Wednesday, December 8, 2010

Psychological Flexibility and Pain Management

In a previous blog post, I briefly wrote about the benefits of psychological flexibility. Psychological Flexibility refers to one's ability to adapt thinking, emotions and behaviour to various situations. A helpful way to think about psychological flexibility is to use the example of 'control.' There are things in life we have control over and things that we do not. For example, while driving a car we have control over the vehicle's movement. However, we do not have control over other vehicles on the road. Therefore, whenever we decide to go for a drive, we have some control over our safety -- but not complete control, as other drivers could cause an accident for us.

Monday, September 20, 2010

Tis' the Season to Get SAD: A Review of Seasonal Affective Disorder and the Winter Blues

With the Fall and Winter seasons on the horizon, many of us will start to notice changes in our mood in the coming months. Seasonality is the term used to describe the mild to moderate decrease in positive mood that a significant number of people in the population experience when daylight hours are reduced. For a select portion of population, this decrease in mood will be significant enough to meet criteria for Seasonal Affective Disorder (SAD) – a form of clinical depression that only occurs with changes in seasons (it almost always occurs during the Fall and Winter period). To help interested readers better understand seasonality and SAD, including the causes and treatment of SAD, I offer the following brief review.

Friday, September 10, 2010

The Cost of Mental Health Care in the Workplace: Some Considerations for Businesses

A recent study out of the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada, found that mental illness costs $51 billion per year in terms of costs from lost productivity. When an employee of a company develops a mental health problem and is forced to take a leave of absence, it costs the company $18,000 (on average) -- more than any other chronic condition. Hopefully the findings from this study grab the attention of businesses and corporations to take the mental health of their employees seriously.

If I could offer a few tips for managers and executives of businesses in terms of managing the mental health of employees, it would be this:

Friday, August 20, 2010

The Science of Stress and Performance: Tiger Woods as a Hypothetical Case Example

One of the most popular stories over the past year has been the struggles of Tiger Woods, not only in terms of his complicated personal life, but also with regard to his professional downfall. Since his return to the PGA following his marriage problems, Tiger's golf game has not been close to the level his fans have been accustomed to seeing on a weekly basis. Most sports commentators and analysts have played the role of armchair psychologist by asserting that the cause of Tiger's poor performance is stress. This is a commonly used explanation for declines in professional performance, whether it be athletics or any other job. And rightfully so -- stress is well known to be a psychological experience that can negatively affect most elements of people's lives.

Thursday, August 5, 2010

Random Psychology Fact -- August 16th, 2010

The average number of "personalities" in a person with Dissociative Identity Disorder (formerly known as Multiple Personality Disorder) is 15.

Source: Ross, C.A. (1997). Dissociative Identity Disorder. New York: Wiley.

Wednesday, August 4, 2010

Random Psychology Fact -- August 9th, 2010

The human brain can detect and process information presented at ultra fast speeds. For example, if you flash the word "Intelligent" on a computer screen for 17 milliseconds, your eyes won't see it, but your brain knows that it appeared. Research on subliminal brain processes has been growing in recent years.

Source: Dijksterhuis, Ap (2004). I like myself but I don’t know why: Enhancing implicit self-esteem by subliminal evaluative conditioning. Journal of Personality and Social Psychology, 86, 345-355.

Tuesday, August 3, 2010

Random Psychology Fact -- August 3, 2010

Women attempt suicide 3-4 times more frequently than men.

Men die from suicide at a rate that is 4 times higher than that of women.

Source: Canadian Mental Health Association

Successfully Treating Obesity in Children: Results from an 8-year follow-up study

A recent article in the journal Behaviour, Research and Therapy* (a well-respected psychology journal) caught my eye, and thought it was worth the time to describe the findings here.

Following a initial screening process, 90 children took part in a weight control program. The average age of the children was 10 years, and all were overweight (28%) or obese (72%) at the start of treatment. This was a multidisciplinary treatment program involving a pediatrician, dietician and psychologist. The overall program consisted of three parts:

(1) teaching healthy eating habits

(2) achieving a moderate amount exercise

(3) learning cognitive-behavioural techniques (the psychology piece)

The program lasted 1 year in total -- there was an acute treatment phase that consisted of 6 biweekly sessions (group and individual) over twelve weeks, followed by a follow-up phase where the health professionals met with parents and children to encourage lifestyle changes and to maintain motivation.

As mentioned, the goal of the program was weight control and not weight loss. Health professionals are coming to appreciate the benefits of weight stabilization alone, as relatively small changes in weight can yield major health benefits.

The researchers then contacted the same children approximately 8 years after the start of the treatment program. They found that the program was successful immediately following the end of treatment (i.e., the post-treatment results). However, even more impressive were the follow up results -- the children (who were now adolescents) had reduced their BMI by an average of 8%. This is a significant accomplishment as maintaining weight loss over a period of years can be quite difficult.

Furthermore, the researchers identified some notable variables that predicted successful outcome: (1) the children's self-esteem -- those children who had higher levels of self-worth were more successful at keeping the weight off, and (2) their mother's mental health -- when mothers had higher levels of psychological distress, their children tended to not have as much success with weight loss.

It is important to remember that these are only correlations, so we cannot say that poor self-esteem directly caused some children to struggle in the program. However, it is easy to conceptualize how weight loss and self-esteem work together. Also, this 8-year study was not a randomized control trial, so it too is correlational in nature.

Overall, the findings are encouraging because it indicates that childhood obesity can be successfully treated. Indeed, at the start of treatment, 72% of the children were classified as obese -- whereas that number had dropped to 47% by the end of treatment. In fact, 66% of the children had maintained weight stabilization (i.e., they did not gain weight over the 8 year period) -- very important from a weight prevention standpoint.

Imagine if a new diet drug were found to prevent weight gain in the majority of children over an 8 year period -- you would read the following headlines:

"New Medication May Lead to Millions is Health Care Savings"

"Wonder Drug the Key to Saving Our Children's Health"

Unfortunately, you won't see such headlines for this or other such studies. Improving diet, exercise and psychological health isn't a corporate money-maker -- but it is arguably the best approach to dealing with the growing obesity epidemic.

Monday, July 19, 2010

Self-Control and Problems with Eating

One of the benefits of basic psychological research is that it can help us develop solutions to everyday problems. Unfortunately, such basic research can sometimes have difficulty moving beyond the confines of academic journals and books, and into the hands of the general population who might benefit from practical applications of this knowledge. Furthermore, basic research does not always reach health care practitioners as well, whose practice might benefit as a result.

