by Marcia Moitoso | Oct 19, 2018 | Anxiety, Communication, Counselling
In my previous blog post, I talked a bit about what social anxiety is and the many strengths that people prone to social anxiety often show. I recommend reading that post first, but as a little re-cap, people who develop social anxiety are often highly compassionate, conscientious and creative. They tend to feel deeply which can either lead to anxiety or an ability to creatively explore their world with curiosity. What often stands in the way of the ability to creatively explore their world is an intense fear that they are not good enough. If you’re struggling with social anxiety, I’d like to offer some strategies to move past that fear while maintaining your many strengths!
How to Hold on to the Good Traits of Social Anxiety and Work Towards Growth
Get out of your own head and turn your attention outward
When we feel socially anxious, we tend to turn inward and start monitoring ourselves. Thoughts like “why did I just say that,” or “what if I just offended her,” circle around and around in our heads and take up all of our mental energy so we often then freeze and can’t think of anything to say.
When you notice this happening, turn your attention outward. Focus on who you’re talking to and listen closely to what they’re saying. This takes our focus away from what we think we’ve done wrong and frees up our mental capacity to be able to engage in the conversation with natural curiosity. Studies show that doing this dramatically increases a person’s likability, and also combats our fears.
Expose yourself to social situations and allow confidence to catch up with you
Don’t wait until you feel ready to give that toast or attend that party! Usually, when we start doing something, our mood follows – you’re more adaptable than you think. If it doesn’t go well the first time, keep practicing. If you persevere, the skill and confidence will catch up with you.
This allows you to refute the two lies your anxiety is telling you:
- The worst-case scenario will definitely happen
- You can’t handle what life throws at you
When we face social fears, we learn that we can live through it and it’s never as bad as we think.
tip: sign up for an introductory improv class. In improv, there is no script and you’re put in a situation where you’re forced to make mistakes in front of others. Sounds terrifying right? I thought so too so I tried it at the height of my social anxiety and it ended up being surprisingly safe. At first, it was embarrassing but then I realized everyone was being embarrassed too. Improv helps us to develop the skills to navigate unstructured social situations that cause anxiety in the real world.
If you drink at a social engagement, do it because you want to, not because you have to
A lot of people drink to make themselves feel more confident in social engagements; after all, it is called “liquid courage.” The problem is that if you do have a good time while drinking, the tendency is to give the alcohol the credit, not you. In reality, that person who was having a good time navigating an otherwise anxiety-provoking situation was you without inhibition. You have that confidence within yourself and you can access it with practice; in facing your fears, you don’t need the alcohol.
Dare to Be Average (Dr. David Burns)
A lot of anxiety comes from our belief that we need to be perfect in social situations. We believe that if we stumble over our words or pause in a conversation, people will see our flaws and reject us. There’s a whole list of “musts” that come with that belief:
“I must be entertaining”
“I must sound smart”
“I must carry the conversation for both of us”
Everyone pauses in conversations, loses their train of thought and says something awkward from time to time; it makes us human and it’s endearing. Dr. David Burns encourages us to “dare to be average.” He reminds us that people are attracted to people who own their averageness because most of us are average. It’s relatable, it’s honest and it’s human. As Dr. Kristin Neff says, “we’re all on this long, awkward journey together.” If you’ve experienced an embarrassing moment, a million other people have had that same embarrassing moment – you’re not alone.
Create a structure for yourself in social engagements
Simon Thompson and Ronald M. Rapee (2002) found that in structured social interactions, people with social anxiety showed a much higher level of social skill than in unstructured social engagements. Dealing with the unpredictable creates anxiety for many people so next time you’re in an anxiety-provoking social setting, create a structure for yourself. Dr. Hendricks suggests giving yourself little missions at parties such as taking to 3 people you don’t know and finding out as much as you can about them. This creates some predictability and some direction in the social interaction.
Dr. Hendrickson’s Tips for Making New friendships
a) Repetition – Show up!
It takes an average of 6 hangouts for someone to consider a person a friend. Many people with social anxiety become discouraged when they work up the courage to go to a social engagement and don’t come away with a new friend. But in reality, this almost never happens for anyone. The way to make new friends is to keep showing up and to see the same people over and over again. Some options might be joining a fitness class with consistent members, dropping the kids off at school and saying hello to the same parents each day or going to a café at the same time each day.
b) Self-disclosure
Many people with social anxiety have trouble talking about themselves for a variety of reasons that may feel really valid after past hurts. Dr. Hendrickson urges us to push through and to gradually share a bit about what you think, feel and do with a person you want to be friends with. Friendships are reciprocal, so gradually the other person will begin to share about themselves as well. People are generally interested in what the world looks like from another’s point of view.
c) Just be kind
Many people think they need to appear confident and competent in order to make friends. In reality, people are drawn to warmth, kindness and trustworthiness. You don’t have to appear confident, just be nice and curious.
Practice self-compassion
Shame feeds social anxiety, but if you can think about yourself in the same way you’d think about another person you care about, it will help you to forgive yourself when you make a social blunder that feels so painful and isolating. Dr. Kristin Neff has an amazing website full of free exercises to help build self-compassion. My favourite is the self-compassion break which is a guided mindfulness exercise that takes only 5 minutes.
Find the exercises here: https://self-compassion.org/category/exercises/#exercises
Counselling
Social anxiety can be completely unbearable and painful and so it can be hard to take any of the above steps on your own. A counsellor can help work with you, at a pace that feels safe for you, to remove the blocks of shame and fear that are inhibiting you from living the life you want to live. If you’re struggling, please don’t hesitate to reach out to a counsellor who can help you with this. You’re too important to deprive the world of getting to know you!
Sources
Burns, D. D. (2008). Feeling Good: The New Mood Therapy. Harper: New York.
Hendrickson, E. (2018). How to Be Yourself: Quiet Your Inner Critic and Rise Above Social Anxiety. St. Martin’s Press: New York.
