Frequently Asked Questions

We accept psychology and neuropsychology referrals from all health professionals, community coordinators, agencies, insurers, lawyers and other organizations. Please download our referral form and fax it to our confidential fax number: 416 342-1968. You can also email it to us via SecureDocs, a secure encrypted portal. If you have any questions, please contact us.

Toronto Brain Health is a registered treatment provider with WSIB under the Community Mental Health Program. We are listed in the WSIB Psychologist Directory. The Community Mental Health Program is for all people with a WSIB claim who require psychological assessment or treatment, this includes individuals who have sustained a concussion or moderate to severe brain injury in the workplace or a psychological injury (e.g., workplace related PTSD, depression, anxiety or adjustment disorder following a physical injury).

Approval for psychological services is required by your WSIB case manager prior to proceeding with assessment and treatment.

Once approved, please schedule an initial intake call to get started. Once we determine that we are a good fit for your needs we can schedule your psychological assessment appointment with one of our psychologists. If you have any questions, please contact us.

For more information on why to see a neuropsychologist after sustaining a concussion at work, see our related blog.

Psychology and neuropsychology services are not covered under OHIP. Our therapy and assessment rates are set according to information and guidelines provided by the Ontario Psychological Association.

Most extended health insurance plans cover all or part of neuropsychology and psychology fees. Some plans allow direct billing for psychology services. We recommend that you review your individual plan as health benefits differ between providers. Fees which are not reimbursed can be claimed as medical expenses on your income tax return.

We work with service members, or their family members, of the Royal Canadian Mounted Police (RCMP) and Ontario Provincial Police (OPP). We assess and treat individuals who were psychologically and/or physically injured in the workplace under WSIB (e.g., PTSD, depression, anxiety, adjustment disorder, somatoform disorders, chronic pain, concussion, or moderate to severe brain injury).

Yes! We provide the following services by online appointment to individuals located throughout Ontario, Quebec, New Brunswick and Nova Scotia:

• Psychological consultations and assessments.
• Psychological and neuropsychological treatment.
• Neuropsychological evaluation – clinical interview only, cognitive testing requires in-person evaluation.

We can also provide phone sessions if needed and appropriate to your specific needs.

Yes. Our psychologists provide in-person appointments at our clinic. However, if you are sick or symptomatic with a virus, please change your in-person appointment to a virtual one or provide cancellation notice.

We have several psychologists for you to choose from. If you have someone specific in mind, then we will do our best to book you with this individual, if applicable, notify you of their wait time, or provide alternate psychologists at Toronto Brain Health with immediate or near future availabilities. We further work toward booking you with a psychologist who has experience and competency in the areas you would like help in.

If we do not have a psychologist who has the knowledge or experience to address the issues you are dealing with, we will let you know and may be able to provide resources to finding a more appropriate provider in the community.

Each psychologist’s bio is also listed on our website. Finally, you can schedule a free 15-minute call with a psychologist if you want to determine whether the fit is good. After you meet or start with a psychologist at Toronto Brain Health, if you are not happy with the fit, you can switch providers if another psychologist at our clinic has availability, or we can make recommendations for other providers in the community who may be able to meet your needs.

20 De Boers Drive, Suite 315
Toronto, ON, M3J 0H1

[Google Map]

Subway
We are a 3-minute walk from Sheppard West subway station.

Driving
Toronto Brain Health is located in the Domo Centre at 20 De Boers Drive. The closest intersection is Allen and Sheppard with nearby access to Highways 401 and 400.

Our office hours are as follows:

Monday 9a.m.–8p.m.

Tuesday 9a.m.–8p.m.

Wednesday 9a.m.–8p.m.

Thursday 9a.m.–6p.m.

Friday 9a.m.–6p.m.

Saturday Closed

Sunday Closed

Note: Office hours may change during civic and national holidays. Please contact us if you have any questions.

Yes. There is outdoor paid parking, and 6 levels of above-grade paid indoor parking.

If parking outdoors, proceed through the main entrance, enter the elevator to your right and exit on the fifth floor. Follow signs for suite 535.

If parking indoors, suite 535 is one floor above P6 however you can access the elevator from other indoor parking levels as well.

Yes. For wheelchair access from our parking facilities, proceed by elevator from the ground floor or parking levels P1 through P5.

For wheelchair access from the ground floor level, please proceed through the side entrance of the building (to the right of the main entrance if entering from outside). Take the ‘service elevator’ and exit on the fifth floor.

Yes! We provide the following services virtually via secure online client portal:

• Psychological consultations and assessments.
• Psychological and neuropsychological treatment.
• Neuropsychological evaluation – hybrid assessment options are available.

You can attend your virtual sessions via your preferred device (phone, tablet/iPad, laptop), access services from anywhere within Ontario, and save time by cutting out the commute or attending your appointment over a lunch break from work. We can also provide phone sessions if needed and appropriate to your specific needs.

Yes. We have a few psychologists who are seeing clients in-person at our clinic. Not all psychologists are providing in-person services at this time. We require clients to wear a medical grade mask upon entering our clinic and during their in-person appointment. We can provide you with a mask if needed. Please see our COVID-19 update for our most recent in-person appointment guidelines.

Not every hit to the head results in a brain injury. If hitting your head was that dangerous, our toddler years would be pretty rough, and we would not survive as a human species. However, some hits do result in concussions. A concussion, also known as a mild traumatic brain injury, is an immediate and temporary alteration in brain functioning due to physical trauma.

A concussion can occur because of a hit to the head, or forces causing a sudden jolt to the head such as whiplash or blow to the body. Loss of consciousness is not necessary for a concussion to occur. In fact, only 10% of individuals who sustain a concussion lose consciousness. Up to a third of individuals experience post-traumatic amnesia, also known as a post-traumatic confusional state, which disrupts memory for events occurring shortly before or after injury. Loss of consciousness, post-traumatic amnesia, plus feeling dazed, disoriented, or ‘out of it’ are all examples of altered brain functioning which suggest that a concussion may have occurred (a physician, nurse practitioner or neuropsychologist are able to diagnose concussion).

For early diagnosis of concussion, see your physician or nurse practitioner, or if there are delays, attend a walk-in clinic. If you are experiencing severe symptoms such as severe headache, confusion, seizure, repeated vomiting and worsening in your symptoms, then a trip to the ER may be needed to ensure you did not sustain a more severe injury.

The content on this website is for informational and educational purposes only and is not intended to be a substitute for medical advice, diagnosis, or treatment.

Following a concussion, a brief period of rest is recommended for the first 24-48 hours, such as avoiding intensive work or pushing yourself cognitively or physically. Rest does not mean lying in a dark room with no stimulation and avoiding all activity. We now know that isolating yourself in a dark room is not helpful and can actually prolong your concussion symptoms.

After the brief rest period, gradually increase your activity levels while still taking it easy by staying just below your symptom threshold (e.g., onset or worsening of symptoms), taking breaks as needed to stay comfortable, and not pushing into and making your symptoms worse (Type A personalities beware!).

In fact, ignoring and pushing through your symptoms will not get you back to life faster. Instead, it could make your recovery take longer.

So, what does a Type A person with a concussion do?

Don’t beat yourself up. Take it easy, take breaks as you need, make room for some self-compassion, and gradually increase activities over time over the next couple of weeks. After the initial rest period, research has shown that light cardio exercise (e.g., walking) can help with recovery. But don’t push into your pain and symptoms. In the case of concussion, “no pain, no gain” does not apply.

The content on this website is for informational and educational purposes only and is not intended to be a substitute for medical advice, diagnosis, or treatment.

80% of people recover from concussion symptoms within 7-14 days of injury, with the average recovery period lasting 10 days. Although post-concussion symptoms may resolve within 2 weeks, we do not yet know how long it takes the brain to physically heal after a concussion. So, take care not to re-injure yourself in the weeks ahead, it could set you back in your recovery.

The following are risk factors for longer than expected recovery following concussion. The more risk factors you check off, the higher the chances for a prolonged recovery.

• Multiple moderate to severe physical symptoms and sensitivities following mild traumatic brain injury (concussion).
• Moderate to severe cognitive symptoms.
• Post-traumatic headaches and/or migraine that won’t quit.
• Symptoms of depression, anxiety, trauma or sustaining the injury within the context of a stressful period in your life or stressful circumstances.
• Pre-existing mental health history including anxiety, depression, trauma.
• Adverse childhood history or adverse life events pre-existing injury (adversity can wire the brain for chronic pain).
• Past history of concussion(s)

Being at risk for prolonged recovery following a concussion does not mean that there is nothing you can do to change your outcome. If you have checked off several of the above risk items, you may benefit from targeted treatment to reduce your recovery time.

The short answer is yes.

The longer answer is, it depends. They don’t have to. There is a lot we have learned over the past several years about who is at risk for prolonged concussion recovery, what the barriers are to recovery and how to effectively target barriers to concussion recovery in treatment.

Although symptoms experienced immediately or shortly after injury can be directly related to brain injury, over time the brain heals and persistent symptoms can be maintained by many other factors, known as barriers to recovery.

Barriers to recovery following concussion can include depression, anxiety, avoidance of triggers (e.g., sound, lights, screens, physical or cognitive exertion), sleep problems, fatigue, pain (e.g., headaches), focusing on your symptoms, over exertion and experience of repeated setbacks in symptoms, and misinformation by well meaning family and health professionals. These factors can further interact to escalate each other (e.g., anxiety can fuel pain circuits in the brain) and maintain or even worsen symptoms.

Fortunately, neuropsychologists knowledgeable in concussion management can treat most barriers to recovery and get you on the right track to feeling like yourself again.

Neuropsychological treatment at Toronto Brain Health may include the following:

• Education and guidance to resolve symptoms more quickly.
• Biopsychosocial approaches to the treatment of chronic pain and physical symptoms (e.g., headaches, light and sound sensitivities), in conjunction with physiotherapy and neurology at other clinics or programs.
• Treatment of anxiety, depression, irritability, trauma, sleep problems, symptom preoccupation, low stress tolerance.
• Cognitive exertion training and cognitive rehabilitation , if indicated.
• Return to work or school readiness determination, a return plan, and guidance through the process.
• Many of our psychologists provide services under the WSIB Community Mental Health Program, insurer benefit plans and auto insurance for motor vehicle accidents.

Neuropsychology is a specialty of clinical psychology that addresses the relationship between the brain, nervous system, thoughts, emotions, and behaviour. Neuropsychologists assess many changes that can occur following a concussion including in memory, attention, organization, processing speed, irritability, depression, anxiety, low stress tolerance, trauma, insomnia as well as onset of chronic pain/ headaches, and light and sound sensitivities. These changes can be temporary or persistent depending on pre-existing health and psychological factors. Neuropsychologists are uniquely qualified to assess and treat the full spectrum of brain, emotion, pain and behaviour changes due to concussion.

Neuropsychologists have training and expertise in functional neuroanatomy, neuropathology, behavioural neuroscience, psychological and neuropsychological assessment, cognitive rehabilitation, and psychological therapies, which are invaluable to the comprehensive management of sports-related concussions. In the past few decades, neuropsychologists have significantly contributed to the knowledge, research, and clinical practices pertaining to traumatic brain injuries, most recently including those sustained in sport.

"A subspecialty of clinical neuropsychology that applies the science and understanding of brain-behavior relationships to the assessment and treatment of sports-related brain injury. The practice of sports neuropsychology requires education, training, experience, and competence in the primary field of clinical neuropsychology, followed by a secondary specialization through experience and understanding of applying clinical neuropsychology to the unique demands of evaluating and treating brain injury in the sports domain.”  - An Official Position of the Sports Neuropsychology Society.

For most athletes, post-concussive symptoms resolve within 10-14 days. By approximately 2 weeks, based on the pooled mean across multiple studies, athletes (18 years and older) make a full return to sport following evidence-based recommendations. By an average of 10 days, studies show that 93% of student athletes of various ages make a full return to learning with no additional academic support (Putukian et al., 2023).

Each athlete’s return to school and/or sport plan should be evaluated on an individual basis, including consideration of specific factors that can impact their recovery and successful return. If an athlete’s symptoms worsen or their recovery plateaus between 2 to 4 weeks, adding a neuropsychologist to the care team can be invaluable in identifying and treating barriers to recovery and return to play or learning. However, involving a neuropsychologist can be beneficial at any point following injury; early on for those with risk factors for prolonged recovery, or later after all other avenues have been exhausted as gains are possible even months to years after injury depending on the clinical profile of the athlete.

In our clinical experience, we have seen professional or elite athletes prematurely retire or leave the sport only to make a full recovery up to a decade post-injury with neuropsychological rehabilitation. Many symptoms in uncomplicated concussions (e.g., no evidence of more severe brain injury such as skull fracture or brain bleed) are amenable to full resolution when a broader biopsychosocial approach is applied to identifying and targeting key barriers to recovery.

80% of people recover from concussion symptoms within 7-14 days of injury, with the average recovery period lasting 10 days. Although post-concussion symptoms may resolve within 2 weeks, we do not yet know how long it takes the brain to physically heal after a concussion. So, take care not to re-injure yourself in the weeks ahead, it could set you back in your recovery.

The short answer is yes.

The longer answer is, it depends. They don’t have to. There is a lot we have learned over the past several years about who is at risk for prolonged concussion recovery, what the barriers are to recovery and how to effectively target barriers to concussion recovery in treatment.

The following are risk factors for longer than expected recovery following concussion. The more risk factors you check off, the higher the chances for a prolonged recovery.

• Multiple moderate to severe physical symptoms and sensitivities following mild traumatic brain injury (concussion).
• Moderate to severe cognitive symptoms.
• Post-traumatic headaches and/or migraine that won’t quit.
• Symptoms of depression, anxiety, trauma or sustaining the injury within the context of a stressful period in your life or stressful circumstances.
• Pre-existing mental health history including anxiety, depression, trauma.
• Adverse childhood history or adverse life events pre-existing injury (adversity can wire the brain for chronic pain).
• Past history of concussion(s)

Being at risk for prolonged recovery following a concussion does not mean that there is nothing you can do to change your outcome. If you have checked off several of the above risk items, you may benefit from targeted treatment to reduce your recovery time.

Although symptoms experienced immediately or shortly after injury can be directly related to brain injury, over time the brain heals and persistent symptoms can be maintained by many other factors, known as barriers to recovery.

Barriers to recovery following concussion can include depression, anxiety, avoidance of triggers (e.g., sound, lights, screens, physical or cognitive exertion), sleep problems, fatigue, pain (e.g., headaches), focusing on your symptoms, over exertion and experience of repeated setbacks in symptoms, and misinformation by well meaning family and health professionals. These factors can further interact to escalate each other (e.g., anxiety can fuel pain circuits in the brain) and maintain or even worsen symptoms.

Fortunately, neuropsychologists knowledgeable in concussion management can treat most barriers to recovery and get you on the right track to feeling like yourself again.

In many cases, an initial consultation helps determine whether neuropsychological assessment is recommended before beginning treatment. Assessment may be helpful when diagnostic clarification, detailed functional evaluation, rehabilitation planning, or readiness to return to cognitively demanding, high-responsibility, or safety-sensitive roles is being considered. Providing relevant medical or rehabilitation documentation in advance of the initial consultation can assist us in understanding your individual circumstances and guiding recommendations.

Neuropsychological rehabilitation may be appropriate for individuals experiencing cognitive, emotional, or functional changes following acquired brain injury (e.g., stroke or traumatic brain injury), autoimmune conditions such as multiple sclerosis, neurological illness including neurosurgical or tumour-related conditions, or medical treatments affecting brain function, including cancer treatment.

Yes. Cognitive rehabilitation and neuropsychologically informed psychological therapy are available both in-person in Toronto and virtually for individuals located in Ontario, Quebec, Nova Scotia, and New Brunswick.

Yes. Treatment often includes structured support with return-to-work or return-to-school planning particularly in cognitively complex, high-stakes, or safety-sensitive roles. This may involve cognitive strategy development, work hardening or graduated reintegration through work-like tasks, psychological support, development of individualized return-to-work or academic reintegration plans that can be shared with employers or educational institutions, and recommendations regarding accommodations to support functional performance and a sustainable return to work or study.

Services provided by registered psychologists are often eligible for reimbursement through extended health benefit plans. Coverage varies, and individuals are encouraged to confirm details with their insurance provider. Costs which are not covered can be submitted under medical expenses when you file your taxes.

Direct billing is available for select extended health benefit plans. Coverage and eligibility vary. Our intake coordinator can assist in determining whether direct billing is available through your provider. When direct billing is not available, receipts are provided for reimbursement.

Referrals are welcome from physicians, rehabilitation professionals, insurers, legal representatives, and other healthcare providers. Individuals may also contact the clinic directly to inquire about services, and a referral is not required to begin care.

The duration of treatment varies depending on individual needs, clinical complexity, and rehabilitation goals. Some individuals benefit from short-term targeted intervention, while others may require longer-term support.

Treatment for functional neurological conditions, somatic symptom presentations, and post-viral syndromes is provided through our Chronic Pain Clinic.

Attention-Deficit/Hyperactivity Disorder or ADHD is a neurodevelopmental condition that was previously separated into ADHD and Attention-Deficit Disorder (ADD). ADHD is now the umbrella term for 3 different conditions: Inattentive, Hyperactive/Impulsive, and Combined. ADHD occurs in about one in every twenty children with a third of children retaining their diagnosis into adulthood. You are more likely to have ADHD if you have a first-degree family member with ADHD, such as a parent or sibling. ADHD is diagnosed twice as often in males than in females. Males are more likely to have readily apparent hyperactivity symptoms whereas females tend to have inattentive symptoms. As a result, ADHD is more often missed in females.

For many individuals ADHD symptoms can be chronic and lifelong. Although more than 50% of individuals with ADHD are diagnosed in childhood and adolescence, many people are not formally diagnosed until adulthood. Symptoms of ADHD can present differently across the lifespan, with teens and adults showing fewer symptoms of hyperactivity than children.

Inattentive symptoms:

• Lack of attention to detail or tendency toward careless mistakes in school or at work.
• Difficulty sustaining attention during task completion.
• Tuning out when spoken to, even without external distraction.
• Failing to follow instructions or complete work or school assignments.
• Often having difficulty organizing tasks or activities (keeping belongings in order, disorganized work, poor time management, failing to meet deadlines).
• Avoiding, delaying or reluctance to engage in tasks requiring sustaining mental effort.
• Often losing or misplacing things.
• Frequently being distracted by inner thoughts or outside stimuli.
• Forgetfulness for day-to-day activities (house maintenance tasks, paying bills, keeping appointments).

Hyperactivity-impulsive symptoms:

• Often fidgeting with hands, feet, or having difficulty sitting still.
• Difficulty staying seated for longer periods of time in situations where this is socially expected.
• Feeling restless.
• Difficulty engaging quietly in activities.
• Often being “on the go” and feeling uncomfortable staying still for extended periods of time such as at restaurants or in meetings.
• Talking excessively.
• Interrupting others in conversation, blurting out the answer before the question is completed, finishing other people’s sentences.
• Difficulty with waiting, such as in line.
• Interrupting or intruding on others’ conversations, games, or activities, or using other people’s things without asking.

If you experience several of the above inattentive, hyperactivity-impulsive symptoms or a combination of both, and these symptoms are interfering with your functioning at school, work, and/ or in your social life, it is possible that you have ADHD. A formal assessment can help clarify whether a diagnosis of ADHD is appropriate.

Individuals can receive a diagnosis of ADHD from a mental health provider (e.g., psychologist or psychiatrist) or a primary care provider (e.g., family physician). However, it is important to note that diagnosis of ADHD can often be complicated in the presence of other medical, psychological, neurological, or circumstantial conditions, such as nutritional deficiencies, thyroid dysfunction, severe anemia, medication side effects, history of mood or anxiety disorder, history of concussion and other neurological conditions, or circumstances such as high stress or sleep deprivation.

In other words, difficulties with attention are not specific to ADHD and can occur for several reasons. Likewise, ADHD is frequently missed in people with psychiatric and neurological conditions as the related symptoms can mask those of ADHD. A comprehensive neuropsychological evaluation can provide a clearer understanding of relevant medical, neurological and psychiatric conditions, and whether they are contributing to or accounting for your attentional difficulties.

Moreover, neuropsychological evaluations include a detailed clinical interview of your personal history and current symptoms, review of medical documentation, diagnostic psychological evaluation, psychometric measures of psychological symptom severity, and objective psychometric testing of your attention and other cognitive abilities.

Neuropsychological assessment involves an examination of brain and behaviour. Your performance on a variety of paper-pencil and computer tests provides a cognitive profile and information about the integrity of your brain function. Cognitive testing can take several hours to complete depending on the reason for referral. For many conditions, objective cognitive tests are more sensitive in detecting brain dysfunction or changes than current neuroimaging methods. Thinking abilities tested can include attention, IQ and academic abilities, processing speed, learning and memory, language skills, visuoperceptual abilities, motor coordination, and executive functions, such as problem solving, planning, reasoning, impulse control, and working memory (the ability to hold and manipulate information in mind).

Psychological psychometric testing is also completed. All psychometric scores are compared to normative datasets. Normative datasets can control for the effects of age, education, gender, neurological or psychological conditions on test scores. In addition to cognitive and psychological testing, neuropsychological evaluations include a detailed clinical interview, diagnostic psychological evaluation, and review of medical, psychological and/ or neurological documentation. Interpretation of the comprehensive neuropsychological profile and formulation of diagnoses are informed by considering the interplay and impact of many variables.

Questions that can be answered by a neuropsychological evaluation, depending on the nature of the referral, can include the following:

• Diagnosis of neurological or neurodevelopmental disorders and their impact on cognitive function.
• Provision of clinical opinions and information to assist multidisciplinary care teams in reaching diagnoses of complex conditions or determining whether a medical intervention or medication was successful in improving cognition.
• Diagnosis of psychological conditions including their impact on cognitive function.
• Types of cognitive abilities impaired or preserved.
• Severity of cognitive difficulties.
• Factors likely contributing to or causing cognitive difficulties.
• Improvement or decline in cognitive functioning over time with repeat testing.
• Recommendations pertaining to treatment plans for neurological and/or psychological conditions.
• How to optimize cognitive functioning via intact cognitive abilities (cognitive rehabilitation).
• Recommendations pertaining to accommodations for work and academic settings.
• Whether cognitive changes are normal for age or indicative of a neurodegenerative process.
• Guidance on future planning and decision making in cases of neurodegenerative or brain injury conditions (dealing with finances, medication administration, meal preparation, and driving).
• Informing prognosis and/ or recovery in neurological and psychological conditions.

Neuropsychologists have advanced training in the administration and interpretation of psychometric tests, psychological and neurological diagnosis, neurocognitive and behavioural interventions, and psychotherapy.

An accurate diagnosis of ADHD is important to effectively treat the underlying cause of attentional symptoms. For instance, if your difficulties with attention are due to underlying anxiety, then taking prescription medication for ADHD will not improve your symptoms. Once a diagnosis is attained, the first line of treatment for ADHD is a medication which can be prescribed by primary care providers and psychiatrists. Education about the nature of ADHD, related conditions diagnosed, and their impact on your symptoms and difficulties can be helpful in creating an effective treatment plan specific to your needs.

The benefit of combined treatment for ADHD, medication and cognitive behavioural treatment is supported by research and widely recommended as it can lead to better functional improvement than one type of therapy alone. For instance, stimulant medication, the primary pharmacological approach to treating ADHD, cannot cover the whole day due to the need for medication breaks to address side effects such as insomnia and appetite suppression. Likewise, learning and implementing cognitive behavioural strategies may be challenging without sufficient ability to focus.

ADHD is also often accompanied by other conditions such as depression, anxiety, sleep problems, low self-esteem and substance and/or alcohol misuse, that if treated, can improve one’s overall well-being, productivity and functioning.

Cognitive behavioural treatment for ADHD can include cognitive, behavioural and psychological strategies including:

• Time and task management
• Prioritization
• Problem management and decision making
• Planning and organization
• Goal management
• Dealing with distractions
• Procrastination and avoidance
• Initiation and motivation
• Environmental modifications
• Coping with task-interfering thoughts and emotions

Psychological interventions or psychotherapy for conditions often associated with ADHD may include the following approaches:

• Acceptance and commitment therapy
• Mindfulness-based approaches
• Cognitive behavioural therapy (CBT)
• Assertiveness and healthy boundaries in personal and professional relationships.
• Other evidence-based approaches, as needed, to treat accompanying psychological conditions, facilitate navigation of academic and workplace issues, or integration of cognitive remediation and behavioural tools (see above).

Signs and symptoms of anxiety

Anxiety can present in a range of ways, including excessive worry, panic attacks, feeling physically tense or on edge, and difficulty sleeping or concentrating. Many people begin to seek anxiety treatment when these symptoms persist, worsen, or start to interfere with daily life, work performance, or relationships.

