Mental Health and Universities — More Needs to Be Done, Now.

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Mental health services for students on campuses have always been underfunded. As a former board member of the Virginia Board of Counseling  and a therapist in private practice in McLean, Virginia, this has been very apparent to me. Federal law requires universities to be more responsive and proactive. This problem has only skyrocketed during the pandemic. If universities claim to be responsible institutions they have the legal and moral responsibility to do better. Here a a few comments from a recent piece in the Washington Post:

  • College students nationwide are more stressed — with the  pandemic adding loneliness, worry about illness, economic distress, relentless uncertainty and churn to a time of life that is already challenging for many. Demand for mental health services had already been high, but a recent study of college students found increased levels of anxiety and isolation during the pandemic.
  • Last year, the Centers for Disease Control and Prevention reported that more than 10 percent of adults surveyed in June 2020 had seriously considered suicide within the past month. Two years earlier, the share stood at about 4 percent. The issue is particularly acute for young adults. Among 18-to-24-year-olds surveyed in 2020, the CDC said, about 25 percent had seriously considered suicide.
  • Campuses are a microcosm of the larger societal problem of worsening mental health during the pandemic, said Samantha Meltzer-Brody, chair of the department of psychiatry at UNC, who will be leading a university summit on mental health this month. “The needs are massive.”
  • Mental health has historically been underfunded nationally, Meltzer-Brody said, “and the data is very clear that our kids and adolescents are struggling.” That will require more money and more commitment to reach students in a variety of ways, to create connections to combat the pervasive isolation of the pandemic.
  • Schools across the country have taken steps to address the need, from Virginia State University and others adding days set aside for students to decompress, to Dartmouth College, one of hundreds of schools partnering with a suicide prevention nonprofit to study its mental health policies and plan changes.
  • Federal officials say schools are obligated under civil rights law to address the needs of students with mental health disabilities. On Wednesday, the Education Department sent educators a letter urging steps to prevent students from harming themselves. Suicide is a perennial concern on campuses. Now officials say the pandemic has cast a new spotlight on the stress and fear students endure.
  • Without doubt, students have suffered. They were shut out of campuses abruptly in March 2020. Then they endured long stretches of isolation during the last school year, whether they took remote classes from home or lived on or near campus under tight public health restrictions. And this fall is hardly back to normal.
  • The data did not show any significant uptick in suicidal ideation in fall 2020 compared to fall 2019. But it did show increases in stress, social isolation and general anxiety. “These data indicate that colleges and universities should be preparing to specifically support the mental health needs of students during COVID-19, especially in the areas of academic distress, family, eating concerns, trauma, and anxiety, among others,” the center reported in February.
  • At many colleges, the pandemic accelerated a trend toward providing counseling online. That continued even after campuses reopened. “Most of our service right now is still telehealth,” said Jennifer Hung, assistant director of counseling and psychological services for the University of California at Riverside.
  • Now, Hung said, the university is seeking to help students through a new challenge: reentry anxiety. Coming back to campus isn’t as easy as it might seem. “How do we navigate this new normal?” Hung said. Some students need help plugging back in. “We really tailor our workshops to managing stress, managing this transition.”

          “Students Mental Health and Colleges.” Washington Post (October 15, 2021).

ANXIETY AND JOURNALING — “Guided Notebooks” and the Pandemic.

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A good article appeared today in the New York Times on journaling, anxiety and the newer use of ‘guided notebooks.’ “Feeling Anxious and Journaling.”  This is a growing trend and is very important in dealing with anxiety.  Here are some highlights concerning ‘guided notebooks’ as a newer development in treating anxiety during the pandemic:

Over many centuries, journals have served as tools for recording history, as emotional outlets and as creative stimulants. In the current age of self-care and self-optimization — not to mention digital overload — logbooks are resurging, this time as a means of supporting one’s mental health.

The Anti-Anxiety Notebook, a tidy blue-and-white volume, is one example. It takes a page, or several, from cognitive-behavioral therapy, featuring work sheets that aim to challenge cognitive distortions — the thought patterns that can make anxiety worse, such as catastrophizing (assuming the most disastrous possibility will play out) or self-blaming (“believing that you are entirely responsible for a negative situation,” as the book’s appendix puts it).

