Cumulative Grief

It is no surprise that suffering multiple losses in a short period of time is painful and difficult. I began noticing during the height of the pandemic (and since) that grief had become more complex and difficult to process. This article from Georgetown Psychology is an excellent explanation of why. (Click the link below)

The Distress of Cumulative Grief

Anti-depressants, psychotherapy, or both? Research into effective treatments for depression

The Psychotherapy Practice Research Network recently summarized the findings of recent research on anti-depressants versus psychotherapy versus a combination. This is what they had to say:

Furukawa, T.A., Shinohara, K., Sahker, E., Karyotaki, E., Miguel, C., ….Cuijpers, P. (2021). Initial treatment choices to achieve sustained response in major depression: A systematic review and network meta-analysis. World Psychiatry, 20, 387-396.

Two common treatments for major depression are antidepressant medications and psychotherapy, both of which have been tested in randomized controlled trials. Antidepressants are among the most prescribed medications, and an increasing number of patients are on longer-term use of these medications. However, it is unclear as to whether choosing antidepressant medication or psychotherapy at the beginning or the acute phase of depression will lead to a sustained response in the longer term. In this network meta-analysis, Furukawa and colleagues examine the important question: “which therapies can get me well and keep me well?” The authors selected randomized controlled studies in which antidepressants or psychotherapy, or their combination were prescribed and compared to each other or to a control condition (treatment as usual or placebo pill). In these studies, adult participants with major depression remained in the treatment or control condition up to 12 months post-treatment. Psychotherapies included many known treatments like CBT, behavioral activation, psychodynamic therapy, and interpersonal psychotherapy. This network meta-analysis included 81 trials representing over 13,000 patient participants. Combined psychotherapy plus antidepressant medication resulted in a more sustained response to treatment (better outcomes) in the long run than control comparisons (OR: 2.52, 95% CI: 1.66, 3.85). Psychotherapy alone was more effective in the long run than pharmacotherapy alone (OR: 1.53, 95% CI: 1:00 – 2.35). The advantage of combined treatment over antidepressants alone was about 14% to 16%, whereas the advantage of psychotherapy over antidepressants was about 12%. There were no differences in longer term effectiveness among the different types of psychotherapy.

Practice Implications

This study shows that the effects of psychotherapy when initiated in the acute phase of major depression (at the outset of symptoms) are enduring over a longer time frame. Psychotherapies outperformed antidepressant medications, standard treatment, and pill placebo. The results also suggested that adding pharmacotherapy to psychotherapy did not interfere with the enduring effects of psychotherapy. The authors suggest that treatment guidelines for depression should be updated to emphasize psychotherapy as the preferred initial treatment option.

You can find the blog itself here: PPRNet Blog



Help for Women who are being Abused

If you know someone (or are someone) who is in an abusive relationship, knowing your legal rights is important. This handbook may be a good place to start: “Do you know a woman who is being abused? A legal rights handbook” from CLEO (Community and Legal Action Ontario.

You should also consider calling your local Community Resource Centre to seek their assistance and advice.

Many people are also unaware of services like “Shelter Movers” who will move furniture and belongings of women and children who are escaping domestic violence, and of organizations like “Safe Pet Ottawa” who will foster your pets if you need them to be safe as well.

Trauma →

Trauma

Trauma can take many forms. According to the Centre for Addictions and Mental Health:

A traumatic event can be:

  • a recent, single traumatic event (e.g., car crash, violent assault)

  • a single traumatic event that occurred in the past (e.g., a sexual assault, the death of a spouse or child, an accident, living through a natural disaster or a war)

  • a long-term, chronic pattern (e.g., ongoing childhood neglect, sexual or physical abuse).

A person who has experienced a traumatic event might develop either simple or complex PTSD:

  • Experiencing a single traumatic event is most likely to lead to simple PTSD.

  • Complex PTSD tends to result from long-term, chronic trauma and can affect a person's ability to form healthy, trusting relationships. Complex trauma in children is often referred to as "developmental trauma." provides some useful definitions.

Source: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/trauma

Trauma affects both mind and body. I recommend several key books on this topic:

  • The Body Keeps the Score by Bessel van der Kolk

  • When the Body says No by Gabor Maté

Childhood Trauma

Childhood trauma (also referred to as Developmental Trauma or Complex Trauma) can take the form of physical, sexual, or emotional abuse. Vincent Felitti and colleagues conducted the Adverse Childhood Experience Study in 1998. They defined several categories of adverse childhood experiences:

  • Psychological / emotional

  • Physical 

  • Sexual 

  • Household dysfunction 

  • Substance abuse

  • Mental illness

  • Mother treated violently

  • Criminal behaviour in household 

(Felitti, V. J., Anda R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). The relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245- 258.)

 If you would like more information on the ACE study, a good place to start is https://www.cdc.gov/violenceprevention/aces/index.html

Physical Impacts of Complex trauma in Adulthood:

The ACE Research showed that childhood and developmental trauma are not only devastating at the time of trauma, there are significant and serious impacts on the health of individuals later in in life.

Examples:

  • Coronary artery disease 

  • Liver disease 

  • Chronic obstructive pulmonary disease 

  • Autoimmune disease 

  • Chronic pain 

Common comorbidities:

  • Depression 

  • Anxiety

  • Psychosis

  • Substance use/abuse

  • Eating disorders

  • Personality disorders (e.g. BPO)

  • Dissociative symptoms / disorders & Somatoform disorders 

  • Suicidality and risk-taking behaviour 

(For information on the long-term impacts, refer to Dr. Matthew Kerr’s 2013 presentation An unwanted legacy: Long term effects of chronic childhood trauma presented at Conversations at the Royal. It can be retrieved from: https://www.slideshare.net/theroyalott/an-unwanted-legacy-longterm-effects-of-chronic-childhood-trauma.)

Other resources you may wish to consult are: