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Archive for category: Mental Health

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How Anxiety and Depression Can Impact Cognition

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Co-written with Ashley Carnegie, Occupational Therapist

As a student working with an Occupational Therapist in the community, I realized early in my placement that many clients struggle with anxiety and depression in combination with cognitive challenges like decreased attention, concentration and focus, difficulties with memory, and slower information processing abilities. This spiked my interest, as I was unaware of the possible impact anxiety and depression could have on cognition and how these symptoms could be related.  I decided to look into this further, and am sharing my findings below.

Occupational Therapists work in a wide variety of settings including the community. As the hospitals become less and less able to accommodate people long-term, community-based occupational therapy services are becoming more and more common. Working in the community allows occupational therapists to reach a wide variety of clients, and therapists utilize a strength-based approach to build on the client’s current strengths to promote wellness and productivity.

Depression and anxiety are the most common types of mental illness throughout the world, including Canada. From my community placement experience as a student Occupational Therapist, I have found that the majority of the clients I have seen are experiencing depression and/or anxiety, often in combination with other primary diagnoses.

Interestingly, depression and anxiety can negatively impact the way the brain thinks, learns, and processes information and thus how it functions.  However, the relationship is complicated as a decrease in cognition may also lead to an increase in depression and/or anxiety which can then perpetuate the cycle.

Research has highlighted how anxiety and depression can negatively impact several aspects of cognition including:

  • Psychomotor speed
  • Attention
  • Executive functioning
  • Problem-solving
  • Attentional switching
  • Cognitive flexibility
  • Visual learning
  • Memory

The result for most people tends to be poor functional outcomes in their daily lives. Additionally, the brain regions believed to be responsible for these functions have been shown to be abnormal in people that also suffer from anxiety and depression  (e.g. hippocampus, amygdala, temporal lobes, and prefrontal cortex). Decreased memory, slowed information processing, and issues with verbal communication can negatively impact multiple areas of people’s lives. This information demonstrates the importance of the need to detect and treat anxiety and depression as early as possible as well as the need for early cognitive interventions for clients with anxiety and depression.

As a student Occupational Therapist, I wanted to further investigate how Occupational Therapists can help. I found evidence that Occupational Therapists can help clients in reducing functional decline, while also reducing the probability of relapse by treating cognitive deficits. Occupational Therapist’s target these areas by teaching client’s cognitive remediation and compensation strategies during their interventions and treatment monitoring.

Examples of remediation interventions may include:

  • Retraining higher-level cognitive skills (e.g. strategy use, self-monitoring, self-correction, problem-solving, self-evaluation)
  • Education
  • Relaxation and stress management techniques to regain control
  • Divided attention training (e.g. learn tasks separately and then combine tasks)
  • Imagery
  • Rehearsal strategies

Examples of compensatory interventions may include:

  • Modifying the environment (e.g. dim lights, reduce distractions)
  • Altering the task, (e.g. use of rest breaks, breaking the task into smaller components, repetition of instructions)
  • Use of both internal and external cueing/reminders (e.g. use of mnemonics, post-it notes, organizers, applications)

With both, often, a cognitive behavioural approach is taken.  Cognitive behavioural therapy (CBT) works to change clients thought structure to allow positive mood change, enhance coping strategies/problem solving, and help challenge faulty beliefs.

Anxiety and depression are common and are known to negatively impact a person’s cognition.  Worsening cognition then can deteriorate anxiety and depression further.  Early intervention is key to break this cycle and to promote function and wellness.   Occupational therapists play a vital role in providing interventions for those with anxiety and/or depression by implementing interventions for these issues, as well as treating the common resulting cognitive deficits.  Both remediation and compensatory techniques are used, often through cognitive behavioral therapy.  If you, or someone you know, is struggling with anxiety or depression this may present as cognitive difficulty, or if cognitive issues are present, anxiety and depression may also surface.  Consider occupational therapy if you would like support and strategies to improve these symptoms and to reduce their effect on your daily life.