With this in mind, I thought it might be helpful to discuss basic research on a particular topic (self-control), and discuss how this knowledge might be used to assist people in a practical way (in this case, overeating).

Self-control can be defined as the ability of a person to regulate various impulses, urges, emotions, behaviours, and thoughts. Self-control is important because it allows people to avoid doing harmful things, such as overeating, alcohol and drug abuse, and destructive, impulsive behaviour.

After years of research, psychologists have learned that self-control works like a muscle. Self-control is a function of the brain, and the brain requires energy to work effectively. Whenever we engage in an activity that requires the brain to use energy, it becomes fatigued. For example, if you get someone to resist the temptation to eat chocolate chip cookies, it becomes more difficult for them to then resist something else later on (ex: cake).

There seems to be a limited amount of energy for the brain to use, and if you engage in tasks that use this energy, it can make self-control more difficult. So, if you are mentally or even physically fatigued, it makes self-control more difficult. This finding has been tested in numerous experimental studies. In fact, psychologists have noticed that when glucose levels (which is where the brain gets most of its energy) decrease, people have a more difficult time with self-control. And if you give them more glucose (ex: a sugary drink), their self-control improves again.

From the results of these studies, people can use this information to exert more control over their environment, which can help with problems like overeating. Eating is a classic activity that requires self-control. People with problems resisting the temptation to eat can use the information presented here to help control their eating.

Knowing the circumstances under which you are most likely to make poor food choices is not always obvious. Based on what we know from self-control research, it should be a bit easier to know when you will be most vulnerable to poor food decision-making. As such, here are some ideas about how to use this information:

(1) Knowing when you are most tired, both physically and mentally, throughout the day can help you avoid overeating. If you are someone who has energy lows in the early afternoon and after work (like many people), it will be helpful to not have sweets and other unhealthy snacks around during those times.

(2) Stress is something that can deplete the brain's energy levels, and so managing stress can be an important part of healthy dieting.

(3) To assist with glucose levels and self-control, it might be helpful to have a fruit drink or some other source of energy available when you are vulnerable to problems with self-control. I recommend talking to a dietician about various healthy options.

(4) Self-control research has also found that self-control can be improved. Similar to building muscle by exercising, self-control can be strengthened by regularly practicing self-control. This is important for those people who believe that resisting temptation is a constant uphill battle. The more you practice self-control, the more you improve, and the easier it gets.

Knowing how to set up your environments (ex: home and at work) is a big factor in controlling unhealthy eating (I highly recommend the book Mindless Eating to get a better sense of what I mean). Knowing yourself as a person, including when you are most vulnerable to poor decisions, is very important for managing poor habits. In this case, knowing more about how self-control works, gives you another tool in the fight against overeating.

Dr. Roger Covin
Montreal Psychologist

Wednesday, June 23, 2010

Psychology's Absence from Mainstream Media

Scientific journalism can be both informative and interesting -- qualities that are likely prioritized by editors and producers of media. However, scientific journalism occasionally falls short in terms of the writers' ability to present information in an accurate and balanced manner. For example, stories will sometimes avoid discussion of a study's limitations, or present correlational research findings as causal -- to name a few.

As a psychologist, one of the main problems I have with scientific journalism is the media's tendency to under-report on findings from psychological outcome studies. Indeed, whenever I read a newspaper or watch a news report on TV, I am more likely to be exposed to research on antidepressants or alternative medicine, in terms of their relationship to mental health.

Why is this important? Well, if you are someone wanting to know about current treatment options for depression, including any new outcome studies demonstrating positive effects, mainstream media outlets are a popular option for learning more on this and other health topics. The amount of exposure that a particular treatment receives can influence people's understanding of treatment in general. If people only ever read stories about pharmaceutical drugs' effects on a particular problem, then over time the general public comes to consider this treatment to be the gold standard.

So, if treatment A gets 85% of the media coverage, then treatments B and C are likely to be considered less important, regardless of their true efficacy. And this is the problem -- the general public should be given more clear and direct information about various treatments' effectiveness. Furthermore, if there is going to bias in coverage, then it should go in the favour of treatments with large effect sizes (the most effective treatments) for serious issues.

But this is not the manner in which scientific journalism operates. Treatments are more likely to be covered if a company issues a press release. This type of coverage was exemplified in a recent Montreal Gazette story on Omega-3 vitamins and their impact on depression.

I've read the actual research article on which this story was based. Basically, the researchers designed a nice study examining the effect of this Omega-3s on depression, using a double-blind randomized trial. The researchers failed to find a significant overall effect. However, they found a small effect for people who had depression, but no anxiety disorder. The effect size was .27 which is in the small-moderate range.

The Gazette has run similar stories over the past few months. They ran a large story on micronutrient therapy for mood disorders. They ran a study recently showing a link between vitamin-B deficiency and depression in older adults. There are also periodic stories on antidepressants, which tend to portray the treatment of depression as follows: antidepressants are the gold standard of treatment, and sometimes counseling can help.

The problem with all of this is that these stories misrepresent the state of knowledge on treatment of depression. For example, hundreds of studies on the treatment of depression with Cognitive-Behavioural Therapy (CBT) have been published, and what you find is an average effect size of .82(1) versus placebo/ wait-list control. This is 3 times larger than Omega-3 treatment! Furthermore, CBT's effect size is statistically equivalent to antidepressants. You also find that CBT has a lower relapse rate than medication (29.5% vs. 60%), and is more cost-effective. Research has also found CBT to be equally effective as medication for moderate to severe cases of depression(1).

Does anyone ever see this in the news cycle?

Well, you might ask, have there been recent psychological findings worthy of printing a story about?

Let's see. How about a recent meta-analysis showing that mindfulness based therapy is an effective treatment for anxiety and depression(2). Or how about really interesting research showing that computer software programs designed to retrain people's attention significantly reduces their anxiety?(3) Or how about the ability of psychological treatment to simultaneously treat depression and reduce smoking?(4)

At the end of the day, psychologists have to work harder to promote these findings. But the media has to work harder to better represent health research....and not simply follow-up a press release from a company with financial ties to the findings.

