Q&A with a Mental Health Professional: Maryam Kia-Keating, Ph.D.
Maryam Kia-Keating, Ph.D.
We asked teens from around the United States to anonymously send us questions that they would like to be answered by a mental health professional. Below, Maryam Kia-Keating, Ph.D., a Professor of Clinical Psychology at the University of California, Santa Barbara (UCSB), thoughtfully answers many of these questions.
1. What’s the best path to take to help mental health?
If you suddenly had to run in a race, you would be so relieved, and have an easier time, if you had been exercising and training all along, up to that minute. In fact, instead of worrying, or being overwhelmed, you might think to yourself, “I’m ready for this!” Stressful events in life are like that sudden race: they aren’t predictable in terms of timing, but they are predictably going to happen, in that all of us have to be ready to face significantly stressful life events. The more prepared you are ahead of time for the bumps in the road, the better. And the more you “stay in shape” with your mental health, the easier it is to get through the parts of life that sometimes feel more like an endless and exhausting uphill climb, than a bump. The best path to take to help mental health is by having your mental health toolkit ready. Here are five key tips:
Find and nurture your relationships and support systems.
Make it a priority to find and then regularly participate in activities that bring you joy and meaning.
When possible, minimize your exposure to extreme stress, such as monitoring how much you watch media content that includes violence or other upsetting news items.
Practice mindfulness.
Take care of your physical health by eating healthy, getting regular exercise, and avoiding harmful substances.
2. How do you get diagnosed with a mental health disorder? What does the process look like?
If you are concerned about your mental health, want to get a mental health check-up, or just want some support, you might seek out a formal appointment with a counselor/therapist, psychologist, or psychiatrist. These licensed professionals can diagnose you with a mental health disorder once they have completed an in-depth evaluation of your symptoms. In the U.S., mental health professionals use a manual known as the DSM-5 which provides the standard classification system to diagnose a mental health disorder. Just like anytime you see the doctor, they will do their best to gather information about what you are experiencing, and how it is impacting your life, as well as what other factors may be at play. Usually, that means asking you a lot of questions, and sometimes it also means having you fill out some questionnaires.
3. How do you know if it’s just a phase or if you actually have a mental health disorder?
A licensed mental health professional is the best person to help you sort out whether something is just a ‘phase’ and/or if you have a mental health disorder. But remember, just because you get diagnosed with something doesn’t mean you will have it forever – it could technically be ‘just a phase’ too. Just like any illness, you are capable of healing! In order to figure out what’s going on for you, you might be inclined to start with a Google search BUT it’s important to not just rely on what you read on the internet for several reasons. First of all, you can run into inaccurate information there. Second of all, once you start reading, it’s common for people to feel like they might have every condition they read about even when they don’t (commonly known as “medical student syndrome”). Third of all, seeking out proper support early can only be helpful in preventing a mental health disorder. So there’s really a lot of reasons to get a professional evaluation, and assistance to help you through a difficult “phase,” no matter how short or long it lasts.
4. How do I know if I have depression?
Typically, you’ll notice that your mood is low for most of the day, nearly every day. You’ll also experience some related symptoms such as a change in your appetite, energy, thought process, ability to concentrate or make decisions, and/or ability to experience pleasure in things you used to enjoy. Sadness is a normal part of life, and in many cultures, it’s encouraged to be embraced as a tool that can help you reflect and bring you guidance. However, if these symptoms are getting in the way of your functioning, lasting for longer than two weeks, or are accompanied by thoughts about hurting yourself, you should immediately tell someone supportive in your life, and seek treatment from a licensed mental health professional and/or a medical provider.
5. How do I deal with nighttime anxiety?
It’s always helpful to get support from loved ones. Licensed mental health professionals can guide you in coping with nighttime anxiety. Some methods that tend to be useful in addressing anxiety include 1) creating a calming nighttime ritual (also making sure to “unplug” from devices early), 2) having a daily meditation or mindfulness practice that helps keep you grounded and provides you with some breathing techniques, 3) exercising consistently which has benefits for your body from the inside out, and 4) avoiding substances that can increase your anxiety, including caffeine, and sugar.
6. How can you prevent anxiety from taking over your daily life? How do you contact a therapist for anxiety issues?
The best trick is to just keep living, and give yourself that extra push to get through activities that your anxiety tries to get you to stop. The more you avoid activities, people, or places that make you anxious, the more the anxiety stays rather than dissipates. So, instead, commit to yourself that you will continue to embrace and seek life’s adventures whether or not your anxiety is coming with you on that journey. Accept that it might be there sometimes but know that it is most likely to go down over time, especially with anything you practice and have repeated exposure to. Seek help from a mental health professional for guidance and support in dealing with your anxiety – therapy can be incredibly useful for people who experience anxiety and know that the work you do for a short amount of time in therapy can last a lifetime. You can get a referral from your primary care provider, or look over a list of providers and directly contact one of the mental health professionals to schedule an appointment via phone or email, depending on what contact information they offer. Typically, providers will list their areas of expertise, so look for someone who lists anxiety as one of the issues they treat.
7. How do I know if I have gender dysphoria?
According to the DSM-5, gender dysphoria is defined as clinically significant distress or impairment related to a marked incongruence between your expressed gender (i.e., how you experience your gender) and your assigned gender (i.e., what your gender assignment was at birth) for at least 6 months. You also have to experience several other criteria, including a strong desire to be of another gender, which might include the strong desire to change primary and/or secondary sex characteristics, to officially receive the diagnosis of gender dysphoria. It can be helpful to seek support from an affirmative, licensed mental health professional for support, especially if you are experiencing significant distress or impairment (such as in relationships, school, or work) in your functioning.