 

References:

1. Carrier, A., & Raymond, M. H. Community occupational therapy practice in Canada: A diverse and evolving practice.

2. McRae, L., O’Donnell, S., Loukine, L., Rancourt, N., & Pelletier, C. (2016). Report summary-Mood and Anxiety Disorders in Canada, 2016. Health promotion and chronic disease prevention in Canada: research, policy and practice, 36(12), 314.

3. Statistics Canada (2014) Survey on Living with Chronic Diseases in Canada (SLCDC). Retrieved from http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5160

4. Lee, R. S., Hermens, D. F., Porter, M. A., & Redoblado-Hodge, M. A. (2012). A meta-analysis of cognitive deficits in first-episode major depressive disorder. Journal of affective disorders, 140(2), 113-124.

5. Jaeger, J., Berns, S., Uzelac, S., & Davis-Conway, S. (2006). Neurocognitive deficits and disability in major depressive disorder. Psychiatry research, 145(1), 39-48.

6. Bora, E., Fornito, A., Pantelis, C., & Yücel, M. (2012). Gray matter abnormalities in major depressive disorder: a meta-analysis of voxel based morphometry studies. Journal of affective disorders, 138(1), 9-18.

7. Femenía, T., Gómez-Galán, M., Lindskog, M., & Magara, S. (2012). Dysfunctional hippocampal activity affects emotion and cognition in mood disorders. Brain research, 1476, 58-70.

8. Lorenzetti, V., Allen, N. B., Fornito, A., & Yücel, M. (2009). Structural brain abnormalities in major depressive disorder: a selective review of recent MRI studies. Journal of affective disorders, 117(1), 1-17.

9. Fleming, J. (2017). An occupational approach to cognitive rehabilitation. Workshop presented through the Canadian Association of Occupational Therapists, Toronto, ON.

10. Grieve, J. I., & Gnanasekaran, L. (2008). Intervention for Cognitive Impairments. Grieve, JI, & Gnanasekaran, L.(3rd ed. ed.). Neuropsychology for occupational therapists: cognition in occupational performance. Oxford. Malden, Mass.: Blackwell.

11. Haran, D. (2009). Cognitive-behavioral therapy for depression. The Israel journal of psychiatry and related sciences, 46, 269.

12. Knapp, P., & Beck, A. T. (2008). Cognitive therapy: foundations, conceptual models,  applications and research. Revista Brasileira de Psiquiatria, 30, s54-s64.

 

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Social Outings Rx

We’ve said this before and we will say it again… being social is good for your health.  Occupational Therapists recognize the importance of social interaction within leisure activities for persons with and without disabilities. We work with clients to explore their interests to help find activities that offer opportunities for social interaction and, if needed, find ways to address the different barriers to engaging in these meaningful past times.

Great news!  Your family doctor can help with this too. There is now a pilot program in Ontario that allows physicians to write prescriptions for social activities and the ROM is assisting with this initiative.  Learn more in the following care of CBC News.

CBC News:  Doctor’s orders: ‘Social prescriptions’ have been shown to improve health

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Youth Anxiety and Depression on the Rise

The Centre for Addiction and Mental Health (CAMH) has released the results of the latest Ontario Student Drug Use and Health Survey and the results are showing rising instances of anxiety and depression in grades 7-12 students.  Learn more about the results and how gender may play a role in the following care of CAMH.

The Centre for Addiction and Mental Health:  Half of female students in Ontario experience psychological distress, CAMH study shows

 

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Giving Back this Holiday Season

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Tis the season for me to carefully balance my dislike for the Holiday season with my desire to not bring those around me down with my “baa-hum-bug” attitude.  My hate-on for Christmas started in my late 20’s probably around the time I had four kids under age 5 and through some lack of communication among my family, my kids had like 15 presents to unwrap EACH.  No, I am not complaining that my kids have access to such “abundance” by some very loving and well-meaning people, but with this display of affection comes a parent’s concern that their child will love Christmas because of the stuff.  And the more stuff they get, the more they want.  The more they want, the more they miss the point on the difference between want and need and the more they expect the “bar” to be raised with each passing year.

