Brenda B. Toner

University of Toronto, Toronto, Ontario, Canada

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Publications (100)510.18 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Breast cancer treatments and the traumatic nature of the cancer experience frequently elicit considerable sexual difficulties. Breast cancer survivors (BCS) experiencing body image (BI) issues may represent a vulnerable group for developing sexual dysfunction posttreatment. The current study explores sexual functioning (SF) in this unique clinical group. A descriptive study assessed 127 BCS who were engaged in sexual activity. Standardized baseline measures included the following: BI Scale, BI after Breast Cancer Questionnaire, Female Sexual Function Index (FSFI), Kansas Marital Satisfaction Scale, and Functional Assessment of Cancer Therapy - Breast. Levels of SF were compared with BCS, heterogeneous cancer, and healthy female populations. Correlational analyses were conducted between SF, BI, relationship, and health-related quality of life variables. Guided by a conceptual framework, regression analyses were conducted to determine significant demographic, clinical, and psychosocial predictors of sexual desire, satisfaction, and overall SF. Eighty-three per cent of BCS met the FSFI clinical cutoff score for a sexual dysfunction. Participants exhibited poorer SF when compared with other female cancer and healthy groups. No significant correlations were found between BI questionnaire total scores and SF. BI after Breast Cancer Questionnaire - Body Stigma subscale showed significant associations with FSFI Arousal, Orgasm, Satisfaction (average r = -0.23), and overall SF (r = -0.25). Vaginal dryness (β = -0.50), body stigma (β = -0.24), and relationship satisfaction (β = 0.27) were significant predictors of overall SF. Difficulties in SF appear to be highly prevalent in BCS experiencing BI disturbance posttreatment. Brief screening tools assessing SF should adopt a biopsychosocial model, which includes questions regarding vaginal dryness, relationship satisfaction, and body stigma issues. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
    Psycho-Oncology 04/2015; DOI:10.1002/pon.3819 · 2.44 Impact Factor
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    ABSTRACT: Research from the United States suggests that Latin American immigrant and refugee women are one of the groups most greatly impacted by intimate partner violence (IPV) and associated mental health consequences including higher rates of depression than women from other ethno-racial groups. In Canada, little is known about the experience of IPV and mental health among this population. Even in the broader North American context, how Latin American women themselves perceive the connection between IPV and depression is unknown. This paper presents the findings of a pilot study that examined the perceived relationship between IPV and depression among Spanish-Speaking Latin American Women in Toronto, Canada. The theoretical framework guiding this qualitative study combined an ecological model for understanding gender based violence and mental health with critical intersectionality theory. Using a convenience and snowball sampling method, semi-structured interviews (n = 12) were conducted and thematic content analysis was completed supported by Nvivo9(®) qualitative data management software. All participants had experienced some form of IPV in their adult lives, with psychological violence being the most common. Women perceived a powerful connection between IPV and depression, a link made stronger by the accumulation of other adverse life experiences including childhood abuse, war traumas and migration. The results suggest that IPV is just one of the challenges experienced by Latin American refugee and immigrant women. IPV is experienced in the context of other traumatic experiences and social hardships that may work to intensify the association of IPV and depression in this population.
    Journal of Immigrant and Minority Health 12/2014; 17(6). DOI:10.1007/s10903-014-0145-1 · 1.16 Impact Factor
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    ABSTRACT: The development of posttraumatic growth (PTG) and the relationship between PTG and distress outcomes in sexual assault is an important area of investigation. Recent research suggests that some forms of cognitive processing might be critical in the development, maintenance, and resolution of posttraumatic mental health among sexual assault survivors. The objective of this study was to examine factors associated with posttraumatic mental health among sexual assault survivors. Seventy-three participants who experienced sexual assault completed measures of trauma symptoms, PTG, changes in outlook, cognitive processing, and support and coping. Results revealed that significant levels of posttraumatic symptomatology and low levels of PTG were reported 3 years following sexual assault. A weak relationship was found between symptoms of distress and growth. Contrary to predictions, only ratings of hope and brooding rumination were mediators of the relationship between posttraumatic symptoms and PTG. Reflective rumination was not related to the development of PTG.
    Journal of Aggression Maltreatment & Trauma 03/2014; 23(3):301-317. DOI:10.1080/10926771.2014.881948
  • Danielle Katz · Brenda Toner ·
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    ABSTRACT: Substance use disorder (SUD) onset, trajectory, comorbidity, and outcome can differ greatly according to sex and gender. Mindfulness-based interventions are promising treatments for SUD; however, as of yet, no systematic review has organized the results of studies examining these treatments according to gender. The purpose of this review was to determine whether gender influences the efficacy and effectiveness of mindfulness-based treatments (MBTs) for substance use. A systematic review was conducted on journal databases, and out of 36 papers that met the criteria for inclusion, 6 included participant gender as a variable. Two papers based on one randomized controlled trial study failed to find gender differences in the efficacy of MBTs for substance use, though a number of quasi-experimental studies and case series did find that women gravitated more towards MBTs or that women may have benefitted more from mindfulness interventions. Overall, MBTs hold promise as treatments for SUD. Additional research on mindfulness-based interventions for SUDs is needed that includes gender as a variable.
    Mindfulness 12/2013; 4(4). DOI:10.1007/s12671-012-0132-3
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    ABSTRACT: Background: Physical activity is associated with reduced mortality and morbidity. Cardiac rehabilitation (CR) is an effective intervention for patients with cardiovascular disease (CVD). Unfortunately, women are less likely to engage in, or sustain, regular physical activity. Objectives were to (1) describe women's guidelines-based levels of physical activity during and after CR and (2) determine the physical activity trajectories of women from entry to CR to one year after CR. Methods and results: A prospective, longitudinal study of 203 women with CVD enrolled in a 6-month CR program. Physical activity was measured using the Godin Leisure Time Exercise Questionnaire (LSI), focusing on moderate-strenuous activity. Data were analyzed using latent class growth analysis (LCGA) and logistic regression. Mean scores on the LSI showed women to be "active" at all follow-up points. LCGA revealed a two-class model, respectively, called "inactive relapsers" and "moderately active relapsers." Predictors of the "moderately active relapsers" class were employment status and diagnosis of myocardial infarction. Conclusions: Women achieved the recommended physical activity levels by the end of CR and sustained them until one year after CR. LCGA allowed us to determine the class trajectories associated with moderate-strenuous activity and, from these, to identify implications for targeted intervention.
    09/2013; 2013:121030. DOI:10.1155/2013/121030
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    ABSTRACT: Objective This study aimed to explore the relationships between gender-role socialization, objectified body consciousness and quality of life in breast cancer (BC) survivors with body image (BI) disturbance post-treatment. MethodsA total of 150 BC survivors participating in an ongoing randomized clinical trial of a group psychotherapy intervention for BI-related concerns completed a baseline battery of standardized measures including the following: Body Image Scale (BIS), Body Image after Breast Cancer Questionnaire (BIBCQ), Objectified Body Consciousness Scale (OBCS) measuring Body Shame and Surveillance, Gender-Role Socialization Scale (GRSS) measuring internalization of traditional gender roles and attitudes and the Functional Assessment of Cancer Therapy-Breast Quality-of-Life Instrument (FACT-B). Correlational analyses were conducted between the two BI questionnaires, the two primary psychosocial variables GRSS and OBCS, and FACT-B. Path analysis was conducted on a proposed theoretical model delineating pathways between the two primary psychosocial variables and BI disturbance. ResultsSignificant positive correlations were found between the two BI scales and (a) GRSS (average r=0.53, p<0.000), (b) Body Shame (average r=0.53, p<0.000) and Surveillance (average r=0.48, p<0.000). The BIS and BIBCQ were negatively associated with the FACT-B (r=-0.62, -0.73, respectively; p<0.000). Results from the path analysis demonstrated support for the proposed model. Conclusion Breast cancer survivors who endorsed greater internalization of traditional gender roles and attitudes, who engaged in greater self-surveillance and experienced greater body shame, reported greater BI disturbance and poorer quality of life post-treatment. Women with these predispositions are likely to be more vulnerable for psychological distress and may experience poorer adjustment after BC treatment. Copyright (c) 2013 John Wiley & Sons, Ltd.
