The rise of anxiety in adolescents - could it be smartphones?

You’ve probably heard that today’s high school students have around the same level of anxiety as the average psychiatric patient in the early 1950’s used to experience. Unfortunately it’s true. We really do have the most depressed cohort of young adults the world has ever seen. Frame that in the context of history – there is no world war happening right now – and you probably have a few questions. How can children as young as ten come home from school just to stay in their rooms and live their life on their phone or iPad? How healthy is it for teens to obsessively check messages, snapchat every moment of their day, and text constantly? How can first world teens, who are well fed, well clothed and well educated, be suffering so badly from depression?

These are all good questions. Like a lot of other parents you’re also probably thinking about the rise of social media and the associated pressure that must bring. Imagine how awful it must be to be fourteen, covered in pimples and believing you will always fall short of what people really should look like – which many teens are convinced is a filtered, sculptured Kardashian face on Instagram. Most parents I know have come to the conclusion that all of this stress, depression and anxiety has been created by internet access and social media. Well, it has and it hasn’t. There’s more to today’s adolescent levels of stress and anxiety than just smartphones, so let me run you through some of the research. You have probably read a number of articles shared by friends telling you how bad phones and media are, but few offer useful when ideas for alternatives. In this article I’ll make some practical suggestions for you to try with your own teen.

But first, some context.

Once upon a time our teens would come home from school, do chores, and then be sent outside to go away until dinner. They played an informal game of football or cricket, caught up with friends, went to the river, park or beach. They connected with each other – in person. Many a schoolyard fight was ironed out in backyard play. Hold this image in your head for a moment. Think of your own childhood. Where were you after school? You could have been many places, but you certainly weren’t trapped at home.

With the rise of digital technology came more access to world news. Parent shaming created a cultural shift around fear, over-parenting, over-protectiveness and blame (‘where was the mother when that child was hurt?). Children have gone missing and we’ve worried for them. We have been heartbroken when they were found and we’ve agonised over all the awful things that may have happened to them. As a result we’ve held our own children tighter, and kept them at home. Many teens are either over-scheduled with after-school activities or isolated at home, doing homework and chores and wishing they were with friends. Neither of these effectively meet adolescent needs, and that’s where social media comes to the teen’s rescue.

Adolescence – untangling from the family and tangling up with friends

Between 13 and 18 adolescents are in the process of individuating; separating themselves from the parental and family nest that has been home for so long and turning their attention to identity formulation. Through this period their gaze turns outwards to peers and teachers, as they ask the world, ‘who am I?’ Teens incorporate the feedback they receive – good or bad – into their sense of self. It’s true that parents will have primacy in the internal structure that adolescents create, but parents should keep in mind that peer feedback plays a critical role in adolescent self-construction during this time.

The point of all this is that it’s important – in fact, absolutely essential – that teens get to spend time with friends. One of my favourite quotes explaining this says, ‘Friends for children aren’t the icing on the cake. Friends aren’t even the cake. Friends are the vegetables.’

So when adolescents need peer relationships but can’t see their friends in person, what happens? They spend their afternoon on the phone, interacting in the next best possible way, over social media. This is fraught with risk - more bullying is likely to occur over media than in face-to-face situations, and the reason for this is simple: words delivered across a screen are difficult to assess for tone and meaning.

Too much and too little screen time both cause depression

The journal Emotion recently published a fascinating research article, ‘Decreases in Psychological Well-Being Among American Adolescents After 2012 and Links to Screen Time During the Rise of Smartphone Technology.” Using a large national survey of eighth, 10th and 12th graders conducted annually by the University of Michigan, the study examined what support happiness in teens. The results were rather surprising for many people. It turns out that less than six hours of screen time per week is correlated with depression in teens. Yes, you might have to read that twice - teens with less than six hours of screen time experience more depression than teens who have more than six hours of screen time.

But too much is far worse than too little

However, more worryingly, more than 20 hours of screen exposure a week causes profound depression and anxiety. Given that screen time includes computer time, phone time, television and gaming, then you’ll appreciate it’s fairly easy to hit the 20 hour mark. Teens are potentially doing one or the other from the time they get home until the time they go to bed.

