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By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
I suppose this is a problem of old age, but I think constantly about my ex-husband, who has been dead for almost 40 years. Could this be from unresolved trauma? It was not a happy marriage. The answer: Regularly thinking about someone who was an important part of your life – good or bad – even years or decades after they have died is not unusual. Grief is a mysterious creature and the process can be so unpredictable, and so very individual. Thoughts of someone who has died tend to be more frequent and intense when the death was of someone particularly close (a partner, a child). The grieving process is protracted when the death is untimely, unexpected or particularly traumatic or tragic. Having unresolved or complicated emotions from the relationship while the person was alive can also play a role, as you have alluded. As a society, we are strangely ill-equipped to deal with death. I am often asked questions about how long it will take to “get over” a loss, or how one can deal with “unresolved issues” when it comes to their grieving. My experience – both personally in dealing with the death of my father, as well as professionally – is that we never really get over the death of someone that was an important part of our life. We simply learn to cope better over time. Whether your thoughts are a problem depends on a few factors. First, when you say “constantly,” what do you mean? I have many patients who will describe thinking on a daily basis about their deceased loved one. A fleeting thought on most days, even decades later, is not necessarily unusual. Consider the intensity of the emotions associated with thoughts of your ex-husband. Are they neutral thoughts that pop in and out of your head, and don’t interfere with your day-to-day activities? Or, do you find you get stuck in a ruminative state that causes a high degree of emotional stress? There is no magic formula for how long it takes to cope well after a death. But most people will find that it can take from a few months to a few years to get back to their usual mood and activities, and have thoughts of their loved one without breaking down or becoming overly emotional. Four decades later, you still sound disturbed by the quality or quantity of thoughts you are having about your ex-husband – so clearly something needs to change. Spend some time reflecting on what impact his death had. Do you feel that there were unsaid things that you want to communicate to him that you never did? Do you have anger or regret at yourself for not doing things differently, such as leaving the marriage earlier? Are there elements of self-blame or shame for decisions you did or didn’t make? Have you made efforts to move on in your life, or is your past relationship still affecting current-day decisions? Doing some soul-searching on the above can help you move forward. Start by writing down your thoughts in a journal; every time you get stuck on a thought, note what it is specifically that’s in your head, and what it means about your life now. This can be a very powerful exercise. If you find this doesn’t make things better, joining a grief support group or seeking the help of a therapist may be of benefit. 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  Suicidal Thoughts: Making a Safety Plan
When someone is experiencing significant or persistent distress, or negative feelings, in their life, it’s easy to feel overwhelmed or hopeless about the future. Many people think about suicide because they’re looking for a way to escape the pain. If you’re thinking about suicide, know that you’re not alone and your feelings are valid. The best things you can do when you’re feeling suicidal are; make sure you are not alone, be in a safe place including making your home safe by getting rid of things you could use to kill yourself, and make a safety plan. What is a safety plan? A safety plan is a written set of instructions that you’re able to use when you’re feeling suicidal and may be at risk of hurting yourself. When using the safety plan, you start with the first item and work your way through escalating steps until you feel safe. It is helpful to make the safety plan with someone you trust. A therapist may be the best option, but a close friend or family member can also be helpful. It’s particularly important to get these people in your life involved because they’re the ones you’re likely to call for support when you need to execute the safety plan. It’s also helpful to create the safety plan when you’re not actively suicidal, and keep it in a place where it is easy to access when suicidal thoughts arise. How to create a safety plan Before starting to write down items on your safety plan, it can be helpful to determine the situations where using the safety plan is necessary. Consider the situations, thoughts, feelings, and behaviours that precede or accompany suicidal thoughts for you and when a safety plan would be most helpful. Next, see our free digital download Coping with Suicidal Thoughts where you can print and fill out a safety plan. The information below can help with filling out the safety plan. When making a safety plan, the following are the key elements you want to consider and have a ‘plan’ to do: 1 - What can I do to calm or comfort myself?
