The GoodTherapy Blog

Cyber bullying has become more common with advances in technology. Messages can be posted on social networking websites, and pictures can be downloaded, altered, and made available to the world in seconds. Although there has been abundant research into the consequences of cyber bullying and traditional bullying, little has been done to determine which type may cause more psychological damage. It is well established that bullying itself—the act of terrorizing, intimidating, and ridiculing another through verbal or physical acts—can have numerous deleterious effects.

Those who endure bullying are at increased risk for internalizing problems such as anxiety, depression, and suicide ideation. Understanding how each type of bullying impacts young people is of critical importance in order to target those most vulnerable and help them deal with the ramifications. To get a better idea of the effects of cyber bullying in comparison to traditional bullying, Sheri Bauman of the University of Arizona’s College of Education recently conducted a study asking college students to rate their levels of distress based on hypothetical cyber and traditional bullying scenarios. The scenarios were similar in nature and differed only in delivery.

Bauman discovered that three main bullying themes emerged, including generalized bullying, name calling, and sexual victimization through explicit sexual images. Although the female participants reported higher levels of distress for all three types of bullying, the method of delivery did not impact emotional response. Specifically, although their responses varied by bullying scenario, all participants reported similar distress levels whether the bullying event was traditional in nature or cyber bullying.

However, Bauman found that one type of bullying was the most distressing. “We … found that bullying with sexual material, whether conventionally or by technological methods, is the most upsetting kind of incident to targets,” she said. This was especially true for female participants. Those with a history of victimization had higher distress than those without. In sum, Bauman believes that these findings demonstrate that it may not be the delivery method of bullying behavior that is most detrimental to young people, but rather the content of the message conveyed.

Reference:
Bauman, S., Newman, M. L. (2012). Testing assumptions about cyber bullying: Perceived distress associated with acts of conventional and cyber bullying. Psychology of Violence. Advance online publication. doi: 10.1037/a0029867

Reaching woman sitting with TV

Reality television programs are anything but real. Shows that depict romantic relationships or the pursuit thereof—such as The Bachelor and Real Housewives—reveal fantasy lives filled with high-octane intimacy, infidelity, and unrealistic ideals. These factors seem to add to the appeal for many people. But do these portrayals influence people’s expectations of their own, real-life relationships? Yes and no, according to a study conducted by Jeremy Osborn of Albion College in Michigan.

Osborn surveyed almost 400 married people to find out if their perceptions of relationship satisfaction and commitment were affected by what they viewed online, on television, and in movies. He found that those who believed in fictitious romance had a lower sense of relationship commitment. They expressed concerns about the high cost of losing their independence and having to sacrifice their own interests for those of their partner. Because they viewed the price of relationship commitment to be high, they also placed relationship satisfaction at a premium. This could explain, in part, why the reality romance supporters had the same level of relationship satisfaction as those who did not believe in reality romance.

Perhaps people who view relationships as emotionally costly expect more from their relationships than people who view their relationships as less emotionally expensive. In fact, if someone anticipates having to invest quite a bit into a partnership, he or she probably expects a large return. Therefore, those who see romantic relationships as requiring a big injection of time and effort may value the outcome of their efforts differently than people who do not approach relationships the same way. However, Osborn cautions that commitment is a key element to relationship satisfaction and that culture’s definition of relationships, as manifested in the media, does not demonstrate that. “We live in a society that perpetually immerses itself in media images from both TV and the web, but most people have no sense of the ways those images are impacting them,” Osborn said. Because marriage failures are holding steady in the United States, he believes it is imperative that couples take a good, long look at how everything, including reality TV, affects their relationships.

Reference:
Gannon, Megan. Commitment harder for those who watch TV romances, study claims. (n.d.): n. pag. The Huffington Post. 19 Sept. 2012. Web. 19 Sept. 2012. http://www.huffingtonpost.com/2012/09/19/commitment-issues-tv-romances_n_1896784.html

The term “hook up” is one modern way individuals, especially young people, refer to casual-sex encounters. Teenagers who are sexually active, but not in romantic relationships, may “hook up” with other teens. But are these encounters damaging to adolescents’ sense of well-being? Research has suggested that teens who date are more likely to experience stress, depression, and emotional conflict than those who do not. However, the level of depression and stress teens experience in committed relationships has not been compared to the depression and stress in teens who “hook up.”