Moscovitch, D. A. (2009). What Is the Core Fear in Social Phobia? A New Model to Facilitate Individualized Case Conceptualization and Treatment. Cognitive and Behavioural Practice, 16, 123-124. Available from https://uwaterloo.ca/psychology/sites/ca.psychology/files/uploads/files/moscovitch_2009.pdf
Neff, K. (2018). Self Compassion. https://self-compassion.org/
Richards, T. A. (2018). What is social anxiety? Social Anxiety Institute. Retrieved from https://socialanxietyinstitute.org/what-is-social-anxiety
Thompson, S., & Rapee, R. M. (2002). The effect of situational structure on the social performance of socially anxious and non-anxious participants. Journal of Behaviour Therapy and Experimental Psychiatry, 33(2), 91-102. DOI: 10.1016/S0005-7916(02)00021-6 ·
by Marcia Moitoso | Oct 11, 2018 | Anxiety, Counselling
Social anxiety is an intense fear about one or more social situations. It can be generalized to all social situations, or it can be activated in specific situations, such as having a conversation, meeting new people, being observed while eating, drinking, walking, etc., or performing in front of others, such as giving a speech or speaking in front of a class. According to the Social Anxiety Institute, social anxiety is the third largest mental health care condition in the world today. So, if you’re dealing with social anxiety and feeling alone, statistics show that you’re not; at least 7% of the population is right there with you!
Dr. David Moscovitch, a Clinical Psychologist at the University of Waterloo, discovered that social anxiety is more than just a fear of being embarrassed. Rather, it’s an urge to cover up a perceived flaw. People with social anxiety believe that something is fatally wrong with them that makes them socially undesirable, and they fear that this perceived flaw will be seen by others. Finally, they believe that when this flaw is discovered by others, they’ll be humiliated and rejected.
Here’s an example of a situation that someone with social anxiety might find themselves in, and their thought process:
Joe is an average guy, but he believes he’s really boring and that if people found out how boring he is, they won’t like him. One day while Joe was talking to his friend Martin there is a long pause in the conversation. Now, long pauses in conversation with people we’re comfortable with are pretty normal! In this case, however, Joe perceives the long pause as an awkward silence, and believes that the awkward silence confirms his worst suspicions that he is boring and at fault for the awkwardness. His brain became flooded with thoughts about how Martin must be noticing and judging Joe as a boring person, who he’d rather not be friends with. Joe’s mind is filled with even more anxiety, and he can’t think of what to say to Martin. It’s so overwhelming that he can’t bear the idea of being placed in this situation again where he might be judged as boring, so he proceeds to avoid social interactions as much as possible. In reality, Martin didn’t think Joe was boring, and he wasn’t judging him, he was lost in his own train of thought and didn’t think much of the “awkward” silence at all.
This is why Dr. Moscovitch stresses that Joe’s fatal flaw only exists in Joe’s mind. He perceives himself to be boring, and so finds information in the conversation to confirm that his perception is true. People with social anxiety are extra sensitive to social blunders, to the point where they often believe they’re the only ones who make them. The truth is that social blunders are part of what makes us human. Everyone is boring some of the time, we all trip over our words and we all have awkward moments. As Dr. Ellen Hendrickson states in her book How to Be Yourself: Quiet Your Inner Critic and Rise Above Social Anxiety, “nothing is wrong with you, it’s just the blemishes of being a person.”
While it’s normal for everyone to feel socially self-conscious from time to time, “social anxiety is like self-consciousness on steroids”, as Dr. Hendrickson says – it’s a big and heavy feeling, and often very tricky to work around. Because of this, people who have social anxiety are often quite distressed and unable to function as fully in their lives as they’d like. When self-consciousness reaches this level of social anxiety, most people benefit from getting help with regulating it.
How Does Social Anxiety Work?
Social anxiety works in a cycle of fear and avoidance. People begin to avoid the social interactions that make them feel anxious because the anxiety they feel is so painful and unbearable. They understandably want to protect themselves from the trauma of feeling rejected or inadequate. Unfortunately, avoiding social situations only makes things worse because when we’re not interacting with our source of fear, the fear increases and becomes much scarier. On top of that, when we avoid certain social situations we’re also unable to practice the social skills necessary to get through them and the associated anxieties. When we feel we don’t have the necessary skills for something, we continue to avoid it and the cycle of fear and avoidance continues.
Are There Good Things About Social Anxiety?
Many people with social anxiety believe there’s something wrong with them and want to change their personality altogether. They often believe that the opposite of social anxiety is confidence. In her book, Dr. Ellen Hendrickson points out that people with social anxiety tend to have a lot of desirable traits. They’re so anxious because they desperately want to connect, and so are sensitive to the needs of others to such an extreme that it becomes a fault. In fact, psychopathy; not confidence, is the opposite of social anxiety.
People with social anxiety tend to be very conscientious, compassionate and caring, open to new experiences and agreeable. They have all the traits that would make a person socially desirable, they merely are inhibited by fear and an excess of shame. It’s, therefore, best to work through social anxiety by removing the fear and developing confidence on top of the amazing characteristics that are already there! It’s a process of learning to be yourself without fear. Dr. Hendrickson points out that your true self is the self you are without fear. Think about the person you are when you’re most comfortable, maybe when you’re with a pet or with a person you trust or doing an activity you enjoy. That’s who your real self is, and that person is lovable and worthy of connection.
How Can We Move Past Fear and Shame and Live the Life We Want?
My next blog post will detail eight strategies for working through social anxiety. In the meantime, I recommend picking up Dr. Ellen Hendrickson’s book How to Be Yourself: Quiet Your Inner Critic and Rise Above Social Anxiety. It is also a great idea to talk to a counsellor and see how you can work together to come up with a plan to work towards quieting that inner critic. For any question, feel free to contact us.
Sources
Burns, D. D. (2008). Feeling Good: The New Mood Therapy. Harper: New York.
Hendrickson, E. (2018). How to Be Yourself: Quiet Your Inner Critic and Rise Above Social Anxiety. St. Martin’s Press: New York.
