All posts in Psychotherapy & Mental Health

Indecisiveness and Motherhood

By: Dr. Tanya Cotler, PhD, CPsych
Why is it so hard for me to decide what to make for dinner since becoming a mom?

Mothering and parenting often involves a barrage of daily decisions, many of which we don’t even notice. How often do you wish someone else (maybe your partner?!) would figure out who is wearing clothes three sizes two small and what the kids are going to have for dinner? Or what about when your child asks if they could go out for lunch or stay at the park after school and you feel like they are asking you how to initiate world peace?

The difficulty with making these sometimes basic decisions is that as mothers our every day routines require decisions. All the constant choosing and deciding wears out the primary decision maker (for many that’s mom!)

Below are some of the reasons decision making is compromised:

  1. One of the symptoms of depression, and specifically postpartum depression, can be difficulty making decisions. When someone is struggling with depression and feels things are more hopeless or they themselves feel helpless-  this often translates to seeing minimal options available or feeling that your power or your agency over your choices is missing.
  2. Anxiety: there is a lot of research to support how anxiety can actually inhibit decision making by disengaging the prefrontal cortex- the area of the brain specifically responsible for executive functioning, planning and judgment as well as flexibility in decisions. The prefrontal cortex allows for “calm” decision making- it removes the intensity of emotion from decisions by quieting the amygdala (the part of the brain that runs on raw emotion and instinct). The research shows that anxiety seems to interfere with being able to limit distractions, making it difficult for the person to weed through the muck so to speak. Distractions can be physical but also emotional such as thoughts or worries. Anxiety numbs some neurons in the prefrontal cortex that are specifically involved in choice making and accordingly anxiety selectively shuts down mechanisms needed for clear choice making.
  3. Motherhood as a period of change and loss: During a phase of life when you are inundated by so many changes (hormones, physiology, psychological, relationships etc) and losses (relationships, identity, expectations and hopes) it can be unbearable to add to the exhausting list of changes and losses. With every decision comes a loss, as well as one more thing to think about and one more thing to grieve -or at least one more thing to adjust to. Simply put, the decision- even just what to make for dinner- feels like one more thing to consider when the mind is already overwhelmed with making adjustments.
  4. Guilt: with guilt often comes an increased difficulty decision making. This is because part of what complicates decision making is the sense of “loss.” As described above, with every decision there is something you “gain” and something you “lose.” If someone is already feeling worried or concerned about wrong doing, or not being good enough it  becomes harder to decide anything else for fear of making more mistakes.
  5. Insecurity and lack of trust in oneself or fear of feeling exposed or judged: With so much noise on how to mother, combined with the general idealization of motherhood, many mothers fear they will fall short or won’t be able to measure up to the expectations held out for them. This can also affect decision making. The more one feels insecure about how they are performing in their mothering role, the less likely they are going to be to rely on themselves for anything. Every decision feels like a challenge when you feel you can’t trust yourself.
  6. The  tendency for the mothering one to take the primary role with the emotional load or otherwise  termed emotional labor. The mothering one’s mind is often responsible for the executive functioning of parenting (think of it as mom as the organizer, planner, thinker, holder of all detail from who needs socks to what’s for dinner to program registration and more). This role can often keep a mom up at night running through her to-do list fearing what she missed or will miss. The perpetual cycle from “emotional labor” to anxiety to sleep deprivation to anxiety to emotional labor and back again, makes it inevitable that decisions are increasingly difficult for many moms. It’s just too much for the mind to compute constantly!
  7.  Decision Fatigue– Mothers are constantly needing to decide everything from bedtime routines to what to wear (themselves, their children, their partners!) It can become exhausting and utterly depleting to be in charge of any additional, even minute, decisions like what’s for dinner. Decisions require conscious thought and attention and even when invisible (or we aren’t cognizant of it) our brains go through a process of weighing pros and cons and thinking through. An element of expending energy occurs with every decision whether we want it to or not. Taking this together, more decisions mean diminished energy reserves and willpower impacting future decisions.

There are ways we can mitigate these difficulties making decisions. If we learn from prominent leaders in our world- one trick when in a position of power and high decision making power- is to minimize other competing decisions which may be of less importance.A quick look at some business or world leaders (I.e Steve Jobs or Barack Obama) and you can see how many leaders openly talk about wearing the same color scheme everyday or limiting wardrobe to few pieces to minimize daily choice and allow more space for bigger decisions.