2 - What are my reasons for living
3 - Who can I talk to?
4 - Where can I go to be safe / how can I make my current environment safe?
5 - What can I do if I still don’t feel safe?
Final Thoughts Many people experience suicidal thoughts and it’s not something to be ashamed of. Having a safety plan helps you and your loved ones be prepared to keep you safe when you are feeling distressed. If you or somebody else is at immediate risk of suicide, call 9-1-1. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
Lately I’ve been feeling uninterested in socializing. All I want to do is stay home and have netflix marathons. I’ve been feeling like this for about two months. Should I be worried I’m no longer wanting to spend time with friends and family – which I used to enjoy? The answer: All of us can benefit from the occasional TV binge. It can give us time to unwind from the day-to-day grind of our lives and give us an opportunity to recharge. However, if your tendency to avoid people has been going on for weeks or months on end, there may be cause for concern. Periods of feeling down or sad are common for all of us; most of the time when we feel this way, we aren’t depressed. Usually, mood changes will go away on their own within a few days or weeks, especially as stressors that commonly cause these mood changes start to resolve. For some people, mood issues may continue for weeks or longer. If you find that you have been feeling sad or down and have had little interest in things you normally enjoy, like spending time with friends, for an extended period, it’s possible you are struggling with an emotional problem like depression. Depression is one of the most common psychological health conditions and affects one out of four people over the course of their lifetime. Contrary to popular belief, depression doesn’t always mean feeling sad or tearful – for some people, a “depressed” mood may feel like irritability or frustration, and for others it may be associated with feeling “flat” or feeling “nothing.” Depression comes along with other problems that may include:
If you are feeling any of the above – particularly if you are having dark thoughts – you should speak to your family doctor or a psychologist or psychiatrist. There are very effective treatments for depression, including cognitive-behavioural therapy, interpersonal therapy and, for some people, medication therapy. With time and the right treatment, you can get better. You may be able to access free services through your local mental health agency (see www.cmha.ca for a Canadian Mental Health Association office near you). By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  How to Practice Self-Compassion
We often hear that we need to be kinder and less critical of ourselves, but that’s easier said than done. Often, our self-critical thoughts have been developed over so many years that we hardly even notice them happening anymore. Or, at times, we may believe we need this type of ‘tough love’ in order to motivate ourselves to be better (that we will be ‘soft’ if we are too kind to ourselves). This is untrue. Repeated criticism results in increased levels of cortisol and adrenaline, which leads to the body trying to protect itself by beginning to shut down (e.g., depression). So, it’s important to be aware of those critical voices and challenge them when they come up. Engaging in the practice of challenging those self-critical voices is an act of self-compassion. What is Self-Compassion? Self-compassion is expressing kindness towards oneself, especially during times of pain and suffering. It includes:
There are three elements to self-compassion: 1 - Self-Kindness
2 - Common Humanity
3 - Mindfulness
What’s the difference between self-compassion and self-esteem? Sometimes people equate self-compassion with self-esteem which can make it difficult to believe that one can improve their skills when it comes to self-compassion. So, it’s important to know the difference. Self-esteem is typically used to describe a person’s feeling of self-worth, and while this is important, many people have a challenging time making significant changes to their self-esteem. Self-compassion on the other hand isn’t a judgement of self-worth or rooted in your value, it’s simply the act of treating yourself with kindness, care, and support. These are things you can do independent of self-esteem. Self-compassion offers the same well-being benefits without all the pitfalls such as fewer social comparisons, is less contingent on self-worth, has no association with narcissism, and buffers against negative effects of low self-esteem in adolescents. Self-compassion is also linked to better overall coping and resilience, as well as provides individuals with some of the following benefits:
How to Practice Self-Compassion It’s important to remember that self-compassion is going to take practice – it isn’t something you are going to develop or improve on overnight. That being said, it’s a practice that is worth investing in knowing the numerous benefits for your overall physical and psychological health, wellness and resilience. But how do we start practicing self-compassion? A great place to start is with mindfulness. To be compassionate towards yourself, you need to be mindful of your pain and suffering; recognize it, allow yourself to feel it, and embrace it. Mindfulness is a practice that helps you to become more attuned with your emotions and will help you to more easily identify the moments where self-compassion is needed and where your voice is the most self-critical. Once you’ve begun to recognize your self-critical voice, you can start to practice making changes to it and providing yourself with self-compassion in those moments instead. 6 ways to practice self-compassion:
By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
I recently have had a string of deaths in the family, all from cancer. Now I stress out about every little bump on my body. I’ve been to the doctors, who say I’m fine, but I’m still anxious all the time. What can I do to not feel crazy? The answer: My sincere condolences on the deaths in your family. I’ve had multiple family members deal with cancer diagnoses, some at a very young age, and can personally appreciate the significant emotional toll it takes on everyone, including close family and friends. To be feeling stressed and worried about your health is very normal given the circumstances. Our emotions – positive and negative – all serve a purpose. They provide us with validation about things that are important to us, they motivate us toward action, and they communicate things to people around us. In your case, your anxiety is providing your brain and body a few messages: First, cancer is a reality that could affect anyone. And secondly, there is value in being attentive to your health, and obtaining a professional opinion on risks or concerns you may have. Your worry is also helping to communicate to your loved ones – from whom you may need support – that you are feeling sad about those you’ve lost and that you have concerns about your own health and possible mortality. In all cases, there is a shelf life on the value our worry has. Worry (or any other negative emotion) is helpful insofar as it serves a useful function. It sounds as though you are recognizing that you are past a stage that is helpful. You have sought medical advice, which I will assume has included a comprehensive medical checkup from a physician you trust, and had your concerns allayed. To be in a state where you are overly stressing or ruminating about any minor change or bump even when you have been told there is nothing to be concerned about is clearly not serving a useful role, and it is impacting your quality of life. Once worry starts, it can easily grow exponentially simply being fed by our (often unrealistic) thoughts. So, it’s important to actively work on challenging your thoughts and making them more realistic. Ask yourself (and write down) the answers to the following key questions when you find yourself getting caught in a state of worry:
I’ve co-authored a book that you can download for free titled Positive Coping with Health Conditions. It offers useful, evidence-based chapters on relaxation strategies, managing worry, and managing depressive thinking (which can often be a side effect of worry). These chapters offer cognitive and behavioural strategies that have been proven to reduce worry. Another great book is Mind Over Mood: Change How You Feel by Changing the Way You Think, by Drs. Dennis Greenberger and Christine Padesky. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. The question:
I’ve been taking a low dose birth control pill for about a year now and I’m wondering how much of an effect the hormones can have on my mood. I’ve always suffered from mild anxiety, but lately I just don’t feel like myself. I could be fine one minute and the next I feel a rush of anxious energy, worry and sadness. Could it be the pills and should I stop taking them? The answer: Virtually any pharmaceutical – particularly one that is focused specifically on hormonal regulation – has the potential to impact mood. Sadness, anxiety, as well as irritability or sleeplessness are among the most common potential consequences. Speaking to your family doctor about the changes you have noticed is an important first step. There may be a pill that is a better fit for your body, or alternative forms of birth control may be options to consider. It is equally important for you to consider other situational or life events that may be impacting your anxiety. Interestingly, as humans we generally tend to be pretty poor and often inaccurate in our attributions of what factors affect our emotional and physical health. This can be chalked up to a case of being “too close to home” when it comes to factors that affect us. You say you’ve always suffered from mild anxiety – do you have a sense of what factors (situations, scenarios, concerns, people) contribute to the anxiety for you? Putting pen to paper and articulating in writing the personal contributors is a good way to gain some insight. What is going on in your life right now? Pay attention to changes that may be exacerbating your anxiety. Relationship conflict, work stress and financial concerns tend