Smart phones are particularly addictive. Every ‘like’, every message, every connection, no matter how small, provides a dopamine hit. The very real reason that teens become addicted to phones is that they get a lift from looking at them that closely resembles what happens during in-person communication. However, eye contact provides the real thing that dopamine is faking - a boost of oxytocin. Oxytocin builds trust in relationships and it can only be acquired during in-person communication.

Parenting Tip: How do you know if your teen is having too much screen time? Pull them off the phone, the television or the PS4. If they get grumpy, if they snarl, if they’re rude and uncooperative, then they need a 24 hour detox, effective immediately.

So how do we get addicted teens to detox away from their devices?

First, the golden rule, which you will hear repeated by experts everywhere, is to make sure that there are no devices of any kind in bedrooms at night.

Parenting tip: Try the ‘Family Zone’ app or one of the similar gatekeeping apps available to limit internet access.

But it’s not as simple as just taking their phones away or reducing screen time. There’s more to adolescent wellbeing than just making sure they watch the screen less. They’re addicted, remember? The bottom line is that in order to effectively remove screen time, you need to replace it with in-person peer connection and outdoor activities. I like to use a plan that I developed for this specific purpose.

The Four Elements of Teen Wellbeing.

In order to be mentally and physically healthy, after school time for pre-teens and teens need a four-point balance of;

-        Time to connect with friends – the right friends, the right way;

-        Time to exercise – scheduled (team sport, dance) or non-scheduled (surfing);

-        Time for work – either a job, helping out at home, or school work;

-        Time to be creative – let them get bored so they fill their time with expression.

Let me expand on these.

Time to connect with friends:

Successfully introducing this system with your pre-teen and teen is really going to be about how well you negotiate out the finer details. Your teen is possibly pushing for more freedom and time with friends. Time with friends is great, but it has to be time without screens. So negotiate with your teen that this new free time to hang out must be outside time – this is critical. You don’t want your teens visiting each other to play the PS4 or Xbox. Instead you want them out in the fresh air, playing sport, hitting the beach. You need to make a deal that where possible includes the cooperation of other parents so the friend group is on board and focused on outdoor activities.

Parenting tip: Remind your teen that they become the five people they spend the most time with, and it’s not to say that their friends may not be good people, they just may not be a good person for your teen to be around. Support them in creating solid, accepting friendships.

Time to exercise

This can be scheduled or unscheduled. I know many teens do organised sport, dance and play on teams and these options are all great. Keep in mind though that the time should be a mix of scheduled activities and free time. An impromptu surfing session, bodyboarding afternoon or basketball game at the park will provide more of a lift than a scheduled activity because impromptu activites feels like play, and play is critical to wellbeing. Scheduled activities, though useful for keeping teens occupied and supervised at the same time, feel a lot to teens like learning, and don’t offer nearly as much of a wellbeing lift.

Time for work

A teen with a strong work ethic and a decent set of life skills is a teen with self-esteem that’s fairly impervious to bullying, depression or ridicule. If your teen doesn’t have an after-school job then they should be helping out around the home. Adolescents that know how to vacuum, mop, cook and babysit help the family and actually feel a genuine sense of achievement when they do so. Teach your sons to cook and clean and your daughters to change tyres. Teach them all about banking, shopping, budgeting and how to book in to see a doctor. This is the work of life, and it builds happier adults.

Parenting tip: it isn’t praise that strengthens the adolescence sense of self, but knowing they have the skills and resilience to cope with whatever life throws at them. Teaching real-life skills beat praise out every time.

Time to be creative

Let your teens get bored. There must be some time in every child’s life when they get bored, have nothing to do, and are forced to occupy themselves. Keep the phones out of reach and the art supplies handy. Let them pour out their frustration with the world into a musical instrument or some clay. No chores, no homework, no phone… let them find ways to occupy their considerable brain space without you making suggestions or organising their time for them.