8. How can I stop doing self-harm?
It’s important to recognize that self-harm is never going to provide you with a lasting solution, and it could ultimately cause you some serious consequences, so it’s great that you are motivated to stop. Seeking help and getting appropriate treatment from a licensed mental health professional can help you learn some healthy ways to cope, emotion regulation strategies, how to tolerate distress, how to improve your relationships, and mindfulness skills. These kinds of strategies can help support you to stop self-harm, and to prioritize self-care and self-compassion.
9. What are some distinct differences between ADHD and Autism?
There’s a lot of overlap and researchers are still trying to better understand the relationship between ADHD and Autism. It’s notable that approximately 30-80% of children with Autism also meet criteria for ADHD, and 20-50% of children with ADHD also meet criteria for Autism, so you can see that the two issues can go hand-in-hand. Social skills, language delays, and attention problems can impact people with either diagnosis. That said, someone with ADHD might be more likely to have difficulties with sustained attention, difficulties with organizing tasks or activities, high activity level, impulse regulation, or forgetfulness. Someone with Autism, on the other hand, may be more likely to experience difficulties in social interactions and communication, difficulties maintaining relationships, repetitive behaviors, and restricted interests.
10. How do I know the difference between having ADHD and just being lazy?
Most of us feel lazy at one time or another. Some of that feeling might relate to exhaustion, boredom, lack of motivation, or not enough reward to outweigh the draw of doing nothing. The main difference is that someone with ADHD (which only has a prevalence rate of 7-12%), has impaired executive functioning, and, at a neurobiological level, is experiencing difficulties with planning, organizing, and managing their impulses. Either way, if you are struggling with some of these tasks, it’s always a good step to get professional support in order to not only sort out the causes, but also find some solutions together.
11. How do I know if I have an eating disorder?
There are a number of different ways in which eating disorders will manifest themselves—including restricting food intake, excessive exercise, binging, purging, preoccupation with food, and feelings of loss of control about eating. The bottom line is that it relates to an unhealthy relationship with food and your body, and can include unhealthy behavior patterns, low self-esteem and self-worth, and difficulties in relationships. Engaging in disordered eating patterns can have long-term, severe negative health consequences. Thus, it is especially important to check with both a medical and licensed mental health professional to assess and get treatment for your health and mental health related to eating, nutrition, and learning healthy patterns.
12. Does Bipolar Disorder affect everyone the same way, with the same extent of highs and lows?
Symptoms and severity of Bipolar Disorder can vary quite a bit. Some people have years without symptoms. Some people can experience rapid shifts between highs and lows. Although genetics play a part, studies of identical twins demonstrate that genetics don’t fully determining the outcomes – one identical twin might have Bipolar Disorder while the other does not. If left untreated, Bipolar Disorder can get worse. It’s best to seek help from a licensed psychologist or psychiatrist who can provide treatment and guidance towards creating a long-lasting, consistent healthy lifestyle.
Maryam Kia-Keating, Ph.D. is a Professor of Clinical Psychology at the University of California, Santa Barbara (UCSB), where she oversees the Trauma & Adversity, Resilience & Prevention (TARP) research lab. She is a Licensed Clinical Psychologist and a key collaborator with the Center for Scholars & Storytellers. Her education and training were completed at Dartmouth College, Yale University, Harvard University, Boston University, and the University of California, San Diego. Her interviews on ways to protect mental health and promote resilience have been included in outlets with high volume readerships, including the Washington Post, ABC news, CNN, and Self Magazine. Her website is www.kiakeating.com and she is on Twitter @drkiakeating.
How to Support Mental Health in People with Autism
A new study suggests that autistic individuals have higher levels of stress and depression when they don’t feel accepted.
This article originally appeared on Greater Good, the online magazine of the Greater Good Science Center at UC Berkeley.
Mental health among autistic individuals is an underdeveloped area of research—a situation that many autistic people are advocating to change. This is especially crucial since rates of depression and thoughts of suicide are higher among autistic people than in the general population.
But why would there be a stark difference in the mental health and well-being of autistic people compared to “neurotypical” people? A recent study, one of the few looking at this issue, set out to examine the importance of acceptance.
One hundred eleven autistic individuals in the U.K. filled out online surveys about their levels of acceptance—from themselves and society—and their depression, anxiety, and stress. Authentic autism acceptance would imply “an individual feeling accepted or appreciated as an autistic person, with autism positively recognized and accepted by others and the self as an integral part of that individual,” the study explained.
The results? As predicted, those who felt less accepted by others and by themselves showed higher levels of depression and stress.
When asked about societal acceptance, 43 percent of participants said they did not feel accepted by society in general, and 48 percent said they did not feel accepted sometimes.
In describing their experiences of not feeling accepted, respondents most often alluded to “misunderstandings and misconceptions about autism, experiences of masking/camouflaging,” and other issues, the study authors report. Masking and camouflaging refer to an autistic person making efforts to “pass” as neurotypical and the stress and exhaustion that result from that. It makes sense that feeling pressured to hide a part of yourself would result in higher stress and a tendency toward depression, given how critical social relationships and a sense of belonging are to well-being.
On the other hand, there was no significant link between autism acceptance and anxiety. The researchers postulate that anxiety can come from a host of sources for the autistic person; acceptance may not be as primary as, for example, the sensory sensitivities that can accompany autism.
So how can we support the mental health of autistic people?
According to the researchers, one factor that can contribute to acceptance is how we think about autism—in particular, whether we embrace the “neurodiversity” framework and a social model of disability, as opposed to a medical one. Neurodiversity is a way of conceptualizing mental differences as part of natural human diversity, as opposed to pathologizing some neurological makeups (such as autism) as abnormal. The social model of disability focuses on systemic factors within society that disadvantage particular people, whereas a medical model sees certain people as intrinsically, biologically disabled when they differ from a perceived norm.
The results of this study also indicate that we should pay greater attention to the stressful experience of “masking,” and ways that friends, colleagues, acquaintances, and family members can deepen their understanding of the autistic experience and help autistics feel seen for who they are.
