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By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Breathing Exercises to Manage Stress
Breathing exercises can be very helpful tools for managing symptoms when our “fight-flight-freeze” stress response is triggered. And the great thing about breathing techniques is they’re easy – once we master the steps. One of my go-to breathing exercises, which we teach to many clients in our clinical practice group, is “four stage breathing”. This is a variant of the more common box breathing approach. Both can be equally effective approaches – it’s just about finding a style that works for you! What is Four Stage Breathing? Four stage breathing is a type of breathing technique that slows down our breathing actively and intentionally. It’s called four stage breathing as there are – surprise! – four stages to each full breath: two parts to the inhale, and two parts to the exhale. Why do breathing exercises work? And why is it important? Stress triggers our “fight-flight-freeze” response and when this response is triggered, we tend to shallow breathe. So why is shallow breathing a problem? Shallow breathing can lead to a whole host of physiological symptoms – including for example, changes in body temperature, lightheadedness or dizziness, or feelings of derealization or depersonalization (where distance/perception can be altered). These symptoms can mimic anxiety – and so shallow breathing can inadvertently make subjective feelings of anxiety or stress worse. Four stage breathing helps anxiety by providing control over the physiological symptoms – and this, in turn, helps calm the emotional symptoms. The Technique: How to do Four Stage Breathing First, ensure you are breathing in through your nose and out through your mouth. This naturally slows down the pace of our breathing. Second, make each full breath last at least 10 seconds – 5 seconds on the inhale, and 5 seconds on the exhale. Break each inhale and exhale into two parts: On the first inhale, fill up most of your lungs; on the second inhale, think about ‘topping up’ your lungs with air. On the first exhale, push out most of the air, and on the second exhale think about fully emptying your lungs. This helps to maximize our lung capacity. Repeat this cycle for 3-5 minutes. When you are first learning four stage breathing, it’s important to practice when you are already relatively calm or feeling low stress – this can help build mastery. Then, over time, use it as a tool when you feel your stress or anxiety increasing. How I incorporate Four Stage Breathing into my life
There is a very strong evidence-base on the benefits of breathing to reduce the frequency and intensity of the physiological symptoms associated with stress and anxiety-related. I encourage you to try four stage breathing regularly for a week – just a handful of times a day, for just a handful of minutes at a time and see how you feel. Remember: when we are experiencing stress, the best thing we can do is focus on the things within our domain of control and breathing is one of them. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
My daughter and I are close, but we can’t seem to communicate well. She’s in her 30s, but as long as I can remember we lose our temper or snap at each other over the smallest or biggest things. This starts to get embarrassing when we’re among family or friends and can’t seem to talk politely. I’ve tried to talk to her about it but usually the changes are short-lived. Is it just too late and are we too set in our ways to change the behaviour? The answer: None of us are ever too set in our ways to change our behaviour – we have free will over our actions and full control over the way that we choose to conduct ourselves with others. Now, does this mean that changing the patterns of communication you and your daughter have will be easy or happen overnight? Of course not. Family interactions are often the toughest to change. The dynamics that exist in families are long-standing, and the communication that we adopt is often established at a very young age. The more time that passes, the more resistant to change these patterns become. Interestingly enough, we also tend to feel most helpless or give up the easiest when it comes to changing our family relationships. Strange, isn’t it, when most of us consider these to be among the most important and defining relationships in our life? Start by stepping back and get a big-picture perspective on the reasons your communication is so poor. Is the way you communicate with each other similar to how you interact with others in your life? Does your communication represent a more pervasive style each of you has with others or is it limited to your relationship only? What types of issues trigger conflict? Do you each react to in-the-moment situations, or are there bigger underlying issues that have remained unsaid or unaddressed between the two of you? Keep in mind that there is only one person’s behaviour you have control over – yours. You cannot, no matter how much you wish, force your daughter to act or react in a different manner. Be brutally honest with yourself about the elements you are contributing the situation. Ask a family member or friend whom you trust to weigh in objectively. What nonverbal behaviours (tone, posture, facial expressions) change for you when you are around your daughter? Are there hot-topic buttons that you purposely or inadvertently push? How do you respond when she gets snappy? Once you have identified the verbal and nonverbal behaviours you bring to the mix, have a discussion with your daughter. Express to her that you want your style of communication to change. Let her know what you will work on adjusting (be specific and detailed). Ask her what else you can do that would make things better for her (there are likely things you do or say that trigger her that you may be unaware of). Be mindful of not reinforcing her behaviour. For example, if she gets short with you, do not engage or escalate your response – simply stay silent or walk away (assuming the behaviour does not violate a personal boundary or become abusive – in which case you would need to establish parameters). Even if your daughter is unwilling to take a look at her contribution, it is almost impossible for her behaviour to not naturally start to change once you truly commit to changing yours. After all, communication is inherently bidirectional, and our responses are shaped significantly by the responses of those we are interacting with. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Ahhh, relationships…
No matter what gets people through the therapy door, relationship-related challenges are often what keep people in the room – whether it’s our family relationships, social or work relationships, or our intimate relationships. Our intimate relationships, in particular, can be so beautiful, and also a source of such angst – particularly when we are with someone who we may know is not the right fit for us, or who isn’t as invested in us as we are in them. When they just aren’t that into you We often intuitively know if someone is as “into us” as we are into them – but often we ignore these feelings. We may hold out hope that the person’s feelings will change or grow, we may try to convince ourselves that we don’t care as much as we do and can keep it casual, we may blame ourselves for not being ‘good enough,’ or we may excuse their behaviour by becoming overly empathetic to their plight to ‘figure things out’ at the expense of putting our own needs far below theirs. Moving forward from unrequited love When relationships are not mutually beneficial, it’s important to understand the reasons why and take steps to move forward emotionally. So, what can you do to move forward?
Good luck with moving on and finding the love you deserve! Editor’s Note: This post was originally published as part of a Globe and Mail “Ask the Psychologist” column authored by Dr. Samra, and has been edited and updated. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  People often turn to their friends for support with difficulties in their romantic relationship and bluntly ask for their opinion. Rarely, if ever, does any good come from providing candid opinions about others’ relationships – particularly when the stakes are high (if they’ve been together for a long time or have children, for example). Some of the difficult-category questions we receive may range from ‘do you like my partner’ to ‘should I stay with them’ or ‘do you think they are cheating?’.
The best general advice? Keep your unfiltered and unedited opinions to yourself. And if you feel tempted to do otherwise, rewind and repeat that mantra. Brutal honesty is not always the best policy When asked for a candid opinion from someone you care about, you want to be truthful. However, brutal honesty is not always the best policy, especially when there’s the potential to provide advice or input a friend may not be willing or open to receive. Sometimes not providing our honest opinions can feel misleading or untruthful; however, if any of us went through life fully verbalizing the “bubble above our head,” it’s likely most of our relationships would end. We make the best decisions for ourselves Ultimately the people in a relationship are the ones that have to decide what to do next, and they are ultimately the only people who can come to a resolution about how their relationship should unfold. So, when asked for advice in these types of situations your role is twofold: to provide friends support when they ask for it and help guide them toward making the best decision for themselves. What are some ways we can approach situations where we are asked for our candid, unfiltered advice – and we know that advice is probably not what our friend wants to hear?
Remember, when it comes to other people’s relationships, good questions asked are better than candid opinions given! Editor’s Note: This post was originally published as part of a Globe and Mail “Ask the Psychologist” column authored by Dr. Samra, and has been edited and updated. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth Taking Medications for Sleep – Do They Work?
