Dr. Selchen is a Staff Psychiatrist and Director of Education at Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre.

Stress affects everyone. Where does yours stem from?

I don’t think my stressors are significantly different from a lot of folks. In no particular order, there’s work. As a psychiatrist, there are a lot of people who rely on me, especially throughout this pandemic, so being present and available can be challenging. I have other roles; I’m a husband and father, and I want to support my family through the challenges they are facing. So stress comes from having enough time in the day to attend to those people and things that are meaningful to me, along with the other things that get in the way.

Would you describe yourself as a calm person?

I don’t know if I’m calm by temperament, but I’m calm but cultivation. I am an “earned” calm. My professional focus is on people’s mental health and wellbeing. One of the selfish benefits of this job is that I can help myself as much as others, and I wouldn’t be authentic in my work if I didn’t do that.

So what does that look like for you?

Especially during the pandemic, I’ve been mindful to keep track of my relationships, so making time for people and checking in on them. I carve out time every day for meditation practice. I do yoga. I’ve also been doing martial arts for years and have a black belt in karate. It’s been great for physical, mental and spiritual health. I also have a Netflix practice.

Tell me more about your Netflix practice!

I’m human, I watch television. My kids are big into the Marvel cinematic universe so we all love that. During the pandemic, it was hard not going to movie theatres, so we translated that into family movie nights.

Part of your role is teaching mindfulness. It seems like such a big abstract idea.

For many people, mindfulness has become synonymous with calming the mind and emptying it of thoughts. To be honest, that’s not how I would define it. Mindfulness is really about the relationship we have with what we encounter and our life experiences. The people, the sights and sounds and events around us and within us; the physical sensations that move through our bodies, the thoughts that move through our minds and the emotions we are experiencing. So it’s really a question of how do I relate to those things? Am I relating in a way that’s adding more stress, or am I relating in a way that lets me work with the challenges? A lot of what I do is helping people unlearn what they thought mindfulness was all about.

How hard is it to practice what you preach?

There is a real difference between embodying and modelling. Modelling is about putting on a behaviour that I want you to have, but it’s deliberate and not necessarily authentic. It’s about playing a part. Embodying is really living a behaviour; the more we can do that, the more authentic it is, the more meaningful it becomes for us and the more impactful it is for others. When it comes to taking my own advice, embodying good habits and behaviours is what I try to apply into my own life.

The post How to live like the experts: Finding a balance between daily stress and mental health with Dr. Steven Selchen appeared first on Your Health Matters.

There is hope, and treatment, for anxiety during pregnancy.

A new study – Treating Anxiety in Pregnancy (TAP) – by Sunnybrook Research Institute and Women’s College Research Institute is looking at a type of talk therapy called Mindful Adaptive Practice in Pregnancy to determine how the treatment works in reducing anxiety. If you are 18 years of age or older, live in Ontario and are between 12 and 30 weeks of pregnancy, you may be eligible to participate.

Dr. Sophie Grigoriadis, Head of Sunnybrook’s Women’s Mood and Anxiety Clinic: Reproductive Transitions, answers questions related to pregnancy and anxiety, and about the study.

I’m pregnant and feeling quite anxious and overwhelmed. What should I do?

Don’t keep it to yourself. Talk to your family doctor, midwife or obstetrician. There is help available.

What will my doctor or midwife do when I reveal my anxiety?

Your health care provider will use screening tools and ask you questions like:

• How are you sleeping? How’s your appetite? Can you focus and concentrate?
• Are you getting pleasure out of any activities, or is everything overwhelming? Are you thinking of harming yourself?

How will my anxiety be treated?

There are different approaches to treating anxiety during pregnancy. These include community resources like support groups and apps to connect you with techniques for reducing anxiety. Your family physician, obstetrician or midwife may also refer you to a psychiatrist. Following a psychiatric consultation, you may be given resources and may be further referred for individual or group psychotherapy. Medication is reserved for moderate to severe anxiety in those diagnosed with an anxiety disorder or depressive disorder with prominent anxiety.

What’s involved if I’m selected for the TAP study?

Our team has adapted a talk therapy treatment called Mindful Adaptive Practice in Pregnancy, which can help women who are pregnant learn how to reduce their anxiety very quickly. It is an exciting and innovative treatment because it is:

• Ultra-brief in duration (one month)
• Specific to pregnancy
• Delivered in a group format
• Provided over the internet and done from home

What is talk therapy?