Parenting tip: forcing your teen to rescue themselves from boredom without a screen is how you future-proof your teen. Intelligent minds who know how to cope with loneliness and boredom will be able to occupy themselves, and the easy options of smoking, drink, destruction and drugs will stay far absent from their lives. Let them walk, think, draw,

Finally

With careful negotiation and through working in conjunction with other parents, you can support your teen in weaning off social media and screens. It probably won’t be easy…giving up addictions never is. Try putting your own phone away for the same length of time you’d like your teen to put it away.

Parenting tip: keep your eyes open. Depression and anxiety in adolescence can be hidden in surprisingly deceptive ways. Just because your teen heads off to school with a smile doesn’t equate to happiness; they may just be extremely good at masking their inner pain. Keep the lines of communication open and where possible, stay close to family and friends so your teen has someone safe to go to for help if they can’t talk to you. And remember, if you’re seriously concerned, find a therapist.

COUNSELLING MEN - Falling Off The White Horse

I am forever in awe of the courage it takes to come in to therapy, of the sheer grit and determination of people who sit with a counsellor and ask for help to change their lives. But I admit when a male client walks into my practice, I respect the courage it takes them even more. For men, being strong and not admitting weaknesses is in many ways a cultural expectation of Australian males, making asking for help just that little bit harder.

If you have seen Brene Brown’s TED talk on vulnerability or her follow up TED talk on shame, you may remember what she says about men:

“I did not interview men for the first four years of my study. It wasn't until a man looked at me after a book signing, and said,

“I love what say about shame, I'm curious why you didn't mention men?”

And I said, "I don't study men."

He said, "That's convenient."

And I said, "Why?"

And he said, "Because you say to reach out, tell our story, be vulnerable. But you see those books you just signed for my wife and my three daughters?"

I said, "Yeah."

"They'd rather see me die on top of my white horse than watch me fall down. When we reach out and be vulnerable, we get the shit beat out of us. And don't tell me it's from the guys and the coaches and the dads. Because the women in my life are harder on me than anyone else."

It’s an important point. It isn’t just the male macho culture of ‘suck it up Princess’ that causes problems. It is true that often women expect the men in our lives to be the strength we lean against; the solid, immovable trunk of our family tree, calm, strong and fearless in any storm.

When we see the men in our life start to struggle, we may not recognise what we’re looking at. We might think they’ve put weight on and need more sleep than usual, but might not associate that with depression. We might see them working late and worrying over small issues, and we may not register that as an early symptom of anxiety. Subsequently, men may feel isolated and lonely, which will affect their physical health even more. Men are far more likely to take themselves into the doctor for a general feeling of fatigue, than consider they need to see a counsellor.

As a result, of the approximately eight people who commit suicide every single day here in Australia, six of them will be men. Yes, you read that correctly.

It doesn’t help that men resist counselling. Despite research that shows men who continue to suffer without asking for support are likely to experience an ongoing decline in their interpersonal relationships followed by a higher rate of illness, men are often still reluctant to ask for help.

So perhaps you can appreciate a little of why I sometimes wish I could stand up and applaud when I see a man courageous enough to walk into a counselling room. It’s hard enough for women – and generally we love to talk about our feelings, emotions and life events. Men, not so much. Silent and strong are bywords of masculinity. It can feel like transgressing some unspoken code to open up, and for some men it’s for the first time.

We now know – thanks to recent research published only this month by Katie Holloway and colleagues from the University of Portsmouth – that when it comes to counselling, men aren’t as interested in talking about problems as they are in fixing them. I’ve found this to be true in my own practice. In my experience men get a lot out of Solution-Focused work, in which we work through proven techniques to support creating effective changes in their day-to-day lives. Once engaged in therapy I find men are full-throttle forward, active in working for change, interested in results, and willing to ask the hard questions of themselves.

But how do you carefully and gently suggest that a man you know may benefit from therapy? Research shows that men are more likely to seek help for issues they perceive to be shared by other men. They are also less interested in the idea of counselling when they think all that’s going to happen is endless talking – either about the past or their feelings. Men want to know that they’re going to be presented with concrete and useful strategies and solutions.

