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Richard Bloch, Registered Psychotherapist, 101 Dupont Street, Toronto, ON (2026)

05/13/2020

COVID-19 TIPS WEEK 5
MASTERY AND PLEASURE ACTIVITY SCHEDULING

When the reality of the COVID-19 pandemic set in, it brought much confusion, uncertainty, and anxiety along with it. This period lasted several weeks at which point we entered into a new phase of tolerance and acceptance. We developed routines, figured out how to function with social distancing, and began to find our “new normal.” In some cases, many of us may have even enjoyed not having to commute to work, spending more time with children, and wearing pyjamas all day.

It seems as if we may be entering a new phase yet again. Researchers studying confinement and reintegration call it the “dreaded third-quarter” phase otherwise known as “third-quarter phenomenon” (TQP). TQP describes a point at which the emotional toll of being isolated gets more difficult to bear. Being aware and prepared for this new phase is the best way to arm yourself with the tools you need to get through it unscathed.

So how can we get prepared for the inevitable? Let’s break it down. In order to feel good, people need to feel secure, connected, competent, and in control. While many of us are feeling quite the opposite right now, we need to find a way to change that. So how do we do this?

Let’s begin by recognizing that we do have some control in managing our reactions to obstacles in our path. A good place to start is by creating a schedule of activities that you could follow religiously. There are two types of activities that should always be considered when putting together a schedule, mastery (accomplishment) and pleasure activities.

Mastery Activities
Tasks or activities that provide a sense of accomplishment when completed.

Examples:
- Sticking to bed time and waking time
- Following a daily exercise routine
- Cleaning/chores
- Managing meal planning and diet
- Personal hygiene/grooming

• Keep it simple: You may think that setting such basic tasks as goals seems silly, but in times of uncertainty, when we feel anxious or depressed, these basic tasks may become very difficult to accomplish.

• Start small: Specific goals for small tasks will provide you with a sense of accomplishment and the confidence to create larger goals.

• Goal setting: Set SMART goals that will guide you to completion

- Specific: What do I want to accomplish? Where will it take place? Who is involved? Why is it necessary?

- Measurable: How will I know when the goals are accomplished? How many do I need to attain? How much do I have to do?

- Achievable: How do I go about achieving this goal? What are the obstacles and how can I overcome them?

- Realistic: Is it worthwhile? Am I capable of achieving it? Is the timing appropriate? Do I have the right knowledge, skills or equipment?

- Time-bound: When should this goal be accomplished (date)? How often should progress be evaluated?

- Checklists: Make them, use them for everything related to your goals. The more complex the goals, the more checklists you should have.

Pleasure Activities

Examples:
- Talking to a friend
- Listening to music
- Hobbies (playing video games, collecting, art, decorating, etc.)
- Exercise
- Getting fresh air
- Social interaction/affection
- Caring for others
- Relaxation/meditation

Keep in mind, there can be some overlap in activities. For example, while one person may get pleasure out of physical activity, other’s may not, yet they can still feel a sense of accomplishment after engaging in the activity. If you are incorporating a good balance of mastery and pleasure each day, you will be in a better position to get through this “dreaded third-quarter” phase.

Here is a link to a sample activity schedule template you can use to begin the exercise. https://www.cci.health.wa.gov.au/~/media/CCI/Mental%20Health%20Professionals/Depression/Depression%20Worksheets/Depression%20Worksheet%20-%2003%20-%20Weekly%20Activity%20Schedule.pdf

This can be a complex task for some, especially if you are currently experiencing an episode of depression. If this describes you, I urge you to reach out for support. I can be reached at richard.bloch@mail.mcgill.ca for more information or support.

05/04/2020

COVID-19 TIPS WEEK 4 - PERSONAL COPING STRATEGIES

What’s the first thing you do when you begin to feel anxious or depressed? I often ask my clients this and the most common responses were: drink alcohol, smoke ci******es and/or ma*****na, shop, overeat /under-eat, and procrastinate. Many of these behaviours, while effective in the short- term for reducing anxiety and/or depression, have negative consequences attached to them.

During this time of uncertainty where the average person is at risk for developing mental health issues, I thought I would offer some helpful coping strategies that can be done on your own, used anywhere, used immediately, with relatively no consequences, and they’re free!