A great place to start is to follow the #ActuallyAutistic hashtag on Twitter (an online social media movement whereby autistic voices are amplified with the slogan “nothing about us without us”), as well as the blog of autistic scholar and activist Nick Walker and my own The Neurodiversity Project. Learning about topics such as sensory sensitivities, heightened empathy (as opposed to lessened), and other unique autistic experiences can go a long way in understanding autistic people in our lives.
This particular study is noteworthy for surveying autistic individuals, as opposed to simply reporting professionals’ views of them. With greater self-acceptance and societal acceptance, autistic people may be able to foster a larger sense of belonging and agency, thereby reducing feelings of isolation, loneliness, and depression—all critical for mental health.
Author of the acclaimed book Divergent Mind
Creator of The Neurodiversity Project and The Interracial Project
This article originally appeared on Greater Good, the online magazine of the Greater Good Science Center at UC Berkeley.
African American teens face mental health crisis but are less likely than whites to get treatment
This article originally appeared on The Conversation.
Black youth in the U.S. experience more illness, poverty, and discrimination than their white counterparts. These issues put them at higher risk for depression and other mental health problems. Yet Black youth are less likely to seek treatment. About 9% of them reported an episode of major depression in the past year, but less than half of those – about 40% – received treatment. By comparison, about 46% of white youth who reported an episode were treated for depressive symptoms.
Instead, some turn to suicide, now the second leading cause of death among Black children ages 10 to 19. That rate is rising faster for them than any other racial or ethnic group. Data from the Centers for Disease Control and Prevention show the rate of suicide attempts for Black adolescents rose 73% from 1991 to 2017.
With schools nationwide grappling with how to offer instruction to students, principals and teachers need to be reminded that Black children have endured a distinctive kind of trauma since the pandemic began. They have had a different experience. The shootings of George Floyd and Ahmaud Arbery – and what happened afterwards – are just two examples.
As an expert in child and adolescent psychology, I know that a multitude of barriers keep Black children, and their families, from receiving that treatment. They need help to deal with the pervasive poverty and racism that surrounds them.
The ‘crazy’ label
Studies suggest Black youth and their families may be less likely to identify their own mental health symptoms. If they do receive referrals for care, they may follow up less often than whites. Delays in seeking care can lead to negative consequences, including emergency psychiatric hospitalizations and non-compliance with treatment recommendations. These youngsters may then become adults with mental health issues that remain unaddressed.
Parents and caregivers should encourage treatment. But interviews with them done as part of one study revealed they sometimes obstruct the process. Many feared their child would be labeled “crazy.” Those caregivers, sensitive to social stigma, also relied on others in the community when deciding to pursue treatment for their sons. Sometimes they would receive support from those they spoke with; other times, they would not.
Because of discrimination and abuse, Blacks have good reason to distrust the mental health system. Health care disparities exist there just as they do in other health care domains. Black adolescents are less likely than white teens to be treated with beneficial psychiatric medications, and more likely than white teens to be hospitalized involuntarily. Other reports suggest Black youth with psychiatric disorders are more likely to be referred to the juvenile justice system, while white youth are more often referred for mental health treatment.
That same study found that schools were also pivotal, in both positive and negative ways. Some parents and caregivers said school staff validated their concerns and provided support. Others felt forced to seek services only because they believed their son would be expelled.
Stigmatizing mental illness
Researchers have found that Black adults, exposed to a police killing of an unarmed black citizen through media or word of mouth, had worse mental health. This includes an increased fear of victimization, diminished social trust and a revisiting of prior trauma.
Much the same seems true for Black adolescents. When a group of them aged 11 to 19 viewed traumatic events online – including viral videos of police shootings – they had higher rates of depressive and post-traumatic stress symptoms, including re-experiencing, avoidance, numbing, and hyperarousal. Experts have suggested that police violence be viewed as a public health issue, because each killing impacts individuals and communities both physiologically and emotionally. Each incident reminds Black youth that, in this country, their lives have been devalued.
One might consider the impact from the case of Ahmaud Arbery, a 25-year-old Black man shot to death in Glynn County, Georgia, last February. Three white men are charged in the killing. An attorney for one of them attempted to cast doubt on the character of Arbery, who reportedly had a previously diagnosed mental illness. The lead investigator in the case testified that Arbery suffered from hallucinations, though he was not undergoing treatment on the day of his death.
Hallucinations are actually relatively common in children and adolescents. Up to 13% of youth experience them. If Arbery had hallucinations, it appears they had little bearing on his killing, but those with mental health issues were further stigmatized.
With protests sweeping the nation calling for racial justice and defunding the police, I believe more funding to address disparities in mental health care for Black youth is critical. But merely investing in treatment is not enough. To support them and their families, we as a society must deal with stigma, cultural mistrust, systemic inequities and social supports.
Assistant Professor, Department of Psychiatry and Behavioral Neurosciences, Wayne State University
This article originally appeared on The Conversation
How Adults Can Support the Mental Health of Black Children
Psychologist Riana Elyse Anderson explains how families can communicate about race and cope with racial stress and trauma.
This article originally appeared on Greater Good, the online magazine of the Greater Good Science Center at UC Berkeley.
With his last breaths, George Floyd called out, “Momma!” before he was killed in Minneapolis. He was one of nearly 1,300 black people who have been killed by police in the last five years. They are two times more likely to be killed by police than white Americans.
Facing destructive policies and attitudes in the United States, mothers and fathers try to safeguard their black children from racism. This often takes the form of preparing them for bias and communicating the real threats to their lives from a history of othering that continues today. But it also involves highlighting how to draw from a well of strengths that black culture and black families—immediate, extended, and historical—possess.
To better understand this process, we interviewed Dr. Riana Elyse Anderson, clinical and community psychologist and professor of public health at the University of Michigan. Anderson developed Engaging, Managing, and Bonding through Race (EMBRace), a program to help families communicate about race, cope with racial stress and trauma, and build strong relationships and well-being. Below, she explains how black parents can support their children’s mental health, and their own.
