1407 Yonge Street, Suite 406,

Toronto, Ontario M4T 1Y7

 

416-835-9994 | ambercohen@thecohenclinic.com

 

© 2016 by Dezine Optional

Services Offered

Adult Individual Therapy

Adolescent Therapy

Couples Counseling

What is Cognitive Behavioural Therapy (CBT)?

 

CBT posits that our cognitions (thoughts), behaviours and emotions are all linked together.  Unfortunately, we don’t have direct control over our emotions. If anyone has ever given you the advice “Just don’t worry about it!” then you know that trying to just change an emotion is a difficult feat.  Fortunately, we do have control over our thoughts and behaviours.  By utilizing CBT coping strategies, we can shift and change our thoughts and behaviours in order to impact how we feel. 

 

Behavioural management techniques run a very wide range. We are often engaging in behaviours that are not improving our mental health, so CBT looks to identify ineffective patterns of behaviour and replace them with behaviours that are clinically proven to help us feel better.  Some examples of behavioural changes are: 

 

  • practicing meditation 

  • boundary setting

  • gaining improved work-life balance 

  • engaging in physical movement 

  • engaging in hobbies 

  • increasing our social connectivity 

  • spending more time in nature 

  • logging thoughts 

  • decreasing avoidance behaviours 

 

Decreasing avoidance behaviours can be a significant piece of work for many people.  When we feel worried, distressed or anxious about something, we quickly learn that if we avoid the trigger, we don’t have to feel those ways. For example, if I avoid public speaking then I don’t have to worry about it.  Avoidance is a perfect short-term solution to emotion management. However, as a long-term solution, it’s the pits.  When we avoid, we don’t get to have experiences that may be in-line with our goals and values. Additionally, avoidance maintains difficult emotions. Usually, whatever we are avoiding is not as bad in reality as it is in our thoughts.  So, if we engage in something we want to avoid, we will likely gain the evidence that it wasn’t so bad and next time we try it out it will be easier.  

 

Managing thoughts is also possible and helpful to our mental health.  CBT states that the way we perceive a situation is more closely connected to our reaction than the reality of the situation itself.  Therefore, we shouldn’t always listen to our thoughts! There are two main themes of thought management techniques: distraction and thought replacement: 

 

  • Distracting away from our ineffective thought patterns is beneficial to our mental health.  The less time we spend ruminating in thoughts that make us feel anxious, sad or self-critical, the better.  

  • Thought replacement involves identifying ineffective patterns in thinking and replacing them with effective patterns to help us feel better. For example, if a common thought is “I’m so stupid, why do I always do things like that?!” you can learn to replace this thought with “I am doing my best and I am enough.”  This type of cognitive work involves thinking through the evidence that does and doesn’t support your original ineffective thought and using that information to come up with a replacement thought that resonates for you. 

 

What is Eye Movement Desensitization and Reprocessing Therapy (EMDR)?

EMDR was originally developed for PTSD.  It can be used to help people manage difficulties associated with any trauma, even when a client does not meet criteria for a PTSD diagnosis.  Additionally, research shows it is beneficial for anxiety, chronic pain, phobias, grief, anger management, obsessive compulsive disorder and bipolar disorder.  

 

Usually, when something difficult happens, it happens first to the body, then the emotions kick in and you start to reprocess the event – you think on it, talk about it, sleep on it, dream about it, let time pass, etc.  At the end of that difficult event you remember what happened, but it no longer bothers you with the same intensity.  We have a feeling that it happened in the past.  When we have had a difficult or traumatic experience, often our bodies and minds naturally heal themselves; however, sometimes our brain’s information-processing system gets stuck which negatively impacts our mental and physical healing.   

 

EMDR is based on the Adaptive Information Processing Model (AIP.)  The AIP model posits that the human brain can usually process stressful information to heal the self.  During stressful situations, this processing can be impaired and the memory may go unprocessed and stored in a maladaptive form.  The situation gets stored in its original distressing form and is blocked from connecting to other memories that provide adaptive information that allows us to heal.  Dysfunctionally stored memories are the foundation for future ineffective responses, because perceptions of current situations are automatically linked with memory networks of these unprocessed memories.   EMDR activates the AIP and reprocesses the memory by integrating adaptive memory networks which leads to a decrease in symptoms and enables one to learn and move on from the initial experience. 

 

In EMDR treatment, the client and therapist work together to identify what difficult experience would be beneficial to reprocess.  Memories chosen to reprocess are ones that still illicit high distress for you in the here-and-now when you look back at the situation.  The therapy involves thinking about that experience while the brain is also being stimulated by: tracking a therapist’s hand with one’s eyes, listening to alternating beeps on headphones, feeling vibrations in alternate hands, or alternative tapping on the client’s knees by the therapist – this is called bilateral stimulation.  This dual awareness is akin to the brain processes activated during the dream stage of REM sleep, but in a conscious state. Part of dreaming is processing our experiences.  You will have one foot in the past with the image of your memory, and one foot in the present with the stimulation.  

 

In successful EMDR therapy, new associations and perspectives arise and the meaning of painful events changes.  For example, one may move from self-blame and feelings of powerlessness to self-compassionate understanding and feelings of strength.  These new insights are gained from the client’s own cognitive and emotional processing versus clinical interpretation related to traditional talk therapy. 

 

On a biological level, EMDR has been shown to: 

  • Restore emotional regulation due to increased activity of the prefrontal lobe.

  • Inhibit the over-stimulation of our limbic system by regulating the association. 

  • Reduce temporal lobe activity which reduces the intrusive and over-consolidated trauma memories.  

  • Reduce occipitally mediated flashbacks.

  • Restore balance between the limbic and prefrontal areas.