When to seek treatment for anxiety

From a clinical perspective, anxiety therapy is recommended when symptoms are not only present, but are causing significant distress or interfering with important areas of life such as work, relationships, health, or day-to-day responsibilities.

This may show up as difficulty maintaining focus or performance at work or in academics, avoiding situations or people due to anxiety, disrupted sleep, feeling persistently overwhelmed or on edge, muscle tension (e.g., in the neck and shoulders), increased irritability, or fatigue.

When anxiety may indicate an anxiety disorder

When symptoms reach this level of impact, they may meet criteria for an anxiety disorder. Because different types of anxiety (e.g., generalized anxiety, panic disorder, phobias, or trauma-related conditions) can present with overlapping symptoms, accurate assessment and diagnosis by a psychologist or psychiatrist are important to guide the most appropriate, evidence-based treatment targeting the underlying source of symptoms.

Common physical symptoms of anxiety

• Heart racing or palpitations
• Tightness or pressure in the chest
• Trembling or feeling shaky
• Tingling in the hands, feet, or face
• Nausea, diarrhea, or stomach upset
• Hot flashes or chills
• Light-headedness or dizziness
• Feeling physically tense or persistently on edge
• Difficulty falling or staying asleep
• Difficulty concentrating or maintaining focus
• Fatigue or low energy

Common cognitive symptoms of anxiety

• Excessive worry
• Difficulty concentrating due to worry
• Mind going blank or losing your train of thought
• Feeling as though one is going crazy or losing control
• Obsessive thoughts or persistent rumination

What to do if anxiety is affecting your daily life

If your symptoms are persisting, worsening, or beginning to affect your work, relationships, or daily functioning, an initial consultation can help clarify what you’re experiencing and determine whether targeted treatment would be beneficial. Our clinic offers in-person anxiety therapy in Toronto, with virtual services available across Ontario, Quebec, New Brunswick, and Nova Scotia.

You can also learn more about how anxiety develops and responds to treatment in our Anxiety Blog.

What a panic attack feels like

A panic attack is the sudden onset of intense fear or discomfort. It triggers a range of physical and cognitive symptoms, such as a racing heart, chest tightness or pressure, tingling in the hands or feet, or dizziness. Symptoms can be so intense that people often fear they are having a heart attack, suffocating, or in danger of dying. As a result, it is not uncommon for individuals to go to a hospital emergency department during their first panic attack.

Because these symptoms can overlap with medical conditions such as heart problems, it is important to seek medical evaluation if they are new, severe, or unclear.

Panic attacks differ from general anxiety or worry in that they involve a sudden surge of intense symptoms that peak quickly, rather than a gradual build-up of tension. In some cases, escalating anxiety or worry can build to the point of triggering a panic attack.

Common symptoms of a panic attack

• Rapid heart rate or palpitations
• Chest tightness, pressure, or discomfort
• Shortness of breath or feeling smothered
• Dizziness or light-headedness
• Tingling or numbness
• Sweating, chills, or hot flashes
• Feeling detached, unreal, or out of control
• Fear of losing control, suffocating, or dying

Can panic attacks occur during sleep?

Panic attacks can also occur during sleep (sometimes referred to as nocturnal panic attacks). Individuals may wake suddenly with intense physical symptoms such as a racing heart, shortness of breath, or a sense of fear. These episodes can feel particularly alarming, but they are understood within the same framework as daytime panic attacks.

How long panic attacks last and when to seek help

A panic attack typically reaches its peak within a few minutes. It usually subsides within 5 to 20 minutes. In some cases, individuals may experience multiple attacks within a short period or across a single day.

If panic attacks are recurring or lead to avoidance of certain situations or physical sensations (e.g., avoiding activities that increase heart rate or foods and drinks that trigger physical sensations), this may indicate panic disorder. Evidence-based treatment, such as cognitive behavioural therapy (CBT), can be very effective in reducing fear of these sensations and breaking the cycle that drives repeated attacks.

When panic attacks occur as part of another condition

Treatment for panic attacks depends on the context in which they occur. Panic attacks can arise as part of several psychological conditions, including generalized anxiety, phobias, trauma-related disorders, or periods of escalating stress. In these cases, treatment is directed at the underlying condition driving the symptoms, rather than the panic attacks in isolation.

Accurate assessment and diagnosis of an anxiety disorder by a registered psychologist are important. This guides the most appropriate and targeted treatment approach. It also helps ensure that treatment focuses on the underlying factors driving symptoms, rather than relying primarily on symptom management strategies, which may provide short-term relief but can inadvertently maintain or worsen the problem over time.

Understanding the panic cycle in panic disorder

When panic attacks occur in the context of panic disorder, treatment focuses on reducing fear of the physical sensations associated with panic and breaking the cycle between physical sensations, catastrophic interpretations, and reactive fear. This cycle can lead to repeated panic attacks, persistent concern about further attacks, avoidance of triggers, and behavioural changes that maintain or worsen panic disorder over time.

For example, someone may notice a racing heart and interpret it as dangerous. This increases anxiety and leads to further escalation of physical and cognitive symptoms, such as shortness of breath, sweating, or fear of having a heart attack or dying. In response, they may begin to avoid situations that trigger these sensations, such as walking up stairs, going to the gym, or engaging in activities that increase heart rate.