Of course in addition to limiting the number of less crucial decisions what’s also required is some advanced planning. For example, having a daily menu of meals that rotate each week.

Also important is to ask for help  and to  attempt to share decision making power with others you trust such as a partner. Like in any business partnership, this requires dividing roles. If you feel that a lot of the “mental labor” is falling on you,  talk about it with your partner. Perhaps your partner becomes in charge of wardrobe while you are in charge of meals. And maybe you divide seasonal ownership over activities registration or doctor appointments.

Ultimately if you are struggling with decisions try to identify which of the many possible reasons might be contributing to your decision difficulty and then try to plug in some solutions or help accordingly. All this needs to be couched in the fact that no one can do this alone mama, we all need help, and with help it’ll feel easier.

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Mom Brain


By: Dr. Tanya Cotler, Clinical Psychologist
Don’t tell but I had that awful daydream again: New moms and scary thoughts.“ Every time I would descend a stairwell with baby Nila*  I imagined falling with her. The day nightmare changes – sometimes I fall on her, or she cracks her head. Sometimes I just shake my head to make the ugly thought go away. ”Molly* sat in front  of me curled in a ball , half hiding her face as she slowly shared with me the “day nightmares” she’d been referencing for several weeks in therapy but had been frightened to share. As I sat and listened, Molly’s body slowly unfolded out of its contorted shape and relaxed a bit more into the seat. She shared that she expected my face to be horrified, and opened up about her fear that if she let anyone know the scary thoughts she was having then they would be horrified or maybe worse actually take her baby away. I helped Molly label these thoughts- they are intrusive thoughts- they are uninvited and come on their own without invitation and indeed can be quite disturbing, but, they are actually quite normal.

As new mothers the idea of being solely responsible for the well being and protection of a precious new little life can be quite overwhelming and indeed anxiety provoking and therefore intrusive thoughts are quite normal and common. These thoughts are a common way for the human mind to test out scenarios  especially when it’s an issue of importance or the person is in a state of increased anxiety. Well, here we are new mom (common increased anxiety) and something she cares about (clearly it’s her baby) and so intrusive thoughts show up.

Donald Winnicott, a prominent English pediatrician and psychoanalyst, coined the term “maternal preoccupation” to describe the early mental process when a mothers mind is constantly focused on her baby. He depicted the optimal “holding” environment for a new baby to thrive as one in which the mother is psychically and physically present for the infant’s needs. That is, just as a new mother is constantly physically occupied with her newborn baby’s needs (diaper, feed, nap repeat!), so too is her mind constantly occupied by nap times, feed times, and concerns over baby‘s physical and emotional safety and health. Winnicott explained that the mother’s mental  preoccupation, and sensitive responding to baby, facilitates the building of a secure attachment bond which is grounded in mom and babe tuning in to one another’s feelings, thoughts and behaviors. Moreover, there is now scientific evidence to support the normalcy of maternal preoccupation. There are brain changes such as changes in grey matter, that occur in most women post partum. These changes help the mother to be increasingly empathic toward her baby’s experience, while devoting less “brain space” to other trivial stuff like memories of what was for dinner the day before (Insert “mommy brain experience” here).

Despite worrying being part of a normal maternal mental process, at times this experience of preoccupation can also cause a mother undue distress. A mother may feel her mind is unrelenting with thoughts of baby’s well being or she may constantly obsess over bad things happening. When the anxiety feels inescapable, even the most basic decision making becomes difficult. For many this is exacerbated by the information overload and constant opinions from well meaning friends, family (and strangers in grocery lines!). When the scary thoughts feel all consuming and interfere with daily functioning or when a mother starts to develop behaviors to attempt to ward off the “bad” from happening, then it’s possible the mom is struggling with postpartum anxiety or post partum OCD. Indeed, If a new mother finds herself wondering whether her worries and scary thoughts are too much, or she struggles to know what is real or not real, then it is very important to seek professional opinion and support. A mother should not feel alone and plagued by these thoughts.

Indeed, it is common to avoid seeking advice or support because the constant worry and anxiety feels embarrassing or shameful. The problem is that shame over scary thoughts, perceiving them as dangerous and unacceptable, or as evidence of being a bad mother, can make these thoughts even more pervasive.  That is, the secrecy and shame increases feelings of sadness, loneliness and guilt which perpetuates the scary thoughts themselves. Alternatively, sharing these thoughts with a trusted friend, family member or professional may help with tolerating and accepting the dichotomy of emotional experience in motherhood- the love and hate, happiness and sadness, anxiety and calm. The goal when experiencing these scary thoughts is to be able to notice these thoughts, acknowledge them, and then let them go.