The potential value of mental health care has not escaped businesses. Venture capital firms invested $852 million in mental health tools in the first quarter of 2021, an increase of 73 percent since the same period last year. –

And there’s a documented demand for such tools. “Individuals are seeking out treatment at levels we’ve never seen before,” said Dr. Vaile Wright, the senior director of health care innovation at the American Psychological Association.

SOCIAL ANXIETY, PANDEMIC AND TEENS.

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A good piece appeared in the New York Times today (Sept. 28, 2021)  discussing social anxiety and teens. This has increased as the pandemic has continued. Here are some highlights.

  • About 9 to 10 percent of young adults and adolescents in the United States have the disorder, defined as an intense fear of being watched and judged by others, according to the National Institute of Mental Health. Now many have felt their extreme self-consciousness grow more severe, psychologists say.
  • As the country continues its gradual re-emergence from lockdowns, some young people are grappling anew with the disorder’s symptoms, encountering newfound insecurities, a fear of public spaces and a reluctance to hang out with friends. The result, experts said, has been a harmful weakening of their socializing muscles, underscoring the pandemic’s potential long-lasting effects on the mental health of a generation.
  • Intertwined with these feelings, many young people say, is a pressure to enjoy their youth while knowing the pandemic and their social anxiety have prevented them from taking even the simplest steps of early adulthood, like meeting new co-workers in person, going on dates or simply having fun with friends on a night out.
  • As we start to socialize more, we’re going to probably see greater rates of social anxiety than there were before the pandemic.
  • Several studies and psychologists across the country expect the disorder to become more prevalent in the coming months, leading to greater rates of depression, which already affects about 13 percent of adults ages 18 to 25.

“Pandemic and Social Anxiety.” New York Times (Sept. 28, 2021).

Reconnecting After Covid With Grandchildren.

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I noticed a change in my relationship with my seven year old grandson after covid distancing — wearing masks and keeping away.

 

I tried hard to reconnect after being vaccinated but felt my efforts were falling flat.  Then I figured out how to meet him where he was and connect in a way he would welcome my interest in his new passion.

 

I took Pokémon tutorials, ordered online starter sets, which led to our first Pokémon battle. He won.

 

But now my grandson can’t wait until our next card battle. I am still a bit confused but I’m learning the game.

 

My suggestion – determine your grandchild’s interest and then connect.

“Inter-Intimate Relationships” — Emotionally Reconnecting.

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An interesting article in the New York Times recently discussed “inter-intimate relationships.” Defined as dealing with emotional intimacy and reconnecting. Here are a few excerpts: 

  • There are many ways in which we show our love and we all need and want different amounts of emotional and physical intimacy. While couples with differing sex drives face hurdles, many couples may also be involved in “inter-intimate” relationships, where each partner has different preferences when it comes to giving and receiving nonsexual affection.
  • ‘Inter-intimates’ describes the incongruent needs and desires that exist between people in a relationship, which inevitably will be mismatched at various times.
  • Touch is a form of intimacy distinct from sex, with its own set of rules that can threaten to undo romantic entanglements.
  • Regardless of quantity, physical affection plays a biological role in one’s happiness. Oxytocin — sometimes called the “cuddle hormone” — releases at higher levels in moments of physical affection.
  • So how do you reconcile your inter-intimate relationship? “Proper communication about affection wants and needs should occur often in the relationship.
  • When broaching the topic of inter-intimacy, it helps to approach calmly and seek to understand and inquire rather than complain or demand.
  • Good communication, a curiosity to understand what makes the other tick and an active interest in meeting these needs are the formula for success in any relationship. In an inter-intimate relationship, it can be the saving grace.
  • Part of what makes their relationship work is a concerted effort from both parties.
  • If you aren’t getting the affection you need in your relationship, there are other options that don’t involve divorce or devastation.
  • If the only touch you get is in sexual activity, then you are missing out on a basic human need. 

To me this short article raised issues that many couples often overlook. It’s a good piece to connect for the first time or to reconnect.

“An Inter-Intimate Relationship.” New York Times (July 27, 2021).

Factors Fostering Resilience.