“Talk therapy” is also sometimes called psychotherapy. It’s a term for a variety of treatment techniques that aim to help you identify and change troubling emotions, thoughts, and behaviour. Talk therapy is recommended to treat mental health problems but some treatments are not often utilized because they take time to learn and use. The pandemic has added another layer of burden because in-person treatment is not routinely available.

Have questions about the TAP study and eligibility? Please contact our research assistant, Morgan Sterling at morgan.sterling@sunnybrook.ca.

The post Anxious and Pregnant? You’re not alone appeared first on Your Health Matters.

Climate change and health

According to infectious diseases physician and Sunnybrook Research Institute scientist Dr. Samira Mubareka, our changing environment has helped arboviruses (viruses transmitted through insects, such as West Nile) and their vectors (such as mosquitoes) to thrive.

“With climate change, we’re seeing a change in mosquito behaviour and even in mosquito populations themselves,” she says. “It’s opened up the possibility of new viruses and existing viruses to change their epidemiology.”

Longer, wetter and hotter summers have meant arboviruses and their carriers are able to multiply faster and live longer, she says. And with shorter, milder winters, mosquito vectors are overwintering more. She adds that vectors have more opportunities to feed and transmit viruses to other hosts, including humans, plus, with higher temperatures, vectors that used to only live near the equator are expanding their range and creeping north.

“We’re seeing more exotic mosquitoes that normally would not have been able to survive Canadian winters,” says the infectious diseases physician. “Some have been introduced into Southern Ontario.”

And it’s not just viruses that are on the rise, she says. Other pathogens, like the bacterium Borrelia, which can cause Lyme disease, have seen an increase in prevalence too.

“I’ve seen so much Lyme in the past year relative to the 10 years before,” she says.

Reflecting beyond infectious diseases, Dr. Mubareka points out that climate change has done more damage to our health than just increase the spread of pathogens.

In recent years, we’ve also seen negative impacts on cardiovascular health (the federal government estimates 15,300 premature deaths per year in Canada due to air pollution) and sudden death due to heat (British Columbia saw the deadliest weather event in Canadian history last summer, with 595 people killed by heat), to name a couple things.

“We are only scratching the surface. We really need to understand more,” says Dr. Mubareka.

The rise of climate change anxiety

As more work is done to unpack and address this growing problem, and as climate change becomes more visible and harder to ignore, more and more, climate change anxiety is becoming a topic of conversation.

A few years ago, Dr. Anthony Levitt, chief of the Hurvitz Brain Sciences Program at Sunnybrook, spoke briefly with the Globe and Mail about climate change anxiety.

“It got such traction,” he says of the interview. “I got emails and letters from all over the world asking about the subject.”

To better respond to those questions, Dr. Levitt conducted a survey in the United States and Canada to understand climate change anxiety and who it impacts most.

In general, he found that individuals who live in close proximity to events triggered by climate change, such as British Columbians who saw massive floods and numerous fires last year, were more likely to experience anxiety, and sometimes, even depression. Canadians, females and young people between 18 and 29 are also more vulnerable to climate change anxiety.

“They’re experiencing it, they’re seeing it, they’ve been educated in school about it,” says Dr. Levitt, explaining why young adults are feeling the pressures most. “And now, they’re getting into child rearing age; they’re seeing their children, and they’re thinking about what kind of a legacy they’re going to leave them.”

Like other forms of anxiety, Dr. Levitt says if climate change anxiety is affecting someone’s daily functioning, then they should seek help from a professional. However, he says we shouldn’t try to get rid of it altogether.

“There’s a functional part to anxiety. If you’re anxious about climate change, you’re going to mobilize your resources and do something about it. So, we don’t want to completely remove anxiety because that might remove some of the motivation,” he says. “However, we have to be careful. If you become too anxious, it becomes a barrier to effective problem solving, and you end up being paralyzed.”

What you can do

Dr. Levitt says the “antidote,” to both addressing climate change and to mitigating anxiety, is to take everyday action. Feeling that you are contributing to a solution has the dual job of helping the environment and of helping your symptoms of anxiety.

Dr. Mubareka practices this in her own life.

From biking more often to work, to eating less meat, to studying and educating about the complexities of climate change, she says, “I personally find doing something relieves my anxiety.”