So, in my search to not pass on my “hate-on for the holidays” gene to my children, I landed on charity and acts of service to balance the fact that they, like most of their friends, live in abundance but still need to be mindful and grateful that they get a lot of what they want, while “needing” nothing.  After all, most of us can give something and there are so many options for this.  This new approach has been helping me to beat the Holiday Blues for the last few years.  It helps me to slow down, reflect, and be mindful and grateful for the things I have and can provide others, and for the pleasures of my own life. 

But in stepping out and getting my girls involved in local charities over the holidays, I have realized that there is an art to “giving” that can have the most impact.

Here are my Top 5 Things to Consider when Giving Back This Holiday Season:

Donate Money – good and responsible charities are appreciative of every dollar.  From the Salvation Army Bell Ringers to putting in a payment online or in the mail.  Money does help.  Search online with your kids to find a charity close to your heart, and have every member of the family donate.

Donate Items – some charities collect food, clothing, toys, or housewares to provide to those in need.  Time to purge those things you don’t need or use.  But before you donate items, ASK the charity what they need and HOW they want the items provided.  If they want new toys, these need to be packaged and un-used.  If they want them unwrapped then don’t take the time to wrap them – it only adds cost and time for you, and cost and time for the charity to unwrap the item before distributing.  Also, ASK what age groups they have a hard time providing for.  I was volunteering at the Good Shepherd recently and they had an abundance of items for small children, but very few for teens.  If you ask them, they will tell you the age categories they struggle to provide for.  Lastly, be sensitive.  If the charity is serving refugees or people immigrating from war-torn countries, toys that involve violence or war (i.e. guns or tanks) might not be appropriate and will need to be screened out by the charity before providing it to the recipient, again adding time and administration during a busy season.

Purchase Charity Goods – some charities sell “goods” that provide an item with a donation.  World Wildlife Federation sells small stuffed animals to represent an “endangered species” and most of the cost of the animal goes to the charity.  So, for $40.00 my child gets an “endangered stuffie” with a certificate about the animal they have adopted, and the charity gets $32.00 as a donation to their cause.  This is also true of other charities that aim to sell farm animals or agriculture supplies that are provided to third world countries.

Support Events – many charities offer dinners, auctions, or other seasonal events to raise money.  This is a great way to donate while engaging in an “experience” with a friend, partner or as a family.

Donate Time – sometimes donating your time reaps the best reward for you and the charity.  Not only does it provide you with an opportunity to see how the organization operates and allow you to be “hands on” in making a difference, it saves the charity from needing to fund staffing to manage the busy holiday season.  I have been at the Good Shepherd three times this month doing anything from sorting clothing donations, food donations, stocking housewares on the shelves in their store, and sorting toys for their Christmas hampers.  There are many organizations that just need some extra hands during the holiday season and sometimes our time is our most impactful gift.

Next week on our blog we begin our annual tradition of giving back to our readers with the 12 Days of Inspiration.  We hope you find these uplifting stories a source of inspiration and hope this Holiday Season.  

Previously Posted December 2016

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“The Cost of Caring” — Coping with Compassion Fatigue

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Co-written with Kayla Colling, Student Occupational Therapist

There are many reasons we become health care providers.  Sometimes it is a passion for helping a certain population, a desire to help people achieve specific goals, or the recognition that people are needed to fill gaps in health care delivery.  Whatever the reason, there are physical and emotional risks that come with “helping” work.

If you are a helping or social professional who uses compassion and empathy with your clients who have experienced trauma and suffering, you may already be familiar with compassion fatigue.  Nurses, physicians, trauma therapists, social workers, workers in child protective services, and military healthcare teams are recognized to be at risk of exposure to second hand trauma through their work and may benefit from understanding and recognizing compassion fatigue.  Other health care providers, such as occupational therapists, advanced practice registered nurses (APRNs), respiratory therapists and physical therapists may also suffer the consequences of compassion fatigue in their work with people and their families that are experiencing a health crisis.

What is compassion fatigue?