Maryam Abdullah: Your research focuses on how black families use racial socialization to protect their children in the face of pervasive racial stress and trauma. What is racial socialization?
Riana Elyse Anderson: Socialization, generally, is the statements that parents are making to their children about how to think or behave in the world. Some common examples of that might be “Look both ways before you cross the street,” or “Don’t touch that iron. It’s hot.” For gender socialization, we’re familiar with suggestions of which sports to play between girls and boys, as a crude example.
Racial socialization is the behaviors and the attitudes being passed down from parent to child with respect to race in particular. Some of those might be wearing certain kente cloth if you’re going to celebrate Kwanzaa or if you’re going to the National African American Museum in Washington, D.C., to celebrate your culture. Those are some of the more positive ones. Unfortunately, we also have to think about “Keep your hands on 10 and 2,” “You can’t wear your hoodie in the store,” or “You have to work twice as hard to get half as far” as some of those elements that are part of “the talk,” the racial socialization talk.
MA: How does racial socialization help black children cope with racial stress?
REA: We’re talking to our children about what it is that mommy or daddy experienced or what they see in the world. We’re able to have that conversation between parent and child, rather than the children not really having a space to ask what’s going on and why so many people are upset or frustrated—or seeing people like them on the news either being snuffed out or arrested for uprising, and then wondering or just keeping it to themselves. That opens up lines of communication, and it doesn’t stop there.
After that line of communication opens up, we get to practice and talk through what it is that we would want to do as a parent or as a child—a series of coping strategies. Do I want to sit here on the couch? (which is totally fine if I want to do that). Do I want to go out and protest? Do I want to write a letter to someone? Do I want to not support a certain business? Now I have options of the things that I want to do, and I feel more efficacious in my ability to execute any of them because I’ve talked with my family about that.
Talking to our family, thinking about strategies, and supporting our children in their ability to execute those strategies is how racial socialization works.
MA: In EMBRace, children and parents work together on a variety of practices. Can you share one?
REA: We use a family tree exercise. Before we even meet with the family about their family tree, we ask them to do some digging. Tell us a bit about who your family members are, who your support system is, then go ahead and put that on this family tree.
Then, demonstrate on this family tree how big and resourceful your community, your garden, your village is. Now you’re seeing, OK, my grandma is with me, my aunts are with me—especially as a child, I can rely on all these people.
And even though I don’t know Michelle Obama, she feels like an auntie to me, so I’m going to put her on my [family] tree. We have a space for greater community influences. OK, Rosa Parks passed away before I was here, but I know that there are streets named after her in Detroit and she’s given a lot of support to black people like me, so I’m going to put her [on].
You start to understand there are people who have come before you and who will come after you who will continue this really rich tradition of who we are and how wonderful our people are. You’re now demonstrating and seeing that I have a whole community who has my back in a time where George Floyd’s life was taken from us in the most violent and visible way. To know that there are millions of people, who now count him as our brother and that he now has as his family, continuing on his legacy, speaks to what it is that we’re trying to do here within EMBRace. We have a whole group of people who are going to support you should you need us. You don’t have to take this racist event by yourself. You can come to your family and that family is an extended family.
MA: What’s important for parents to know about when and how to speak to their young children about racism?
REA: I want you to think about this concept of racial literacy that psychologist Dr. Howard C. Stevenson talks about. Racial literacy pretty much means you’re not going to give a Shakespearean novel to a three year old. You’re going to give an age-appropriate reading book or coloring book to that child, and you all are going to work up gradually to the understanding of what literacy means for their age. We don’t ask you to go beyond your child’s level.
When we’re saying we’re afraid to talk to our children about race, it’s not for them; it’s because we are afraid, if we’re being honest. We don’t know how to talk about it and we’re concerned. What we encourage in EMBRace is to think about your competency, rather than your content—to focus first on building your own skills, confidence, and resilience to stress in these conversations before talking with children.
Skills: Becoming more skillful at these kinds of interactions might involve preparation for and practice using inquiries or questions to ask our kids: “What did you notice?” or “How did that make you feel?”
Confidence: Confidence comes from practicing it more. Maybe that means you practice with yourself in the mirror like you do when you go to your job interview. Maybe you practice it with your loved one. You’re unpacking for yourself first.
Stress: If you go into it without having spoken about it, without thinking about what it means for yourself, you’re going to be highly stressed the entire time you talk to your child. But you can focus on “What are the things that are within my control when I talk to my child? Maybe I can’t change the entire police system, but I can help my child to navigate that one specific thing that they have going on. What can I do today?” That will reduce stress in that moment, along with practice and with inquiry-based questions.
Your child is never too young to have any discussion about it, but you don’t want them to have the most stressful and the most strenuous conversations. You’re the expert, you’re the parent, you already know what [the right level of conversation] is. It’s time for you to take your fear away from your child being the best that they can be.
MA: What further advice do you have for parents right now as they help their children cope with the trauma of current events?
REA: We’re thinking about this idea of “the talk.” Sometimes people have it once and they say, “Done. Great. Did my job.” Then they walk away.
If you think about how frequently you have to tell your child to pick up toys, buckle their safety belt, and clean up after themselves, we understand that having the racial talk once is not sufficient. So, yes, these events are current and, yes, it feels so imminent and so important that we have this conversation right now. There’s a lot going on in the media. There’s a lot going on that your children are hearing or experiencing and they have access to it in ways that years ago children would not have.
At this moment, you should be having conversations with your child. And next week when the protests have died down, you should continue having conversations with your child. And the month after that, you should continue. And weeks after that. At this point, the amount of content in books or media that is around you makes it possible to create a consistent environment. If that practice becomes consistent enough where you are bringing it up and you are letting them know this is an expectation you have for conversation, they will feel comfortable enough bringing it to you: “Mom, I noticed this.”