Dr. Roger Covin
Montreal Psychologist


1 Butler, A.C., Chapman, J.E., Forman, E.M., & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17-31.
2 Hofmann et al. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review, Journal of Consulting and Clinical Psychology, 78(2), 169-183. 
3 Amir, N., Beard, C., Taylor, C., Klumpp, H., Elias, J., Burns, M., et al. (2009). Attention training in individuals with generalized social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 77(5), 961-973.
4 MacPherson, L. et al. (2010). Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depression symptoms. Journal of Consulting and Clinical Psychology, 78(1), 55-61.

Wednesday, June 9, 2010

Why See a Psychologist for Obesity?

Readers of this blog have no doubt noticed that I tend to highlight research evidence on psychological outcome studies, primarily those testing Cognitive-Behavioural Therapy (CBT), which tends to be very effective for many psychological issues -- often equally and sometimes superior to medication.

Well, I wanted to use this post to address psychology's role in obesity treatment. As most readers know, obesity has become a hot-button issue because the majority of people living in the US and Canada are at least overweight, with significant numbers meeting criteria for obesity (generally defined as a BMI >30). There are various treatment options available for obesity, including diet, medication and even surgery. But how do people know which are effective treatments?

Fortunately, people do not have to be left in the dark on decision-making for treatment options. There are experts in the area who can wade through the vast amounts of research, including outcome studies that examine whether various treatment strategies are effective. In 2007, the Canadian Medical Association published treatment recommendations based on the work of an expert committee. (Side Note: I had the pleasure of working at the same clinic with the lead author of this panel, Dr. David Lau from Calgary).

This expert panel recommended that psychologists be included in the treatment of obesity. Furthermore, they gave comprehensive lifestyle interventions, such as CBT, a grade A rating (this is the highest rating possible in the treatment guidelines).

Why would a psychologist be needed to help treat obesity? An entire book could be written to fully answer this question. But to give you an idea of the association between psychological variables and obesity, I offer the following research findings from recent studies:

(1) According to a recent Canadian study, obesity was associated with the following psychological problems -- depression, mania, panic attacks, social phobia, and agoraphobia without panic disorder. It was also associated with suicidal behaviour.

(2) A similar American study basically replicated most of the findings of the Canadian study.

(3) A recent US study found that 66% of obese patients undergoing bariatric surgery had a lifetime history of a psychological disorder.

Indeed, the link between psychological problems and overeating has been well-demonstrated. If you are someone thinking of making a concerted effort to lose weight, you should consider the advice of health experts and consider consulting a psychologist -- particularly one with experience in health psychology.

Dr. Roger Covin
Montreal Psychologist


Mather et al. (2009). Associations of obesity with psychiatric disorders and suicidal behaviors in
a nationally representative sample. Journal of Psychosomatic Research, 66, 277-285.

Simon et al. (2006). Association Between Obesity and Psychiatric Disorders in the US Adult Population. Archives of General Psychiatry, 63, 824-830.

Kalarkian et al. (2007).Psychiatric Disorders Among Bariatric Surgery Candidates: Relationship to Obesity and Functional Health Status. American Journal of Psychiatry, 164, 328-334.

Lau et al. (2007). 2006 Canadian clinical practice guidelines on the management and prevention of obesity
in adults and children. Canadian Medical Association Journal, 176 (Suppl. 8), Online 1-117

Tuesday, June 8, 2010

Back Pain is Overtreated

A very interesting story by the Associated Press was released today highlighting a disturbing trend in treatment for back pain in the United States. Although the vast majority of acute back pain subsides after 4-6 weeks, Americans are receiving way too many tests (ex: MRI; X-Rays) for back pain, and opting for unproven and unwarranted surgeries. It is estimated that Americans spend up to $86 billion every year on health care costs for back pain.

This pattern of behaviour is quite consistent with other indicators of the quick-fix mentality that has become so prevalent in North America. Pharmacology sales (particularly mental health prescriptions) and surgeries for obesity are on the rise. Advances in modern technology allow for such improvements in health care, but there tend to be at least two problems with some of these approaches.

First, the health care costs are tremendous. Second, they do not always target the problem. There is a widespread assumption that back pain must be due solely to physical tissue damage, obesity is due to genetic and biological problems (or a lack moral character -- ex: laziness) , and mental health problems reflect problems with neurochemistry. Unfortunately, things are more complicated than this, and such uni-theoretical models are often inadequate to explain complex problems.

Thus, I was very happy to see a list of recommendations posted with this story. One of the recommendations listed is that Cognitive-Behavioural Therapy be included as part of treatment. This kind of recommendation, for the inclusion of a psychologist, is now standard practice in pain treatment. Unfortunately, I rarely see mention of this fact when I read about pain in the popular press.

Monday, May 31, 2010

Do Your Brain Yoga -- Research Underscores The Value of Psychological Flexibility

Is it more important to feel positive emotions or negative emotions? Is is healthier to suppress emotions or express them? What's more important to our mental health - the ability to experience the perceptual details of everyday moments (ex: getting immersed in our experiences) or the ability to stand back from situations to think about things objectively?

I think I can guess some of the more popular answers to these questions. Many people believe that they should always strive to feel positive emotions, and if something is bothering us, we should express it -- not suppress it.

Well, things are not always as they seem and there's a reason why psychologists conduct research -- especially on topics that appear to be based on intuitive wisdom. A recent review article in a major psychology journal inspired this post* on psychological flexibility.

First, let me start with a definition. Psychological Flexibility is somewhat difficult to define, but generally speaking, it can be understood as the ability to adapt your thinking, emotions and behaviour to various situations. When people can change and manipulate these three factors, it can lead to many psychological benefits (ex: reduced stress; fewer depression and anxiety symptoms; improved goal attainment). However, when people get stuck using the same strategies and approaches with each new situation, they are more likely to suffer psychological consequences.

Returning to my questions above, let me show how psychological flexibility works.

First, always striving for positive emotions is an inflexible strategy. There are times when negative emotions are needed and are important. For example, worry sometimes motivates us to work harder or solve a current problem. Expressing anger and frustration to others can be a beneficial communication strategy. Feeling anxiety keeps us alert and prepared to react, which is a useful state of mind in some circumstances.

Similarly, the ability to suppress emotions is often considered unhealthy and to be avoided. There is some truth to this, in that the chronic suppression of emotions has been shown to have negative consequences on physical and emotional well-being. However, sometimes suppressing emotions is useful and necessary.

