Centre For Interpersonal Relationships: depression

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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.)

Self-Harm – It’s More Than You Think

By: Brent Mulrooney, M.A.S.P., Ph.D. Candidate

What is Non-Suicidal Self Injury?

Non-suicidal self-injury (NSSI), commonly described as self-harm, involves deliberate acts (such as cutting) that directly damage the body but occur without suicidal intent. Typically, when we think of NSSI we think of individuals who cut, burn, punch or pinch themselves. In the psychological literature, these behaviours are referred to as direct NSSI. In an ideal setting, individuals who engage in self-harm behaviours either independently seek out psychological support in the form of therapy, or are noticed to be engaging in self-harm by individuals close to them and are encouraged to seek support at that time.

Indirect NSSI

However, individuals can also engage in other self-harm behaviours that are not as clearly noticed by others, since the methods of self-harm do not directly lead to bodily damage. These behaviours are termed indirect NSSI.

‘Indirect’ methods of NSSI can include:

Involvement in abusive relationships
Substance abuse
Risky or reckless behaviour (e.g., reckless driving, bar fights, risky sexual practices)
Intentionally putting one’s body into physical danger (e.g., ‘daredevil’ acts)
Disordered eating behaviour

Since these activities are not often identified as self-injury, and can even be missed as warning signs by therapists, hospitals, and primary care physicians, it is important to notice problematic behaviours before their severity increases.

Men and Self-Harm

For a variety of reasons, individuals who identify as male are more likely to engage in indirect self-harm than those who identify as female (St. Germain & Hooley, 2012; Hooley & St. Germain, 2014). One such reason that has been proposed is that behaviors that have often been labeled as traditionally male expressions of anger and frustration sometimes contain indirect forms of NSSI (e.g., punching walls, picking fights with others, overconsumption of drugs and alcohol; Green & Jakupcak, 2016) Adherence to these traditional male gender norms is also associated with difficulties articulating thoughts and feelings, which can further increase an individual’s risk of engaging in self-harm (Levant et al., 2003). As a result, some men might not readily identify the intentionality behind some of the harmful actions described above.

Finding Help

Psychologists and therapists at CFIR are able to diagnose and guide the treatment related to direct and indirect self-harm for all individuals. We provide support to children, adolescents, adults, couples, and families who themselves struggle with self-harm, or have loved ones who do. We help clients establish solid networks of physical and emotional care and support We also provide specific psychological treatment for individuals who self-harm, supporting them through the cascading negative emotions that may precede or accompany instances of self-harm.

Brent Mulrooney, M.A.S.P. is a therapist at CFIR (Toronto). He has substantial interest and treatment experience in the realm of family functioning and relationships, anxiety and mood disorders, work and school success, addictions, violence (especially violence in the home), trauma, and gender identity and sexuality. Brent is nearing the completion of his doctoral degree in School and Clinical Child Psychology at the University of Toronto.

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.

Helping You To Cope With Postpartum Depression

by: Dr. Lila Hakim, C. Psych.

Upon birth, many couples will require some time to get used to their new home circumstances. Learning how to create and adapt to sleep and feeding schedules that suit the reality of the couple can be challenging. Numerous issues related to sleep and feeding emerge that can create distress, particularly in the context of a lack of sleep and the novelty of figuring out and managing the newborn’s needs. The relationship will transition during this period to adjust to these new circumstances.

For some women, this period becomes complicated by depression caused by numerous physical and psychological factors, including a growing sense of isolation, emotional residues of birthing problems, sleep difficulties, and a change in sense of self and identity. Feelings of depression during this period may also be accompanied by self-criticalness and identity challenges that can then increasingly spiral into hopelessness and despair. Partners may also struggle and find themselves slipping into states of anxiety and depression. They may experience similar challenges during this transition period.

CFIR psychologists and clinicians are able to diagnose and guide the treatment post-partum depression. We provide support individuals and couples to adjust to their initial challenges upon return to home with their newborn. We help individuals and couples establish solid networks of physical and emotional care and support to ensure that isolation is reduced. We support new parents by providing them with resources to connect to the outside community. We also provide specific psychological treatment for post-partum depression, involving both individual and couple sessions to support women to emerge from the cascading negative emotions and biological turmoil that may occur during this period.

Read more about our Fertility Counselling Treatment Service.

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.

Perfectionism vs. Healthy Striving

by: Dr. Marie-Pierre Fontaine-Paquet, Psy.D., C.Psych.

In this post, we will define perfectionism vs. healthy striving, describe when perfectionism is a problem, and we’ll offer strategies for overcoming perfectionism.

Defining Perfectionism

Wishing to do things well and having high standards is often adaptive and can help you to pursue and achieve your goals in life. This healthy striving can be contrasted with perfectionism, which is a felt need to do things perfectly and to regard anything short of perfection as unacceptable. To help clarify the distinction between healthy striving and perfectionism, here are some characteristics of each one.

Characteristics of Healthy Striving:

Striving for high but achievable standards that result in feelings of satisfaction and increased self-esteem

Motivated by enjoyment of the process, enthusiasm, enjoyment of what you do, and desire for success and mastery

Efforts (not just results) give you satisfaction and a feeling of accomplishment

Self-esteem is not based on accomplishments and performance

Rewarding self or others for good performance

Seeing mistakes as opportunities for growth and learning

Bouncing back quickly from failure or disappointment

Characteristics of Perfectionism:

Repeatedly setting goals for yourself that are beyond reach and reason and not being satisfied by anything less than perfection

Motivated by fear of failure, obligation or duty

Driven to be the best, but unable to enjoy accomplishments

Feeling that your sense of self-worth and acceptance is based on accomplishments and performance

Criticism and judgment of self or others

Seeing mistakes as evidence of unworthiness

Becoming depressed when faced with failure or disappointment

When is Perfectionism a Problem?

Like many things, perfectionism can be viewed as a problem when it interferes with a person’s wellbeing and happiness, relationships, or functioning at school or work. This is not always easy to know. If you struggle with perfectionism, the high standards you hold for yourself or others may be so long-standing and ingrained that they may even be unconscious and outside of your awareness. You may have a self-critical internal voice that constantly judges and berates you for not being “______” enough (fill in the blank: smart, hardworking, rational, strong, attractive, thin, sexy… and the list goes on), but you may be more aware of ensuing feelings of guilt, shame, sadness, inadequacy, anxiety, helplessness and hopelessness. You may also be aware of feelings of anger, frustration and resentment when others fail to live up to your expectations, and perhaps this has caused difficulties in your relationships.

Perfectionistic thoughts and behaviours can place an individual at higher risk for depression (see blog ‘Depression: How Your Thinking Can Lead to the ‘Blues’’) and anxiety. Research shows that perfectionism is associated with several psychological problems, such as depression, anxiety, worry about being judged by other people, excessive anger, body image and eating disorder problems, and obsessive-compulsive behaviours.

Strategies for Overcoming Perfectionism

Building Awareness:

The first step to change is to first build awareness of what it is that you want to change. Since perfectionistic thoughts and behaviours can be automatic and unconscious, this may not be an easy task! One way of identifying perfectionistic thoughts is to notice situations in which you experience emotions such as anxiety, sadness, anger, frustration or shame, and to reflect on thoughts and interpretations that may be contributing to these feelings. You can also pay attention to situations in which you find yourself engaging in perfectionistic behaviours (e.g., checking and rechecking your work, spending too much time cleaning, excessive organizing and list making, difficulty making decisions, procrastinating, exercising excessively to stay thin, etc.), and notice what you may be thinking and feeling in these situations.

Evaluating Your Standards

Here are some questions to consider when evaluating whether your standards are serving you well or whether you might benefit from challenging or altering them:

The excessiveness of the standard (e.g., Can this goal be met?)
The accuracy of the belief (e.g., Is it true that this standard must be met?)
The costs and benefits of imposing the standard (e.g., Does it help me to have the belief or standard?)
The flexibility of the standard or belief (e.g., Am I able to adjust my standards and change my beliefs when necessary?).

If you determine that a particular standard cannot be met or that the costs of having a particular standard or rule outweighs the benefits, you may want to consider loosening your standards for that particular issue. If you are unsure, you may consider asking the opinion of a friend or loved one whom you trust.

Making Changes to Perfectionism:

Rather than being unwilling to accept anything less than perfection, remind yourself that no one is perfect nor do we need to be in order to be worthy, lovable and valuable as human beings. Think about what is good enough and possible in your current life situation rather than how things should be in order to be perfect. Work on developing self-compassion in place of harsh self-criticism and perfectionism, and more compassion for others. Coping statements like “It’s okay to make mistakes” and “Nobody’s perfect” can be helpful in challenging perfectionistic thinking. People who struggle with perfectionism tend to go to great pains to control many different aspects of their lives, including their own behavior, the behavior of other people, and the environment in which they live. Because you often cannot control or predict things that occur, it can be helpful to find ways to tolerate some degree of uncertainty and ambiguity in your life.

If perfectionism is a problem for you, chances are that the high standards you hold for yourself or others are long-standing and ingrained. The thought of giving up these standards may be very frightening for a number of reasons, and changing these long-standing patterns can be difficult. You may find that it is too difficult to overcome your perfectionism alone or with the help of your family and friends. A psychologist can help you better understand your perfectionism and the role it plays in your life, and support you in changing these long-standing patterns. A psychologist can also support you in addressing problems often associated with perfectionism, including anxiety, depression, anger, eating disorders and relationship problems.

This blog is based on some parts of the book: “When Perfect Isn’t Good Enough: Strategies for Coping with Perfectionism” by Antony & Swinson (1998)

Read more about our Anxiety, Stress & Obsessive-Compulsive 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.