Do you struggle with sleep difficulties? Too much on your mind or too much on the go? This is a common problem in the fast-paced world we are living in. Many people are plagued with stress and worry thoughts that make it difficult to fall asleep. Have you used or considered using sleep medication to help you sleep? Many of us have because it seems like a simple and easy solution to our challenges. But are medications for sleep really a good solution? Should you take sleeping pills?Sleep medication, both prescription and non-prescription, should only be used in conjunction with making lifestyle changes and should only be used intermittently, for a short duration of approximately 5-10 days. More extended use leads to drug tolerance, dependence, withdrawal effects, side effects, and rebound insomnia (where sleep problems after medication cessation become worse than they were prior to taking medications). When taking sleep medications, it’s important to note that you should never mix them with alcohol, and you should always ensure you have allowed for at least 7-8 hours to sleep after taking medication, as it can affect your ability to function the next day. What about melatonin? I’m sure you’re thinking, ‘what about melatonin? It is natural isn’t it?’ Yes, melatonin is the key hormone that increases sleepiness. About 50% of people with sleep problems can benefit from up to 3mg of melatonin, taken 0.5 to 1.0 hours before bedtime. But, just because melatonin is a natural hormone doesn’t mean it should be used regularly. Melatonin can cause some side effects including:
It can also interact with other medications. So, the answer to the question should you take sleeping pills? It should also be used sparingly and in conjunction with lifestyle changes, good sleep hygiene, and CBT. Cognitive-behavioural treatment (CBT) is the most effective treatment for sleep problems, as well as associated mood and worry or anxiety issues, all of which commonly impact our ability to sleep. It may also be helpful to talk to your family physician to ensure there are no other underlying issues that may be impacting your sleep. If you’re still struggling with sleep difficulties, sign up for a video consultation with a counsellor at the Psychological Health and Safety Clinic. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
I have recently started checking and rechecking certain things, such as making sure that I’ve turned off the stove or locked the door, sometimes four or five times. Is this normal? The answer: Virtually all behaviours – obsessive and compulsive behaviours included – exist on a continuum of severity level, and most people will experience mild forms of most “psychological” symptoms at some point in their life. Checking and rechecking behaviours are very common, and not necessarily of concern unless they take up a significant period of your time, get in the way of you being able to do other things in your life, and create ongoing distress or anxiety. Only about 2 per cent of the adult population will experience clinical levels of these symptoms that would constitute a diagnosis of obsessive-compulsive disorder (OCD). True OCD has some very clear markers. First, there are persistent, repetitive and intrusive/interfering thoughts (obsessions), behaviours (compulsions) or both.
Try to identify other stressors in your life at the current time, and work to resolve those. It can also be very helpful to actively set limits on the number of times you check or re-check (e.g., setting a maximum limit of 2 or 3 times) as this can effectively reduce the behaviour. If you find your symptoms may meet criteria for a diagnosis of OCD, speak to a family doctor, psychologist or psychiatrist. There are very effective treatments for OCD. For most, a combination of cognitive-behavioural therapy (incorporating a treatment approach called “exposure/response prevention”) and medication treatment can lead to very positive improvements in symptoms. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Stress is a common and normal – and something we all experience on a day-to-day or certainly week-to-week basis. It’s our body’s innate defense mechanism against a perceived threat or danger. Our stress response – also known as the fight, flight, or freeze response – can be brought on by anything, such as change, an argument we had with our partner, or an upcoming work deadline that we need to meet.
While the way we experience and manage stress varies between individuals, stress can usually have both positive and negative effects. When it’s short in duration, it can keep us focused and motivated. But when we’re in a heightened state of arousal for a long period of time, stress can be harmful to our emotional and physical well-being. The connection between our physical & mental health Medicine – and society in general, for that matter – are increasingly recognizing the intertwined nature of our physical and emotional health. Gone are the beliefs of traditional medicine that purported that we could somehow separate our physical state from our psychological, emotional, and spiritual well-being. The experience of stress manifesting itself as physical symptoms is a common one: Most people who are dealing with chronic stressors experience some impact on how they feel physically. Research demonstrates the comorbidity rate between physical and emotional health conditions (those with psychological conditions who will also experience impairing physical symptoms) to be as high as 80 per cent, and vice-versa. How we experience stress The way our stress reveals itself depends on myriad factors, including our childhood history; personality and genetic predispositions; how we observed our parents dealing with stress; and whether or not overt emotional displays were viewed as ‘acceptable’ ways to communicate stress in our family. Individual differences exist in the degree and intensity to which emotional issues manifest physically, but the most common physical symptoms are stomach/gastrointestinal problems (tension, nausea, constipation, diarrhea), pain (headaches, back pain, chest tightness), appetite changes and sleep problems. What can we do about it? So how can we effectively manage stress when the physical symptoms become distressing and potentially damaging? A good first step is to consult with your medical doctor. They can offer objective input into the contributors of your physical symptoms and ensure that nothing more serious is going on. Next, get very structured and rigid about ‘the usual suspects’ – sleep, diet, and exercise. Aim for a minimum of 7 to 8 hours of sleep, ensure you are getting at least half an hour of movement in a few times a week, ensure you are eating healthy meals a few times a day (with an emphasis on plant-based and non-processed options), and reduce and ideally eliminate the use of substances, such as alcohol or smoking. Another way to effectively manage stress is to incorporate deep breathing and mindful practice into your daily routine. Even just five minutes at a time, a few times a day, can be extremely helpful. If you need help getting started, or a refresher on these techniques, we put together two short videos on mindfulness and 4 stage breathing for guidance. Finally, learn the basics of cognitive-behavioural therapy (CBT). CBT is an effective evidence-based stress-management approach, which helps you change unhelpful cognitions (thoughts, feelings, and beliefs) that contribute to your stress. CBT provides strategies for problem-solving to tackle primary stressors in your life (such as finances, relationships, or work-related challenges) and teaches behavioural strategies, like breathing and relaxation, to target the physiological manifestation of your stress. Stress is no match for a healthy body and mind Stress can be harmful to our physical and mental well-being when not managed accordingly. But with proper sleep, diet, exercise, and mindfulness and meditation practices, we ensure our body’s innate response is kept in check (and reserved for moments of real threat and danger!). Editor’s Note: This post was originally published as part of a Globe and Mail “Ask the Psychologist” column authored by Dr. Samra, and has been edited and updated. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Is someone you care about working themselves so hard it may be damaging to their health? Maybe they aren’t just exhausted, but are starting to isolate themselves? Or they’re tired enough that they’re putting themselves at risk every time they drive home – many people don’t consider the fact that tiredness at the point of exhaustion is the same as impaired driving. Or, they may be engaging in unhealthy behaviours such as excessive drinking or overeating as a way to self-soothe or self-medicate.
