Cognitive Behavioral Therapy is a form of psychological treatment that effectively reduces symptoms of mental health challenges such as depression and anxiety and is also one of the most effective ways of treating substance abuse. Cognitive behavioral therapists typically help patients deal with their problems by breaking them into smaller parts, focusing on the relationship between thoughts, feelings, and behavior. Through this form of talking therapy, patients are taught coping skills to deal with their various issues, commonly focusing on present challenges rather than past issues.
Dr. Jocelyn Sze is a licensed psychologist specializing in cognitive behavioral therapy, attaining her Bachelor's in Psychology at Stanford University and her Ph.D. in Clinical Psychology at the University of California, Berkeley, where she is an assistant clinical professor. In addition to her practice, Dr. Sze researches many topics, including emotion and empathy, publishing the research in scientific journals. Her areas of expertise include anxiety, mood, trauma, sleep, stress, anger, and more, and she is a member of nonprofits that help empower others.
In this article, I ask Dr. Sze for her professional viewpoints on teen mental health and advice for both teens and parents to cope with their mental health challenges. For more information on Dr. Sze, feel free to check out her website at http://cbtsanfrancisco.com/.
There is a lot of information about worsening rates of depression/anxiety, especially in teens, over the last few years. Can you discuss the trends that you’ve noticed, and theories for what has contributed to the trends?
"These are complex questions to which no one knows the definitive answer. Social media and increased screen time seem to be contributing factors. With social media, there are some potential mental health benefits, such as finding peers who identify with similar issues and generating increased awareness and openness about mental health. When I was growing up in the 80s and 90s, I had little access to language about feelings, identity, inclusion, anxiety, depression, etc. Teens now have access to empowering narratives about mental health, and social media has played a role in that.
On the other hand, Surgeon General Dr. Murthy's warning on social media use is based on a growing body of research showing its significant harmful effects on teens. I specialize in sleep, and the research on teens shows that the single most effective intervention you can do to improve sleep in teens is remove social media and screen usage from the bedroom. Particularly for teens who are going through rapid hormonal, body, and brain development, sleep is a cornerstone to mental health.
Another big factor is that social media activates what CBT therapists call the "Compare and Despair" part of the brain. We are social creatures, and we are all wired to compare ourselves to others and scan for where we are measuring up and falling short. This part of the brain is particularly active in teens and young adults. In our evolutionary history, being an outcast and rejected by the tribe was often a life-or-death matter. So when a teen feels left out, like they are missing out or not "measuring up" to the social standard around them (portrayed in distorted ways by social media), this can be registered in the limbic brain as a terrible threat. Unfortunately, social media is a technological innovation that pours rocket fuel on the Compare and Despair part of the brain and can hook teens into a chronic state of social threat activation. Excessive social media usage can also exacerbate a host of other risk factors, such as perfectionism, self-criticism, intolerance of uncertainty, reassurance seeking, and avoidance of the real world, all key mechanisms that maintain common mental health struggles such as anxiety and depression.
Finally, we're seeing a lot more awareness in teens about existential threats such as climate change, racism, and rising inequality. In the mental health field, we're in a phase of trying to "catch up" with these threats by helping to empower the public with the psychological and community resiliencies necessary to face these types of challenges, together."
I know you are a CBT expert. Wondering if you have advice for parents of adolescents/teen years to promote good mental health? For teens to help themselves or their peers?
"First, to let teens know that anxiety and depression is not their fault, and therefore not something that they should have to solve by themselves. The increasing rates of anxiety and depression in teens suggest a need for structural, policy-based, and culturally responsive solutions. Advocacy groups like SafeSpace are playing an important role in tackling these issues systemically. As a parent, asking your individual teen to reduce their cellphone usage for the good of their mental health will likely be a losing battle. It might be more effective as a parent to advocate for system-wide changes, such as getting phones out of schools, period.
Peer support is key for mental health, as is doing activities that align with your values and feel meaningful in some way. Thus, participating in mental health advocacy groups, joining affinity groups, group activities such as sports or arts, all these things can be protective. Based on the research on core mental health building blocks, I made up an acronym I use with my own clients called FERNS: Food, Exercise, Rest, Nature, Social connection. Give yourself nourishment and care in these five categories. Don't get obsessive and try to do any of them "perfectly" (I've seen a big rise in orthorexia, an obsessive preoccupation with eating healthy food). But be honest with yourself about whether you're neglecting one of these buckets, and then see if you can give yourself greater permission to care gently for yourself on that front. Get a buddy to join you. If you've experienced trauma or something difficult that you're holding in, find safe spaces like therapy to metabolize what happened so you can feel more freedom and ease in your life and unhook from stories of self-blame or inadequacy. Finally, develop an internal voice that is as kind and compassionate to yourself as you are to your best friend. If you can learn how to do that now as a teen, you're going to save yourself a lot of money in therapy bills as an adult!"
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