Moscovitch, D. A. (2009). What Is the Core Fear in Social Phobia? A New Model to Facilitate Individualized Case Conceptualization and Treatment. Cognitive and Behavioural Practice, 16, 123-124. Available from https://uwaterloo.ca/psychology/sites/ca.psychology/files/uploads/files/moscovitch_2009.pdf
Neff, K. (2018). Self-Compassion. https://self-compassion.org/
Richards, T. A. (2018). What is social anxiety? Social Anxiety Institute. Retrieved from https://socialanxietyinstitute.org/what-is-social-anxiety
Thompson, S., & Rapee, R. M. (2002). The effect of situational structure on the social performance of socially anxious and non-anxious participants. Journal of Behaviour Therapy and Experimental Psychiatry, 33(2), 91-102. DOI: 10.1016/S0005-7916(02)00021-6 ·
by Alannah Mcintee | Oct 4, 2018 | Counselling, Depression, Emotional
Grief is a normal emotional process that happens when adjusting to a loss or change. It happens not only when someone has died, but also after things like a job loss, the ending of a relationship, or while anticipating a future loss. Grief is a complex process that has no concrete roadmap, but there are some common factors that influence the process we go through. Some of these factors are:
- Our relationship with the individual who is gone
- The circumstances surrounding the loss
- Our current coping mechanisms and how past emotional distress has been handled
- The availability of support networks while we grieve
(Living Through Loss, 2017)
No matter what we are grieving, it is difficult, painful, and exhausting.
Part of the difficulty in grief, as I alluded to above, is that the roadmap isn’t clear. What we do know, however, is that there’s no right or wrong way to grieve. It is okay to feel relief, emptiness, or nothing at all when coping with a loss. It’s also okay to cry, feel physically exhausted, be angry, or struggle with feelings of guilt. Grief is a process that is unique to each person and so our bodies and our minds will respond as best they can in whatever way they feel is best for us to move on; in other words, they do the best they can at the time, with what they have to work with.
Sometimes the timeline of grief can be a challenge. Often, we expect ourselves, or even others expect us to move through the grieving process more quickly than we’re able to. It’s important to know that it’s okay to take as long or as little time as we need to move forward. Given the popularity of the five stages of grief (denial, anger, bargaining, depression, and acceptance), many people believe that they need to go through these five stages linearly to move forward (Living Through Loss, 2017). That may be the case for some people, but it is not for everyone. As mentioned above, people experience a wide range of emotions and experience grief in different ways so their grieving process may not always be forward moving. Sometimes we get stuck, sometimes we go backwards, or sometimes we’re all over the place and have a mix of good days and bad days, which sometimes ends up looking like a mess.
How do we manage while all of this is happening? With how intense and exhausting grief can be, it is vital that we take care of ourselves. Often, we’re so overwhelmed we can’t even think of how to take care of ourselves. Here are some suggestions for ways you can practice self-care while going through the grieving process:
- Avoid drugs and alcohol since they may make you feel worse
- Avoid isolating yourself and find support from a friend or counsellor
- Get lots of rest. Grieving is exhausting, so you will likely be more tired than usual
- Drink lots of water and try to eat the best you can, and try to avoid sugar and caffeine
- Exercise, even if it’s only going for a walk around the neighbourhood
- Give yourself time and permission to mourn as often as needed
- Do things that make you feel good such as journaling, art, listening to music, reading
- Be kind to yourself. You’re doing the best you can
(Living Through Loss, 2017)
After some time, we will adjust to our losses. It’s hard work and takes time, but eventually, we can come to terms with what has happened, grieve and mourn our loss, and move forward. However, some people find themselves stuck. This experience has been described as something called Complicated Grief. Some of the signs of complicated grief are:
- Being unable to move on
- Being unable to carry out everyday routines
- Isolating yourself
- Feeling intense loneliness or numbness
- Feeling extreme sorrow, pain, or depression
- Feeling that life has no purpose
- Ruminating or experiencing intrusive thoughts about your loss
- Wishing you died with your loved one
(HealthLinkBC, 2017)
If you notice that you or someone you care about are experiencing any of these symptoms, then may be time to seek out professional help such as counselling. Therapy can give you a space to talk about your loss and help you to work through your thoughts, feelings, and memories relating to your experience. Counselling can also help to identify and work through any potential trauma relating to the loss and helping you to adjust to this change.
I hope this article has been helpful if you’re experiencing grief and loss. We’ve all been there, and some of us are there right now with you. If you could use some help as you walk through this journey of grief, we would love to talk to you. Please give us a call or contact us anytime, we’re here.
References
Complications of Grief. (2017). Retrieved from https://www.healthlinkbc.ca/health-topics/aa129291
Grief and Loss Resources. (2017). Retrieved from https://livingthroughloss.ca/
by Andrew Neufeld | Sep 27, 2018 | Counselling, Guidance, Tips
I recently attended the Recovery Capital Conference of Canada 2018 with our associate, Richard Somerset. This is the second year we’ve gone to the conference, and each year I leave, reminded of one thing: the importance of hope. It’s wonderful to hear the research, discuss different topics, see old friends; but, what I enjoy most are the stories from clinicians and people from the recovery community alike – stories of recovery, rejuvenation, and hope.
The role of counselling in recovery is an interesting one. I remember my earlier days working on the downtown east side with youth living on the street and suffice it to say, my “office” was pretty different back then. Most of my work involved a trip to Tim Horton’s, or sitting in a local park, or even sitting on the ground in various alleys. Most of my work back then seemed less “clinical” if you will – you might even call it counselling guidance.
The reality was, as it still often is, that there was precious little I could do to make things better. Some of the stories I heard from these youth were devastating, horrific even, and it didn’t stop. I could help find them a place to stay at Covenant House, my employer at the time. I could talk to them about job opportunities, addiction treatment options, mental health resources. What I couldn’t do is change their past, or sometimes, their present and future.
So, what then? What good is counselling guidance? How does it instill hope in a life where there doesn’t seem to be any?
What I found in the alleys of the downtown east side of Vancouver, and what I continue to find in my nice, cushy office in the suburbs, is that most of my role in the lives of others is as a guide – helping people find their way back to seeing hope in themselves. Hope in who they are. Hope in what they could become. Even if some of the circumstances don’t change.
This is the power of empathy and connection. While our current circumstances are important, I find that they have very little to do with hope. We can be in the worst of times and be hopeful, and we can be in the best of times and find it meaningless. This is where the guidance fits in.
Counselling guidance, in this case, takes the form of slowly helping clients entertain the idea that hope resides in self and others, and not in the situation. Hope resides in the idea that you are still, at your core, worthy of love and that life can be different. In the words of Marsha Linehan, life can be worth living again.