For example, whenever we date or marry someone, the other person is never perfect. Your spouse probably does one or two things (or more!) that can be irritating. Should we discuss and complain about every little thing that bothers us? Sometimes we have to pick and choose our battles, and learning to suppress our annoyance and frustration over the minor irritations is necessary to maintain relationships. There will always be things about people (life, the world, our jobs,...) that bother us. If we constantly expressed how we felt about every little annoyance, we might risk pushing other people away. However, there are times when we should say something about others' behaviour. Knowing when to do this, and being able to regulate our emotions in the process can be a challenge, and certainly requires mental flexibility.

Finally, what about being immersed in the moment (as preached by mindfulness meditation advocates) or being able to stand back and analyze situations. Well, I'm guessing you can see the pattern by now. A balance between these two states of mind is optimal. Sometimes being fully focused and absorbed in something is practical and useful (ex: thinking about a work project), and sometimes it is not (ex: thinking about a work project while having supper with your family).

There are other aspects to psychological flexibility not discussed here (ex: self-control), which I will post about later. The take home message is that psychological flexibility is an important attribute that is actually predictive of happiness and well-being.

Psychological flexibility is a skill that can be improved with practice. So, we should all do ourselves a favour and practice psychological yoga on a daily basis.

Dr. Roger Covin
Montreal Psychologist

* Kashdan & Rottenberg (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psych. Rev., 30, 467-480.

Tuesday, April 27, 2010

Some Mild Advertising for the Psychology "Industry"

Whenever a pharmaceutical company finds a new a drug that works (even mildly), they follow up with a marketing campaign. This is understandable in the sense that they devote money to research and development, and they are in the business of making profits, so they have to get a return on their investment. The conflict of interest inherent between (1) needing to make money, and (2) helping and protecting the public at large, is another issue altogether and won't be addressed here.

Their system is so very effective. Psychology on the other hand, is near immobile in comparison. This is not to say that psychological treatments are not as effective. Quite the contrary. In fact, psychological treatments often work as well as, if not better than medications. Unfortunately, you'll rarely hear about this.

The field of psychology is not well understood by the general population to begin with. Many people make assumptions based on popular media (laying on couches and spouting Freudian theories that blame your mother). As such, for those readers who might not be aware, I'd like to briefly compare psychology and pharmaceutical research.

First, both types of research make use of randomized controlled trials to test the relative efficacy of their treatments. When testing a drug, you can compare the drug's efficacy to a placebo (a substance that appears to be a drug, but actually has no effect). Similarly, psychologists will often compare treatments to either no-treatment groups (ex: people on wait-list for treatment), or people who receive basic counseling (simply talking about problems). This allows psychologists to assess whether the new treatment is an improvement over a basic standard.

Now, what kind of new treatments do psychologists develop? Well, every year millions of dollars are spent by psychological researchers on basic research examining all aspects of human psychology. Researchers study things like attention and memory biases, personality traits and genetics, emotion regulation, behavioural principles, etc. This basic research can then be used to expand upon existing treatments, or generate new ones. Cognitive-Behavioural Therapy is a treatment that is always being studied and modified in order to improve treatment outcomes.

Thus, psychologists conduct basic research and outcome trials similar to pharmaceutical companies. And what you find is that psychological treatments are often just as effective as medications for disorders such as depression, PTSD, Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, and OCD. In fact, there is research showing that psychological treatments are superior to drugs in some ways. For example, when people with depression stop taking their medication, they are more likely to relapse compared to when they have stopped seeing their psychologist.

Also, psychological treatments don't have the side effects that drugs have. Furthermore, some people who take SSRIs to treat depression sometimes become worse with each new drug they take. Or, if they take benzodiazepenes for anxiety, they can become addicted to this medication.

Needless to say, seeing a psychologist can offer just as many benefits, if not more than taking medication for mental health problems. Unfortunately, most people don't know about it. Psychologists do not have the resources to advertise their findings. When Pfizer develops a new drug, you'll know. When psychologists develop a new treatment, you'll rarely hear about it. When was the last time you saw this in the newspaper: "Psychologists Find Highly Effective Treatment for OCD!" This headline is true. Exposure and response prevention is a highly effective treatment for OCD -- as effective as medication. But no one knows this.

So, whenever I see a client for 12 sessions and successfully treat their Depression or Anxiety Disorder, they are often surprised. They might say "I've tried 5 different drugs for the past 10 years, and now I get better after 3 months of CBT!"

Anyway, I know this blog is not exactly Time Magazine, but it's at least one more resource for people who may not know about the benefits of working with a psychologist.

Dr. Roger Covin
Montreal Psychologist


Butler, A.C., Chapman, J.E., Forman, E.M., & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17-31.

DeRubeis, R.J., Gelfand, L.A., Tang, T.Z., Simons, A.D., 1999. Medications versus cognitive behavior therapy for severely depressed outpatients: mega-analysis of four randomized comparisons. Am. J. Psychiatry 156, 1007–1013.

DeRubeis, R.J., Hollon, S.D., Amsterdam, J.D., Shelton, R.C., Young, P.R., Salomon, R.M., et al., 2005. Cognitive therapy vs. medications in the treatment of moderate to severe depression. Arch. Gen. Psychiatry 62, 409–416.

Imel, Z.E. et al. (2008). A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. Journal of Affective Disorders, 110, 197-206.

Leykin et al. (2007). Progressive Resistance to a Selective Serotonin Reuptake Inhibitor but Not
to Cognitive Therapy in the Treatment. Journal of Consulting and Clinical Psychology, 75, 267-276.

Thursday, April 22, 2010

Well Done Sigmund Freud -- Sort of...

If you've ever taken a psychology course where Sigmund Freud's theories are discussed, there's a decent chance that your professor spent some time highlighting all the problems with his theory. Although Freud is the most recognizable name in the profession of psychology/ psychiatry, his theories have been criticized and even mocked by some contemporary psychologists.

In some cases, it is quite appropriate to criticize many aspects of his theories. But that's to be expected - he did not have the luxury of the scientific data we modern psychologists have access to. If Freud were alive today, he would surly take time to read what's happened in the 80 or so years since his death, and revise his theory. For the many criticisms I have of Freud's work, I must admit there some elements of his theory that appear to be fairly accurate (ex: the notion of defense mechanisms). In particular, it is his ideas about the unconscious that are quite impressive.

Freud believed that the brain operated at levels we were aware of (consciousness) and those we were unaware of (unconscious). Throughout history , many professionals and lay people have questioned this belief. However, the past 20-30 years of research, particularly in the fields of cognitive and social psychology, have really supported the idea that we have unconscious thinking.