And while she wants people to know how serious and multifaceted climate change is, rather than being alarmist, she says she always wants to emphasize what can be done.

“We have an opportunity right now to prevent the spread of emerging infections through mitigating climate change,” she says. “Climate change is very multilateral, very multisectoral, but that means even the small steps matter. We can all do our part.”

The post The far-reaching effects of climate change on health and anxiety appeared first on Your Health Matters.

Do depression or anxiety impact the risk of contracting COVID?

There have been several studies looking at this question. One analyzed the electronic health records of 61 million Americans and found there was a dramatically increased risk of contracting COVID for people with the four mental health disorders they included in their analysis: depression, schizophrenia, attention deficit hyperactivity disorder (ADHD) and bipolar disorder. If these conditions were recently diagnosed, people were five to seven times more likely to contract COVID during the early stages of the pandemic.

A second study found people with depression or anxiety had a small increased risk of contracting COVID if diagnosed later in life, and that risk increased for people with both conditions. Also, people with Alzheimer’s dementia appear to have a dramatically increased risk for contracting COVID.

There are several theories around why people with mental illness appear to be more likely to contract COVID. The immune system could be negatively impacted by older age, some mental health conditions and their associated treatments. Mental illness can also affect decision making, making it more difficult to navigate risk exposure.

Do depression or anxiety affect the outcome of infection with COVID?

Yes, it does appear that people who have both depression and anxiety experience worse outcomes from COVID infection. This was the conclusion of one study in particular. We still don’t know the exact reasons why, but there could be some link to the immune system at play. Additional research is needed to shed more light on this question.

Does COVID increase the risk of an episode of depression or anxiety?

One study completed by a Sunnybrook team found that after people had tested positive for COVID, there was an increased incidence of depression, cannabis use, opioid use, alcohol misuse and anxiety.

This study is still underway during the current wave of COVID. Researchers are hoping to determine if the same holds true throughout this stage of the pandemic.

Does having depression or anxiety affect a person’s willingness to receive COVID vaccination?

Part of this Sunnybrook study looked at vaccine readiness. In January 2021, 76 per cent of people in the study were ready to get their vaccines, 15 per cent were hesitant and 7 per cent were resistant.

This study found people were more willing to get vaccinated if they had anxiety and depression. Other factors that led to wanting to get vaccinated included older age and having a higher socioeconomic status.

Have studies shown any silver linings resulting from the pandemic?

This question was also asked as part of the Sunnybrook study referenced earlier. Surprisingly, up to 60 per cent of people identified a silver lining from the pandemic. Specifically, many people said they felt more fortunate, healthy and successful. Those people who felt they were less successful, resilient and fortunate had a much higher incidence of depression and anxiety.

The post The intersection between COVID-19 and mental health appeared first on Your Health Matters.

Acknowledge what you’ve lost

Dr. Boulos says first- and second-year post-secondary students have missed a lot of the typical high school and college experiences such as sports and clubs, graduation, and frosh activities. This could create some mixed emotions about starting classes this year.

“Recognize that there is some grieving,” says Dr. Boulos. Lack of enthusiasm, boredom, as well as anxiety with starting back in person could indicate there are some feelings that need to be addressed.

“Think about how this year was different. What were the things you feel that you’ve missed, and then when [you’re] able to identify what [you’ve] missed, you can grieve it,” she says. “If you don’t know why you’re feeling like this, it’s hard to grieve.”

Remember what you’ve already been through

The pandemic continues to create a lot of uncertainty for post-secondary students heading into this school year, and that too can create anxiety. But Dr. Boulos says it can be helpful for students to remind themselves that uncertainty isn’t new.

“You’ve already gone through a lot of this uncertainty in the last 17, 18 months. You’ve managed it,” she says, pointing to adjusting to wearing masks in school, learning online, ending high school or starting post-secondary differently than they thought they would.

“Remember, you have rolled with it already, you’ve gone through these things, and you will adapt,” she says. “You know that it’s possible.”

Set expectations

Students can manage their anxiety around uncertainty by focusing on what they can control, Dr. Boulos says. She suggests, for example, setting expectations with roommates beforehand, and if you’ll be far away from your support system of family and friends, making plans ahead of time on how you’ll stay in touch. It’s also important to establish routines for exercise and sleep.