To address this void in research, Jane Mendle, of the Department of Human Development at Cornell University in New York, conducted a study that compared the emotional and psychological well-being of more than 1,500 pairs of siblings ranging in age from 13 to 18. She gauged whether the siblings were romantically involved with another person, engaging in sexual activity with that person, or whether they were sexually active with nonromantic partners. She found that although the teens in committed relationships did have moderately higher levels of depression than those who were single, the teens who participated in “hook-ups” had the highest levels of emotional distress and depression. This was especially pronounced in teens under the age of 15.

Mendle believes that one of the reasons for this finding could be the fact “hook-ups” often involve partners who used to date, or who may want to date each other in the future. In this sense, one of the participants may be more emotionally invested in the encounter than the other. The subsequent dismissal of a romantic relationship may bring on feelings of sadness, disappointment, and even jealousy. The findings in this study are rather robust because they are based on sibling pairs. However, this dynamic can also limit the results, and further family history should be gathered in future work. Additionally, romantic relationships, as defined by the participants, may not necessarily involve sexual intercourse but may include other intimate acts. This should also be explored in future research. “Continued exploration of how the transition to sexual maturity may be moderated by contextual factors can help clarify the particular developmental challenges and stressors of adolescence,” Mendle said.

Reference:

Mendle, J., Ferrero, J., Moore, S. R., Harden, K. P. (2012). Depression and adolescent sexual activity in romantic and nonromantic relational contexts: A genetically-informative sibling comparison. Journal of Abnormal Psychology. Advance online publication. doi: 10.1037/a0029816

It is normal for adolescents to conflict with family members, especially parents. In fact, this transition from obedient, caring, and emotionally attached child to sometimes distant, moody, and rebellious teenager is often seen as a normal stage of development. Adolescents begin to find their own identities, their own sets of friends, and their own interests during the teen years. During this exploratory period, they begin to pull away from the safety of family and assert their own independence as they start their foray into adulthood. But even though moderate conflict is viewed as relatively normal, researchers have raised questions about the effects of conflict on social functioning. In a recent study, Katherine B. Ehrlich of the Department of Psychology at the University of Maryland took this question one step further. Using a sample of 189 adolescents, Ehrlich assessed how parental conflict and peer conflict affected social functioning independently and collectively.

The participants and their two parents, mothers and fathers, were observed as they engaged in conversations about topics that caused conflict. The adolescents were then asked to detail any conflicts in their closest peer relationships. Finally, the participants’ friends were interviewed about the level of social acceptance and general behavior of the participants while in social environments. Ehrlich discovered that although conflict with parents was linked to more aggression and risk taking, this effect was significantly amplified when peer conflicts were occurring simultaneously.

It has been suggested that conflict is a catalyst for social development and that adolescents need to experience disagreements in order to learn how to engage in problem solving and adaptive stress coping strategies. However, Ehrlich believes that when there is too much conflict present in teens’ lives, their resources may become quickly depleted, thus impairing their ability to function socially. It should be noted that the results gathered in this study were only obtained from married, heterosexual parents and were not examined independently. Future work should isolate mother-child conflict and father-child conflict to capture a more in-depth look at the individual influence of each. Additionally, single-parent environments should be examined in relation to parent-child conflict and its effect on social functioning. Ehrlich added, “We encourage researchers to continue using a multimethod approach to explore the ways in which conflict across family and friend relationship contexts influences adolescent development.”

Reference:
Ehrlich, K. B., Dykas, M. J., Cassidy, J. (2012). Tipping points in adolescent adjustment: Predicting social functioning from adolescents’ conflict with parents and friends. Journal of Family Psychology. Advance online publication. doi: 10.1037/a0029868

Adolescent girls are among the most vulnerable for issues that relate to body image. They are assaulted with unrealistic images and unachievable ideals from virtually every media outlet. Teen girls struggle to find their identity at a time when appearance often determines their social circle and affects their self-esteem. In fact, research shows that teen girls worry more about their bodies than they do about academics, family life, or any other stressors. Young women who develop unhealthy eating behaviors can find themselves in a lifelong battle of physical and mental distress. Eating and food issues can lead to other negative psychological problems such as depression, anxiety, or even suicidal ideation.

Kathryn E. Rayner of the Centre for Emotional Health of the Department of Psychology at Macquarie University in Australia recently led a study to explore how peer relationships affect eating and body image issues in young women. Social acceptance is critical to teens, so Rayner theorized that perhaps young women select their friends based on eating and body image similarities, or perhaps they shape their own perceptions and behaviors based on the friends in their social circle. Rayner examined selection versus socialization in a sample of 1,197 teen girls from nine separate high schools in Australia. The adolescents were assessed for bulimic and dieting patterns, body satisfaction, and peer relations over a period of three years.

The results of the study revealed some interesting trends. First, the participants tended to choose friends with similar body satisfaction/dissatisfaction levels and bulimic behaviors. However, they did not choose girls with similar dieting and eating patterns. The girls also chose to engage in friendships that were bidirectional and avoided one-sided friendships. Rayner discovered that the girls who dieted the least had more people who wanted to befriend them, while those with more depressed mood and overt dieting behaviors had fewer peers soliciting their friendship. Additionally, the girls in the study, although they selected girls with dissimilar behaviors from their own, did not change their own actions to model those of their friends. Rayner believes the results of her study shed new light on some of the factors that influence eating, dieting, and body image in girls at risk. She added, “These findings represent important building blocks in facilitating the formation of more effective prevention and intervention strategies.”

Reference:
Rayner, K. E., Schniering, C. A., Rapee, R. M., Taylor, A., Hutchinson, D. M. (2012). Adolescent girls’ friendship networks, body dissatisfaction, and disordered eating: Examining selection and socialization processes. Journal of Abnormal Psychology. Advance online publication. doi: 10.1037/a0029304

People who drink coffee usually crave it first think in the morning. Similarly, individuals who enjoy a glass of wine or a cocktail after a long day of work may have physiological cravings during peak happy hour times. And according to a new study conducted by Lydia A. Shrier of Harvard Medical School’s Department of Pediatrics and the Division of Adolescent/Young Adult Medicine at Boston’s Children Hospital, young adults who crave marijuana also do so at specific times of the day. Persistent cravings are associated with high levels of relapse, regardless of the substance. People who crave sweets, alcohol, cocaine, or other substances tend to report that obsessions of cravings for their substance are what preceded their most recent relapse. Some reports suggest that the majority of individuals who receive treatment for drug addiction have cravings when they abstain. This is a primary symptom of withdrawal in drug and alcohol addiction and can lead to eventual relapse. To better understand what causes or increases cravings, Shrier gathered information from 41 young adult marijuana users over a period of 2 weeks.

The participants were cued six times a day, and they recorded where they were, who they were with, their level of desire to use, the availability of marijuana, and mood. Shrier discovered that even though the participants had all been selected because of their current drug use, just over half of them reported any desire or craving for marijuana during the study period. Of those who did, location, companionship, and time were critical triggers. For instance, the participants had more cravings when they were with friends than when they were with parents. Additionally, cravings were more common in the evening than in the morning. The participants in this study may have been engaging in more social activities in the evening and more academic or job-related activities in the morning. This would explain the increase in reported cravings during evening hours, a time that is often viewed as more social. Shrier said, “The association between times of day and increased desire suggests that intervention strategies recommending alternative activities be focused on vulnerable times.” She believes that marijuana use may decrease if individuals are able to reduce their desire for marijuana, especially in situations when cravings are strongest.

Reference:
Shrier, L. A., Walls, C. E., Kendall, A. D. , Blood, E. A. (2012). The context of desire to use marijuana: Momentary assessment of young people who frequently use marijuana. Psychology of Addictive Behaviors. Advance online publication. doi: 10.1037/a0029197

A client that drops out of therapy is one who does not complete the recommended course of treatment. Many therapeutic approaches, such as cognitive behavioral therapy, do not have a specific treatment deadline, and clients are considered dropouts when they have voluntarily stopped therapy prior to resolving the issues and symptoms that brought them there to begin with. Dropout is a serious concern for the medical community and the general population. Individuals who drop out of therapy are more likely to have future psychological complications and seek services multiple times, which places an economic burden on society. Because they do not learn adaptive coping strategies and fail to address the issues that plague them most seriously, they are likely to be less than productive in their careers, families, and communities. Additionally, therapists who experience client dropout may begin to question their ability to help clients and their own adequacy.

Understanding the factors that contribute to dropout can provide clinicians with the information they need to address the problem. Joshua K. Swift of the Department of Psychology at the University of Alaska in Anchorage wanted to explore this problem further and made it the focus of his most recent study. Swift analyzed over 650 studies that included more than 83,000 clients and looked at factors such as client age, therapy setting, therapist experience, type of therapy, issues addressed in therapy, and clinician definition of dropout.