1) Practice relaxation: In times of increased stress, such as a pandemic, our bodies carry muscle tension. Muscle tension is commonly associated with stress, anxiety, and fear as part of a process that helps our bodies prepare for potentially dangerous situations. Even though these situations may not actually be dangerous, our bodies respond as though they are. Sometimes we don’t even notice our muscles becoming tense. Consider, for instance a time when you felt your jaw tense and later realized you are clenching your teeth, or maybe your neck and shoulders feel achy because without realizing it, you are holding your shoulders in a shrugging position for extended periods of time. Muscle tension is often associated with neck pain, backaches, and tension headaches. Progressive Muscle Relaxation (PMR) is an exercise that was designed to relax our bodies, thereby giving us one less thing to worry about. Anxiety Canada has a useful “How To” guide (https:// www.anxietycanada.com/si…/default/files/MuscleRelaxation.pdf)

2) Practice mindfulness: Mindfulness is a type of meditation in which you focus on being intensely aware of what you are sensing and feeling in the present moment, without interpretation or judgement. Practicing mindfulness involves breathing techniques, guided imagery, and other practices to relax the body and mind to help reduce stress. There are several resources to learn how to do this effectively including the book, “The Mindful Way Through Depression” by Mark Williams et al., and “The Mindful Way Through Anxiety” by Susan M. Orsillo and Lizabeth Roemer. If you are interested in learning more about mindfulness, or attending a reputable mindfulness workshop please contact me for details.

3) Stay physically active: You may not be able to get to the gym right now, but that doesn’t mean you can’t exercise. You just need to get more creative. Regular exercise is effective at reducing the stress response and symptoms of anxiety and depression. It may even work as well as antidepressant medication. Set aside at least 30 minutes a day for some form of physical activity that gets your heart going (of course, modifications would be necessary for certain medical conditions. Please contact your physician if you have questions or concerns about this before proceeding). A great resource for ideas can be found at: https://www.participaction.com/en-ca.

Ask yourself:

1) What are my go-to coping strategies when I am feeling anxious or depressed?

2) How can I incorporate some relaxation strategies, mindfulness practice, and/or more physical activity in my daily routine?

04/28/2020

COVID-19 TIPS WEEK 3 - NAVIGATING NEWS & SOCIAL MEDIA

Have you found yourself glued to the news or social media more than usual? Most people I speak with tell me they are anxious about things they hear yet they consistently turn it on and it keeps increasing their anxiety. Turn it off? Easier said, than done.

Below I laid out some things to be aware of when engaging with the news or social media, but first, let’s explore how news and social media can be beneficial.

The news is essential to obtain useful and credible information during a pandemic. It simply can’t be ignored. Here are some ideas of how watching the news can be beneficial. It is helpful when the news accurately conveys recommendations by public health authorities. It can also provide information on what services may be impacted, or when it reports on positive events (e.g., recovery rates, communities coming together, etc.). It is most helpful when you LIMIT YOUR EXPOSURE TO 30 MINUTES PER DAY.
Let’s talk about social media. Can you easily say that you have not logged in to Facebook today? If you said yes, you are mistaken. You are accessing this article through Facebook right now! It is so easy to get drawn into the world of social media, especially when physical distancing keeps us from socializing the way we are accustomed to. So why does it draw us in so much?

We seek out things that are amusing, shocking, educational, or interesting. Support on social media is easy to find through our connections, groups, and forums of shared interests. It is exciting to connect with people we may not have seen in a while or share news with people we care about, after all it is a convenient and efficient medium to reach a large group of people within minutes. Lastly, it is an efficient source of information.

Beware of factors that might increase anxiety or depression when exposing yourself to the news and/or social media in general, but particularly as it relates to the pandemic.

· CREDIBILTIY OF “EXPERTS”: Do your own research to determine the credibility of statements made by “experts.” How many “experts” in one profession have you heard contradict each other? Be skeptical and do your own digging to find out how credible these sources are.

· CREDIBILITY OF INFORMATION: Remember that media is not impartial. There are biases that need to be considered. We have all heard the term “fake news.” Verify your facts from credible sources, especially when something makes you anxious.

· OBSESSION: If you find yourself getting obsessive about the information you are provided, you have the option of turning it off. Give yourself a time limit.

· MEDIA GRENADES: Watch out for the sad or disturbing pieces of information we see while searching for things that uplift us.

· THE GRASS IS ALWAYS GREENER: Be wary of comparing yourself to someone else’s social media content.

· TROLLS: People are quick to impose judgment online to express their opinion, other times simply to get a reaction out of you.

· MISINTERPRETATION: People may not perceive messages the way you intend it and vice-versa thus, their replies might be distorted.

· BROKEN TELEPHONE: Commentaries via the news or social media can be full of perceptual biases. Opinions by news media and/or posts on social media may be based on emotions rather than evidence.

· POWER IN NUMBERS: Just because we hear something repeatedly on social media, does not make it true.