How, then, can we start finding hope, and even joy in the midst of emotional and/or situational turmoil? How can counselling help this process along? Here are three things to keep in mind in terms of counselling and hope:
- You are not your addiction, your depression, your borderline personality disorder, or otherwise. These are all things that love to tell you otherwise, preying on the negative thought processes and painful emotions that may be running through heart, mind, and soul.
- There is always hope. You may not see it right now, and you may think that what you’ve done, what you’re battling, or what you anticipate are too much for hope to conquer. What I can tell you is that in all of my experience, I’ve never seen these things evidenced in truth. There are no hopeless causes, hopeless battles, or hopeless futures if we continue to hold on.
- You may not be in a place where you can hold hope for yourself. You may need someone to hold if for you. This is where a counsellor comes in. Our job, in my view, is to hold hope for those that can’t hold it for themselves. I know I’ve been there. I consider it an honour to be able to hold hope for others.
If you see yourself in any of the above, I would encourage you to give counselling a try. Sometimes counselling is a very specific clinical intervention. Sometimes, however, it’s guidance, and guidance toward the possibility of hope.
If we have hope, we have a chance.
by Marcia Moitoso | Sep 13, 2018 | Counselling, Depression, Stress
Over the past two decades, we have seen a steady rise in media attention covering Postpartum Depression (PPD). This is partly because the psychiatric community officially recognized PPD as a distinct condition in the mid-90s [i] and partly because of celebrities who have started to talk about their experiences with postpartum depression. And yes, you read that correctly, although there are abundant records of women talking about their experiences with maternal mental illness from the early 1800s to the present, it only started being recognized as a distinct mental illness in the 1990s[ii]. As you might imagine, the result is that the science, the literature and the media reporting are all a bit behind. Luckily, with organizations such as Postpartum Support International (PSI), the science is finally starting to catch up and hopefully, that means the media and our social perceptions of maternal mental health will too.
What is Postpartum Depression?
Postpartum depression is often used as an umbrella term for all maternal mental health conditions, but in reality, there are a number of maternal mental health conditions that are distinct and vary in terms of severity, duration and characterization. All of these conditions tend to get jumbled up together in the media which is confusing for those who have PPD, as well as their loved ones. So, let’s break it down.
The technical term for postpartum depression is a Major Depressive Episode with Peripartum Onset. What that mouthful of jargon basically means is that PPD can be understood as a depressive episode that lasts a minimum of 2 weeks and is characterized by depressed mood, insomnia or hypersomnia, fatigue, feeling worthless, low interest in pleasurable activities and having thoughts of suicide[iii]. If you read my last blog post about the Baby Blues, you might note here that PPD is very different from the Baby Blues. Baby Blues are a normal part of giving birth where most mothers experience a drop in the mood right after giving birth for a short period of time. PPD not only last longer but is more severe. About 15% of new mothers experience PPD as opposed to 85% of mothers who get the Baby Blues[iv][v]. And while this distinction is important, keep in mind that whether you have the Baby Blues or PPD, you can absolutely get treatment, you don’t have to wait and see if it’s severe enough. Every person’s experience is different, and you deserve help. Do yourself a favour and check in with your doctor, midwife and/or therapist to see how they can support you to feel like yourself again.
Men experience PPD too. A growing body of research has shown that roughly 5% of new fathers experience PPD which comes as no surprise because mothers and fathers both endure the many new stressors like lack of sleep, way more responsibilities and demands put of their plate, and feelings of failure and inadequacy often associated with bringing a baby home[vi].
I won’t go too far into the causes of PPD here but if you ever want to talk about them, my door Alongside You is always open.
I’ve spoken to a lot of mothers and fathers who were very confused about the way their PPD presented itself. Interestingly, PPD might look different from what we might think of as a typical episode of depression. A lot of people with PPD have reported either anger or anxiety as their primary symptoms[vii]. Some experience periods of elevated energy and racing thoughts where they’re unable to sleep and can’t stop cleaning. Many also report panic attacks[viii]. While these responses may feel scary at the time, they are normal and can be helped with a number of different therapies that I will get into at the end of this article.
Overcoming Stigmas and Getting Help
Experts agree that PPD is underdiagnosed, primarily because those who endure it often feel too ashamed to seek help. There’s a common misconception that PPD is associated with infanticide which is simply not true. Those over-reported cases of infanticide are not cases of PPD, they are cases of severe psychosis with peripartum onset. Unlike depression, psychosis is characterized by delusions and hallucinations[ix]. And even if a parent does show signs of psychosis with peripartum onset, it is incredibly rare that these delusions will lead to infanticide[x]. I can’t stress enough how rare that is.
New parents are often under a lot of stress and experience intrusive thoughts. When a person’s brain is in an anxious state, it’s common for their mind to go to the worst possible thing they could do (as if you weren’t stressed enough already…). This happens to all of us. Sometimes when I’m driving up the Sea to Sky highway, my brain imagines veering my car off the cliff. Of course, I will never do that, but my brain plays some pretty wild tricks sometimes, just like yours might when you’re under a lot of stress and your baby is still crying.
The main danger with PPD is that the stigmas that result from those sensationalized media stories keep many new parents from reaching out for help. As a result, suicide (not infanticide) is the greatest risk associated with PPD.
What can Help Postpartum Depression
As I mentioned at the start of this blog, science is catching up and we now have many treatments to choose from for PPD. Some find antidepressants helpful, like one woman said, “the me I was used to re-appeared after medication.” Other treatments include infant sleep interventions, massage therapy and relaxation, increasing Omega-3 intake (fish, nuts, seeds, healthy oils), spiritual practices, yoga, bright light therapy and, of course, counselling (individual and couples counselling are both helpful). For most new parents, a combination of any of these above methods works best.
I’ll leave you with a simple and accurate quote from a mother I recently spoke with who had PPD – “Let people help, they want to.”
We’d love to help, if you’ll let us. Give us a call at the office, or contact us through our contact page and we’ll be happy to talk to you about how we might be of help!
Some books that have been helpful to others:
- Motherhood May Cause Drowsiness: Mom Stories from the Trenches: A Second Edition Monkey Star Press Anthology (What Is a Mother to Do? Adventures in Motherhood and Mayhem) – by: Lisa Nolan, et al.
