationally depressed are more responsive to the supportive interpersonal or relationship aspects of therapy. In contrast, those who are introjectively depressed are more responsive to the interpretive or explorative elements of the treatment process. A mental health therapist who understands different types of depressive experiences can help a range of depressed individuals understand themselves better and also overcome the difficulties that come along with depression.

CFIR psychotherapists can support you to deal with your negative beliefs of self and other, and the relentless characteristics that might be at the root of your depression. We integrate cognitive-behavioral, mindfulness and acceptance and commitment, and psychodynamic-based approaches to help you deal with the thinking that might be contributing to your depressed moods.

Dr. Alexander Vasilovsky, C.Psych. (Supervised Practice) is a psychologist in supervised practice at the Centre for Interpersonal Relationships (CFIR) in Toronto. Dr. Vasilovksy works with adult and couple clients from an integrative therapeutic perspective, and helps them overcome difficulties related to depression and mood, anxiety and stress, trauma and PTSD, interpersonal conflict, major life transitions, and identify-related struggles.

Accompanying You Through Your Losses and Grief

by: Dr. Dino Zuccarini, C.Psych.

Life can be a symphony of losses. Many of us struggle to cope with unresolved losses from either the past or present day. We can experience loss as we transition through various life stages (i.e., childhood onward toward the end of life). Some individuals will experience loss as a result of unmet needs, separation, divorce, or death of loved ones, or unfulfilled goals and potentials. Some of us will experience a deep sense of loss as we inevitably experience changes in our physical and mental abilities, health status, and roles and identity. The emotional residue and grief associated with these losses, when left unaddressed and unprocessed, can evolve into anxiety and depression.

In terms of overcoming your grief, we help you to understand the meanings of your losses, and to process the unresolved or complicated emotional residue from these losses. Unprocessed grief and loss can affect our emotional well-being, our functioning in everyday life, and our interpersonal relationships. We support you throughout your grieving process so that you may move forward with your life with a renewed sense of meaning, purpose, and hope. CFIR psychologists and clinicians employ psychodynamic and experiential approaches to support you through the process of dealing with past and present-day losses.

Read more about our Depression, Mood & Grief Treatment Service.

Let’s Talk About Depression, Mood and How Can We Help You

by: Dr. Dino Zuccarini, C.Psych.

Depression

Depression can bring about debilitating symptoms, both of a physical and emotional nature. Depressed individuals typically find themselves experiencing hopeless feelings, disruptions to sleep and eating patterns, a loss of pleasure in everyday life, and possibly thoughts about suicide or death. Often individuals who are depressed have physical symptoms, including aches and pains.

Finding a path toward recovery can be challenging, but the good news is depression is treatable; recent research indicates that psychotherapy is extremely important in your recovery from depression.

When depressed, we can become bombarded by an internal chorus of negative thoughts and feelings about our selves other people, and the world around us. We can be overly self-critical of our selves and others, or may find ourselves struggling to come to terms with deep feelings of loss. At these times, it can be difficult to imagine a way to restore our vitality, hope, and optimism for life. When the severity of your symptoms seriously disrupts your capacity to function at home, work, or school, consider consulting with a psychologist immediately.

Negative thoughts and feelings about ourselves and others: Healing requires us to try to make sense of and deal with the distressing negative thoughts, feelings, and emotional responses that lie at the root of our depression. Depression is often linked to negative thoughts and feelings we hold about ourselves, of other people, and of the world around us. The origins of these thoughts and feelings can extend back into our childhoods and onward to the present day. These negative thoughts can create a sense of hopelessness about our selves and the world around us. A negative, critical voice and overly rigid standards and ideals can also be at the root of your depression.

We all have standards and ideals that we internalize from childhood onward about how we should be. These standards and ideals create expectations about our own and other people’s behaviour and guide us in terms of how we ‘should,’ ‘ought to,’ or ‘must’ think, feel, and behave. Some of us will rigidly hold onto and strive to live according to unrealistic standards and ideals, and be unrelenting in our efforts to have ourselves and others live up to them. Rigidly held standards and ideals can fuel harsh self-criticism and perfectionism. Indeed, research affirms that self-criticism and perfectionism often contribute to symptoms of depression.