WHAT THE RESEARCH SAYS

There is some research that supports the idea that limiting use of social media does have a positive effect on mental health. One study, conducted by Melissa Hunt at the University of Pennsylvania suggests “direct and positive impact on subjective well-being over time, especially with respect to decreasing loneliness and depression” and “…limiting social media use to approximately 30 minutes per day may lead to significant improvement in well-being.” It might be advisable to do the same as it relates to exposure to the news.

ASK YOURSELF

How much time do you spend daily consuming news, and/or on social media related to issues about COVID-19?

On a scale of 0-10 (10 being the most), how anxious would you say you have been over the last six weeks about everything you have seen and heard on the news and/or social media?

CHALLENGE YOURSELF

Limit your news and/or your social media consumption to a maximum of 30 minutes per day for three weeks, then rate your level of anxiety again. Notice any change?

04/20/2020

COVID-19 TIPS WEEK 2 - ESTABLISHING ROUTINE

During the first week of physical distancing, my usual routine began to unravel piece-by-piece. I had to figure out how to provide therapy at home with a three-year old running around pining for my attention. I was no longer going into my office to see clients so I began sleeping in as if I were on vacation, dressing like it was the weekend, snacking whenever I wanted instead of having meals at scheduled times, etc. That was fun while it lasted, however, in the second week, I noticed that I hadn’t been exercising, and I hadn’t spoken to my friends in a while. I noticed this because I was beginning to feel more anxiety, like my world was crumbling around me and I had no control. Luckily, I recognized these symptoms and pulled myself out of the rut I was sliding into. I did this, wherever possible, by recreating the routine I had before the pandemic started. I forced myself to wake up at 7:00am every day and start my morning routine (including getting dressed as though I was working at the clinic). I scheduled my meal times as I did before. I resumed my exercises (although I had to change the way I do them given that I no longer have access to a gym), and I connected with friends to see how they were coping. Before I knew it, I was feeling less anxious and more like my old self again.

As difficult as adapting to change can be, implementing and maintaining a routine can be reassuring, and in some cases, essential for promoting a normal existence. Waking up in our pyjamas and going about our day is fun (for a day or two), but when we start deviating from structured routine like showering, getting dressed, making the bed, etc., for weeks on end, we open the door to a host of mental health complications such as depression, anxiety, insomnia, etc. For people with a significant history of mood and anxiety, this is even more relevant. Establishing routine can provide us with a sense of control and security in the most uncertain of times.

Here are some things to consider for establishing routine through periods of uncertainty. Try having your routine from your pre-pandemic days resemble the routine your implementing today. Consider these factors:

Sleep hygiene: Wake up and go to sleep at the same time every day (as closely as you can to your pre-pandemic schedule). Avoid screen time in the evening before bedtime, and especially while you’re in bed. I will provide some ideas to help improve sleep in a future post.

Personal Hygiene & Grooming: Maintain your personal hygiene including the number of showers you take in the week, the frequency you brush your teeth, comb your hair, shave, or put on makeup.

Meals: Continue eating similar meals as you had prior to the physical distancing and try to maintain a three-meal per day minimum. Although healthier options for meals are optimal for mental health, they may not be as readily available as they were before, so some flexibility may be necessary. Try omitting or limiting junk food, overeating, or under-eating as much as possible. Sticking to healthy balanced meals is important for mental health.

Social engagement: Incorporate time with family (whether that consists of your core family in your household or extended family outside your household) through phone calls or video chats. Commit with some friends to check in on each other regularly. Schedule game nights, guy’s nights, girl’s nights, or play dates online.

Work/school schedule: This is a complicated one, no doubt. The goal here is to be flexible, patient, and forgiving. You are balancing the world on your shoulders right now trying to manage work, school, and family obligations with little or no support. Every person’s situation is unique with respect to job expectations and family responsibilities. It might take you more time to figure out the details, but you can find a routine that works for you. Speak to your employer about reasonable accommodation* during this time if you have young children or other challenges keeping you from maintaining your regular schedules, consider alternating shifts with your spouse so that parenting or other responsibilities can be ensured. *Refer to the Human Rights Commission to find out more about Reasonable Accommodation.

Self care: That old cliché, “make time for yourself,” is especially relevant today. Find the time to maintain your regular exercise routine (if you don’t have one, create one). Continue hobbies that you would otherwise engage in or start one that you have wanted to but never had the time for. Get some fresh air while ensuring you are maintaining a healthy distance from others.

Chores: Obligations such as cleaning your home, grocery shopping, etc., may need to be adapted to fit current realities such as: changes in store hours, closures or cancellation of services. For example, last night, my wife, with no prior dog grooming experience, groomed our mini-schnauzer because the bi-monthly grooming appointment was cancelled. He looks weird, but we need to make time to continue fulfilling our obligations while realizing that our methods of fulfilling them may be different.