- When Postpartum Packs a Punch: Fighting Back and Finding Joy – by: Kristina Cowan
- Tokens of Affection: Reclaiming Your Marriage After Postpartum Depression 1st Edition -by: Karen Kleiman, Amy Wenzel
- The Birth Partner: Everything you Need to Know to Help a Woman through Childbirth – by: Penny Simkin
References:
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.) VA: American Psychiatric Association
[1] Segre, L.S., & Davis, W.N. (2013). Postpartum Depression and Perinatal Mood Disorders in the DSM. Postpartum Support International. Retrieved from www.postpartum.net.
[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). VA: American Psychiatric Association
[1] Shapiro, G.D., Fraser, W.D., & Seguin, J.R. (2012). Emerging risk factors for postpartum depression: Serotonin transporter genotype and Omega-3 fatty acid status. CanJPsychiatry, 57(11), 704-712.
[1] Khajehei, M., Doherty, M., & Tilley, M. (2012). Assessment of Postnatal Depression Among Australian Lesbian Mothers During the First Year after Childbirth: A Pilot Study. International Journal of Childbirth Education, 27(4), 49-54
[1] Breese McCoy, S.J. (2012). Postpartum depression in men. In M. G.Rojas Castillo (Ed.) Perinatal Depression (p. 173-176.) Rijeka: InTech. Available from: : http://www.intechopen.com/books/perinatal-depression/postpartum-depression-in-men-
[1] APA (2013)
[1] APA (2013)
[1] Postpartum Support International (2018). Postpartum Psychosis. Retrieved from http://www.postpartum.net/learn-more/postpartum-psychosis/
[1] APA (2013)
[1] Shapiro, et al. (2013)
[i] American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.) VA: American Psychiatric Association
[ii] Segre, L.S., & Davis, W.N. (2013). Postpartum Depression and Perinatal Mood Disorders in the DSM. Postpartum Support International. Retrieved from www.postpartum.net.
[iii] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). VA: American Psychiatric Association
[iv] Shapiro, G.D., Fraser, W.D., & Seguin, J.R. (2012). Emerging risk factors for postpartum depression: Serotonin transporter genotype and Omega-3 fatty acid status. CanJPsychiatry, 57(11), 704-712.
[v] Khajehei, M., Doherty, M., & Tilley, M. (2012). Assessment of Postnatal Depression Among Australian Lesbian Mothers During the First Year after Childbirth: A Pilot Study. International Journal of Childbirth Education, 27(4), 49-54
[vi] Breese McCoy, S.J. (2012). Postpartum depression in men. In M. G.Rojas Castillo (Ed.) Perinatal Depression (p. 173-176.) Rijeka: InTech. Available from: http://www.intechopen.com/books/perinatal-depression/postpartum-depression-in-men-
[vii] APA (2013)
[viii] APA (2013)
[ix] Postpartum Support International (2018). Postpartum Psychosis. Retrieved from http://www.postpartum.net/learn-more/postpartum-psychosis/
[x] APA (2013)
by John Bablitz | Sep 13, 2018 | Anxiety, Children, Parenting
An interesting piece about “The big myth about teenage anxiety” ran in the New York Times this week, authored by a fairly prominent psychiatrist – which you can find here.
The essence of Dr. Friedman’s editorial is that much of the research showing a rise in teen anxiety is not conclusive, which from a scientific perspective is unsurprising. Many of these studies rely on self-reports, which, though scientifically imperfect, offer an important window into human experience – something we as mental health professionals consider of paramount importance. A better understanding of what we deal with internally and externally on a daily basis (and the meaning we make of it) is essential to better understanding ourselves. Dr. Friedman also encourages readers to remember that phones are not necessarily to blame for anxiety, as much as it may seem that way. He points out that anxiety is normal, and that our brains are quite well-equipped to handle it.
The article is nuanced, and while I would hesitate to back up many of the things Dr. Friedman says, one important distinction he makes is between actual anxiety disorders and day-to-day anxiety and worry – something most teens are virtually guaranteed to experience. Social media and the internet have indeed made the social world more complex for teens to navigate – as many have noted, there is no “escape” from the reach of the internet anymore, and it is more than understandable that teens are often glued to their phones. Teens are under a lot of stress developmentally, socially and physically, and Dr. Friedman is careful to point out that there will and should be plenty of anxiety in teenage life.
The crux of the matter then is not eliminating or avoiding anxiety (avoidance, of course, will actually make the anxiety seem stronger than it is), but focusing on what we can learn to do in the face of anxiety. Teens can learn that anxiety is normal, learn to notice bodily sensations that arise, learn to stay grounded, and even learn to appreciate their anxiety for protecting them.
Many parents are highly distressed when they learn their teen or child is struggling with anxiety, and I would encourage those parents to remember how normal that is. Your job is not to eliminate or protect from that anxiety, but rather to be with your child as far as they will let you, and creating as best you can a space of rest from it. There are many anxiety management techniques that can be learned to reduce day-to-day anxiety, but one of the best things to have is a secure relationship within which you do not need to be anxious. I can’t stress enough the impact of having someone with whom you feel safe to just be you, warts and all.
It’s no secret that I (along with many others here at Alongside You) am a big fan of attachment parenting, an idea propagated by Dr. Gordon Neufeld and brain researcher Daniel Siegel, among many others. I am also a big fan of parents taking care of themselves before they worry too much about taking care of their children, for several reasons. So I should mention that your anxiety about your kids’ anxiety is incredibly valuable: it tells you how important it is to you that your kids are safe and happy. This is wonderful, and you also should get to know that perfectly normal anxiety really well within your own safe relationships, because your kids will use you as a compass point to manage their own anxiety. If you have a good relationship with your anxieties, you will be very much ahead of the game in helping your child or teen with theirs. Normalizing our own experience of anxiety reduces it in our kids, and also shows them that they’re not alone.
Parenting is a tough job, and if you’re reading this, one that I imagine you take seriously. Best of luck, and as always, feel free to ask lots of questions and seek lots of support. If we can be a support to you, please don’t hesitate to contact us. We’re all in this together.
by Andrew Neufeld | Aug 31, 2018 | Anxiety, Children, Communication, Counselling
It’s that time of year again; the time of year where summer ends, and kids are going back to school. I find that this time of year brings one of two primary reactions from parents:
“Hallelujah! They’re back in school and I can finally get things done around the house or at work again!”