“Those things [you] can control. Everyone is going to be having uncertainty, so what you do is you work with what you can control,” Dr. Boulos says.

Anxiety in social situations

She also says there will be students who are facing social anxiety as they go back to in-person classes, and possibly events, for the first time in two years.

“Social anxiety’s going to be there, that’s to be expected,” she says.

She suggests students struggling with social anxiety focus on “gradual, repeated exposure.” Start small and build up. For example, if you have a social activity, you could attend for a short period of time. You can leave if it becomes overwhelming, but it’s important to keep trying.

“You can always go back to your residence. But then, try it again,” she says. “If you start avoiding, it may get worse.”

The post How post-secondary students can manage back-to-class anxiety this fall appeared first on Your Health Matters.

I didn’t hear the shots or see the chaos or have to take cover.

But I am shaken and still thinking a lot about the shooting in my neighbourhood and other mass violence incidence in our city.

I live just steps from the Danforth but I still haven’t been there, even though I keep telling myself I should go…to honour the victims, to support the neighbourhood, and to heal. I have been avoiding crowds and the subway. I jump when I hear sirens. My mind wanders: Could it happen again?

Do other people feel the same? Is it normal to feel anxious after something like the Danforth shooting occurs in my neighbourhood?

Yes, said Dr. Ari Zaretsky, Psychiatrist-in-Chief at Sunnybrook. He said it’s very normal to feel anxious after an event like the Danforth shooting or April’s van attack — even if you weren’t there or personally involved.

“In general, the closer in geographic proximity to the event, the more likely you are to feel anxious because you experience a more personal sense of violation of expectations of safety,” he explained.

This anxiety might show up in the form of chronic worry and rumination (reviewing the events over and over again), muscle tension, headaches, poor concentration, startle response, insomnia and panic attacks.

“Panic attacks are sudden bouts of intense fear and dread that reach a crescendo in minutes,” he said. “During that time the person experiences some of these symptoms: palpitations, shortness of breath, feeling unreal, lightheadedness, tingling and tunnel vision.”

While some anxiety is normal after this type of event, he added, it becomes an issue if it is persistent (it sticks around for weeks not just a few days) and impairs your day-to-day functioning.

“That’s when we start to ask: Is it negatively affecting your sleep, appetite, ability to enjoy activities, concentration at work and social relationships?” Dr. Zaretsky said. If so, it is time to seek some help from a healthcare professional or counsellor.

In the meantime, talking to someone you trust can help, he added.

“Remain physically active and stay socially connected,” Dr. Zaretsky said. “Maintain your sleep and activity schedule.”

One of the classic signs of anxiety is avoidance, he said. This can include restricting travel, avoiding specific places or not thinking about certain things that cause upset or anxiety. In the short-term, this can be helpful.

“There is no need to emotionally flood yourself with exposure to that upsetting event, like over-exposure to media or going to an exact location where a traumatic event occurred,” Dr. Zaretsky said. “But in the long-term, it is more healthy and adaptive to not avoid. Don’t restrict your movements. Get back to your routine and go to the same parts of the neighbourhood as you did before the traumatic event.”

Human beings in general are resilient creatures and the most common outcome — even after very traumatic events — is that people will cope and be OK over time, he said.

“However, some people will continue to feel anxiety, and it is believed that these individuals are more sensitive to the effects of trauma for complex biological and psychological reasons,” Dr. Zaretsky said. “These people are not weak. They simply need psychological support and with that support, they will generally also get better and cope.”

So, Toronto: it’s OK to feel anxious. Let’s talk about it. We are not alone.

For me, my next step after talking to Dr. Zaretsky will be to ask a friend to join me for a walk in my neighbourhood (update below), so that I can talk about these feelings more, and try to get back to my routine.

If you need to talk or need support about this traumatic event or others, here are some resources below.

Resources:

• National Institute of Mental Health
• Sunnybrook Department of Psychiatry resources on anxiety
• How to talk to your family / kids about traumatic events

*Update: Between writing this blog and posting it, I did meet my friend at Broadview and Danforth. We walked and talked for a few blocks, had Greek fries and a mini ice cream cone, and gathered with some people at Logan and Danforth to take in this lovely rainbow. And I’m feeling a little bit better.

The post How to cope with anxiety after a traumatic event appeared first on Your Health Matters.