Based on the wealth of scientific research in this area, psychologists now believe there are two types of thinking: automatic and controlled. Automatic thinking (also called implicit cognition) requires no effort or motivation on the part of the person. This is simply the brain processing information on its own. Controlled thinking is the type of thinking we're all used to -- the deliberate kind. This is when we take the time to think about things intentionally.

Clinical psychologists observe these two kinds of thoughts in therapy all the time. I will illustrate with an example. Imagine you see a spider scurry across your kitchen floor. It's a tiny spider that is obviously quite harmless. Yet, many people would be inclined to take a step back and feel a bit anxious. You might think "I hate spiders!" However, if someone asked you if the spider was harmful or dangerous, you'd probably say "no -- I know it's not harmful, but I just don't like them." What's going on here?

Well, it seems that automatic thinking is based on associative connections in the brain. An associative connection is a neural link between two concepts or ideas. For example, what word comes to mind when you read the following:

Bacon and ______

Did you think car? Horse? Probably not.

Most people think eggs.

Why? Because eggs and bacon are often paired together -- in meals and in sentences or expressions. So, over time we associate these to things together. Over time, you could create a whole network of associations. For example, eggs, bacon, toast and coffee and more likely to be associated than things like car and grass. This means that thinking of one thing (ex: bacon) makes it more likely for something related to come to mind (ex: eggs or toast).

Well, we can and do build associative networks for all kinds of things -- like spiders. Throughout your life, spiders have probably been associated with more bad than good. You might have seen your mother jump in fear at the sight of spiders. You might have watched a show on the discovery network showing them trap, kill and eat insects. You've probably heard how some are deadly. In any case, most people make connections between spiders and negative things. Therefore, many people have at least a little bit of a spider fear. When you see a spider, it activates the other negative associations, and we're often left with a negative feeling of some sort -- a discomfort or feeling of anxiety.

This is a very basic example of automatic thinking, but it shows the process of how thinking can be unconscious:
        (1) A network of associations was created in the brain,
        (2) They get activated when you see a spider
        (3) They cause an emotional reaction without the person thinking about it.

Usually, people are only aware of the emotion at the end of this process. The creation and activation of the network are automatic, and usually outside of the person's awareness -- hence, it can be considered unconscious processing. 

In the example I used earlier, the person didn't want to go near the tiny spider despite knowing it was harmless. Here you have a battle of thinking -- automatic thoughts versus controlled thinking. I sometimes see this with clients. For example, I will hear someone say the following:

"I know I'm a very successful person, but I FEEL like a failure."

Here, there is a battle between an automatic thought process ("I feel like a failure" or "thoughts of being a failure keeping popping into my head") and a controlled thinking process ("When I take the time to examine the evidence, I realize I'm not a failure").

Here's a piece of advice: when you have two competing thoughts, go with the controlled thinking -- the one with the evidence.

It is more likely that the automatic thought is not correct. Here's a simple example to highlight how automatic thinking can lead you astray:

I want you to remember the first word that comes to mind after reading the following question?

What do cows drink?

How many of you thought water?

The most common thought that comes to mind is milk, which is obviously wrong. Automatic thoughts can be useful in many situations, but we have to keep an eye them. This is actually an important part of Cognitive Behaviour Therapy.

So, getting back to Freud and the unconscious. This explanation and these examples are very simplified ways of highlighting how the brain can have two minds. Things get much more complex when you factor in associations involving trauma, traits, beliefs, social values, etc. Psychologists have a long way to go to fully understand how the brain organizes its network of thoughts, and how these networks affect our emotions and behaviour.

Freud may have been wrong about how the unconscious mind worked, but you have to give him kudos for being able to see it operating in patients on some level.

Dr. Roger Covin
Montreal Psychologist

Tuesday, April 6, 2010

Emotional Support Decreases Pain of Rejection

An interesting study in a recent issue of the journal Social NeuroScience demonstrates how social support can decrease feelings of social pain. In a previous post, I noted how researchers had identified regions of the brain that become activated when people are rejected by others. One of these regions in the brain (ACC) was examined by the researchers in this new study. Here's what they did:

They had research subjects perform a task (like a game), where they were made to feel rejected. Later on in this game, they were offered some emotional support. What the researchers found was that the area of the brain associated with pain (ACC) decreased in activation when the subjects were being emotionally supported.

What does this mean? It means people have the ability to cause us serious pain...but they can also give us reprieve from pain. Like a drug.

These results help explain why talking about problems can be helpful. For example, it seems that talking to a friend following a break-up can decrease the level of activation in the brain responsible for the pain....which could speed up the emotional healing process.

Prior to this study, psychologists already knew that emotional support had positive effects on physical pain.

For example, pain researchers have found that pain thresholds increase (ex: people can keep their hand in a bucket of ice water for longer periods of time) when a loved one is standing next to them and offering support.

It was always assumed that emotional support decreased both social pain and physical pain. However, this study offers clear scientific support for this assumption.

The lesson? If you're feeling hurt, rejected or alienated -- talk to someone to get emotional support. It's like taking aspirin for headache!

Dr. Roger Covin
Montreal Psychologist

Thursday, April 1, 2010

Confusing Wealth and Beauty with Happiness

An opinion piece in the Montreal Gazette today inspired this next post. The article discussed research on happiness. Specifically, it detailed how research generally shows that happiness is best achieved through the creation and maintenance of interpersonal relationships. Things like money and success can be predictors of happiness, but having healthy relationships is an even better predictor of happiness.

This kind of research can surprise a lot of people...primarily because people often mistake the method for the goal.

"The method for the goal?...what does this mean?"

As I discussed in an earlier blog, the need to be liked and avoid rejection is one of the most fundamental human needs. It is a goal we all strive for, either consciously or unconsciously. There are different methods we can use to accomplish this goal. Here are some of the more common methods in Western society:

(1) Maximize your level of physical attractiveness. People have an inherent preference and positive bias for attractive people, so looking good can help.

(2) Increase the amount of money you have. This can help in multiple ways. Money can help improve social status, which is an attractive quality.

(3) Attain success in your career to earn power and respect. Again, success and power are qualities that are well respected in Western society.

(4) Try to become popular. Popularity can work as a symbol or proxy for likeability. If people know that other people know you, this could mean you are likeable. 

Obviously, there are other ways to get people to like you, and I am only focusing on the more superficial methods to being liked. But I'm doing this to help make a point. Nevertheless, I am being serious when I say that each of the aforementioned methods has the potential to improve one's interpersonal life.