When putting in a few too many hours becomes a problem With overworking there are two major issues: The person’s decision to work an inordinate number of hours, and the resultant impacts on their health. Keep in mind that the person’s decision to work the number of hours they are working may not be completely voluntary. There are a number of reasons a person may need to – or feel they need to – work these hours, some of which may include: high living expenses or debts, significant changes to life circumstances, working following a period of unemployment or preparing for retirement. Have empathy & be kind Whatever their reason, try to understand where they are coming from. It can feel awful to be in a position where you are uncertain about your future, particularly as we age. They are probably worried about the future, as well as frustrated or even angry at themselves, or their past circumstances. The reality is that they may need to be working at the level they are to pay the bills or have the future they once imagined. Starting a conversation First, ensure the conversation takes place during a time when you are both feeling relaxed. Remember to keep the conversation light and supportive, and be mindful that they probably will have a lot of pride around these issues. Start with a conversation about their future and talk generally about what their hopes and dreams are. This may help you get a picture of what they’re working toward. Gently inquire about whether the means they are currently adopting (in other words, the hours worked) are necessary to achieve those goals. If appropriate, offer to help them with planning – you may suggest that they could find it helpful to sit down with a financial advisor who can map out plans in more detail. Key messages to communicate After you’ve had the opportunity to talk with your loved one about the future and gained some insight into their goals and underlying values associated with work, then, in a separate conversation, you can express your concerns about their health. Here are some suggestions about how to approach this topic:
Unfortunately, you can’t magically get your loved one to value their health more than work, but you can guide them toward possible solutions that improve the situation. Visit MyWorkplaceHealth.com for more workplace resources. Editor’s Note: This post was originally published as part of a Globe and Mail “Ask the Psychologist” column authored by Dr. Samra, and has been edited and updated. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  The Benefits of Online Counselling Services: Is Online Therapy Effective?
Online counselling has emerged as a response to a need that people have been expressing: Almost everything these days can be done through our phone or our computer, so why not health services as well? But the question we continue to receive: Is online therapy effective? Not only is online therapy as effective as in-office sessions but there are many added benefits of online counselling that we will outline here. Who is online counselling for? Online counselling is a unique service that allows people to access regular counselling services from the comfort of their own home. It increases the level of accessibility for clients, and the Psychological Health & Safety Clinic is proud to be able to offer these services with the same level of care as would be expected from in-office appointments. Online counselling, however, is not just for people with busy schedules who struggle to make in-office appointments. Online counselling also benefits people who:
What are the benefits of online counselling? Of course the main, and most obvious, benefit of online counselling is convenience. We save both time and money. We’re not required to spend time on hold or call during office hours to make an appointment. We don’t have to spend any extra time or cost travelling to a physical location and are less likely to be required to take time off work to attend appointments. And, of course, we’re able to do therapy from wherever we are able to get access to a computer and an internet connection. That even means we can have an appointment in our pyjamas if we’d like to! Reduced wait times, broader options for appointment times (including evenings and weekends), and increased access to the counsellor of your choice are all additional benefits of online counselling. Not having to force your choice of therapist (which is a very important consideration in therapy) based on where you live is also a fantastic advantage – it allows you to select the therapist who would be the best fit for you, regardless of where you or they live. This is particularly attractive for individuals who live in smaller or more remote communities where options for counsellors are limited. The specific nature of therapy itself (as opposed to other physical/medical treatments) is the added comfort of being able to have the appointment from the privacy and security of your own home. In therapy, it is common to discuss extremely emotional topics and people are often required to be vulnerable. For many, this is easier to do via video conference in comparison to an office setting that one is unfamiliar with. Being in your own home when a therapy session ends can also often facilitate a more conducive way to regroup and settle emotions post-therapy. Benefits of Online Counselling – Removing BarriersAnother major benefit of online counselling services is to help remove barriers for people seeking services. Not having to travel to a physical location is often a preferred choice for many people, particularly for those who:
Are you ready to book your online therapy session? If so, get in touch! We’re also happy to provide more information if you have any questions. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The Psychological Benefits of Mindfulness: How to practice Mindfulness
“Eyes watching. Ears listening. Voices quiet. Body still.” – These words said by a wise kindergarten teacher to her 5-year-old students perfectly embodies the essence of mindfulness. What is Mindfulness? Mindfulness – very simply – involves increasing our attention and awareness to the present moment – the here and now. And continuing to draw it back to that present moment each and every time our attention drifts. Mindfulness is something all of us have many experiences with, often throughout the course of each day. We just aren’t mindful – of being mindful! So when are we naturally mindful? We are mindful when we are present, engaged, when our mind is on the task at hand, and when we are immersed in what we are doing with all of our senses. Most of us are naturally mindful when we are engaging in an activity or creative pursuit we love – during a focused, intense workout; when we are creating art; when we are freely dancing around to music; and when we are making love, just to name a few. However, when we are under stress, demands, or dealing with mood issues, we are much less likely to naturally be mindful. Science tells us that being intentionally and actively mindful has so many positive benefits on our psychological health.These include, but are not limited to:
How to practice Mindfulness There are many different ways to practice mindfulness and not every way is going to work for every person. So, give a few different methods a try and find what works best for you. And remember that practice does make perfect. It won’t be easy at first, but the more you practice the more your skills will improve, and the easier time you will have being mindful in stressful situations. Focus on Your Breathing A great, and simple, way to start practicing mindfulness is to focus on your breathing. This is something you can do almost anywhere. You don’t have to do a breathing exercise – just take a deep breath and pay attention to that breath and nothing else. Ideally, you can be in a comfortable seated position. Focus on how your breaths feel moving in and out of your body without attempting to change them. Notice when your thoughts start to wander and bring it back to your breath. At first, you can start by just doing this for a few minutes, but as your skills improve you can increase the length of time you do this. Mindful Eating This is another mindfulness activity you can easily build into your day-to-day routine. Because most of us have such busy lives these days, we often rush through our meals or combine eating with other activities, like eating at our desk while we work – or eating in front of the TV in the evening. Mealtimes are the perfect time to take a minute and slow down. Next time you have a little extra time for your meal, sit down and eat mindfully without any other distractions. Mindful eating consists of being present and engaging all of your senses. Slow down, sense and savour your food and even smile between bites if you are so inclined! Purposefully slow down. Use all your senses to see, touch, smell, and really taste your food. Structured Mindfulness Practices If you would like a little more structured mindfulness exercises and have a few minutes you can put aside to practice, give one of these two meditation approaches a try. Don’t be off-put by the use of the term meditation. Mindfulness and meditation practices while different, have some overlap. The exercises below are meant to help you to feel present in your body – and are different than the stereotypical cross-legged practice many people think of when they hear meditation. 1. Body scan meditation. Lie on your back with your legs extended and arms at your sides, palms facing up. Focus your attention slowly and deliberately on each part of your body, in order, from toe to head or head to toe. Be aware of any sensations, emotions or thoughts associated with each part of your body. 2. Walking meditation. Find a quiet place 10 to 20 feet in length, and begin to walk slowly. Focus on the experience of walking, being aware of the sensations of standing and the subtle movements that keep your balance. When you reach the end of your path, turn and continue walking, maintaining awareness of your sensations. Final Thoughts MBSR (Mindfulness-based stress reduction) and MBCT (Mindfulness-based cognitive therapy) are evidence-based treatments for stress, anxiety and depression which combine CBT (cognitive behavioural therapy) with mindfulness approaches. These are modalities of treatment that all of our clinicians are familiar with and often incorporate into treatment. If you have been thinking about seeing a therapist and would like one with these skills, I encourage you to take that first step starting today. Contact Dr. Joti Samra, R.Psych. & Associates today and start on the path to finding the right fit for you! |
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