Use things in the environment, use things in your media, use things in books to ask your child what is it that they’re seeing, how can you support them through this, how do they feel about it?
MA: How can parents take care of their own well-being so they’re in the best position to help their kids?
REA: Our own well-being is compromised right now. We know that anxiety and depression are up three times the amount that they were in January. We are not doing well as a nation right now. If you need time as a parent to step away from this media and these types of conversations, remember that you are a human being, first and foremost—you’re not daddy or mommy first. You really are a human being who needs rest, restoration, self-care, love. There are tasks that parents have that are beyond description. You’re being asked to provide in ways that just defy the amount of energy you might have most days, especially in a stay-at-home-order situation where you are the go-to principal, teacher, nurse, etc.
Unless your child is so young that you cannot step away at all and it would be a physical danger for your child to be alone, if you need a moment to walk around the block or close a door, or to do something for yourself to engage in self-care, by all means, take it. As we’re starting to open up the community a bit more, if you need to create a small cluster of families with whom your child spends some time so that you can find some space and time on your own, by all means safely create that space. It is a cardinal and critical component of your child being well that you are well.
We’ve all heard the mask analogy. We’ve all experienced times where our behaviors can impact those of our children. We know that. It’s not just a saying; we really need you to be well, first and foremost. The practice I would really recommend is just to find time for yourself to carve out your wellness so that you can be the best parent that you can be for your child.
Developmental psychologist, Parenting Program Director of the Greater Good Science Center
This article originally appeared on Greater Good, the online magazine of the Greater Good Science Center at UC Berkeley.
We studied depression messages on YouTube videos and found dangerous and stigmatizing stereotypes prevail
This article originally appeared on The Conversation
Rates of depression have tripled in the U.S. since the beginning of the COVID-19 pandemic, and most recent estimates suggest these numbers remain elevated compared with pre-pandemic rates of mental health problems.
Even before the pandemic, depression was a leading source of disability, affecting over 17 million Americans each year. In a society where mental health education is not uniformly taught in schools, and where most people with depression go untreated, this is a recipe for disaster.
Psychologists have proposed ways to reform mental health care such as increasing access to care through telehealth. These actions are important. However, few experts have provided recommendations for how everyday citizens can flatten the depression curve by reducing stigma.
To better understand why depression stigma persists, my colleagues Ansley Bender and Jon Rottenberg and I examined how depression is depicted in the public sphere. In a recently published study, we systematically coded 327 YouTube videos on depression based on how they presented depression’s causes, prognosis and recommended treatment.
We hoped to gain insight into how one channel of social media presents information on depression. We learned that popular messages on YouTube may unknowingly perpetuate stigma and misconceptions about depression.
Stigma makes depression even harder
While we are no longer in the era of mental institutions and lobotomies, stigma toward depression is alive and well. In a 2018 study that provided 1,173 Americans with a vignette depicting someone with depression, 30% rated them as “violent,” and 20% supported the use of involuntary treatment. In everyday life, many people with depression hear declarations that “depression isn’t real” or “depressed people are just weak and lazy.” Public perception, it seems, either exaggerates or downplays the severity of depression – neither of which captures the truth.
Stigma like this worsens people’s ability to cope with and seek help for depression. For example, a review of 144 studies found that stigma considerably lowers the chance that a person with depression will seek treatment. This is concerning – especially for those who struggle with thoughts of suicide. Former U.S. surgeon general Vice Adm. Jerome M. Adams has called stigma the nation’s No. 1 killer.
This video provides a balanced and accurate depiction of depression.
YouTube says: Nature or nurture
We found that about 50% of the YouTube videos we viewed presented depression as a biological condition, like a “brain disease” or “chemical imbalance.” Over 40% discussed how situational circumstances like losing a job, experiencing abuse, or other life events can cause depression. But these messages are only partially true.
In most cases, depression is the result of a combination of biological, environmental and psychological circumstances, though just 8% of videos showed messaging consistent with this understanding. This is called the biopsychosocial model and is the consensus across clinical psychology and psychiatry. Framing depression as either biological or situational can narrow one’s view of potential treatments, so it is important to convey accurate information about the illness.
For instance, studies show when people are told that their depression is caused by a chemical imbalance, they are more likely to favor antidepressant treatments over other treatments. In other words, these messages may lead people to accidentally ignore other evidenced-based treatments that could help them, including therapy, exercise and lifestyle changes and social support.
The reality is that many treatments work for depression. It might, however, take time for those with depression to find the right treatment combination that works for them.
Further, while many believe that talking about biological origins decreases depression stigma, a review of studies actually found it can have the opposite effect. The story goes like this: When people view depression as a brain disease, they are less likely to blame someone for having depression. However, they are also more likely to view the person with depression as “different,” “dangerous” and “untreatable.” Studies show these beliefs may lessen people’s willingness to support or feel empathy for those with depression.
Regarding his period of depression, Dwayne “the Rock” Johnson states, “I wish I had someone at that time who could just pull me aside and [say], ‘Hey, it’s going to be OK.’”
YouTube says: Depression lasts for years…sometimes a lifetime
This message is partial truth, but the science suggests a more complicated picture. For some, depression can last for years depending on their life circumstances and access to treatment. For others, depression may last for only a few months. A 2011 review of depression studies concluded “the majority of individuals who experience depression will recover within one year.”
Making this distinction is important because it reminds us that depression is not permanent; even though depression, by its nature, can make us feel as if everything is hopeless and won’t improve … or if things do get better, they will inevitably get worse again.
It is important for all of us, in these times of uncertainty, isolation, and worry about our loved ones, to remind ourselves and one another that, with time and direct efforts to improve our mental health, we can persevere.
This video misleads by saying that dark chocolate can treat depression.
YouTube says: There are quick fixes
Some of the most irresponsible videos I watched suggested that depression can be “fixed” with a few “simple lifestyle hacks.” Such videos are reminiscent of overpromising self-help gurus. Quick-fix assertions like “just exercise, you’ll feel better” are not only invalidating but untrue. It’s concerning that these videos disguise themselves with scientific-sounding words.