Unfortunately, people often forget -- or in some cases are unaware --  why they are using these methods in the first place. Consequently, the methods are rendered useless because they are not used properly.

I've worked with a number of people who successfully used many of the above-mentioned methods. They were quite wealthy and successful, and well-known in their community. Or they were quite wealthy and very attractive and popular. Or they were very attractive and popular...anyway, you get the point.

But each one was unhappy. They were unhappy because of problems in their interpersonal lives. They either had an attachment(s) that was not going well ( ex: divorce), or they had no significant attachment (ex: a classic example is someone who has many acquaintances, but no serious relationships).

It was as if each of them were saying, "OK, now that I have (attractiveness; popularity; success; money) I should be happy."

This is like having a shed full of garden tools and saying "OK, now that I have all the tools to grow food, I should not feel hungry."

Collecting tools and trophies to attract and impress people is fine. But you have to constructively use them to get benefits. Use your money, popularity, success, and attractiveness to create and maintain healthy relationships.

It's quite sad when someone spends their whole life stocking the toolshed, only to end up starving.

Dr. Roger Covin
Montreal Psychologist

Wednesday, March 31, 2010

New Research Highlights the Impact of Rejection on Thinking and The Body

In an earlier post, I wrote about research that demonstrates a link between social rejection and physical pain. Well, a new study in a high quality journal (Journal of Personality and Social Psychology) has extended our understanding of the impact of rejection on the body. I've always liked the studies published in this journal because they are often clever and and well-executed.

The researchers tested a particular theoretical model of rejection. They ran an experiment where undergraduate students were placed into one of two groups: (1) "ambiguous rejection" and (2) "no rejection".

Without getting into too many details, the people in the "ambiguous rejection" group were put in a scenario where another person behaved in a way that may have been an act of rejection. Conversely, the people in the other group were put in a similar scenario -- where another person does not want to interact with them -- but it was obvious that it was not a rejection.

What the researchers found was very interesting. They found that people with low self-esteem who were rejected experienced the following sequence of events:

(1) they tended to blame themselves for the rejection (although there was little reason to do so),

(2) they rated themselves as being less likeable

(3) these first two events caused an increase in cortisol (I'll explain the significance of this below), and

(4) this increase in cortisol was followed by defensive behaviour. Specifically, the people who were rejected and had low-self-esteem were more critical of the person who rejected them.

Many of the things that these researchers demonstrated with an experiment, clinical psychologists like myself see all the time. It looks something like this:

A client comes to session feeling stressed and sad. They feel this way because of something that happened during the week. For example, a friend called and canceled plans because something important came up. They believe that the person rejected them because they are unlikeable, which then reinforces how they already think about themselves -- as being unlikeable to others. The client may eventually try and protect their sense of self by attacking the person in some way (ex: saying they are inconsiderate), or by distancing themselves from the relationship.

It is easy to see in this example that the person is feeling sad and stressed for almost no good reason. There was no obvious rejection. Their friend said that something else came up, and so they had to cancel plans. People do this all the time. Research shows that people with high self-esteem do not interpret this as being a rejection experience. Unfortunately, for those with LSE, their interpretation leads them down a dark path.

This research really adds to our understanding of this rejection process. The researchers were able to show that this rejection sequence leads to increases in cortisol. Prior research had already shown that rejection leads to increases in cortisol -- what makes this study unique is that a negative interpretation of rejection appeared to cause the increase in cortisol.

Psychologists know that negatively biased thinking can cause stress and negative emotions (I'll blog about this in more detail later), and now they know that negative thinking can negatively affect the body.

What is cortisol and how does it negatively affect the body?

Well, cortisol is what's know as a "stress hormone." It is commonly secreted by the body when physical safety is threatened. It was originally designed (through evolution) to prepare the body for an attack. It increases arousal and prepares us to handle an impending challenge. For example, if a stranger on the street started to push you around and threaten you, your body would secrete cortisol and other stress hormones.

However, cortisol does not only get released with threats to physical well-being. It also gets released when there are threats to our "social well-being." In other words, when we are rejected by others or even if our social status is threatened in some way (ex: a failure experience), then cortisol and other stress hormones are released in the body.

When cortisol is released repeatedly over time, it can have damaging effects on the body. Research has found associations between heightened levels of cortisol and lowered immune system functioning, cardiovascular disease, ulcers, complications involving diabetes (ex: high blood sugar), etc.

Again, this highlights the interplay between physical health and mental health. When someone has diabetes or high blood pressure, and they have problems with stress and negative thinking, the combination can be very negative to physical health. I've worked with a number of such patients, and when their coping ability improves, you can see the results in medical tests (ex: blood sugar levels drop).

To sum up, people who have negatively biased beliefs about themselves (ex: "I'm unlikeable") and other negatively biased thinking, they can easily get caught in a cycle of negative thinking - negative emotions - stress -- negative thinking, which can take its toll on the body.

Dr. Roger Covin
Montreal Psychologist

Thursday, March 25, 2010

Psychology, Obesity and Managing Your Emotions

I used to work at a health clinic in Calgary, Alberta where I got to work with a number of patients suffering from various physical health problems (ex: diabetes; obesity; hypertension). Now, you might be wondering – why would a psychologist be working with these people? Well, psychologists can play an important role for many health problems – in fact, we have a whole field in psychology devoted to this (behavioural medicine/ healthy psychology).

In an effort to show how psychology plays a role in various health problems, I’m going to follow-up my last post (on chronic pain), by discussing a new health problem:


Specifically, I’m going to talk about how a specific psychological factor (experiential avoidance – a mouthful, I know!!) can impact how much food people eat.

Research shows that over-eating (including binge-eating) is more likely to occur when stress and/ or negative emotions are present.

However, people do not necessarily overeat every time they feel stressed, sad or upset. Another important factor is emotion regulation. Emotion regulation refers to a person’s ability to manage their negative emotions, and not allow these emotions to lead to regrettable behaviour.

Some people have poor regulation strategies. If someone often eats unhealthy food when feeling stressed or upset, this would be considered a poor strategy. The pattern of turning to food (or drugs or alcohol or sex,…) to feel better is not really new in Western society. However, what has changed is the ease with which we can get access to these things (but I’m digressing a bit here).

There does appear to be a certain segment of the population that are more likely to use eating for emotion-regulation (i.e., emotional eating). An important question then becomes, why have they “chosen” food instead of drugs? There are several potential answers to this question, which I will address later.