Unexpressed emotions and needs: For some individuals, unprocessed emotions and unattended needs can result in depression. Depression is, therefore, a signal calling for us to listen to what our feelings are telling us about our selves, other people, and the world around us. Emotions provide us with important information. Being able to identify, label, and express these feelings in words is important for us to understand what our concerns are and to identify the unmet goals or needs that are at the root of the depressed feelings we are experiencing.

Other causes:  Depression may also result from multiple other physical and psychological causes, or as a result of substance abuse. A thorough assessment by your physician and a psychologist provides the best opportunity to determine your best treatment options.

Mood

Some individuals struggle with varying moods. People diagnosed with bipolar disorder struggle with mood variation, including periods of experiencing unusually or somewhat elated moments or ‘highs’, followed by periods of ‘lows’ or depressed periods. During manic periods, individuals with bipolar disorder may engage in risky behaviours leading to financial or legal difficulties. Being aware of triggers or signs of an impending mood episode, developing strategies involving partners, addressing difficult thoughts, creating a more balanced world, and accessing support to adhere to treatment regimens, are all significant components of managing bipolar disorder.

The Depression, Mood & Grief Service at CFIR offers clients counselling and psychotherapy to support them to address depression, mood and past and present grief and loss. We offer children, adolescents, adults, and couples psychological assessment and treatment of depression and other mood disorders. We provide comprehensive psychological assessment of your depression and/or mood difficulties, including the use of psychological tests for the purposes of diagnosis and treatment planning. There are different causes of mood disorders, and different types of depression and bipolar conditions. Psychologists are skilled in assessing, diagnosing, and subsequently developing a tailored treatment plan to address the specific issues associated with your current depression and/or mood difficulties. We employ scientific, evidence-based treatments, including Acceptance and Commitment therapy, Cognitive Behavioural Therapy, Emotion-Foucsed, Mindfulness, Psychodynamic-Mentalization-Attachment based therapies to help you overcome your symptoms and make deeper changes to your self.

Read more about our Depression, Mood & Grief Treatment Service.

Combatting Depression: Strategies for Your Relationships

by: Dr. Dino Zuccarini and Tatijana Busic

Depression can be isolating, and block us from soliciting emotional or physical caregiving from others, which inevitably worsens our depression symptoms. Other people’s responsiveness toward our feelings and needs can make us feel more connected and better about ourselves.

Identify a friend, family member, or partner who you sense will be mostly available and responsive to you at this time. Good indicators would be someone you think is sensitive, a good listener, and understanding of others’ feelings and viewpoints. If you are unsure or cannot identify a responsive other in your life, or if your emotions and needs for support exceed what others can provide you, you can seek out the support of a registered clinical psychologist. Professional support can make a critical contribution to your recovery in these cases.

Sharing and Expressing Feelings and Needs to an Accessible and Responsive Other

Don’t isolate yourself! Let those closest to you know that you have been struggling with depression so that they will understand you more so. Share what you know about your own mental health. Let them know that connecting to them may help you with your depression. You may want them to participate in some activities with you, such as walking, going out for dinner or a movie. Let them know that you may need their support from time to time.

Sharing feelings with someone important to you can alleviate depressive symptoms. Prior to talking to another person, try to put your difficult feelings into words and share them with this person. The good news is that you don’t have to have things all figured out before you reach out. You can simply tell this person that you want him or her to listen or to support you to problem-solve a difficult situation or experience, or you can simply ask for reassurance or a hug. Talking things through with others can help you to clarify what you truly think, feel, and need in a way that can give you a more positive direction. Try not to expect perfect responses from others. Sometimes people close to us are trying as hard as they can to support us and have good intentions.

Confirming/Disconfirming Negative Views with Responsive Others

When talking to your available trustworthy confidante, bounce off of them some of the negative views you hold about yourself and others.

Try to figure out what some of the biases and assumptions are that you are holding of yourself and others. Share what your most difficult thoughts and feelings are about yourself or about others in your world. Ask this individual to provide you with feedback about your views and to support you to identify counter-examples of your negative views. It can feel vulnerable to open up about some of the distressing thoughts and feelings that go on inside your mind and body, but sharing with another person that you trust can help you to break the negative thought patterns, perceptions, and biases that perpetuate your depressed feelings.

Asking for Reassurance and Affirmation from Responsive Others

When we are overly self-critical of ourselves or negative about others, we may have difficulties seeing our positive attributes. Relationships are an important source of getting reassurance and affirmation for ourselves when we are having negative thoughts and feelings about ourselves, other people or the world around us.

If you are having doubts about yourself, try asking for reassurance about your lovability, your adequacy, or your competence. Be open to receiving others’ reassurances or positive affirmations of you in a way that helps to calm your sense of hopelessness about prospects for yourself in the present and future. Give yourself and others the benefit of the doubt and allow yourself to feel reassured and affirmed.

Be prepared to observe how others perceive ways in which you might be contributing to your own difficulties by how you are thinking, reacting and relating to others. Interpersonal feedback from responsive others who we trust can provide us important information to consider in our recovery process. Try to remember that being perfect is not a requirement for being worthy.

Repairing Disconnection and Creating Positive and Rewarding Relationship Moments

Sometimes, while depressed, our relationships begin to break down, which leaves us at greater risk of being isolated in our emotional distress. We all make missteps at one point or another in our relationships. Perhaps either you or someone else has said something that was offensive, frustrating, or hurtful.  Since relationships provide all of us with valuable emotional support, it is important to make some effort to repair our relationships with others.

Try to find a constructive way to repair or reconnect with others. In these conversations, it will be important to discuss you and the other person, who may have offended, frustrated, or hurt each other. Be prepared to listen and respond in a constructive manner, including empathizing with the other person’s hurt, sadness, or anger.

Take responsibility, express heartfelt regrets, and make amends if possible. Repairing difficult relationship moments or disconnected relationships can restore a positive sense of yourself and other people in your environment. This process of reparation and healing can create a sense of connection at a time when you need it the most.

Also, try to create opportunities for lightness and fun in your relationships. Meaningful connection with others does not always have to be serious and intense. Although deep, intimate conversations in which you can feel understood and supported are key, it is also important to find some balance by seeking out some frivolous and even spontaneous moments purely motivated by pleasure and some needed distraction in the company of others.

Seeking out Professional Support: Consulting with your Physician and a Registered Clinical Psychologist or Psychotherapist

Consulting with a physician may also be an important first step to assess your current mental health status. Depression can be associated with many biological and medical causes that require medical interventions.

Seeking the professional support of a registered clinical psychologist or psychotherapist may be important to help you address the negative thoughts and feelings you are having about yourself, or others. Learning how to address perfectionism, self-criticalness, and process your emotions and clarify wants, needs, and goals can be challenging. Contact a psychologist or psychotherapist if you find that dealing with your thoughts and feelings on your own has become unmanageable.  

Contacting a psychologist or psychotherapist may also be an important first step if you continue to experience debilitating depressive symptoms that interfere with your functioning at work, home, or school. A therapeutic relationship can help you to make sense of your experience of depression and help you along on your path to recovery.  A confidential, empathic, and compassionate therapeutic relationship can help you to strengthen yourself as an individual, to improve the quality of your relationships, and provide you with further strategies to help you deal with the negative thoughts and feelings you have been experiencing.

Read more additional posts from the 'Depression' series:

• Depression: How Your Thinking Can Lead to the ‘Blues’ (Part One)
• Depression: The Role of Unprocessed Feelings and Emotions (Part Two)
• Combatting Depression: Strategies for Your Self (Part Three)

Learn more about CFIR’s Depression, Mood & Grief Treatment Service.