to be the most common culprits. Even positive life events – such as a having a baby, getting a promotion, or moving – tax our physical and emotional resources and can lead to our body feeling “stressed” (our body doesn’t discriminate between good stress and bad stress!). How is your health generally? Have you been exercising? Eating relatively balanced meals? Getting adequate amounts of sleep? Targeting these areas if they have fallen short, and also minimizing alcohol use, is important. The best way to make sense of triggers and contributing factors to your mood is to keep a daily diary for a week or two. Start from when you wake up, and make an hourly (or close to) entry of the following: your mood, what you are doing, and any particular thoughts you are aware you have been having. Review this with your family doctor, and ensure you have had an up to date physical examination as other health issues (e.g., anemia, thyroid dysregulation) could also be playing a role. 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  How to Manage Feelings of Frustration
With all of the busyness of life, frustration can be a frequently occurring emotion, particularly when we are dealing with competing life and work demands. Here, we’ll address what causes us to feel frustration, how to manage feelings of frustration to decrease our frustration levels. What is frustration? Frustration is the feeling of being upset or annoyed, particularly because of our inability to change or achieve something. When we experience frustration, we often forget the cause of these feelings are often completely out of our control – and the ‘out of our control’ contributors to frustration often can even further amplify the feelings of frustration! (Isn’t that just frustrating?) How can we all better manage frustration?
Final Thoughts Personally, I find when my frustration levels increase, it’s usually because I’m feeling disorganized in life. So, what I do is intentionally reduce ‘extra’ demands in my life – which usually relates to non-essential or non-energizing social commitments – and use that time to catch up on housework, do laundry, get caught up and organized with paperwork that clutters my office, and do some meal planning so that I have one less To Do during the week. I also then commit no-alarms on Saturdays and Sundays so that I can catch up on much-needed sleep debt! We are only in charge of what we can control, so do what you can, and don’t sweat the small things! By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Self-Compassion Journaling – Journaling Prompts
Journaling can be a great way to set aside a specific time to engage in self-reflection. It gives you the opportunity to explore your emotions while also identifying patterns. When it comes to self-compassion, it gives you the opportunity to identify areas for growth and self-acceptance in our lives in an intentional way. It can also be a healthy and therapeutic way of expressing yourself, which can improve mood and help to de-stress. So, here we are going to talk about self-compassionate journaling and how to incorporate it into your life including journaling prompts How to Start Journaling Beginning any routine can be challenging, so it’s best to start with tangible ways of incorporating it into your daily routine. This can include picking a time to engage in a journaling practice, set a notification in your phone to remind you, and have a list of prompts prepared so if you don’t naturally have anything to write about, you have an alternative writing topic. Journaling Prompts that Focus on Self-Love Here is a list of prompts that can help you start thinking about self-compassion and the ways you can re-engage with self-love.
Final Thoughts Journaling is just one way to practice self-compassion, so if journaling isn’t for you, or you struggle to keep it as part of your routine, that’s okay. In most cases these things take practice, so it can be easy to get discouraged. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Managing Self-Critical Voices
We all have that little voice in our heads. Sometimes it can be really helpful and motivate us to accomplish our goals, but other times it can be overly critical. When our self-talk becomes overly critical, it not only has a negative impact on our minds but also on our bodies as well as the people around us. So, it’s important to learn to manage our self-critical voices and practice being more self-compassionate Negative self-talk increases a person’s risk of experiencing mental health challenges. It increases people’s stress levels, makes them feel hopeless, and increases feelings of depression. It also leads to limited thinking, lowered abilities to see and in turn capitalize on opportunities as well as increased perfectionism. When these self-critical voices are expressed outwardly, they can also damage relationships. How to Manage Self-Critical Voices and Negative Self-Talk There are numerous ways to manage and change our self-critical voices and not all of them will work for everyone. We have provided some starting points for changing the sound of the inner critic. 1 Point out your critic.