Perhaps an even more important question is, what kind of emotion regulation strategies are these ‘emotional eaters’ using? Well, to answer this question we must examine a particular style of emotion regulation – called experiential avoidance. However, for simplicity sake, let’s just call it EA.

EA can be a bit of a complex concept to explain. It will help to explain what it means by describing it as a process. So, here goes.

When people use EA, they…

(1) really do not like negative thoughts, feelings, stress, uncomfortable body sensations (e.g., anxiety symptoms), etc. You might be thinking “Hey, no one likes those things!” True, but you can not like something yet still tolerate it. People who have problems with EA have A LOT of trouble tolerating these things.

(2) they decide (often unconsciously) that they are simply unwilling to experience these problems, and

(3) they do something (often quickly) to control or escape these unwanted experiences.

For example, if a person does something unethical, they can (a) ponder their actions and process their guilt, or (2) avoid thinking of the mistake and suppress their emotion. In this example, the former strategy can be thought of as an ‘acceptance’ or ‘willingness’ to experience negative thoughts and emotions. The second strategy is ‘avoidance.’

Certain kinds of EA strategies are healthy and normal under certain contexts. For instance, trying to suppress boredom and disinterest while in a conversation with a friend or colleague is normal, and expected by social standards. However, when you chronically try to avoid or suppress psychological experiences, it can sometimes lead to psychological problems in the long run.

There are several ways in which avoidance/ suppression can cause problems:

(1) there can be what psychologists call a “rebound effect.” This occurs when we try to suppress something, but our attempts to suppress it only end up making it stronger. A classic example of this is the pink bear experiment (Spend the next minute trying not to let the image of a giant pink bear enter your mind – it’s near impossible).

In fact, researchers have shown that trying to suppress negative thoughts only increases their frequency over time (primarily under stress),

(2) EA can make people feel inauthentic and disconnected from their true self. I have worked with many people who constantly try to be very, very positive people (always trying to shut out negative things in their life). These people were not experiencing a full and genuine life (everyone feels sad, angry, anxious, etc. at least some of the time), and they experienced psychological problems as a result.

(3) many negative psychological experiences are actually somewhat useful. Worry (in moderation) helps people anticipate and prepare for potential problems in the future. Self-criticism can be considered a useful self-monitoring process that allows someone the opportunity to identify mistakes and make necessary corrections.

Of course, the question now becomes, how does EA lead to binge-eating? Well, research shows that individuals with a tendency to engage in binge-eating also tend to overuse EA strategies.

Why are binge-eating and EA associated?

Well, eating can be considered to be an avoidance strategy. Eating can help someone distract from unwanted experiences, and can directly calm any physical discomfort the person is feeling. Unfortunately, this strategy works really well. And so, people are more likely to repeatedly use it.

A similar problem is seen in other problems like depression and anxiety. People with depression or anxiety sometimes use alcohol or drugs to blunt the intensity of their emotional experience (i.e., the depressed person feels less sad and the anxious person less anxious, at least for the short term). However, these EA strategies can impair recovery because the processing of emotion is an important component of treatment (this latter point is beyond the point of this post).

The take home message here is that EA is great in the short-term – but very problematic in the long-term.

So, returning to a question posed earlier in this post, why to some people choose food, while other people choose alcohol/ drugs?

There are several possible answers to this question.

First, people can learn to cope with problems by modeling their parents. Some people overeat while stressed because they learned this coping strategy from their parents. For example, mothers will sometimes bake cookies or other sweets to give to their children when they are upset. This strategy can get reinforced (i.e., it works by reducing distress in the short term), and is used repeatedly across time, and into adulthood.

Second, there is some evidence to suggest that the biological response to food involves more pleasure and reinforcement for obese individuals, relative to the general population. Similar to theories of drug addiction (ex: the link between the dopamine system and cocaine), research shows that eating also involves a similar process, where food activates pleasure centres in the brain. Research shows that this pleasure response can be greater in obese people.

Finally, individuals might learn on their own that eating provides an escape from negative emotions. They can learn this later in life (e.g., adolescence; adulthood) through the media, peers, and even by chance (i.e., they stumble onto the fact that eating relieves negative affect).

I guess one of the main points I want to make with this post is that psychology is not discussed often enough when people (ex: government agencies; other health professionals) try and brainstorm ideas for treatment and prevention. I remember a former supervisor of mine discussing an obesity conference that was held in Canada a number of years ago. The organizers had people from almost every profession there to discuss ways of lowering obesity rates. They even had city planners there to discuss how to design urban areas to lower the incidence of fast-food eating. Yet, there were no psychologists! The people there had no clue why they would even need to invite a psychologist.

I’m hoping readers get to learn a bit more about the role that psychology can play – in mental and physical health issues.

Dr. Roger Covin
Montreal Psychologist

Wednesday, March 24, 2010

The Psychology of Chronic Pain

I'm going to switch gears a bit with this post, and discuss a new topic that I feel is important and interesting. I want to talk about how psychological factors can influence chronic pain. I would estimate that the majority of people would not see much of a connection. Most people assume that pain is simply due to some kind of injury to the body. And by extension, chronic pain is due to some injury that has not yet healed. This is partly true.

Usually, when someone with chronic pain is told that there are "psychological factors" affecting their pain, alarm bells go off. The immediate reaction tends to be:

- "You think I'm making this up?"
- "You think this is all in my head?"
- "You think I'm crazy?"

Unfortunately, these kinds of thoughts make chronic pain sufferers less likely to see a psychologist for help. It is not uncommon for a physiotherapist or a GP to recommend that their patients see a psychologist -- only to have their patient feel insulted!

It is for this reason that I wanted to provide a brief introduction to the role that psychology plays in chronic pain. I hope that those with chronic pain get to understand a little more about psychology and pain.

Let me start by answering the common questions written above:

Are you "crazy?" - No.
Is the pain "fake?" - Absolutely not.
Is the pain "all in your head?" - Absolutely yes! But pain is always in the head.

You see, pain is basically a combination of things. First, there is often some damage or injury to the body (ex: broken arm; dislocated disc; micro-tear in the shoulder). There are receptors in the body that detect these injuries and send the information to the brain through the spinal cord.

This "pain information" then gets processed in the brain. Technically speaking -- the pain is actually in your brain and not in the body -- but of course you "feel" it at the site of injury.