Or
“Oh no, my babies are gone back to school! Are they going to be ok? How are they going to survive? What if they [insert any number of parental fears here]….”
Sometimes I wonder who has more anxiety during the return to school period – the kids, or the parents? Counselling for children during this time period can be very helpful, as can counselling for parents. What else is helpful as we prepare our kids for school?
One thing that’s clear, both in my personal experience (clinically, and with my own kids) is that our own emotional climate has a great effect on our kids’ emotional well-being as they return to school. If we are feeling anxious, chances are they’re going to pick up on it and join the anxiety party. If we’re calm, they may not join that party, but at least we’ll be in a position to help.
I get it. I hear your fears and anxieties as parents of young children. It’s normal to be anxious about this time of the year. So, what can we do to help our kids during this important transition? I’d like to offer four questions that we can ask our kids to open a conversation with them as they go back to school. I believe this dialogue will not only help their anxiety (which it will), but it will also build up the reservoir of empathy that is so needed, and strengthen your relationship with them.
1. How are you feeling about going back to school?
What is your greatest fear, and what are you most excited about? With this question, we’re inviting our children to share their emotional world with us, and at the same time, we’re making it explicit that it’s ok to have fears and it’s ok to be excited. We’re also introducing the idea that it’s possible to have both excitement and fear all at the same time! The psychobabble word for this validation.
By validating their excitement and their fears, we’re helping them feel known, accepted, and heard. This is the very basis of empathy, the greatest antidote to stress and existential anxiety. It’s the greatest tool we have with our children and their fight against their anxiety.
2. How do you feel when you’re in school?
What helps you enjoy the great parts and manage the hard parts? This question helps our child explore how they are doing during the school day when we’re not there. Research out of Yale University shows the importance of helping children have a “mood meter” throughout the day at school. It helps them understand their world as well as regulate their emotions. While specific techniques to manage mood are great, their research shows that simply paying attention to our emotions in a validating environment produces emotional benefits and helps students manage their emotions better in school and at home, all while reducing overall stress.
3. How do you feel during recess and lunch?
What are you looking forward to, and what might be more difficult? This question is a sneaky one. This is how we find out about their relationships at school and how they are doing with their peers. I don’t know about you, but if I ask my kids directly, “How are your relationships with your friends,” I’ll invariably receive an answer along the lines of, “Fine.” Or sometimes it’s, “I don’t know,” and finally, if I’m really lucky, I just get, “Dad! Stop butting in!”
If, however, we ask our kids how they are feeling during the times where they’re interacting socially with their peers, we’ll get a glimpse into their relationships. If they’re connecting well with other students we’ll likely get positive reports; if not, we might hear things like, “I’m bored,” or, “I’m lonely,” or, “I hate lunch.” This provides us with an opportunity to ask further questions, but now with a reason that the child has provided themselves. We can ask, “Wow, I’m sorry to hear you hate lunch and I’m curious what it is about lunch that isn’t going well?”
Sometimes, no matter how we ask, our children may not tell us what’s going on. If that’s the case, we can still get a win. Even if we can’t address that problem directly, at least we can provide empathy. If all else fails, we can still respond with, “Wow, I’m sorry to hear you’re having a tough time at lunch. I’m not sure how I can help, but I’m glad you told me.”
4. How do you feel when you get home?
What do you need after a day at school? This final question gives us a window into what our kids need after a long day of school, and believe me, the school day is long for our kids. Each kid is unique, however, and their needs after a day of school are wide and varied. Some kids need to run, some need a nap, some need a hug, some need…well, we’re not sure what. This is our chance to give our kids the opportunity to tell us what they need so we can help them get their need met.
It also provides us with a unique opportunity to connect in a meaningful way with our kids after their day and show that we’re interested in their world. It keeps us from simply yelling, “Don’t drop your jacket on the floor! Put your bag away! Take your shoes off, etc., etc.,” as our main way of connecting when they get in the door.
As parents, we can’t fix everything for our kids. We can’t solve all of their problems, but in this one question, we can at least begin to learn what they need after school so that we can help meet that need. If we can do this, we’ll help reduce their stress, which has many, many benefits for the kids.
It also has the net benefit that if we reduce their stress, give them opportunities to connect, our time with them will be less stressful, and they may actually be less likely to fling their backpacks across the room in frustration as soon as they open the door after school.
Our greatest job as parents
I hope this article is helpful as we all prepare for next week and the return to school. We all love our kids and we often feel like our job is to fix everything. I want to encourage us to focus on accepting our child’s answers to these questions and not let our own anxiety put us into “make it better mode.” If we fall prey to this, we do the opposite of what our kids need. Our kids need validation and empathy. The great thing is that in order to do this, all we need to do is listen and be with our kids. We don’t have to make it all better, because most of the time, the reality is that we can’t.
Need some help?
Parenting is tough, and this is a tough time of the year for everyone involved. If we can be of any help, please give us a call. This is the time of year is when counselling for children can be extremely helpful. We have a team of counsellors who love working with parents and kids and we’d love to be a resource for you.
by Susan Le | Aug 22, 2018 | Dietitian, Nutritionist
What is the difference between a Registered Holistic Nutritionist & a Registered Dietitian?
When I tell people I am a Registered Holistic Nutritionist, I often get asked, “What’s the difference between a Registered Holistic Nutritionist (R.H.N.) and a Registered Dietitian (RD)?” While both healthcare practitioners working in related fields, there are distinct differences as well.
Here at Alongside You, you’ve been familiar with our Registered Dietitian, Annie Tsang. I’ve recently joined the clinic as a Registered Holistic Nutritionist (R.H.N.) and wanted to introduce myself as well as let you know how I can help you achieve your health goals.
Let’s start by explaining the differences between an R.H.N. and an RD.
What is a Registered Holistic Nutritionist?
It is worthwhile to note that there are different nutritionists out there. Each coming from a different school with varying program lengths and certified differently. The term Holistic Nutritionist is an unregulated term.
In Vancouver, there are two schools that certify holistic nutritionists: the Canadian School of Natural Nutrition and the Institute of Holistic Nutrition.