    Psycho-Oncology 03/2013; 22(10). DOI:10.1002/pon.3271 · 2.44 Impact Factor
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    ABSTRACT: Background: Recent advances in schizophrenia genetics are shedding new light on etiopathogenesis, but issues germane to translation of findings into clinical practice are relatively understudied. We assessed the need for, and efficacy of, a contemporary genetic counseling protocol for individuals with schizophrenia. Methods: After characterizing rare copy number variation in a cohort of adults with schizophrenia, we recruited subjects from the majority of individuals who had no clinically relevant structural genetic variant. We used a pre-post study design with longitudinal follow-up to assess both the profile of need and the impact of general genetic counseling on key knowledge-based and psychological factors. Results: Thirty-nine (60.0%) of 65 patients approached actively expressed an interest in the study. At baseline, participants (n = 25) tended to overestimate the risk of familial recurrence of schizophrenia, express considerable concern related to this perceived risk, endorse myths about schizophrenia etiology, and blame themselves for their illness. Postcounseling, there was a significant improvement in understanding of the empiric recurrence risk (P = .0090), accompanied by a decrease in associated concern (P = .0020). There were also significant gains in subjective (P = .0007) and objective (P = .0103) knowledge, and reductions in internalized stigma (P = .0111) and self-blame (P = .0401). Satisfaction with genetic counseling, including endorsement of the need for such counseling (86.4%), was high. Conclusions: These results provide initial evidence of need for, and efficacy of, genetic counseling for individuals with schizophrenia. The findings may help facilitate development of a contemporary genetic counseling process that could optimize outcomes in the nascent field of evidence-based psychiatric genetic counseling.
    Schizophrenia Bulletin 12/2012; 40(1). DOI:10.1093/schbul/sbs138 · 8.45 Impact Factor

  • International Clinical Psychopharmacology 12/2012; 28:e24-e25. DOI:10.1097/01.yic.0000423274.11725.5d · 2.46 Impact Factor
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    ABSTRACT: Background: Premenstrual mood symptoms are considered common in women, but such prevailing attitudes are shaped by social expectations about gender, emotionality and hormonal influences. There are few prospective, community studies of women reporting mood data from all phases of the menstrual cycle (MC). We aimed (i) to analyze daily mood data over 6 months for MC phase cyclicity and (ii) to compare MC phase influences on a woman's daily mood with that attributable to key alternate explanatory variables (physical health, perceived stress and social support). Method: A random sample of Canadian women aged 18-40 years collected mood and health data daily over 6 months, using telemetry, producing 395 complete MCs for analysis. Results: Only half the individual mood items showed any MC phase association; these links were either with the menses phase alone or the menses plus the premenstrual phase. With one exception, the association was not solely premenstrual. The menses-follicular-luteal MC division gave similar results. Less than 0.5% of the women's individual periodogram records for each mood item showed MC entrainment. Physical health, perceived stress and social support were much stronger predictors of mood (p < 0.0001 in each case) than MC phase. Conclusions: The results of this study do not support the widespread idea of specific premenstrual dysphoria in women. Daily physical health status, perceived stress and social support explain daily mood better than MC phase.
    Psychotherapy and Psychosomatics 11/2012; 82(1):53-60. DOI:10.1159/000339370 · 9.20 Impact Factor
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    ABSTRACT: Background: Myths and concerns about the extent and meaning of genetic risk in schizophrenia may contribute to significant stigma and burden for families. Genetic counseling has long been proposed to be a potentially informative and therapeutic intervention for schizophrenia. Surprisingly, however, available data are limited. We evaluated a contemporary genetic counseling protocol for use in a community mental health-care setting by non-genetics professionals. Methods: We used a pre-post study design with longitudinal follow-up to assess the impact of genetic counseling on family members of individuals with schizophrenia, where molecular testing had revealed no known clinically relevant genetic risk variant. We assessed the outcome using multiple measures, including standard items and scales used to evaluate genetic counseling for other complex diseases. Results: Of the 122 family members approached, 78 (63.9%) actively expressed an interest in the study. Participants (n = 52) on average overestimated the risk of familial recurrence at baseline, and demonstrated a significant improvement in this estimate postintervention (P < .0001). This change was associated with an enduring decrease in concern about recurrence (P = .0003). Significant and lasting benefits were observed in other key areas, including increased knowledge (P < .0001) and a decreased sense of stigma (P = .0047). Endorsement of the need for genetic counseling was high (96.1%). Conclusions: These results provide initial evidence of the efficacy of schizophrenia genetic counseling for families, even in the absence of individually relevant genetic test results or professional genetics services. The findings support the integration of contemporary genetic counseling for families into the general management of schizophrenia in the community.
    Schizophrenia Bulletin 10/2012; 40(1). DOI:10.1093/schbul/sbs124 · 8.45 Impact Factor
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    ABSTRACT: Helping women victimized by intimate partner violence (IPV) is a challenge, particularly when the women belong to diverse ethnic groups. The objective of our study was to collect information on perceptions of coping with IPV from the perspective of a specific immigrant group of women. Sixty-three women from the Tamil community in Toronto representing different generations and experiences of IPV were interviewed in focus group settings about their views of coping with IPV. Study findings suggested that their views were deeply embedded in their sociocultural context and influenced by the gender-role expectations from the community. The women showed a marked preference for “passive” modes of coping rather than “active.” Study findings have implications for the development of alternative approaches to helping ethnically diverse women deal with IPV.
    Journal of Family Violence 10/2012; 27(7). DOI:10.1007/s10896-012-9461-1 · 1.17 Impact Factor
  • Paula Godoy‐Paiz · Brenda Toner · Carolina Vidal ·
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    ABSTRACT: Purpose: This paper aims to examine the long-term mental health consequences of war from the perspectives of urban Mayan women in post-war Guatemala. Design/methodology/approach: Ethnographic methodologies, namely participant observation and in-depth qualitative interviews were carried out during 12 months of fieldwork in Guatemala City. Findings: The findings indicate that urban indigenous women confront a range of unresolved war-related traumas and psychosocial distress that require specific attention by researchers, policy makers and service providers. It is argued that psychosocial interventions aimed at addressing the traumas of war must take into account present day conditions of post-war violence, poverty, and social inequity that threaten the health and well-being of indigenous peoples. Practical implications: Recommendations are provided for promoting the mental health of urban indigenous women affected by war. Originality/value: Research that has been conducted on the mental health effects of war has tended to focus on rural areas of the country. This article advances the research on post-war Guatemala through a focus on urban Mayan indigenous women.
    Ethnicity and Inequalities in Health and Social Care 08/2011; 4(3):127-137. DOI:10.1108/17570981111249266
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    ABSTRACT: For clinical trials in functional bowel disorders (FBD), the definition of a responder, one who meets the predefined criteria for a clinical response, is needed. Factors that determine clinical response aside from treatment itself are unknown. The aim of this study was to determine what baseline and post-treatment factors affect treatment response. Females (n=397) with FBD entering a 12-week, four-arm, randomized NIH treatment trial (desipramine (DES), CBT, pill placebo, and education) were studied at baseline and after treatment. Demographic, clinical, psychosocial, and physiological variables were considered in the analysis. A responder was defined as a patient obtaining a score>3.5 on an averaged eight-item, five-point satisfaction-with-treatment questionnaire. Baseline and post-treatment logistic regressions were performed for each treatment condition to predict the responder outcome variable. Similar cognitive features predisposed participants to treatment response across the treatment conditions: sense of control over the condition, positive relationship with therapist or study coordinator, confidence in treatment, improvement in maladaptive cognitions, and quality of life during treatment. Demographic and clinical variables studied were not predictive. Some treatment-specific effects predicting responder status were noted, including a reduction in stool frequency with DES treatment and lack of abuse history in the placebo group. For medication, psychological, and placebo treatment in FBD, satisfaction with treatment depends on cognitive factors of confidence in treatments, perceived control over illness and symptoms, and reduction in negative cognitions related to symptom experience. Addressing these issues among patients with FBD may enhance treatment response to a variety of treatments.