The video “10 Foods to Eat to Fight Depression” shows how the public can be misled. With over 1 million views, the video states, “Dark chocolate can help raise serotonin levels in the body” to fight depression. Unfortunately for people with depression who love chocolate, this scientific-sounding claim is not accurate. Our diet of course affects our mood. But it is oversimplified to say that eating chocolate cures depression.
These messages could lead people to downplay and invalidate the severity of depression. Imagine how a person with depression would feel upon hearing “I know you can’t get out of bed, but have you tried eating a Snickers?”
The next time you or someone you know is feeling depressed, take it seriously. Although the times are tough, and circumstances might feel hopeless, depression is treatable and can be overcome. Check out the National Alliance on Mental Illness for more information.
Doctoral student, clinical psychology, University of South Florida
This article originally appeared on The Conversation
How to Support Teens’ Mental Health During COVID and Beyond
Teens are struggling during the pandemic. Here's what they need from us right now.
This article originally appeared on Greater Good, the online magazine of the Greater Good Science Center at UC Berkeley.
It’s been more than a year since the COVID-19 pandemic changed life as we knew it. Many families across the country have been living in “survival mode.” Tweens and teens continue to experience a range of emotions, including sadness, anger, and fear. If left unresolved, these feelings can take a toll on health and well-being.
Parents of teens share similar struggles. According to Lauren, a mother of two teens in Woodland Hills, California, “My daughter has a hard time spending so much of her day on screens. She says having to do so makes her feel more anxiety than she already was feeling.” Nancy, a mother of two teen boys in Chevy Chase, Maryland, says, “Junior year is supposed to be a key year in high school before college. But my son has shut down.” And Rafaela, whose daughter attends high school in New York City, says, “My daughter is completely stressed about having to go back to school in person because she worries she’s going to get coronavirus.”
Sound familiar? In a survey of more than 4,600 people in Canada last spring, more than a third of families said they felt “very or extremely” anxious about family stress resulting from the pandemic.
When it comes to teens’ emotional and mental health, they are experiencing a crisis, says Dr. Edith Bracho-Sanchez, a primary care pediatrician and assistant professor of pediatrics at Columbia University Irving Medical Center. Even before the pandemic, more than 16% of youth in the United States dealt with a mental health disorder, according to a 2019 study in JAMA Pediatrics.
Bracho-Sanchez, who often treats families in Latino and Black communities that have been disproportionately affected by COVID-19, says the pandemic created the perfect storm of emotional turbulence. “Families are experiencing a lot of stress. Many have lost jobs. They’ve fallen behind on rent. The rates of food insecurity have skyrocketed. All of these things are really hard for everyone in the family—teens included.” Add to these issues virtual schooling, fear of family members getting sick or dying from COVID, feeling isolated and disconnected—it’s no wonder doctors are seeing higher levels of anxiety and depression in teens.
As parents, we can’t control the course of the pandemic. But we can help teens by modeling good coping skills, encouraging healthy habits, and working to understand and relate to what they are going through.
Understand what teens are going through
The first step toward supporting young people through this challenging time is for caring adults to have empathy for the teen experience. And to work to understand how their developmental stage impacts their emotional well-being.
Adolescence is a time when tweens and teens are supposed to be stretching their boundaries and testing limits. That means getting out of the house and trying new things. Figuring out their place among peers and within their communities. Making mistakes and learning how to bounce back. But during the COVID-19 pandemic, as a matter of safety, tweens and teens are limited from many growth opportunities. And that flies in the face of typical teen development.
For teens, peer relationships are a big deal. Their brains are designed to feel rewarded when they socialize, in some ways more so than adults. Spending time with friends helps them discover their identities and gives them the courage to move away from the family and into the larger world. Being restricted from exploring this aspect of themselves may leave them feeling lonely and bored, and it goes against the messages their brain’s reward centers are sending.
And let’s not forget the missed milestones. From birthdays to graduations to religious or cultural celebrations of growth, adolescence is also a time of important rites of passage. But these celebrations didn’t happen or looked dramatically different in the past year. Teens feel a true sense of loss for missing out on important affirmations that remind them they’re growing up.
On top of all that, the pandemic has diminished teens’ support systems or eliminated some altogether. Besides parents, teens often get support from other caring adults, including extended family and kin networks—grandparents, aunts and uncles, cousins, and others. Caring connections may also stem from teachers, coaches, after-school staff, or religious leaders. In normal times, schools also play an important part in providing mental health services for adolescents; research finds that just over a third of teens who get mental health services get them only at school. With these support channels disrupted, parents have an even bigger role to play in supporting teens’ mental health
Strategies to support teen coping
Start with yourself. One of the most important strategies for parents looking to help their teens is too often ignored: self-care. Parents must take care of themselves. You know, the whole “put your oxygen mask on first” concept. When parents show teens the hard but productive work it takes to cope with stress, they’re teaching them how to face challenges.
Children haven’t fully developed the ability to regulate emotions, so they need to co-regulate with the important adults in their lives. They look to see how their parents and other trusted adults are coping to figure out how they should react. They “borrow” our calm and gain a sense of safety by watching us. But they can just as easily “borrow” our frenzy or catastrophic thinking.
Dr. Ken Ginsburg, director of the Center for Parent and Teen Communication, cautions it’s not as simple as just acting calm around your kids. “Looking like a duck calmly gliding on water is not actually the answer. While it may lend stability, it doesn’t teach strategy. As parents, we want to look like the duck moving through the water but also let our children see that our feet are paddling quickly underneath to help us stay afloat.”
Bracho-Sanchez says when she’s working with teens, she often first considers where the parents are in their own mental health and self-care journey. “I think we sometimes forget that until the parent has enough food, a safe place to live, a stable income . . . it’s really hard for them to help in a way that is sustainable. And until we have provided the parents with resources to care for their own mental health, it will be difficult to create the healing environment that we so badly want for all of our kids.”