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     An individual’s resilience is dictated by a combination of genetics, personal history, environment and situational context. So far, research has found the genetic part to be relatively small. Here are excepts from a good article summarizing this research.

  • How loved you felt as a child is a great predictor of how you manage all kinds of difficult situations later in life. 
  • Tools common to resilient people are optimism (that is also realistic), a moral compass, religious or spiritual beliefs, cognitive and emotional flexibility, and social connectedness. The most resilient among us are people who generally don’t dwell on the negative, who look for opportunities that might exist even in the darkest times.
  • Research has shown that dedication to a worthy cause or a belief in something greater than oneself — religiously or spiritually — has a resilience-enhancing effect, as does the ability to be flexible in your thinking.

Additionally, research has concluded the following about resilient people:

  • They have a positive, realistic outlook. They don’t dwell on negative information and instead look for opportunities in bleak situations, striving to find the positive within the negative.

  • They have a moral compass. Highly resilient people have a solid sense of what they consider right and wrong, and it tends to guide their decisions.

  • They have a belief in something greater than themselves. This is often found through religious or spiritual practices. The community support that comes from being part of a religion also enhances resilience.

  • They are altruistic; they have a concern for others and a degree of selflessness. They are often dedicated to causes they find meaningful and that give them a sense of purpose.

  • They accept what they cannot change and focus energy on what they can change. Dr. Southwick says resilient people reappraise a difficult situation and look for meaningful opportunities within it.

  • They have a mission, a meaning, a purpose. Feeling committed to a meaningful mission in life gives them courage and strength.

  • They have a social support system, and they support others. “Very few resilient people “go it alone.”

 

                    “What Makes People Resilient.”  NEW YORK TIMES (June 18, 2020).

Pandemic and Relationships — Making us Stronger? …. Yes.

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A good and interesting article recently appeared discussing the positive impact the pandemic has had on relationships. Here are the major points;

  • During the pandemic, it felt like everything changed for the worse. But one thing got better: our relationships.
  • Those who already had strong relationships with responsive partners felt more
  • The tremendous effort it took for couples to manage over this past year fortified their bonds.
  • Confronting difficulties together can be frustrating for a couple, but the experience can improve their feelings of passion, closeness and commitment. In the pandemic, as couples rose to meet each new challenge.
  • For those still looking for a partner, the pandemic experience will change their priorities.
  • Rather than approaching dating as a game fun and casual connections, people are going to want a stable, committed and dependable partner, with whom they want to develop a relationship. Going forward, the search for a partner will emphasize quality over quantity, the substantial over the superficial.

To me, certainly the pandemic was very challenging but this new research indicates that it has also made many of our relationships stronger. That’s good.

“The Pandemic Made our Relationships Stronger,” Wall Street Journal (June 26, 2021).

PANDEMIC AND RESILIENCY — POSITIVE OUTCOMES FOR COUPLES.

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The pandemic has been a time marked by stress, grief and hardship for many individuals and couples. However, some have also experienced a surprising outcome: a sense of resilience. A recent article has discussed this hopeful development for both individuals and couples. Here are some excerpts:

…. Out of the challenges of navigating a disorienting new world came a shift in perspective and priorities. Couples have made decisions and formed healthy habits that could shape their lives for the better.

…. Some people may even experience post-traumatic growth, which could include a deeper appreciation for life, a greater sense of personal strength and new possibilities for their lives.

…. It might seem counterintuitive for a stressful, tragic time in our history to evoke personal growth. Major changes that can cause rethinking or reordering of life. Things as simple as starting a new daily walking habit or picking up a creative hobby such as knitting can help spur the change.

…. Making a more intentional effort to stay in touch with each other, with friends and family proved to be an effective tool for coping with the stress and isolation.  

…. Circumstances can go a long way toward fortifying people — such as safe housing, living wages, supportive relationships, good mental and physical health, living free from discrimination.

To me, the pandemic shined a light on the importance of mental health and cultivating healthy practices  to make people (couples and individuals) more resilient and better prepared to deal with difficult times.  That’s good.

“Pandemic and Resiliency.” Washington Post (June 22, 2021).