It is the interaction between pain information from the body and the way the brain processes this information that determines how severe the pain will be.

Given that the brain plays an important role in the pain experience, and everyone's brain is different, it is not surprising to learn that two people can have identical injuries, and yet have completely different pain experiences. This is where psychology comes into play.

There is a lot of research showing that negative emotions (ex: depression; anxiety; anger) and feelings of stress tend to be associated with more intense pain. In other words, if you are feeling very sad and stressed, your pain is probably going to be worse than if you were relaxed and happy.

Why? What's going on here?

Based on research findings, what seems to be happening is this -- negative emotions and stress influence the amount of pain information received from the spinal cord. Pain researchers believe there are "gates" in the spinal cord that can be opened and closed depending on various factors. One of the factors that determines how much information reaches the brain is emotion. When you are depressed, more pain information is allowed through the "gate" and the person experiences more pain.

The really unfortunate thing is that increases in pain create negative emotions and stress -- so people with chronic pain end up in a vicious cycle. It's not surprising that up to 50% of people with chronic pain end up suffering from problems with depression.

Emotions and stress are not the only psychological factors that affect pain levels. Here are some other interesting facts that show a pain-psychology connection:

1) Suppressing feelings of anger can worsen pain

2) A number of research studies show that the way you think about your pain can seriously affect pain severity

3) Personality factors can affect pain in indirect ways

4) People who are more sensitive to rejection have lower pain thresholds

I hope this blog helps people understand a little more about how pain works. Especially chronic pain sufferers.

If your physician, physiotherapist, massage therapist or any other professional you are working with recommends you see a psychologist - please don't be insulted! They are simply trying to improve your care. In fact, The International Association for the Study of Pain recommends that mental health professionals be included in the treatment of pain. It's a treatment option that deserves some consideration.

Dr. Roger Covin
Montreal Psychologist

Tuesday, March 23, 2010

How Does the Need to be Liked Affect your Self-Concept and Self-Esteem?

As I discussed in my last post, the need to be liked has a large biological basis, and can really affect all aspects of our lives. In this post, I am going to briefly talk about how this need affects our self-concept and self-esteem.

Generally speaking, the self-concept can be defined as your overall understanding of who you are as a person. I’m going to hold off on defining self-esteem for now – it is actually going to be a definition that is probably different than the ones you have heard before.

So, we all need to be liked to some degree. Therefore, it is important that we have some idea of how likeable we are to others. Figuring this out can be a very difficult process for many people. Not only that, but this process can lead some people to become depressed.

So, how do we know if we are likeable? Well, in order to answer this question, we need information about ourselves. We often get this information from other people. Specifically, we get feedback from other people to help know more about who we are – and whether we have likeable qualities (e.g., intelligence; attractiveness; sense of humour).

Think about it. I can only know that I am funny if people laugh at my jokes. Knowing if you are smart is greatly influenced by external feedback (ex: tests; other people’s comments). Similarly, people can estimate how attractive they are based on the responses they get from other people (ex: flirting; comments, etc.).

So, generally speaking, we need other people to help us understand ourselves. Easy right? This process of coming to understand yourself by looking for feedback from others can be a really tricky process. There are many complicating factors – here are a few:

(1) other people have their own motivations, and so they can hide their feedback from you (ex: you might find someone very attractive or really smart, and yet not reveal any of these beliefs because you want to avoid embarrassment). Unfortunately for the other person, they never get this really nice feedback.

(2) people can have biased perceptions of other’s behaviour. For example, if you noticed a stranger across a room smiling at you while they talked to their friend, you might assume they like you and are saying positive things. However, you might also interpret that smile as meaning they are mocking you! People who are shy usually make the latter interpretation.

(3) we all have different standards for accepting information. Does a grade of 70% on an exam mean you are smart, average or dumb? If someone rated your attractiveness as 7/ 10, does this mean you are attractive? People hold different standards, and unfortunately for some people, their standards are so high that they ignore feedback that is actually positive.

As a practicing psychologist, there is one phenomenon that I’ve noticed over the years that really affects people’s self-esteem and mood. You could call it an “irrational rejection phobia.” It is an extreme fear of being an unlikeable person, despite the fact that there is plenty of evidence that you are a likeable person. It occurs when a person constantly strives or desires to be above average on a particular trait. For example, I have worked with a number of young women who rate themselves as being a 7/10 in terms of physical attractiveness. If you consider that the average of this scale is 5/ 10, these women are telling me that they consider themselves to be above-average in terms of physical attractiveness. Yet, they are not at all satisfied with this fact – in fact, they are depressed by it! They actually want to be a 9/ 10 or 10/ 10.

Whenever I ask these same women how likeable they are, I usually discover that (a) their likeability rating closely matches their physical attractiveness rating, and (b) they want their likeability rating to be higher, despite being above average. Their thinking and behaviour resembles that of a person with a phobia. People with a fear of spiders want to be as far away from spiders as possible. Unless the spider is deadly (over 99% of the world’s spiders are not deadly), this is considered an irrational fear. When people strive to be as far away as possible from the “unlikeable” side of the 10-point scale (ex: 0-4), it too is an irrational fear.

There’s nothing wrong with wanting to avoid rejection, but there certainly reaches a point when it becomes abnormal.

Much research shows that when we are far away from reaching an important ideal or standard, we can feel depressed. For example, if it is really important for you to be thin and you are overweight, you are likely to be feel sad and perhaps depressed. As such, whenever people feel they have to be much better than they are currently (ex: much more attractive; much smarter; a lot funnier), they run the risk of feeling disappointed and sad.

As you can see, figuring out whether you are a likeable person can be a tough process. Yet, it is a very important component of mental health.

So, are you a likeable person? And how does the answer to this question affect your self-esteem? Well, the answer to this question is self-esteem. The traditional definition of self-esteem has typically been “it is the degree to which we like ourselves.” However, some psychologists are now advocating for a new and more accurate definition – Self-esteem reflects the degree to which people believe they are likeable to others.

Or put another way, self-esteem is a person’s estimation of how probable it is that other people will like them and want to be their friend.

This blog post demonstrates how sometimes normal psychological processes have the potential to become dysfunctional. In this case, it is normal to try and evaluate who you are as a person, and how likeable you are. It is also normal to try and avoid rejection and be liked by other people. However, each of these normal processes have the potential to go seriously wrong – and can even lead to mental health problems.

Dr. Roger Covin
Montreal Psychologist