Ways for parents to model good self-care for their teens include spending time with others (in a safe way), healthy eating, exercising, getting enough sleep, and making time to relax. Consider relaxation techniques such as meditation, yoga, reading a book, listening to calming music, or enjoying a hobby. Encourage your tweens and teens to de-stress and take part in self-care routines, as well. Let your teen know these are important tools to take back control of their bodies and minds.
Check in with teens. Amid all the changes and chaos stemming from the pandemic, how do parents learn how their teens are really doing? Ginsburg stresses the importance of listening and taking cues from what teens are saying. And if they’re not saying much, ask open-ended questions that show you care about their well-being. For parents struggling to find the words, try saying, “This is a tough time. I want to know how you’re experiencing this. What are you finding that’s helping you get through it? How can I support you?” Parents don’t have to offer immediate solutions—sometimes kids just need a sympathetic ear.
Re-establish routines. My daughter is in high school, but during the pandemic it has felt like she (and many of her friends) have adopted more of a college-age lifestyle. Staying up late, talking to friends at all hours, sleeping in, snacking throughout the day instead of eating at regular mealtimes. There’s been a loss of structure. Social media and blog posts confirmed my suspicion that parents across the country are witnessing similar things happen with teens in their homes.
It’s essential for our teen’s mental health to get back some structure. Routines offer a sense of order that is calming in the midst of uncertainty. Help your teen re-establish bed- and wake-up times. Encourage them to get dressed in the morning, eat regular meals, and spend time away from screens.
Set the tone. Parents and caring adults can adopt an attitude that is honest, future-oriented, and hopeful. This doesn’t mean denying problems exist. These may be challenging times, but it is also an opportunity to demonstrate how to manage uncertainty. A time to find creative ways to re-connect. And a chance to build resilience.
While it may be difficult to keep a positive mindset, focus on what you can control and remind your children things will get better in the future. Part of this viewpoint includes looking at the reality of the situation and teaching them to believe that their actions (or inaction) make a difference. For example, if watching television news about the pandemic all the time is adding to your teen’s stress, remind them that while they can’t control what appears on the news, they can determine how much they watch. Choosing to turn it off, watch less, or vary the source of programs can impact their ability to maintain a more positive outlook.
Don’t forget joy. As the number of vaccinations continues to rise, Bracho-Sanchez has been encouraging families to (safely) find joy in their lives once again. “Families have been in survival mode for a while now. And when you’re just surviving there’s so much that you don’t allow yourself to do and feel. Families have so much culture and tradition that they can bring to their young people.” She focuses on joy because it’s a powerful emotion for getting through hard times.
For example, my daughter and I have been enjoying putting our own spin on old family recipes. Quincineras, bar and bat mitzvahs—often large, extended family celebrations—are alternatively being enjoyed with immediate family at home as friends and other family members take part “virtually.” Some families are creating new rituals. A friend now works with his kids to come up with “reflection and gratitude” prompts that they write down on slips of folded paper. They open one at dinner to start conversations about things they have to be grateful for and happy about.
Seek help. Sometimes it’s beyond our ability to help teens improve their emotional and mental health. Seeking help from others is an act of great strength. If parents feel unstable or if their own mental health is challenged, there is power in seeking help for yourself and modeling that “I don’t deserve to feel this way. I want to take the steps needed to feel better,” says Ginsburg.
There are many places to reach out for professional help. Find a psychologist near you from the American Psychological Association or ask your personal doctor for local counseling service providers. There are also professionals trained to help children and teens get through tough times. The family pediatrician or a school counselor is a good starting point. You can also reach out to someone you trust in the community for local resources.
Moving toward a new normal
As the pandemic wanes, Ginsburg, who is also author of Building Resilience in Children and Teens: Giving Kids Roots and Wings, says there’s a real opportunity for families and communities to better support teens’ emotional well-being.
Many parents wonder what’s going to happen to this group of teenagers after living through these unprecedented times. What they want to hear is that kids are resilient and will bounce back to normal in no time.
But Ginsburg has a slightly different answer. He says adults first must intentionally work to ensure teens have the support systems in place to help manage the enormous amount of stress they are still under. He adds, “I hope things don’t go back to the way they were before the pandemic. Every generation is shaped by what it’s exposed to during adolescence, and this generation has been exposed to an understanding that human beings need each other. This could be the greatest generation ever if they are shaped by this essential truth.”
Award-winning journalist, writer, and blogger
Executive producer and director of digital content at the Center for Parent and Teen Communication at Children’s Hospital of Philadelphia
This article originally appeared on Greater Good, the online magazine of the Greater Good Science Center at UC Berkeley.
How the media may be making the COVID-19 mental health epidemic worse
This article originally appeared on The Conversation
Since the pandemic began, anxiety rates in the U.S. have tripled; the rate of depression has quadrupled. Now research is suggesting the media is part of the problem. Constantly watching and reading news about COVID-19 may be hazardous for your mental health.
We are professors who study the psychological effects on people caught up in crisis, violence and natural disasters. COVID-19 surely qualifies as a crisis, and our survey of more than 1,500 U.S. adults clearly showed that those experiencing the most media exposure about the pandemic had more stress and depression.
It’s understandable. The intimations of death and suffering, and the images of overwhelmed hospitals and intubated patients can be terrifying. COVID-19 has created an infodemic; members of the public are overwhelmed with more information than they can manage. And much of that information, especially online, includes disturbing rumors, conspiracy theories and unsubstantiated statements that confuse, mislead and frighten.
Stress worse for some than others
A June 2020 study of 5,412 U.S. adults says 40% of respondents reported struggling with mental health or substance use issues. This finding did not address whether respondents had COVID-19. Since then, some people who had COVID-19 are now reporting mental health issues that appeared within 90 days after their illness subsided.