    The American Journal of Gastroenterology 06/2010; 105(6):1397-406. DOI:10.1038/ajg.2009.748 · 10.76 Impact Factor

  • Gastroenterology 05/2010; 138(5). DOI:10.1016/S0016-5085(10)63278-7 · 16.72 Impact Factor

  • Gastroenterology 05/2010; 138(5). DOI:10.1016/S0016-5085(10)63277-5 · 16.72 Impact Factor
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    ABSTRACT: The implications of the Rome III recommendations to change the irritable bowel syndrome (IBS) subtype criteria for stool pattern are unknown. (1) Determine the level of agreement between Rome II and Rome III subtypes and (2) compare the behaviors of Rome II and Rome III subtypes over time. Female patients (n=148) with Rome II defined IBS were prospectively tracked over 5 consecutive 3-month periods. At baseline, bowel habit reports on questionnaires were used to subclassify patients into Rome II and Rome III subtypes. Over the subsequent 15 months, bowel habit reports on diary cards were used to subclassify patients based on previously derived surrogate criteria into Rome II and Rome III IBS subtypes. The level of agreement between Rome II and Rome III subtype assignments was quite high (86.5%; kappa 0.79). The behavior of Rome II and Rome III subtypes over time was also similar in terms of subtype prevalence, subtype stability, and the proportion of subjects who met criteria for alternating irritable bowel syndrome. Rome II and Rome III IBS subtypes are in high agreement and behave similarly over time. Therefore, studies that used Rome II subtype criteria and studies that will use Rome III criteria will define comparable populations.
    Journal of clinical gastroenterology 04/2009; 43(3):214-20. DOI:10.1097/MCG.0b013e31815bd749 · 3.50 Impact Factor
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    ABSTRACT: There has been some question about the classification of painful constipation (PC) and its relationship to irritable bowel syndrome (IBS), and in particular IBS with constipation (IBS-C). We sought to: (1) compare PC with IBS and its subtypes (IBS-C, IBS-D, and IBS-A) in terms of pain scores, stool habit and clinical features, and to determine which factors predict PC over IBS, (2) determine the variation in pain and stool habit for PC relative to IBS over time, and (3) compare whether there are clinical differences between those with high pain constipation (HPC) and low pain constipation (LPC) over time. Among 231 women in an National Institutes of Health trial, Rome II moderate to severe PC (n=41), IBS-A (n=55), IBS-C (n=80), and IBS-D (n=55) received diary cards on stool frequency, consistency, and pain (visual analog scale) daily for 14 days before and after 12-week treatment and at 3-month intervals for 1 year. PC was characterized into HPC (high pain) and LPC (low pain) groups based on visual analog scale pain scores (high pain > or = 50 and low pain < 50) at baseline. Descriptive statistics were calculated, and comparisons performed by chi2 for categorical and t tests for continuous variables. Regressions and repeated measures tested between group and within-group associations, respectively. (a) PC is different from IBS with: higher pain scores (P=0.002), lower education (P=0.02), greater healthcare use and surgeries (P=0.05 to 0.003), and poorer daily function (Sickness Impact Profile overall P=0.004), (b) PC is similar to IBS-C and IBS-A but different from IBS-D for stool frequency and consistency (P<0.0001), bloating (P=0.02), laxative/antidiarrheal use (P=0.04 and 0.02), and lower education (P=0.02). (c) Over 1 year, PC: maintained higher pain scores than IBS, had stool frequencies less than IBS-D and between IBS-C and IBS-A, had stool consistency less than IBS-D and similar to IBS-A, (d) for HPC and LPC there was no difference in constipation, and HPC switched to LPC over time, while LPC pain scores stayed low. Limitations include the absence of a painless constipation group, and that studying moderate to severe symptoms, which may not represent all with PC or IBS. PC is clinically similar in stool pattern and bloating to IBS-C and IBS-A, but with greater pain, healthcare utilization, and poorer daily function. The findings also suggest that PC defines a population where there is greater pain, and poorer health status and daily function, which may be driven more by visceral and/or central pain dysregulation more than the constipation.