Swift found that nearly 20% of all the clients in the studies ended their treatment early. He found that some variables, such as therapy setting, influenced the rates of dropout. He also discovered that rates of dropout were highest among the youngest participants and those seeking treatment for personality or eating problems. Swift believes that more work is needed to determine specific nuances that effect retention. He hopes efforts will be aimed at isolating psychological issues, such as anxiety or depression, and approaches, such as psychodynamic or behavioral therapy, in order to get a clearer idea of the different dimensions affecting treatment completion. Swift said, “By paying attention to these variables and making adaptations where needed, clinicians may be able to reduce rates of premature discontinuation in their work with clients.”

Reference:
Swift, J. K., Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology80.4: 547-559.

GoodTherapy | How Texting Changes Communication Texting has, in many ways, made communication easier by helping people avoid long, unpleasant phone conversations and making a quick “Hello” much easier. According to the Pew Research Center, 72% of teenagers text regularly, and one in three sends more than 100 texts per day. Clearly, texting is the preferred method of communication among young people, and that trend is moving upward toward adults, who are also texting much more frequently. While texting hasn’t been around long enough for researchers to study its long-term effects on communication, there is circumstantial evidence that it is rapidly altering the ways people communicate with one another both via text and in person.

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Face-to-Face Communication

Texting encourages rapid-fire, single-sentence thoughts, but this style of communication isn’t conducive to face-to-face communication. Consequently, people who text a lot may be more uncomfortable with in-person communication and may even use their cell phones to communicate with people who are in their presence. Parents often report that their teens text during dinner, and the friend who texts during a group night out is a common phenomenon. The reality may be not that these people are being rude but that they are uncomfortable with slow-paced, in-person communication.

Surface-Level Communication

Texting increases the frequency of small talk and can be a great asset to people beginning to form a friendship; they may be much more comfortable texting each other witty one-liners than they are picking up the phone and calling. But texting is, almost by definition, surface-level communication. When people communicate primarily via text, they’re much less likely to have meaningful conversations.

Written Communication

People know they’re using improper grammar when they text; it’s merely a shortcut that enables them to relay a message quickly and effectively. But over time, the way we communicate—even if we know the way we communicate is “technically” wrong—affects the way we think. The result is that people who have grown up texting may have much poorer writing skills than people who regularly communicate using grammatically correct sentences either in person, over the phone, or via email. Even worse, they may lose their ability to modify their tone and style depending upon who they talk to. Many employers complain that entry-level hires have no idea how to send a business email or communicate appropriately to superiors.

Impatience and Instant Gratification

Texting is real-time communication but is not in person. This creates an odd situation in which people feel compelled to respond immediately via text, but they aren’t really participating in an ongoing, progressively deepening conversation. The instant gratification of texting can lead to incredible impatience, even aggression. But when people are in person, the requirement of communicating immediately can be daunting for people communicating primarily via text. Thus texting can inhibit both in-person communication and texting itself.

Social Boundaries

Unlike phone calls, there are no clear rules about when it’s acceptable to text. And because texting doesn’t result in an angry person answering on the other end, many people feel more comfortable texting at any time and in any circumstance. The result is a decrease in privacy and social boundaries. People may text in the middle of the night or while someone is on vacation and expect an immediate response, because of the impatience texting encourages. The result is a blurring of the lines between public and private. While a couple might previously expect no interruptions on a vacation or honeymoon, they can now anticipate receiving and responding to texts. Because texting is not old enough for psychologists to know how this affects intimacy, we can only guess at its long-term effects on relationships.

References:

Alison Bryant, J., Sanders-Jackson, A., Smallwood, A. K. (2006). IMing, Text messaging, and adolescent social networks. Journal of Computer-Mediated Communication,11(2), 577-592. doi: 10.1111/j.1083-6101.2006.00028.x
Hanna, J. (n.d.). W&L Psychology Project examines cell-phone usage and adolescent health. Washington and Lee University. Retrieved from http://news.blogs.wlu.edu/2012/07/24/wl-psychology-project-examines-cell-phone-usage-and-adolescent-health/
Influence of Texting on Communication Skills. (n.d.). Influence of texting on communication skills. Retrieved from http://artofeloquence.com/texting/

Young man walking People in their 20s seem to have it all: youth, energy, health, and looks. But they are also still figuring themselves out, and this time of change can bring certain mental health concerns as well. Experts have information on these issues that tend to impact people in their 20s, and provide some solutions for addressing and coping with these problems.

Clinical psychologist Dean Haddock, a marriage, family, and child counselor and the executive director and founder of Community Counseling and Psychological Services, points to a fairly common activity of 20-somethings that can lead to mental health issues if it’s not checked: alcohol and drug use.