A word on trauma: if a new mother has experienced an overwhelming, incomprehensible and devastating psychological experience (be it in childhood, throughout her lifespan, in pregnancy or previous pregnancies, or in labor or birth), scary thoughts can emerge as a fear of the experience reoccurring or as a fear of something else uncontrollable happening. Like a lighthouse, the mind starts to scan the environment for the next ship- the next bad thing- as if catching it before it happens will keep her safe.  This form of “hypervigilance” gives power to the scary thought: it’s the belief that the mother is protecting herself or her baby by obsessing/not taking her mind off of the bad that may happen. If you are worried about how a difficult experience has affected you – and wonder if you are reacting to it or if your scary thoughts are connected to it, talking to a professional is really important and you deserve the support.

The important take home? If you would like to consult a professional about your experience of worries and scary thoughts post partum, you should always feel you can. It may be normal to worry as a new mom, but you should never be suffering in your worries. If you do not know where to turn, you can always look at PSI (post partum support international) for a list of professionals trained in perinatal mental health in your area. You are not – and should not- feel alone.

For further information or to contact the author
Dr. Tanya Cotler
Cotler.phd@gmail.com

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Have you set your 2019 goals yet?

Thrive is so grateful to be a part of your health goals and wants to help you feel your absolute best! Our practitioners are here to help you optimize your health and well-being all year long.

And with January already coming to a close, it’s a great time to create your S.M.A.R.T. Goals to set you up for success in 2019.

S is for SPECIFIC - Describe your goal as much as possible, with a clear vision and description of what you would like to achieve.
M is for MEASURABLE - It’s important to be able to measure your goal, so be sure to include a metric system with a target that you are wanting to reach.
A is for ATTAINABLE - Your goal should be challenging, but ensure it is also realistic.
R is for RELEVANT - Is your goal consistent with other goals you have achieved or set for yourself? Does it align with your current and long-term plans?
T is for TIMELY - Set a start and end date for when you’d like to have your goal achieved by. This will help you with time management and give yourself a little bit of urgency.
From the entire team at Thrive, we wish you a happy and healthy year ahead!

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How to Manage High Stress Periods…Like the Holidays!!

By Dr. Kristin Heins

I came across an article on the Mayo Clinic website (www.mayoclinic.org) on stress management around the holidays and really liked it. It may be especially helpful during the hectic and emotion-filled holiday season; but, is also a useful life approach to stress management. Most of us know that stress and feeling overwhelmed does not limit itself to holidays!! When stress is at it’s peak, it’s hard to stop and regroup. The feeling is often one of overwhelm vs. support. Below are ten ways to try and shift the balance back to a more supportive experience:

headache1. Acknowledge your feelings: If historical or present day loss and sadness exist, accept that it’s normal to feel sadness and grief. It’s OK to take time to cry or express your feelings.

2. Reach out: If you feel lonely or isolated – seek out community, faith-based or other social events as they can offer support and companionship. Volunteering may also lift your spirits and broaden friendships.

3. Be realistic: The holidays may not (likely won’t) be perfect or just like last year. As families change and grow, traditions and rituals often change as well. Choose a few to hold on to, and be open to creating new ones. For example, if adult-children can’t come to your house, find new ways to celebrate together, such as sharing pictures, emails, videos, skyping.

4. Set aside differences: Set aside familial grievances during gatherings until a more appropriate time for discussion. Try and find understanding if others get upset or distressed when something goes awry – chances are they’re feeling the effects of holiday stress just like you may be.

5. Stick to a budget: Before you shop, decide how much money you can afford to spend. Then stick to your budget. Ways to manage budgets:

  • Donate to a charity in someone’s name.
  • Give homemade gifts.
  • Start a family gift exchange

6. Plan ahead: Set aside specific days for shopping, baking, visiting friends and other activities. Plan your menus and then make your shopping list. That’ll help prevent last-minute scrambling to buy forgotten ingredients. Ask for support for party prep and cleanup.

7. Setting Limits: Saying yes when you want to say no can leave you feeling resentful and overwhelmed. If you can’t participate in a project or activity, try and be clear about which ones you can say no to and take that time for other activities like rest and self -care.