MENTAL HEALTH IN THE WORKPLACE — NEWER AWARENESS.

     MENTAL HEALTH IN THE WORKPLACE — NEWER AWARENESS.

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Naomi Osaka’s recent withdrawal from the French Open because of mental health issues highlights the issue of mental health in the workplace. A good article recently appeared in the Wall Street Journal concerning this larger issue. Certainly spurred on by the Covid virus pandemic. Here are some highlights of that article:

  • Ms. Osaka’s openness about her mental-health struggles is a public example of private issues companies are increasingly facing as a young generation more candid about such challenges joins the workforce, employers say.
  • Data show a gap between how well employers think they are supporting employees and how supported those employees feel.
  • Survey research also indicates that younger workers are more likely than older colleagues to report mental-health struggles
  • The Americans with Disabilities Act counts mental illness as a protected disability if it substantially limits a major life activity, like working. In such a case, employers are required to work with employees to find accommodations that may enable them to do their job, such as more frequent breaks or written instructions instead of verbal ones.
  • But symptoms of conditions covered by the act (ADA), such as severe anxiety or post-traumatic stress disorder, can be ambiguous and highly individual, making accommodations a challenging area for companies to navigate.
  • Employers have viewed mental health with greater urgency in recent years.  
  • You want to keep your high performers, and what we know is people with mental-health conditions can often be your high performers.
  • Still, greater awareness about the issue helps companies and workers move forward.

“Mental Health and Work.” Wall Street Journal (June 5th, 2021).

“Digital Therapy’ Without a Therapist — Algorithms and Self-Help — It’s a New World.

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‘Digital Mental Health‘ and ‘Bot Therapy’ are newest developments in the mental health world stemming from startup innovations.  Applying algorithms to  the exploding need for mental health fueled by the Corona virus pandemic. The use of online therapy with live therapists and now the application of Artificial Intelligence to the development of bots (not using actual people) is a huge development today. This reliance on ‘bot therapy’ allows individuals to exercise self-help online, at anytime, without dealing with actual therapists. Something akin to responding to questions when pulling up online your bank account, credit card or HMO.

 

The following are some comments excerpted from today’s New York Times extensive discussing of use of bots and algorithms in providing a means for self-help to first time seekers of mental health therapy:

 

  • During the pandemic, about four in 10 adults in the United States reported that they had symptoms of anxiety or depression, according to the Kaiser Family Foundation. At the same time, the federal government warns of a critical shortage of therapists and psychiatrists. According to the advocacy group Mental Health America, almost 60 percent of those with mental illness last year did not get treatment.
  • Digital mental health has become a multibillion-dollar industry and includes more than 10,000 apps, according to an estimate by the American Psychiatric Association.
  • Almost all psychologists and academics agree —There is not enough affordable mental health care for everyone who needs it. But they are divided on solutions: Some say bot therapy can work under the right conditions, while others consider the very concept paradoxical and ineffective.
  • The use of cognitive behavioral therapy has a philosophical and practical logic to it. Unlike forms of psychotherapy that probe the root causes of psychological problems, often going back to childhood, C.B.T. seeks to help people identify their distorted ways of thinking and understand how that affects their behavior in negative ways. By changing these self-defeating patterns, therapists hope to improve symptoms of depression and anxiety.
  • Because cognitive behavioral therapy is structured and skill-oriented, many mental health experts think it can be employed, at least in part, by an algorithm. 
  • Bots deliver “digital therapeutics.” It a “pure self-help” program that is not meant for emergencies.
  • Like many mental health apps the current, free version of various bots is not subject to strict oversight from the Food and Drug Administration because it falls under the category of “general wellness” product, which receives only F.D.A. guidance.

     Yes, it’s a new world. Yes, technology is impacting, now in real time, the practice of mental health therapy.  Online therapy (both with a therapist or use of a bot) may well be helpful. To me, ‘bot therapy’ may serve as a gateway introduction to therapy generally — to either virtual therapy with a therapist or to therapy with in-person sessions.  And that’s useful. But the implications and effectiveness of virtual therapy generally (both with real people or via a bot) presents many ongoing questions. 

 

“Tell It to Woebot.” New York Times (June 1, 2021).