If you are a man reading this, and you’re ‘falling off your shining white horse’, it will help to begin with understanding how normal this is. We place enormous societal expectations on men - expecting them to bear the primary financial responsibility of supporting families through the child-rearing years, have brilliant careers, earn plenty of money, be physically fit, competitive in a work environment – and yet somehow also expect them to be compassionate, helpful and understanding at home. And this isn’t even touching on additional complicating factors such as sexuality, relationship issues, grief, family dynamics and life changes. With this list of everyday stresses, it should come as no surprise that depression and anxiety can occur.

We need to normalise counselling as an everyday, simple and easy solution to life issues when they arise, and one of the ways we can do that is to offer counselling solutions in ways that support both men and women’s different therapeutic needs.

-  Victoria Matthews.

CLINICAL HYPNOTHERAPY - An Incredible Healing Tool

“Hypnosis started when the first mother kissed it and made it better.”
- F. Bauman

Occasionally I suggest clinical hypnotherapy as a treatment option to a client and find they look at me as though I’ve suggested I’ll wave a magic wand around to make them feel better. Which is ridiculous. It’s closer to the Force than Fairy Godmother Magic. (‘These are not the droids you are looking for…’)

Okay, I’m kidding. (A little. There’s a little bit of Fairy Godmother Magic in there.)

Seriously though, I do understand many of the misgivings my clients have about hypnotherapy. I had a few myself before I was trained, and I actually remember thinking on my first day, “this is fine, I’m happy to put other people into a hypnotic state, but I’m not comfortable going under myself.” How hilarious! I had some misconception that the hypnotic state was extraordinarily vulnerable.

On the bright side, this now means I really do get it when clients aren’t sure about the idea - most people do feel extraordinarily vulnerable at the thought of being in a trance state. It’s easiest to explain it like this: you know how sometimes you can drive from one place to another and not remember the details of the road? Or you sit in front of the window dreaming, but not be looking at anything in particular? Those are trance states, and they are exactly how hypnotherapy works.

It feels a little like focused day-dreaming, where you’re extraordinarily relaxed. In this highly relaxed state you’re aware of what’s happening the entire time and able to hear every word spoken to you, but the thinking and analytical part of your brain goes into rest mode. When that happens, we can access the unconscious part of your mind to support significant change at the deepest levels.

An important point to clarify:

There’s a difference between hypnosis and clinical hypnotherapy. Hypnosis is the process of simply being put into a trace state, during which suggestions are made. This can be helpful, but rarely works with the underlying cause of the issue. Clinical Hypnotherapy is delivered by practitioners trained and qualified in psychotherapy and counselling, and therefore much of the session is spent working on what might be behind the issue before we even begin hypnotherapy.

“Clinical hypnotherapy is a kind of psychotherapy. Hypnotherapy aims to re-program patterns of behaviour within the mind, enabling irrational fears, phobias, negative thoughts and suppressed emotions to be overcome.”
- Dr Hilary Jones

Hypnotherapy bypasses the thinking mind and therefore exceeds even willpower as an agent of change.

I love the way a well-known psychotherapist and hypnotherapist explains this process:

“Though I certainly do not uphold hypnotherapy as the panacea for all psychological ills, it offers any mental health practitioner with an alternative intervention. Like having another tool in the shed, it may be the first one selected, or perhaps a second or third choice if other tools don’t do the job. I like to think of hypnotherapy as an adjustable power tool with various and sundry drill bits and adaptable screwdriver heads. It can be used to repair and build a number of things, but it’s useless if a hammer is called for.” – David Reid

As a good example of the tool analogy, let’s talk about using hypnotherapy to treat anxiety. Clinical hypnotherapy is one of my primary tools to treat anxiety but it’s one of several rather than the only tool required. When clients present with anxiety, it’s rarely simple fear, worry or panic without an antecedent cause. An important part of the process is exploring triggers for their anxiety. What causes anxiety episodes? What historical point in the client’s past may have initiated onset, such as trauma or grief? What physiological processes are in play? What other strategies will support healing? As the answers are explored, healing can begin. Just like other tools I use, such as Cognitive Behavioural Therapy, Solution Focused Therapy or Psychodynamic Psychotherapy, Hypnotherapy supports healing.