Taking care of a relative or friend with the virus might result in mental health problems, and even just knowing someone with COVID-19 can be stressful. And if a family member or friend dies from it, anxiety and depression often follow the grief. This is even more likely if the individual dies alone – or if a memorial isn’t possible because of the pandemic.
Essential workers, from hospitals to grocery stores, have a higher risk for COVID-related mental health problems. This is particularly true for health care workers caring for patients who ultimately died from the virus.
Black and Hispanic adults also report more mental health issues, including substance abuse and thoughts of suicide. Having access to fewer resources and experiencing the systemic racism running through much of U.S. health care may be two of the factors. The COVID-19 pandemic also intersected with episodes of police violence toward Black Americans. This alone may have exacerbated mental health problems.
Children, young adults and college students also show comparatively worse mental health reactions. This could be due to the disconnect they feel, brought on by the isolation from peers, the loss of support from teachers and the disappearance of daily structure.
Setting limits essential
Staying informed is critical, of course. But monitor how much media you’re consuming, and assess how it affects you. If you are constantly worrying, feeling overwhelmed, or having difficulty sleeping, you may be taking in too much COVID media. If this is happening to you, take a break from the news and do other things to help calm your mind.
Parents should frequently check in with children to see how they are affected. Listening to and validating their concerns – and then providing honest responses to their questions – can be enormously helpful. If a child is having difficulty talking about it, the adult can start with open-ended questions (“How do you feel about what is happening?”). Reassure children that everything is being done to protect them and discuss ways to stay safe: Wear a mask, socially distance, wash hands.
Finally, you can model and encourage good coping skills for your children. Remind young people that good things are still happening in the world. Work together to list healthy ways to cope with COVID-19 stress. Then do them. These activities will help your children cope – and it will be good for you too.
Associate Professor of Communication and Public Health, University of Missouri-Columbia
University of Tennessee, College of Social Work, University of Tennessee
This article originally appeared on The Conversation
What Teens Really Think About Their Social Media Lives: Tips for Storytellers
Social Media and Teens
© Photo by Jen Siska
In Common Sense Media’s latest research, teens share their experiences on everything from digital distraction to how social media makes them feel.
What teenagers look like they’re doing and what they’re actually doing can be two totally different things — especially when it comes to social media. A bored-looking ninth-grader could be majorly bonding with her new BFF on Snapchat. A 10th-grade gamer may complain loudly when you cut off his internet but be secretly relieved. An awkward eighth-grader may be YouTube’s hottest star. To find out what’s really going on in teens’ social media lives, Common Sense Media polled more than 1,100 13- to 17-year-olds in its latest nationally-representative research, Social Media, Social Life: Teens Reveal Their Experiences. The new study updates our 2012 study on teens and social media with surprising new findings that address many of parents’ most pressing concerns about issues such as cyberbullying, depression, and even the popularity of Facebook (spoiler alert: It’s not).
Why now? Today, 89 percent of teens have their own smartphones (compared with 41 percent in 2012). They grew up right alongside Instagram and Snapchat. They do research papers on Google Classroom, find emotional support on teen forums, share poetry on Tumblr, and may text “I love you” before they’d ever say it to your face. But concerns over the negative consequences of social media have grown in tandem with its popularity among teens. Grim reports on teen suicide, addiction, cyberbullying, and eroding social skills have caused many people, from parents to teachers to the tech industry itself, to look at social media as a potential contributor — if not the cause — of these issues. This survey clarifies some of those concerns and draws attention to the reasons some kids are deeply affected by — and connected to — their digital worlds.
Key Findings of Social Media Report & Actionable Insights:
Thumbs mostly up. Only a very few teens say that using social media has a negative effect on how they feel about themselves; many more say it has a positive effect. Twenty-five percent say social media makes them feel less lonely (compared to 3 percent who say more); eighteen percent say it makes them feel better about themselves (compared to 4 percent who say worse); and 16 percent say it makes them feel less depressed (compared to 3 percent who say more).
Managing devices is hit or miss. Many turn off, silence, or put away their phones at key times such as when going to sleep, having meals with people, visiting family, or doing homework. But many others do not: A significant number of teens say they “hardly ever” or “never” silence or put away their devices.
Less talking, more texting. In 2012, about half of all teens still said their favorite way to communicate with friends was in person; today less than a third say so. But more than half of all teens say that social media takes them away from personal relationships and distracts them from paying attention to the people they’re with.
Vulnerable teens need extra support. Social media is significantly more important in the lives of vulnerable teens (those who rate themselves low on a social-emotional well-being scale). This group is more likely to say they’ve had a variety of negative responses to social media (such as feeling bad about themselves when nobody comments on or likes their posts). But they’re also more likely to say that social media has a positive rather than a negative effect on them.
Tips for Storytellers:
Show kids (and their parents) putting phones away or on “do not disturb” at key times, such as mealtimes or bedtime. Kids know social media can get in the way of important things, but they have a hard time regulating their own use. Modeling mindful and intentional use can help to normalize behaviors. It’s also worthwhile to depict kids who take phone breaks for a day or more to feel less distracted, or to avoid digital drama.
Highlight the teens who need the most help. An honest depiction of teen social media use for a depressed teen might include a teen feeling unusually happy after receiving online validation (through likes or replies), but also deeply affected by comparing themselves negatively to others online (like on Instagram), or not getting likes or feedback after posting something.
Show the creative side of media to inspire teens to use media to learn and grow. Teens express themselves in a variety of ways on social media: creating and sharing art, photography, poetry and other writing, and music. Take care to show kids creating with their mobile devices, and not just consuming or mindlessly scrolling.
To find out the latest on what teens are doing on social media, check out Common Sense Media.
Michael Robb, Ph.D.
Senior Director of Research, Common Sense
Collaborator of The Center for Scholars & Storytellers
Caroline Knorr
Senior Parenting Editor, Common Sense