2 Be curious.
3 Give the critic a name.
4 Try to use more neutral language.
5 Say the thought out loud.
6 Challenge your inner critic.
Final Thoughts You deserve compassion and there is no reason why you cannot provide it to yourself. Also, remember these skills take practice. So, as you’re starting this process, don’t beat yourself up when you catch yourself being judgmental. Notice it, the same way you would notice your mind wandering in mindfulness practice, be compassionate and empathetic with yourself and take one small step toward self-compassion. We can all learn to manage our self-critical voices and practice being more compassionate. By Emory Oakley. Emory is a writer and LGBTQ+ educator who regularly discusses the intersections of queer identities and mental health. On the morning of February 1st, my mother would smile and like a giddy teenager as she lined up the cereal boxes and state: “it’s only twenty-seven days until my birthday.” As if we hadn’t performed this ritual for as long as we could remember. She was always enthusiastic to celebrate regardless of whether or not she had an actual birthday that year. In reality, the entire last week of the month was all about her. Of course, the leap years were the biggest, but every other year was almost the same. Since there was no actual day to celebrate, “why not celebrate on February 28th and March 1st?” You might think this would be incredibly annoying, and while it was to some extent, it was impossible to be annoyed for long.
A lot of things from my childhood have been forgotten but not those birthday celebrations. I couldn’t tell you which events happened which year or what years were the biggest parties, but I do remember my mother’s enthusiasm. And everyone would have said she was the life of the party. She would inevitably be found in the kitchen – wine glass in hand, small ice cubes clinking against the glass as she danced lazy circles around the furniture or other party-goers. If you could really call what she did dancing. When she really got into it she would do this thing that can only be described as a jump-shuffle-dance. With her feet together, knees bent and ass sticking out, she shuffled backwards, sort of like a reverse bunny hop or maybe a two-footed moonwalk. It was impossible not to watch her when she danced, not only because it was quite funny to watch, but the way her face shone with joy demanded attention. When Everything Changed My mother died just before I turned eighteen years old and three weeks after I graduated from high school. That was more than ten years ago now, but as February 29th approaches I feel heavy. It’s a heaviness that even now as I write this I am having a difficult time describing. It feels almost like something’s missing in my life but not in a way that feels tangible to me. This is because my mother has never been a part of my adult life. Since graduating from high school I’ve come out as queer and transgender. I’ve legally changed my name and have grown into an entirely different version of myself. One that my mother never got to meet. So, while she’s missing from my life now and that burdens my heart significantly, I also don’t know what her being in my life would look like anymore. This is a completely different type of sadness. Does grief last ten years or more?For the last handful of years, I had a hard time describing the feelings I’ve had about my mother as grief. The way I feel now feels nothing like the first few years did. My mother had been sick for a long time before she died and I was lucky enough to have the opportunity to say goodbye. Unfortunately, these things did little to actually prepare me for her absence. The last year, maybe more, was spent making trips back and forth from the hospital. Picking mom up and bringing her home for dinner, or for weekend visits, when she was healthy enough. Then suddenly everything changed. My family home turned into nothing more than a few two by fours and a roof- a place to sleep and eat but it no longer felt like a home. That first year, grief pooled under my tongue, it felt like I couldn’t speak or swallow. I became well acquainted with the feeling of tears welling in my cheekbones, learned to lock jaw keep them out when I could. I told myself to be strong. That my younger sibling needed me to be strong. But as I look back now I realize how much this prevented me from healing. I needed to feel my feelings in order to let them go. Everything was a challenge that year and it felt like I was doing everything alone. The first Christmas felt hollow, I didn’t want to celebrate as there was no reason to anymore, and when we got to the first February I was barely able to function. I somehow managed to maintain my grades in university and show up at work but I was just going through the motions. Doing just enough to exist but nothing more. The First Leap Year The first leap year was 2012, almost three years after my mother passed. I was twenty years old and by then I felt like things had changed, that I’d grown up enough. I was able to look back on the