    Journal of clinical gastroenterology 11/2008; 42(10):1080-8. DOI:10.1097/MCG.0b013e31815146f9 · 3.50 Impact Factor
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    ABSTRACT: Patients with functional gastrointestinal disorders treated with tricyclic antidepressants sometimes report nongastrointestinal symptoms; it is unclear whether these are drug side effects or reflect a behavioral tendency to report symptoms. We evaluated whether symptoms reported before treatment with a tricyclic antidepressant (desipramine) increased in number or worsened in severity after 2 weeks of treatment and assessed the baseline factors that predispose patients to report symptoms. Female patients in a multicenter National Institutes of Health trial for functional bowel disorders completed a 15-item symptom questionnaire at baseline (before randomization), 2 weeks after they were given desipramine (n = 81) or placebo (n = 40), and at study completion (12 weeks). Patients were asked about the severity and frequency of 15 symptoms. Results were analyzed from 57 patients given desipramine who completed the questionnaires. Symptoms reported as side effects to have occurred more frequently and also worsened at week 2 in the group given desipramine included dizziness, dry mouth/thirstiness, lightheadedness, jittery feelings/tremors, and flushing. Symptoms that did not change in severity or showed improvement at week 2 in the group given desipramine included morning tiredness, nausea, blurred vision, headaches, appetite reduction, and trouble sleeping. Psychologic distress but not desipramine blood level correlated with symptom reporting. Most symptoms often attributed to side effects of desipramine were present before treatment; only a few, related to anticholinergic effects, worsened 2 weeks after treatment, suggesting that most so-called side effects were not associated specifically with desipramine use. Such symptoms might instead be associated with psychologic distress.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 11/2008; 7(4):446-51. DOI:10.1016/j.cgh.2008.11.014 · 7.90 Impact Factor
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    ABSTRACT: To examine the presence and nature of disordered eating attitudes and behaviours among Jewish Canadian adolescents, as compared with non-Jewish Canadian adolescents in an urban community. A secondary goal was to examine whether rates of eating-disordered behaviour differed among the adolescents based on the degree of Jewish religious observance. High school students (n = 868) from the Toronto area completed a demographic and religious practice questionnaire together with the Eating Attitudes Test (EAT), a self-report test that discriminated adolescents with syndromal eating disorders from normal adolescents. Jewish females aged 13 to 20 years, but not males, reported significantly more disordered eating behaviours and attitudes, compared with their non-Jewish female counterparts. Twenty-five percent of Jewish females, as compared with 18% of non-Jewish females, scored above the clinical cut-off for the EAT. No differences in vulnerability to disordered eating were found within the group of Jewish females or males related to their degree of religious observance. Adolescent Jewish females, but not males, appear to be at greater risk for abnormal attitudes and behaviours related to eating, compared with their non-Jewish female peers. While the reasons for this finding are unclear, this study is a step toward improving understanding of the relations between sex, culture, religion, and the development of eating disorders. Culturally sensitive and sex-specific prevention strategies and treatment interventions are indicated.
    Canadian journal of psychiatry. Revue canadienne de psychiatrie 10/2008; 53(9):601-8. · 2.55 Impact Factor

  • Gastroenterology 04/2008; 134(4):A-417. DOI:10.1016/S0016-5085(08)61954-X · 16.72 Impact Factor

Publication Stats

4k Citations
510.18 Total Impact Points


  • 1987-2014
    • University of Toronto
      • • Department of Psychiatry
      • • Department of Psychology
      Toronto, Ontario, Canada
  • 2006
    • The Princess Margaret Hospital
      Toronto, Ontario, Canada
  • 2000-2005
    • Centre for Addiction and Mental Health
      Toronto, Ontario, Canada
  • 1994
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 1990
    • Clarke University
      Атина, Georgia, United States
  • 1989
    • York University
      • Department of Psychology
      Toronto, Ontario, Canada