  • Relaxes the nervous system. 

 

Sounds like the back-story for a sci-fi movie; however, it’s evidence-based treatment that has the data to prove it works! 

 

What is Mindfulness?

Understanding Our Body’s Fire Alarm System: 

First, it is important to understand our body’s stress response in order to understand the benefits of mindfulness.  When we are feeling emotional stress or anxiety, our body often responds.  Stress triggers our body’s Fight-Flight-Freeze response and releases stress hormones into our bloodstream.  These stress hormones trigger both physical and psychological responses and is a perfect example of the mind-body connection.  Some physiological reactions we have are: muscle tension, rapid heart rate, sweating, difficulty breathing, chest pain, headaches, gastrointestinal discomfort, and dizziness.  In current day, the majority of our stress is psychological and emotional, but our bodies still react in this physiological manner.  These responses are not problematic when our stress response gets triggered infrequently because our bodies have time to recover.  However, for people experiencing chronic stress or anxiety, the body can remain in an arousal state ready to “fight, flee or freeze” and the symptoms can persist.  This is wear and tear on our bodies and minds.  

 

What Mindfulness Is: 

Mindfulness is about training our brains to be in the current moment without evaluation or judgement. If you are trying to calm your thoughts but your body’s fire alarm is going off and telling you to be scared, then you are embarking on an uphill battle.  Think about a time when your fire alarm went off while cooking – it makes you physically tense and unable to think clearly even though you knew a true fire wasn’t blazing.  Mindfulness exercises can calm your body’s physical reactivity while also calming your thoughts.  Additionally, we are often in all the shoulda-woulda-couldas of the past or the what-ifs of the future.  Training our minds to be in the here and now, is an excellent way to move away from those ineffective thought patterns. 

 

How to Practice Mindfulness: 

Mindfulness Meditation Audio:This involves a voice guiding you in focusing on your breath or body, likely with calming music in the background.  The instructor will guide you to bring your awareness to the present moment non-judgmentally.  You can find different audio on YouTube and Spotify by searching “mindful meditation.” Audios vary in length from 3 minutes to over 1 hour.  Pick a length that works for your lifestyle and makes it easy to practice! 

 

Mindful Tasks:I love this strategy because it literally takes no extra time out of your life! Pick a task that you do anyways (i.e. showering, tooth brushing, cooking, laundry, commuting, etc.) Use all five senses to describe the moment without evaluation.  For example, if you practice in the shower, notice the temperature of the water, what body part you are washing, where the water is hitting your body, the smell of the soap, the sound of the fan, etc.  

 

Mindfulness Tips:  

Mindfulness is a workout for your brain.Just like any exercise, you will build this skill with practice.  Your mind will likely wander from the present moment. Just notice your thoughts have strayed from the here-and-now, and gently circle your mind back to the present. Getting frustrated with yourself will not be very relaxing, so accept your mind wandering as a part of your practice. 

 

Not all mindfulness exercises are created equal. Experiment with different audios and tasks and identify the ones you like.  Pick the ones that resonate with you and stick to those.  You don’t have to like them all!

 

Practice when you’re calm.  When you first start to practice, do so during times when your body’s fire alarm isn’t going off and you aren’t emotionally elevated.  Keeping your mind in the present moment is difficult, so until you strengthen the skill, it will be hard to engage with during elevated times.  

 

Set a reminder to practice.  Like anything new, it can be hard to remember. Set reminders for yourself so you remember to engage.  Also, when we are emotionally elevated, we can’t think clearly.  This makes it hard to remember that we can utilize mindful coping strategies.  Ask a loved one to provide a gentle reminder or create an easily accessible list of coping strategies you can reference during these times. 

 

Practicing mindfulness can have a profound effect on our minds and bodies.  It is 2-for-1 by helping us calm our bodies and minds at the same time – who doesn’t love a deal?! So build your mindful muscle and feel stronger and calmer! 

 

Lastly, mindfulness skills are a great adjunct to other types of therapy (i.e. CBT and EMDR.) Your therapist can guide you in how to use mindful awareness to help you manage your ineffective thought patterns and calm your physical and emotional elevations. 

 

What is Emotion Focused Therapy (EFT) for Couples?

In EFT, the relationship itself is the client.  Couples can get into ineffective behavioural patterns of how they relate to one another. EFT posits that there are reasons for why these behaviours exist, and therapy involves uncovering these reasons. 

 

EFT is based in attachment theory.  Our attachment style comes from the relationships we had with our primary caregivers.  As we develop, these attachment patterns play out in our adult relationships.  When we have insecure attachment styles this can lead to relational difficulties.  The therapist works to gain a clinical understanding of each person’s attachment style and uses this as a road map to identify a couple’s difficulties.  When couples are in trouble, it is because when they argue or disagree, their relationship becomes at risk.  The primary goal of EFT is to create a more secure emotional bond between partners, so that difficulties don’t have to threaten the relationship itself.  When we increase this security, we increase relational satisfaction, intimacy and trust.

 

EFT focuses on the present – it delves into what is happening between the couple in the room at present. Focus is on the present process of understanding the emotions and subsequent interactions that occur in real time during the session.  The therapist guides each individual to understand their emotional response in the here-and-now so they can understand their emotional experience in a new way.  This new understanding of one’s emotional experience, guides behavioural and communication changes. 

 
 

What is Hypnotherapy?

Hypnotherapy is an evidence-based mental and physical health treatment that makes use of specific strategies of hypnotic induction (or heightened focus and concentration on one’s senses) to induce a relaxed or calm state during therapy by a trained professional.  It assists a client in overcoming a wide-range of conditions, such as anxiety and stress, grief, depression, pain-related issues and trauma.