“The first problem that leads to many others is alcohol and chemical abuse, which often leads to dependency,” Haddock said in an email. “The mental disorders that follow are often depression, anxiety, and brain injury. Of course, self-esteem and body-image problems often lead to eating disorders.”

Haddock gives three tips to help people in their 20s prevent and get through some common mental health concerns:

Know your genetic history of mental disorders. Knowing is half the battle to avoid those disorders in yourself.
Be choosey about your friends, as they will influence your decisions. Healthy friends lead to healthier decisions.
Self-esteem is often the result of the people who matter to you. If they do not esteem you, then you will not esteem yourself.

Nerina Garcia-Arcement, a clinical psychologist and clinical assistant professor at NYU School of Medicine, suggests that the many life changes people experience in their 20s can cause mental health issues at times.

“Your 20s are filled with life transitions that can be stressful,” Garcia-Arcement said. “This is a time when young adults are solidifying their personalities, developing their independence from family, starting or finishing college, beginning new jobs, developing a career, forming romantic relationships, and learning to manage their existing family relationships and friendships within these context.”

“Individuals in their 20s don’t have a lifetime of experience to draw on when managing multiple life transitions at once,” she added. “When someone experiences these transitions, anxiety and depressive disorders can occur.”

Here are six of Garcia-Arcement’s tips to help people in their 20s cope with mental health issues more common to that age group:

Seek out and form strong support networks.
Seek out others who are going through similar experiences and share your feelings, whether you are feeling worried, nervous, scared, sad, confused, or excited.
Know that you are not alone in your confusion about your career and relationships.
Seek out mentors who have achieved their goals, and ask for advice.
If you are feeling stress, sadness, or anxiety, engage in activities that will help you manage those feelings such as yoga, meditation, exercise, hobbies, social activities, relaxation exercises, and deep breathing.
If you feel you are not getting the necessary support and feel overwhelmed or depressed, seek out mental health professionals who can help you manage the feelings related to your life transitions.

Stephanie Sarkis, a licensed mental health counselor, said in an email that anxiety and depression are some of the main mental health issues 20-somethings face.

“We have seen an increase in these issues due to the lagging economy and difficulties finding employment,” Sarkis said. “Many people in their 20s have moved back in with their parents, which can trigger feelings of failure and frustration.”

Dr. Maiysha Clairborne, a family physician and wellness and stress management coach, added in an email that eating disorders associated with body dysmorphic disorder and body-image issues are also common for people in their 20s. She has three overall tips for people in this age group:

Talk to someone. The worst thing that a person can do when they are feeling depressed, anxious, or alone is to isolate more. Many times when we talk with someone we trust about what’s going on, we come to realize that we are not the only ones experiencing it and then we can get support.
Get active. Staying physically active not only helps to keep the body fit but also helps release endorphins and serotonin in the brain, which help keep the mood elevated. Physical activity is also a good release for stress and anxiety.
Minimize sugar and junk food. Sugar and processed junk foods can worsen the emotions of stress, anxiety, and depression because they cause erratic changes in your body’s blood sugars. This can disrupt the normal release of hormones in the brain that keep your moods stable.

Scott Carroll, a psychiatrist with dual board certifications in adult and child and adolescent psychiatry, said there are many issues specific to people in their 20s, including problems associated with medication use.

“Many people were on stimulants/meds for their ADHD when they were younger, but they thought it was okay to stop their meds when they were done with school,” Carroll said. “Now they are struggling at work and don’t know why. I’ve also seen young adults stop all kinds of meds like their thyroid meds because they didn’t know why they were even on it, and then they have all kinds of problems.”

Bad habits involving drug and alcohol use can start to become a major substance abuse issue when people are in their 20s, and other mental health issues start coming to the forefront at this time in peoples’ lives. Examples include bipolar disorder and schizophrenia. Also, panic attacks can start for people who have a genetic predisposition and who have higher amounts of stress associated with newfound adulthood.

“The 20s are an important time of social/emotional development,” Carroll said. “Unlike previous generations, identity formation often takes the entire 20s due to the complexity of modern society. It could be said that adolescence lasts until the early 30s in today’s society due to [prolonged] periods of education (grad school, law school, med school, etc.), lack of stable job options, and delays in getting married and starting families.”

Carroll, who is also an assistant professor at the University of New Mexico School of Medicine, suggests that when it comes to serious relationships and marriage, people in their 20s should consider how their choices could eventually affect their mental health and how their brain plays a part in their decision.