Over time, this pattern can shift from occasional panic attacks to persistent concern about having another attack. This is often accompanied by increasing avoidance of both physical sensations and triggering situations—key features of panic disorder.

How panic disorder treatment works (CBT and exposure)

Cognitive behavioural therapy (CBT) is an effective, evidence-based treatment for panic disorder. Treatment includes interoceptive exposure, a targeted technique that involves gradual, repeated exposure to feared physical sensations—such as increased heart rate, shortness of breath, or dizziness—in a safe setting.

As these sensations are repeatedly experienced without the feared outcome (e.g., “I am going to die”), fear of the sensations decreases.

Interoceptive exposure is then paired with broader situational exposure. This involves gradually returning to previously avoided activities, such as exercising, taking the stairs, or re-engaging in daily routines that increase heart rate. Over time, this reduces avoidance and improves tolerance of previously feared bodily sensations.

Over time, CBT can substantially reduce the intensity and frequency of panic attacks. It also supports greater confidence in engaging with previously avoided situations and activities. As fear of the sensations decreases, panic attacks become significantly less likely to occur—even though the sensations themselves may still feel uncomfortable.

Yes. Psychologists are regulated health professionals with advanced training—most often at the doctoral level in Canada (Ph.D. or Psy.D.)—in psychological assessment, diagnosis, and evidence-based treatment. They are qualified to assess and diagnose mental health conditions, including anxiety disorders, depression, obsessive-compulsive disorder (OCD), insomnia, somatic symptom disorder (SSD), functional neurological disorder (FND), post-traumatic stress disorder (PTSD), and other trauma-related conditions, among others, and to provide targeted psychological therapy.

In Canada, the title “psychologist” is regulated by provincial colleges. In some jurisdictions, psychological associates (with master’s-level training) may also be authorized to assess and diagnose. Compared to other therapy providers, psychologists receive extensive training in clinical assessment, diagnosis, and treatment, allowing for a comprehensive understanding of how symptoms develop and are maintained. This supports more precise, evidence-based treatment planning, particularly when concerns are complex, overlapping, or not responding to previous approaches.

All psychologists at Toronto Brain Health have doctoral-level training (Ph.D.), and some have additional post-doctoral fellowship training or board certification in the United States. As a Toronto-based psychology clinic, we bring extensive education and clinical experience across clinical psychology, neuropsychology, and rehabilitation psychology. This depth of training supports comprehensive assessment, accurate diagnosis, and the delivery of targeted, formulation-driven treatment for a wide range of psychological and neurological concerns.

You can learn more about the role of psychologists through the Canadian Psychological Association.

Many people come to therapy with a specific approach in mind (e.g., cognitive behavioural therapy [CBT] or emotion-focused therapy [EFT]), while others are unsure where to start. Both are appropriate.

How therapy is selected

In practice, the type of therapy used is determined through a careful understanding of your symptoms, diagnosis or case formulation, and the key factors contributing to your current difficulties. This process allows your psychologist to identify which evidence-based approaches are most appropriate for your situation—particularly when concerns are complex or overlapping.

Many individuals present with more than one psychological condition. In these cases, diagnostic formulation—developed collaboratively with you—helps clarify where to begin and which areas of focus are likely to have the greatest overall impact, guiding the initial direction of treatment.

This includes identifying the key processes driving distress and the persistence of symptoms, as well as determining whether a particular condition requires priority in treatment due to its nature or severity. In some cases, one condition may contribute to or worsen others. Targeting the most influential area first helps inform which therapeutic approach is selected and can lead to broader and faster improvement.

How different therapy approaches are used

Treatment is then informed by the strongest available evidence for that condition and the mechanisms involved. For example, cognitive behavioural therapy (CBT) is well-established as an effective treatment for panic disorder and obsessive-compulsive disorder (OCD), where targeting fear-based learning, avoidance, and behavioural patterns is central.

Generalized anxiety disorder or depression may benefit from CBT, emotion-focused therapy (EFT), acceptance and commitment therapy (ACT), or a combination of these approaches. Individuals may connect more or less with different therapeutic approaches, and this is considered alongside clinical evidence to ensure the treatment is both effective and a good fit.

Individuals with complex or repeated trauma may benefit from a more integrative approach. This may draw on cognitive behavioural therapy, cognitive processing therapy (CPT), mindfulness-based approaches, and emotion-focused therapy (EFT). These approaches address not only patterns of thinking and avoidance, but also nervous system regulation, emotional processing, relational patterns, and meaning-making.

Your preferences and goals are always taken into account. At the same time, your psychologist provides clear guidance on the most effective starting point and treatment plan based on clinical expertise and evidence. The goal is not to try multiple approaches without direction, but to select and apply the therapies most likely to address the underlying drivers of your difficulties and support meaningful change—particularly when symptoms have been persistent or not fully resolved with previous treatment.