amazing things about my mother and smile rather than just seeing hospital beds and blue gowns. But something about that February broke me open. I felt the hole in my life again and I was completely unprepared to deal with it. The Second Leap Year The next leap year was 2016, and this time everything was different. I’d come out as queer, been through years of therapy and was coming to terms with my gender identity. This time I felt like a new person. It had been years since grief had taken hold of me and I finally felt like I was figuring out how to be an adult. But when February rolled around I felt guilty. It felt like I was forgetting and that made me feel nauseous. It took more effort than I would have liked to conjure the image of my mothers’ smile and I could barely remember the sound of her laughter. It felt like everything was fading and I spent weeks angry at myself for letting go. I didn’t want to forget but I also didn’t want to cling to the sadness that had burdened me so significantly years before. So, I made the decision to write. I’ve been a writer for as long as I can remember, and there is something cathartic about having a place to put your feelings outside of yourself. But this time instead of writing into the sadness – I chose another path. That month I created a chapbook of poems that I titled Unsent Letters. It contained eight poems written as if they were letters to my mother describing my life and how things had changed. In those poems, I was able to come out to her and tell her I wasn’t her little girl anymore. It provided me with healing I never could have anticipated. Of course, I wish I could have spoken those words to her and that she could have met this version of me, but it was the closest I was ever going to get. Grief After 10 Years Now, things continue to change when it comes to my grief. I have casual depression. I call it casual because it doesn’t have a significant impact on my day-to-day functions, but it does make me feel lethargic and heavy some days. And I often feel a weight of sadness that is not caused by anything I can put my finger on. My depression gets worse in the cold, grey winter months or maybe it’s just harder for me to manage in the darkness. But in February, even though the clouds are lifting in Vancouver and the sun is starting to shine, I feel heavy. Sort of like I imagine a knight would feel in plated armour, my motions are slower and where I place my energy has to be more calculated. I tire sooner and I feel like I am not able to do as much and I dislike feeling that way. But it doesn’t feel like sadness. So today I remind myself that sadness does not always show up as tears. That my sadness over losing my mother has changed from a deep sense of grief into a vague sense of emptiness and longing. Both of these feelings are valid and have been a significant part of my process. But dealing with grief is never easy, so let’s talk about grief in a more practical way – and what we can do to manage it best we can. What is grief? And how does it change over time?Grief is a natural response to loss. It’s the emotional suffering a person feels when something or someone they love is taken away. It’s common to experience all kinds of difficult and unexpected emotions, from shock or anger to disbelief, guilt, and profound sadness. The pain of grief can also disrupt our physical health, making it difficult to sleep, eat, or even think straight. These are normal reactions to loss – and the more significant the loss, the more intense the grief will be. The most important thing to know about grief is that there is no one way to grieve. And there certainly isn’t a benchmark for what is normal when it comes to grieving. As time passes, the loss doesn’t disappear completely and it probably never will but it changes. How to manage grief Most of us have probably heard of the stages of grief; denial, anger, bargaining, depression and acceptance. While many people do experience these, calling them stages can be problematic for many. Grief is not something neat and tidy – and it is rare for anyone to experience these ‘stages’ in sequential order and in the way that they’re described to us. So, don’t worry so much about the stages or what you ‘should’ or ‘shouldn’t’ be feeling when it comes to grief. My thoughts on dealing with grief I have learned a lot about the grieving process over the years and here is what I think about how to manage grief.
Final Thoughts Remember that grief looks different for everyone and despite the fact that we are only given a short amount of time off work for grieving, that does not mean the grieving process is or should be over at the end of that allotted time. The first year is going to be the hardest because you have an entire year of first experiences without that person. If you are dealing with grief, no matter what stage you’re at or how much time has passed, and you need support- reach out. Sign up today for a no-commitment referral with a therapist at Dr. Joti Samra & Associates. |
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