8. Keep healthy habits: 

  • Have a healthy snack before holiday parties so that you don’t go overboard on sweets or drinks.
  • Get plenty of sleep.
  • Incorporate regular physical activity into each day as it helps with both physical and emotional wellbeing.

9. Take a breather: Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. Find something that reduces stress by clearing your mind, slows your breathing and restores inner calm.

10. Seek professional help if you need it: Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, seek help from a professional.

I hope that this helps make the holidays more enjoyable for you and yours. Happy Holidays!

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Managing Stress this Holiday Season!

Managing Stress this Holiday Season!
Comments Off
My formula:
  1. Acceptance
  2. Self-care
  3. Social engagement
  4. Assertiveness

Accept there are things that you can’t change or control. Focus on the positives, consider forgiveness.

Self-care: Don’t postpone exercise, pleasurable activities, good sleep, or healthy eating because “you are too busy”; you are only giving away your anti-stress “free medication”.

Be social: time to follow the plan and not the mood! Stressful times are the right time to say “yes” to that coffee, that drink, that dinner with friends/family etc..

Be assertive: say what you need and want respectfully, don’t hold back. Also learn to say “no” to unnecessary commitments.

Take pauses, get into mindfulness practice! Meditation is the “new thing” for a reason. Download a meditation app to your smartphone. 5 minutes a day can make a big difference.

Warmly,
Dr. Maria Chaparro, Registered Psychologist in Supervised
Practice

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Understanding More About Gestalt Psychotherapy

By Dr. Kristin Heins, ND
 

Working as a Naturopathic Doctor, I view mental health as a natural and necessary part of holistic health care. With this philosophy I began, almost ten years ago, seeking to obtain a skill set to speak with patients about their emotions and mental health.

Now, many years later and in my fourth year of the full five year programme, I am able to see clients as part of the supervised practice portion of my training as a psychotherapist. Here is a little taste of the Gestalt approach to give a clearer understanding of what it is and how it may be helpful for you.

  • What is The Gestalt Approach to Psychotherapy?

Gestalt focuses on meeting clients where they are at in the moment and providing support to their experience. At our core, humans are dynamic and adaptive beings always attempting survival. Gestalt refers to this as “creative adaptation”. Sometimes, however, the way we adapt isn’t helpful in all circumstances. We may experience feeling “stuck” or at an impasse. The therapy session is intended as a safe place to both identify these patterns of adjustment and explore alternate ways of adapting.  This is an experiential form of psychotherapy, which may include using exercises to help foster new awareness, understanding and techniques for self support.

Please contact the clinic if you would like to learn more or determine if working together is the right fit for you.

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Mat Leave Blues

by Maya Hammer, M.A., Counselling Psychology 

920145_15195860In Canada it is typical for women to take a year-long maternity leave, with some variation amongst those who are self-employed or sharing the leave with a partner. While parental leave is a great opportunity to take a break from your professional life to raise your child, the day-to-day experience of mat leave can be lonely, boring, and exhausting. Being a mother is hard work as you are in high demand and have limited control over your schedule. Feelings of sadness, anxiety, anger, irritability, and exhaustion are common, especially for high achieving Type A individuals who adhere to a rigid schedule and time management structure. Spending 10 or more hours on your own, five days a week, is quite removed from traditional ways of raising children in community, extended family households, or tribes.

It is important to find ways to support yourself during this time. Be gentle and compassionate with yourself as you grow into your new role. Take time to identify what you need in order to feel good on a day–to-day basis, specifically addressing times that feel most difficult, such as first thing in the morning or the final hours in the afternoon before your partner comes home from work. Stay connected to your partner, family, and friends while seeking out new mom friends so that you do not feel isolated. Connect with people by phone or online when it is too difficult to leave the house. Use your support network to help with childcare or hire a babysitter for 3-4 hours so you can nap, exercise, do something fun, or catch up on errands and other responsibilities. Involve your partner/spouse as much as possible with care for the baby.

Learning to be flexible, creative, and let go will serve you well on maternity leave. This requires a paradigm shift from being productive, organized, and ambitious- qualities that may have been integral to your life pre-baby. Making the switch from ‘doing’ to ‘being’ is not always easy. In the book Momma Zen, Zen Buddhist priest and mother Karen Maezen Miller describes her relentless path towards letting go of expectations, welcoming mistakes, and reconnecting with her innermost self. Maezen Miller reminds us that being a parent is an excellent opportunity for growth and transformation if you accept what is happening, without judgment, on a moment to moment basis.