Be patient and be realistic. Change is hard. You cannot expect to master a new routine overnight, particularly when life is so ambiguous and uncertain. Seek support and advice where you can from family, friends, or a professional. Learn from your mistakes, and be mindful of how you can do things differently tomorrow.

ASK YOURSELF:

How has my routine changed since the pandemic began?

How has my emotional state been affected by changes in my routine?

What can I do today to implement a healthy routine or maintain one that was in place pre-pandemic?

04/15/2020

TIPS FOR COPING WITH COVID-19 - WEEK 1

Before COVID-19, many of us had some level of stability, routine, and predictability in our lives. Now there is so much uncertainty and upheaval which can contribute to a great deal of anxiety and stress for the average person, not to mention those who have current or pre-existing mental health conditions.

Over the last few weeks, I have been impacted by the effects of COVID-19 in my personal and professional life. I have had to readjust the way I practice so that my clients could get the continued care they need by reducing in-person sessions and creating a format for online therapy while learning how to navigate work-at-home challenges with my family to ensure the privacy of my clients.

After several weeks of speaking to clients and observing threads on social media about the mental health implications of COVID-19, it is clear there is a desperate need for support and resources to help people cope. I have decided to offer some free tools and resources in a format that might be a little more practical than what is already out there. There is a wealth of information online pertaining to mental health support and that in and of itself can be overwhelming for many to digest.

I am committed to helping people on social media by breaking down some of this information in to more manageable pieces. Every Monday, I will post a different topic related to managing and maintaining your mental health during these trying times. Each week, you can take some time to reflect on a topic and determine if there are things you can do differently to improve your ability to cope. I am offering support related to these topics in the event you have any questions, need clarification, or require additional resources. Please feel free to reach out.

Your first topic of the week is:

WEEK 1, WEDNESDAY, APRIL 15, 2020

Distinguishing between a current problem and an anticipated problem.

A current problem can be resolved and is within your control, whereas an anticipated problem hasn’t happened yet so you have little or no control over the outcome.

Examples of a current problem where a solution is within your control might be:

• “How do I manage my bills while I’m out of work?”
• “How can I distract my kids while I work from home?”

Examples of an anticipated problem for which you may have no control over might be:

• “What if my loved one gets ill?”
• “What if resources become scarce?”

Staying focused on current problems and disengaging from anticipated problems will enable you to regain some sense of control over your life and empower you to move forward versus stagnating.

Ask yourself:

What are the problems I have been focusing on?

Which of these problems are within my control?

Which of these problems are outside of my control?

04/15/2020

WHAT IS COGNITIVE BEHAVIOUR THERAPY?
Cognitive-behaviour therapy is based on the concept that changing negative thinking patterns and self-defeating behaviours can have a powerful effect on a person’s emotions. CBT is a structured therapy that serves to examine all elements that maintain a problem. Such elements include one’s thoughts, feelings, and behaviours. It requires a collaborative partnership between the client and the therapist.

IT WORKS
Clinical research has demonstrated time and time again that it is the most effective psychotherapy for symptoms of anxiety and depression.

In a review of 332 studies with 10,000 individuals, those individuals receiving CBT had a superior outcome to those not receiving CBT*.

IT WORKS QUICKLY
There is convincing evidence that much of the benefits people achieve in CBT occurs early in treatment for common life problems, such as anxiety and depression.

In one research study, 90% of the symptoms of depression decreased in the first six weeks of treatment*. Although there is no exact formula, a general rule of thumb is that significant benefits should be achieved after approximately ten sessions of CBT.

AND IT LASTS
The benefits of CBT can last for several years.

Reviews of 141 research studies have shown that clients can maintain the gains they have achieved from CBT for at least 6-24 months*. In a long-term study with generalized anxiety disorder, the improvements in symptoms were maintained for up to 10 years after therapy*. A review of 48 studies for approximately 3000 people diagnosed with major depression demonstrated that the relapse rate for those treated with CBT was only 30% compared to 60% for those who received medication alone*.

Take the first step toward feeling better. Book an appointment and find out how CBT can help you.

04/15/2020

IMPORTANT MESSAGES:

- Please be advised that any comments made on posts in this forum are NOT CONFIDENTIAL and will not be replied to publicly. Please contact me directly if you wish to receive a response.

- In an effort to promote physical distancing during the COVID-19 pandemic, sessions are being offered online. Please contact me for more information (416) 876-3059.

Richard Bloch, Registered Psychotherapist

05/13/2020

05/04/2020

04/28/2020

04/20/2020

04/15/2020

04/15/2020

04/15/2020

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