Therapy often includes Cognitive Behavioural Therapy (CBT) to address unhelpful thinking patterns, behavioural withdrawal, and reduced engagement in meaningful activities. We may also integrate Emotion-Focused Therapy (EFT) to support the processing of emotional experiences, such as sadness, shame, and unresolved childhood attachment injuries, or Acceptance and Commitment Therapy (ACT) to help you develop a different relationship with difficult thoughts and feelings, and re-engage with meaningful activities even when mood remains low.

A key part of treatment involves understanding how depression operates in your day-to-day life and addressing both symptoms and the underlying patterns that sustain them. Over time, this approach supports improvements in mood, energy, motivation, and your ability to engage more fully in daily life.

The symptoms of post-traumatic stress disorder (PTSD) typically begin within 3 months of the traumatic event, but some symptoms can develop later. Symptoms last at least one month and cause a significant disruption in day-to-day functioning.

Re-experiencing Symptoms:

• Reoccurring distressing memories and/or dreams of the traumatic event
• Distressing thoughts related to the traumatic event
• Flashbacks of the traumatic event (where it feels as though it were reoccurring)
• Intense, prolonged psychological distress/stress when exposed to trauma-related cues.

Avoidance Symptoms:

• Staying away from memories, thoughts, feelings, related to the traumatic event
• Staying away from people, places and/or things related to the traumatic event.

Negative Changes in Cognition and Mood

• Having difficulty remembering an important aspect of the trauma
• Negative thoughts about oneself, others, or the world
• Negative beliefs about the cause or consequences of the traumatic event
• Ongoing negative emotions (e.g., fear, horror, anger, guilt, shame)
• Significantly less interest or participation in important activities
• Feeling detached or estranged from others
• Persistent inability to experience positive emotions

Significant Changes in Arousal and Reactivity

• Irritable behaviour, angry outbursts, being “on-edge”
• Engaging in reckless or self-destructive behaviour
• Hypervigilance
• Being easily startled
• Having difficulty concentrating
• Having difficulty falling or staying asleep

Symptoms may also present with feelings of depersonalization (feelings of detachment / as if one were an observer of one’s mental processes/body) and derealization (altered sense of reality).

We provide evidence-based treatment for post-traumatic stress disorder (PTSD) and trauma-related symptoms, using an integrative approach tailored to your specific needs and the factors maintaining your symptoms.

Treatment may include Cognitive Behavioural Therapy (CBT) and Cognitive Processing Therapy (CPT) to help identify and modify unhelpful thoughts and beliefs related to the traumatic experience, as well as reduce patterns of avoidance and ongoing emotional and physical reactivity.

We also draw on Emotion-Focused Therapy (EFT) to support the processing of underlying emotions, including fear, shame, and unresolved distress or interpersonal attachment injuries, helping you make sense of your experience, develop a new narrative, and reduce the impact of trauma over time.

Across approaches, treatment focuses on processing the trauma, reducing reactivity in the nervous system, and supporting meaningful recovery in day-to-day functioning.

Cognitive Behavioural Therapy (CBT) is an evidence-based approach for treating anxiety disorders, including generalized anxiety, social anxiety, and panic attacks. Treatment focuses on identifying and modifying patterns of thinking and behaviour that contribute to ongoing anxiety.

In CBT, a psychologist works with you to understand the factors maintaining your anxiety, including excessive worry, threat-focused thinking, and avoidance behaviours. You learn practical strategies to challenge unhelpful thoughts, gradually face feared situations, and reduce emotional and physical reactivity.

Over time, this approach helps reduce anxiety symptoms, improve confidence in managing stress, and restore functioning in daily life.

There are many things we can do to reduce our risk of developing dementia, even starting in mid-life or later. In fact, there is a large and growing body of research on this topic. Through research, we have learned that staying physically active is important to slowing down decline and even improving cognition. The mechanisms by which exercise can be beneficial to brain health are many but can include improving cardiovascular disease and stimulating brain protein production important for growth of nerve/ brain cells and in sustaining them. Advanced education, being a lifelong learner and having an intellectually stimulating career are protective agents against developing dementia as is social engagement. The Mediterranean diet, rich in fruit, vegetables, legumes, whole grains and fish, has been associated with lower incidence of cognitive decline and dementia. Numerous well-designed studies have shown positive effects of diets low in saturated fats on cognition, even showing improvement in as little as 4 weeks.

READ: Dr. Carson’s article for a list of tips on maintaining brain health.

We offer unbiased and comprehensive evaluation of a range of psychological and neurological conditions. We adhere to the latest guidelines and population-based research on the use and interpretation of symptom and performance-based validity measures. Medicolegal evaluations are provided by doctoral-level psychologists with certification in medicolegal expertise, CMLE (ON) and/ or in the assessment for Catastrophic Impairment – Mental Behavioural, C-CAT (MB), through the Canadian Society of Medical Evaluators / Canadian Academy of Psychologists in Disability Assessment (CSME-CAPDA). Regardless of the reason for referral, your client will be treated with respect and care.

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Toronto Brain Health offers a range of clinical services to individuals coping with psychological and/or neurological difficulties. Our referral network is broad and includes physicians, allied health professionals, community and executive health clinics, hospital and rehabilitation centre programs, third party insurers, lawyers and self-referrals from the community. Individuals referred to us by third party sources benefit from our breadth of services and knowledge.

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