Compassion fatigue is often described as the “cost of caring”.  It can also be called “secondary traumatic stress”, which is a more clinical term, but it is generally agreed that these terms are interchangeable.

Compassion fatigue occurs when providers are exposed to another person’s trauma and suffering.  This could be through routine interactions at our workplaces, when we provide compassion and empathy to clients or patients who have experienced trauma.

Symptoms

Compassion fatigue impacts individuals physically, emotionally and spiritually, and tends to have a rapid onset of symptoms.  The symptoms listed below are not exhaustive and not exclusive to compassion fatigue, so they should not be used to diagnose.  If you are concerned, consider making an appointment with your physician or other mental health worker to discuss your concerns.

Physical:  chronic fatigue, frequent headaches, gastrointestinal complaints, sleep disturbances, muscle tension, aches and pains, and anxiety.

Emotional and Spiritual:  heavy heart, emptiness, decreased sense of purpose, low self-esteem, high self-expectations, helplessness and hopelessness, numbness, apathy, depression, anger, irritability.

Behaviour Changes: avoiding or dreading work, calling in sick frequently, inability to maintain empathy, chronic lateness, overworking, and difficulty focusing and concentrating.

So it’s like burnout?

Burnout has a more gradual onset and results from an accumulation of ongoing, daily stressors at work that wear us down if we do not take proper care of ourselves and try to address the contributing workplace issues.  Symptoms of burnout tend to be more subtle and are sometimes misinterpreted.  It is still very important that we try to both address and prevent burnout, but this is clinically different from compassion fatigue.

Building Resiliency/Prevention

Although we cannot entirely prevent compassion fatigue from happening, we can take steps to reduce the risk, recognize warning signs and seek support early in order to reduce the impact on ourselves, our coworkers, our clients and our friends and families. 

By reading this blog, you have already taken a step toward learning more about it.  If we can normalize these emotions after exposure to these types of situations, it might help us to seek and accept support when we need it.

If your workplace permits, it can be helpful to have regular debriefings, even if a specific incident or crisis has not occurred.

Self-care strategies have been shown to help prevent compassion fatigue.  These strategies will likely include enhancing your boundaries to separate your work life from your home life as much as possible.  It also often involves balancing your activities outside of work as well, including engaging in a variety of relaxing, pleasurable and productive activities throughout the week.  Importantly, getting enough sleep at night and eating healthy and regular meals are also parts of self-care.  Avoiding maladaptive coping mechanisms (such as turning to alcohol, increasing smoking, eating or spending) is also important, including recognizing when things are deteriorating to get help quickly.

Practicing self-compassion can also help us to build resilience against compassion fatigue.  You can find meditations to help cultivate self-compassion, or it might be something you explore through reading, watching TedTalks, attending a course or workshop, or talking to your therapist about.  Having a regular mindfulness or meditation practice may also help you build resilience, along with other positive and adaptive outlets like exercise and social time.

Resources

If you are interested in learning more about compassion fatigue, check out the references below.

If you want to “check in” with yourself, you may be interested in looking at the Professional Quality of Life Scale (ProQOL) available here.  This scale will allow you to calculate scores on scales that consider compassion satisfaction, burnout and secondary traumatic stress (compassion fatigue).  I am not suggesting using this scale for self-diagnosis but it can sometimes be helpful to indicate if there is a concern you might want to speak to a professional about.

The symptoms of compassion fatigue can be severe – if you are concerned for your safety, please call your local crisis/distress line for support.  Find a crisis line near you.

References

Sorenson, C., Bolick, B., Wright, K. & Hamilton, R.  (2016).  Understanding compassion fatigue in healthcare providers: A review of current literature.  Journal of Nursing Scholarship, 48(5), 456-465.  doi: 10.1111/jnu.12229

Sorenson, C., Bolick, B., Wright, K. & Hamilton, R.  (2017).  An evolutionary concept analysis of compassion fatigue.  Journal of Nursing Scholarship, 49(5), 557-563.  doi: 10.1111/jnu.12312

Vu, P. &Bodenmann, P.  (2017).  Preventing, managing and treating compassion fatigue.  Swiss Archives of Neurology, Psychiatry and Psychotherapy, 168(8), 224-231.  doi: 10.4414/sanp.2017.00525

 

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“MO”-Tip of the Week: Learn the Male-Specific Symptoms of Depression

Our O-Tip of the week series delivers valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living.