 

Maya Hammer is a psychotherapist in private practice specializing in women’s mental health, prenatal and postpartum mental health, infertility support, pregnancy loss and infant death, and couples counselling.

www.mayahammer.ca  |  maya@healthpsychologyclinic.ca  |  416.597.0015

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The Opposite of the Baby Blues: Postpartum Hypomania

by Maya Hammer, M.A., Counselling Psychology | www.mayahammer.ca

We all know about the “baby blues”, a common experience of emotional ups and downs in the first week or two postpartum. Many of us, however, have never heard of the “baby pinks,” or The Highs, a feeling of intense happiness or euphoria following birth.


Symptoms
of postpartum hypomania include:
-racing thoughts
-fast talking
-being very active
-decreased ability to concentrate
-impulsivity, e.g., shopping
-decreased need for sleep
-irritability

These symptoms can be triggered by childbirth and usually subside after 6-8 weeks postpartum. In some cases, however, postpartum hypomania is an early indicator for bipolar disorder, depression, or psychosis. Therefore, it is very important to seek treatment if you or a loved one you know is experiencing.

Causes
Pregnancy and childbirth can trigger mental imbalance because of physiological changes such as stress, dysregulated cortisol, increased inflammation, decreased serotonin, and hormonal fluctuations. In addition, psychosocial factors can impact mental well-being including disrupted sleep, the demands of caring for a baby, lack of support, life stress, marital difficulty, or trauma. Genetics plays a part too: a personal or family history of mental illness, in particular bipolar disorder, predisposes a woman to prenatal and postpartum mental illness.

Treatment
It is important to seek treatment immediately if you notice unusual behaviour in your partner or loved one. Treatment can involve:

1)      mood stabilizer medication

2)      therapy to stabilize mood and regulate daily schedule

3)      support and education for partners and families


For further reading, check out these resources:

A blog post on postpartum hypomania and mania

mom’s experience of hypomania induced by anti-depressant medication

study on the prevalence of postpartum hypomania

And another study demonstrating that hypomanic symptoms can be used to correctly diagnose postpartum bipolar disorder.

As well, check out an article in Today’s Parent, and Maya’s appearance on CTV Canada AM talking about the baby pinks.

 

 

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Dads Get the Blues Too

This post is brought to you by Maya Hammer. Maya Hammer is a psychotherapist in private practice at Thrive Natural Family Health and the Health Psychology Clinic. Don’t miss Maya’s recent interview about postpartum hypomania, or “the baby pinks,” on CTV Canada AM

Dads Get the Blues Too
by Maya Hammer

It is common for women to suffer from depression and anxiety following the birth of a baby. About 10 to 20% of women are diagnosed with postpartum depression. What is less common, however, is our understanding of postpartum depression in men. Recent research has found that 10 to 25 % of new fathers may suffer from depression. Dads or secondary caregivers experience stress related to feeling rejected after the arrival of the child, relationship or marital dysfunction, burden of financial responsibility, grieving pre-baby freedom and lifestyle, or feeling overwhelmed by partner’s postpartum depression.

Paternal postnatal depression (PPND) is often overlooked because, generally speaking, men don’t express suffering the same way women do. For example, men may not acknowledge feeling sad, guilty, and hopeless. Here are some symptoms to look for in men:

  • Increased anger and conflict, violent behaviour
  • Increased use of alcohol or drugs
  • Frustration or irritability
  • Lower threshold for stress
  • Risk-taking and impulsivity
  • Physical symptoms such as headaches, pain, digestive problems
  • Fatigue
  • Loss of interest in work and hobbies

If these symptoms are familiar to you or a loved one you can get help through therapy and naturopathic or psychiatric medication. For more information, check out postpartummen, a website for men suffering from PPND and in the book Postpartum Depression for Dummies, by Dr. Shoshan Bennett that has a section on depression in fathers.

If you are a dad and your partner/wife is experiencing postpartum depression, you can find helpful information at postpartumdads and The Postpartum Husband by Karen Kleiman.

Another great resource is Parenting From the Inside Out by Daniel Siegel and Mary Hartzell. This book helps to examine how past issues, including trauma or how you were raised as a child, impact your ability to parent.

 

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