Most of my clients with anxiety experience significant improvement in their quality of life. They usually enter treatment with a self-reported level of anxiety of around 10, and by the time they finish treatment (which usually takes around six sessions) they’ve often gone two weeks without an episode and self-report that they permanently sit around a level 2.

I’m sure that kind of shift feels magical to many of my clients, even if there is no actual magic involved.

Which reminds me, I wonder how many of you have seen Moana? Without sharing any spoilers, there is a verse sung during the most poignant moment of the film that without fail reminds me precisely of the process of hypnotherapy:

“I have crossed the horizon to find you
I know your name
They have stolen the heart from inside you
But this does not define you
This is not who you are
You know who you are.”
- Moana

There is an incredible shift that happens with hypnotherapy…one in which as a therapist I can remind my clients that they are not defined by their pain, anger, depression, fatigue, anxiety, grief or any other disorder. Deep in their unconscious, they already know who they are.

If there’s any ‘magic’ in hypnotherapy, it is this: it supports the process of sweeping aside the barnacles of behaviour that have clung and formed habits, side-passing negative thought patterns to reveal the beautiful self that was always there underneath.

-  Victoria Matthews

HOW IS YOUR EMOTIONAL WELLBEING?

Love and belonging are fundamental human needs. As we start a new year, it’s timely to focus on those people who will find themselves standing in a crowded room, yet still feel lonely. Take a moment, and imagine how that feels. How does it happen? It’s because it isn’t solitude that makes us lonely. It’s a lack of connection to others; a feeling that you aren’t loved or cherished, or that you aren’t emotionally safe.

A recent University of Chicago study showed that the bodies of people suffering from loneliness had changed in such a way that the risk of inflammatory diseases increased and their antiviral response diminished. In other words, our brains are wired to equate loneliness with danger, and to switch our bodies into a defensive state. This makes sense if you think back to our origins as hunter gatherers. We’ve come a long way since our time chasing mammoths, but our brains instinctively know there is safety in staying connected to other members of our tribe.

In fact, a recent University of Chicago study identified a link between loneliness and how our genes express themselves. Loneliness changes your body, giving a greater resistance of blood flow through your cardiovascular system, higher levels of cortisol, a poor immune function, an increased likelihood of depression and a failure to sleep deeply. Chronic loneliness is actually as dangerous for you as high-risk behaviours such as smoking, obesity or a lack of exercise.

The truth is you can be isolated and lonely in a crowded room, in a classroom full of people, in a house full of family or even an unhappy marriage.

A comprehensive University of Utah study on marriage quality discovered that men and women in loveless, sexless or ambivalent marriages consistently post higher blood pressure readings on any given day. They also found that a marital fight that was critical, contemptuous or controlling in tone was as predictive of poor heart health as whether the individual smoked or had high cholesterol.

In a similar study, Ohio State University researchers discovered that wounds heal more slowly in couples that have hostile arguments versus those who manage conflict without hostility.

A surprising amount of people endure joyless, ambivalent and even difficult relationships, either with their partner or family members. Yet if you knew how badly it was affecting your physical health, would you continue to settle for what you have? People endure these lives because that’s the Australian way – you do what you need to do and you get on with it.

Yet these people become sick and fatigued. They wonder why they’re not sleeping. Why does their neck ache? Where has this persistent headache come from? Why is their stomach bloated? How could they possibly have gained weight?

These are all symptoms of emotional stress – the early onset of depression. But these unhappy people, even though they might go to a doctor and pick up an anti-depressant, will all too often avoid looking themselves in the mirror and asking that profoundly important question, ‘am I emotionally well? Can I change this situation? And if I can’t, can I change the way I react to this situation?’

For most people, taking a pill won’t change the big picture. It won’t suddenly improve the way you handle people, or the way they respond to you.Interpersonal therapy is the best place to start for the emotional support you need to move your life into a more positive space. From there you move outward into other holistic lifestyle changes.

Quality relationships – with family, friends and loved ones - are associated with much better health outcomes long-term and profound improvements in wellness.

-  Victoria Matthews