I graduated from the Canadian School of Natural Nutrition (CSNN) and am certified as a Registered Holistic Nutritionist (R.H.N.) with a Natural Nutrition Diploma. Because I haven’t been to the Institute of Holistic Nutrition (IHN), I will only speak to my experiences as an R.H.N. from CSNN. To complete my program, I completed case studies, did a board exam, and am registered with the CSNNAA (CSNN Alumni Association).
As an R.H.N., I follow a Code of Ethics:
“The Canadian School of Natural Nutrition has as its mission the education of the individual in the principles of holistic healthcare and the principles of natural nutrition, to further the well-being of people and the healing of planet Earth.”
As Holistic Nutritionist, I use evidence-based and science-based tools to help guide clients through their health goals and concerns. Recommendations include dietary, lifestyle, and supplementation changes.
Like most holistic health care practitioners, I look at an individual as a whole. That’s why recommendations don’t only include dietary changes. An R.H.N. looks at your complete health history, current diet, and lifestyle habits. We take into account how stressed you are, are you sleeping, are you exercising, etc. Through our intake process, we work with the root cause to identify imbalances in the body and make recommendations based on all of that.
For dietary recommendations, I take a whole foods approach with the belief that natural nutrition is a tool in preventing diseases and bringing the body back into balance.
What is a Registered Dietitian?
Registered Dietitians have regulated professions that register with a provincial dietetic regulatory body.
In BC, most RDs graduate from the UBC Nutrition Program with a Bachelor of Science (BSc) in Food, Nutrition, and Health. In the program, an RD takes courses on nutrition, general science, and agricultural science. In the fourth year of the program, they take a few nutrition courses. RDs use the Canadian Food Guide as a tool to help their clients. The Canadian Food Guide is based solely on science and suggests that everyone’s nutritional requirements are the same. Because they are regulated, they are covered by most healthcare benefits programs.
How can I help you?
As an R.H.N., I can help with:
- Chronic pain management
- Chronic fatigue
- Blood sugar imbalances
- Detoxification/cleansing
- Disease prevention
- Digestive issues
- Hormonal imbalances
- Mood imbalances
- Stress and sleep issues
- Weight loss
It is important to note that I do not treat, cure, or heal any diseases.
As an R.H.N. and a Certified Yoga Teacher, I blend both modalities in my recommendations to help my clients achieve their health goals. I use my knowledge I can help with 1:1 health coaching, weekly meal planning, and group support sessions.
Are your services covered by my benefits plan?
Currently, holistic nutrition services are covered under some healthcare benefits plans as “Nutritional Counselling”. Companies such as Greenshield and Manulife will cover my services. However, you will need to check your benefits plans to see if nutritional counselling is covered.
Get in touch
Curious what it’s like to work with me? I offer free 15-minute consultations. Call the office at (604) 283-7827 ext. 0 to book your consultation to see how we can work together!
by Alannah Mcintee | Aug 17, 2018 | Media, Mental Health, Suicide
Over the last few years, there has been an increase in mental health visibility in television, movies, and social media. People have been more open about their own experiences with mental illness, and there has been an increase in the representation of suicide and mental health on television and movies. I believe that this is a significant step forward to de-stigmatizing and normalizing mental illness.
One show that tore down barriers and was a big step in suicide representation was “13 Reasons Why”, which was met with controversy and resistance. For those who have not watched the show, it is terrible. I don’t mean terrible as in it was poorly written or the actors weren’t very talented. I am referring to the fact that it is a raw depiction of suicide that captures the intensity and terribleness of taking one’s own life. This television series is a straight-forward, honest, and painful representation of suicide. As mentioned earlier, this television show is deemed by many to be controversial and inappropriate for its target audience. However, it is meant to bring awareness to the factors leading up to suicide in youth, such as bullying, ostracization, or sexual assault. The purpose of this series is to inspire dialogue amongst others so individuals can reach out for help, recognize warning signs of suicide, or be supportive towards others who are struggling.
We are currently in a cultural shift where advocates are working towards the destigmatization of mental illnesses, which also includes discussing suicide openly amongst each other and in our media. Nevertheless, with this shift, there is also apprehension and opposition because it is ingrained in us that we should not be talking about suicide, let alone see it on television. There is a fear that if it is discussed or exposed to others, then we may inspire the idea in someone else and they will be more likely take their life, which is not true.
It is necessary to mention that as our media begins to introduce these topics, there is still a long way to go. More often than not, television shows and films can miss the point when it comes to getting the proper help and support or how to begin the necessary conversation when acknowledging suicide. The mere depiction of suicide in our media is not enough on its own. Therefore, there is a need for more discussion and awareness present in our media regarding mental illness and symptoms, finding support, and accessing resources to be present. We are only at the beginning of the battle of de-stigmatization, and there is a long way to go before we get to where we need to be.
Given that suicide and mental health is a tricky topic to navigate through, it can feel as though there are so many Do’s and Don’t’s when talking to someone about it. If you’re not a mental health professional, it can feel like you’re walking on eggshells trying to have a conversation about suicide with someone else, but that’s okay, it is a tough topic. The best way to talk about suicide and mental illness with someone else is by being open and direct about it. It’s okay to ask someone if they are thinking about, or have thought about suicide because it creates an opportunity for a person to talk about what is going on for them. Additionally, listen to them, respect and validate their feelings, take what they say seriously, and get them the appropriate help and resources that they need (resources and websites are below).
Many of us are entering a new and unknown territory as we learn how to navigate a discussion about these difficult topics and it makes sense that it is met with resistance and uncertainty. However, it is important to note that this is one of the many reasons that we need media like “13 Reasons Why” that will make us cringe and feel uneasy, to bring light to the fact that we may be uncomfortable discussing these topics. What is still sometimes missing in the media, however, is the follow-up conversation needed after these difficult topics.
Clinical Director’s Note:
When this TV show came out there was a lot of controversy. In fact, in conversation with many of the leaders of the local mental health resources we even considered creating media titled, “13 Reasons Why Not,” because much of the response to the show seemed to be that the show glorified suicide, or certainly did not provide any of the needed conversations to follow up on this important topic.