For the month of Movember, a month dedicated to Men’s Health, our “MO”-Tip series will provide you with OT-approved ways to take care of the men in your life.  

According to Movember Canada, across the world, one man takes his own life every one minute.  By learning some of the less-recognized symptoms of depression that are more prominently seen in men we may be able to prevent this.  These include:

  • Being irritable, short-tempered, or inappropriately angry
  • Spending a lot of time on work (they may be trying to escape their feelings by keeping busy)
  • Reckless driving, extreme sports, or other risky behaviours
  • Excessive controlling behavior
  • Alcohol or substance abuse (men are far more likely to abuse substances)

These behaviours are untraditional of typical depressive symptoms but mean that men who may benefit from emotional aid are often slipping under the radar for health professionals, and this can lead to disastrous consequences including poor quality of life and higher rates of suicide.  If you, or a man you know, is experiencing these symptoms speak to a healthcare professional.

This Movember, commit to walking or running 60 km in recognition of the 60 men we lose each hour to suicide.  Learn more here.

Learn more in our post, “Stressed or Depressed” – Man Therapy

 

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The A to Z of OT: W is For… Workplace Wellbeing

There are many ways that Occupational Therapists promote wellness and wellbeing for those in the workplace.  From ergonomics to accessibility; injury prevention to return to work programs, OTs assist in the workplaces in many facets.  We are going to focus on an important way that Occupational Therapists can assist employees and employers at work – by improving mental health.  Learn more about how OT’s can provide essential information and assistance to enable the support of mental wellness at work in our OT-V video below, or in our post,  Promoting Mental Wellness at Work.

 

October is Occupational Therapy Month and to celebrate we will be sharing a new series called the A to Z of OT.  In our attempts to further educate the public about what Occupational Therapists do we will be highlighting twenty-six of the awesome ways OTs provide Solutions for Living.  

We encourage you to follow along and to add to the discussion by highlighting other awesome things OTs help with for each corresponding letter!

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The A to Z of OT: S is For… Stress Management

In 2013, Statistics Canada reported that 6.6 million Canadians (ages 15 and older) reported that most days were ‘quite a bit’ or ‘extremely stressful’.  Stress can negatively affect many aspects of your physical and emotional health and can have long-term repercussions.  Occupational Therapists can help people manage their stress with a variety of strategies.  Learn more about Occupational Therapy and stress reduction in our post, How Stress is Affecting Your Health.

 

October is Occupational Therapy Month and to celebrate we will be sharing a new series called the A to Z of OT.  In our attempts to further educate the public about what Occupational Therapists do we will be highlighting twenty-six of the awesome ways OTs provide Solutions for Living.  

We encourage you to follow along and to add to the discussion by highlighting other awesome things OTs help with for each corresponding letter!

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Technology – Why it’s Important to Unplug

Our relationships with our smartphones and other devices are bittersweet.  Though these devices seem to enrich our lives in many ways, they also have created numerous problems for our mental and physical health.  Excessive use of technology can lead to serious health problems including addiction, vision difficulties, sleep disturbances and more.  It’s important to try to be mindful of our technology use in order to avoid dependencies.  Check out this infographic, created by Psychologist Barbara Markway, with some great tips to help you unplug regularly for the sake of your health.

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O-Tip of the Week: Let it Go

Our O-Tip of the week series delivers valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

For the month of September, a month of back to school and back to reality, our O-Tip series will provide you with OT-approved ways to put the focus back on you.  This week’s O-Tip can help you learn to put the past behind you in order to have a bright future.

Remember this:  “You can’t start the next chapter of your life if you keep re-reading the last one.” (author unknown.)  Check out these 40 Ways to Let go of the Past and Leave it Behind You care of Self Development Secrets.