Whatever our views are of this new sort of media and its’ appropriateness, it’s a reminder of the importance of having open, honest conversations with youth around suicide and mental health.
It’s a difficult conversation to have, and there are many local resources to help, including Alongside You. If we can be of help please let us know. Here’s a list of other resources in the community as well as larger resources across Canada and North America:
Child and Teen Mental Health
Boys and Girls Club
Deltassist
1-800-SUICIDE
310 Mental Health Support: 310-6789
https://crisiscentre.bc.ca/youthinbccom/
CrisisCentreChat.ca
https://13reasonswhy.info
Alannah McIntee is the one of two new interns at Alongside You. Studying at Adler University she has a keen interest in working with kids and we’re excited to have her on board!
by Andrew Neufeld | Aug 2, 2018 | Communication, Connection, Relationship
Reflections on 15 years of marriage…
Today is the anniversary of the best decision I’ve ever made. This sounds cheesy, perhaps, but it also happens to be true. Fifteen years ago, I married Meg, and it’s been a wild ride ever since. Depending on how you recount history, our story either started in grade 5 or when I was 16. I went to school with her twin sister when I was in grade 5, and I remember when she came into our class for the first time to deliver a message to her sister. Now, you have to understand, I was in no way, shape, or form smooth at that age (many would argue that never changed). But, I distinctly remember turning to my friend and saying, “Wow, she could come back more often.”
Fast forward to when I was sixteen and started working at a summer camp. I walked along the boardwalk and low and behold, there was a beautiful girl that I recognized. I walked up to her and asked her, “Do I know you from somewhere?” She, thinking I was feeding her a line, literally got up and ran away. Now, I’m not using the word “literally” in the new-school hipster way, I actually mean she literally got up, moved her feet at a rapid pace, and in the opposite direction. Great start to a relationship.
Needless to say, it took a few years of work to get her to stop running away and to actually consider that I might be marriageable material. But, when I was 20 and she was 21, I asked her to marry me and, as they say, the rest is history.
As I was trying to fall asleep last night, my mind kept circling the question, over and over, “How is it that our relationship has lasted, and gotten infinitely better over time?” See, it hasn’t been easy. We got married young, and in our first year of marriage we went kamikaze with school, work, and other activities and didn’t see each other a whole lot (I definitely do not recommend this approach…). We are quite different people in many ways, and we often don’t see things the same way. And now, we’re business partners full time. Our recipe for success isn’t so simple! I also realize that we’re still in our infancy in our relationship at 15 years in – my parents will be celebrating 48 years of marriage this year, something I aspire to. So, this article isn’t definitive, because we have a long way to go!
I can’t write nearly as much as I wish I could hear, so I’ll save some for a later article. Here are three things that have been helpful to me in our marriage, and I hope will be helpful to you in your relationships.
- If you know you’re wrong, admit it. If you know you’re right, shut up.
A very close family friend wrote this on the wedding card he gave us on our wedding day. I didn’t realize that this was a quote from Ogden Nash at the time, but it’s always stuck with me. Anyone who knows me knows that I love a good argument, and I’m pretty opinionated. I don’t expect everyone to agree with me, but if we’re arguing, I’m going to try to win the argument.
This is not a recipe for success in marriage. If it’s simply an intellectual argument it might be ok. If the argument is about something you’ve done wrong, arguing that you were right is not going to help things. Similarly, if you know you’re right it may not be your best course of action to beat this over the head of your partner. Chances are they know you’re right (even if they don’t want to admit it), and forcing the issue will just breed resentment.
- Accept influence from your partner.
This one does not come naturally to me, at all. I’m not even sure why because I often say, and I sincerely believe, that I married up. It would only make perfect sense for me to accept Meg’s influence as a matter of course, but for some reason, it’s still challenging for me. There’s still a little birdie on my shoulder that, when I’m under stress, tells me that accepting influence is admitting defeat. Let me assure you, it’s not.
Accepting influence from your partner means that we shift from a focus on me and instead, focus on we in the relationship. John and Julie Gottman refer to this as the we-ness of the relationship and it’s something they measure in their research i. If you’re a research geek like me, feel free to have a read of this article that highlights how John Gottman has shown that relationships are far more successful when men accept the influence of their partner. It’s important for women to do this too, but the research seems to show that most women are already pretty good at it.
- 69% of conflict in relationships is due to perpetual problems.
This fact can either be encouraging or be discouraging depending on how you look at it. This statistic comes from John Gottman’s research and it’s been replicated. Perpetual problems are the issues that come up in the relationship over and over again. These problems are due to fundamental personality differences or lifestyle needs and are not going to be solved. These problems simply need to be managed. The conflict stems from the idea that we can change these things, rather than accepting them and managing them.
Part of me finds this frustrating. My brain and my passion drive me toward creating positive change and my superhero complex leads me to believe I can solve all of life’s problems if given enough time. When I’m stuck in this mode, I get frustrated and wonder why, after 15 years, we stumble through the same issues and I haven’t figured out how to solve them yet.
My more reasonable, rational self-finds this encouraging. I find it encouraging that after 15 years of struggling with the same issues, we still have a great marriage. We haven’t given up. We haven’t grown resentful. Somehow, even though we can’t change it, we find a way through it together. Over, and over, and over again.
We’re not perfect, even after 15 years of working at it
I didn’t want this article to come across as Andrew’s guide to having the perfect marriage that he has with his wife, and I hope it doesn’t come across that way. We’re not perfect, and we regularly screw it up. But when we do, we work hard at it.
Relationships are difficult. My marriage is by far the most difficult thing I’ve had to work on, and I can say without reservation, that I’ve had more work to do on myself than my partner has. She’s better at this than I am, she’s more of a natural, and Gottman’s research seems to support this.
What their research also shows, however, is that if I continue to work on this, and continue to accept Meg’s influence, my doing so is one of the most powerful forces to effect positive change in our relationship – and that’s what I’m going to work on for the next 50 years, God willing.
I love you Meg. Thank you for working on this with me and teaching me every day.
It’s ok to laugh at this. Every time I go to one of their training and they use this word, I laugh. Part of maturity is accepting that we laugh at immature things. Or something like that.
If you’re looking for some summer reading that will improve your relationships, check out this book by John Gottman. It’s a great primer for some of the principles that make relationships last!