“Many 20-somethings are tempted to get married, but it is generally a bad idea because the brain in not done developing until about 25 [years old] … which leaves young adults vulnerable to having their rational mind be overwhelmed by their feelings or stress,” Carroll said. “Relationship choices often dramatically change from the early 20s to the late 20s, so many people find that the person that was perfect at 22 is a disaster at 27. This can be an incredibly hard transition, to have to break up with your former soul mate that you thought you’d love for life because you’ve changed so much over the last several years.”

Major depressive disorder (MDD) is more prevalent in the pediatric population than previously believed. According to some estimates, between 2% and 8% of children and adolescents have mood disorders. Depression in childhood often predicts recurrent episodes of depression later in life. This population is also at heightened risk of psychiatric disorders, substance abuse, social maladjustment, homelessness, and criminality. Clearly, depression in young people is not a problem that can be safely ignored. Early therapeutic intervention is essential and usually consists of cognitive-behavioral therapy and medication. Currently, the only antidepressant medication approved for use in children and adolescents is Prozac (fluoxetine). However, the lasting effects of Prozac exposure during youth are still not completely known. Conventional wisdom suggests that the benefits of treatment likely outweigh long-term risks, particularly in cases of MDD.

The adolescent brain, just like the adolescent body, experiences profound and rapid development. Chemicals in the brain called neurotransmitters direct cellular and structural growth throughout the brain, and this process gives rise to the adult brain: a well-regulated, stable organ that manages consciousness and the central nervous system. During the period of rapid growth, any disruptions or chemical stimuli can lead to functional changes later in life. For this reason, antidepressant use in childhood has come under great scrutiny. Prozac alters the balance of neurotransmitters in the brain. Some have argued that Prozac exposure during adolescence may result in lasting, even permanent behavioral changes. Researchers conducted a controlled experiment with adolescent rats to address some of these issues.

Rats given Prozac during adolescence displayed significant behavioral changes when tested as adults. For example, they showed less response in a forced-swim test and more response to anxiety-producing situations, such as a new environment. The increased anxiety was reduced by a second exposure to Prozac. Most disturbingly, sexual behavior in adulthood was impaired by Prozac taken during adolescence. This finding was completely unexpected. However, the researchers cautioned that the relationship between brain development and behavior is enormously complicated, and the current study only highlights this complexity. How much of these results translate to humans is also an open question. Rats are typically used in these studies because they mimic human physiology and neurobiology. Still, the underlying mechanisms of behavior are not well understood.

The adolescent rat study, among others, adds powerful evidence to the argument that Prozac initiates profound changes in the brain. These changes manifest themselves as behavioral and mood alterations. Human research is necessary to determine the scope of these alterations. As it stands, prescription of this antidepressant for children with MDD is still warranted.

References

PubMed Health. [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Fluoxetine. Retrieved April 11, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000885/
Iniguez, S. D., Warren, B. L., Bolanos-Guzman, C. (2010). Short- and long-term functional consequences of fluoxetine exposure during adolescence in male rats. Biological Psychiatry, 67(11), 1057-1066.

Young soccer player For children, teens, and college students, summertime is associated with freedom from school and positive emotions. However, summer can also be a time where certain mental health issues need to be tended to even more than usual. Experts share information on what mental health problems can be present more often during summer and how to prevent certain issues.

Peter Zafirides, a psychiatrist in Ohio, said he has noticed a common mental health issue for children, teens, and students during the summer. Many evaluate whether they should still take their medication for attention deficit hyperactivity disorder (ADHD).

“Stimulants are often prescribed during the school year, but depending on the severity of the underlying ADHD, the summers may provide for some time off the medications,” Zafirides said. “But it may not always be smooth-going. The combination of unmedicated ADHD symptoms, along with the less structured days of summer can be very problematic for kids and their parents. Beyond the attention symptoms that worsen, kids can experience mood changes, including anxiety and irritability.”

School can provide a consistent schedule, which can be better for children with certain mental illnesses. “The potential unstructured nature of the summer can feed in to any underlying anxiety disorders and depression present in these kids,” he added.

For children who have ADHD, Zafirides has tips to make summer more bearable. “Children and parents may benefit from sitting down at the beginning of the summer and talking about shared goals and expectations,” Zafirides said. “Have a plan ahead of time to regularly check in with each other and, in an open, nondefensive forum, talk about any changes in behavior or concerns about mood.”

He also has other suggestions that can apply to children and teens with any type of mental illness or mental health issues. “Get outside and enjoy the summer. Try to limit the amount of time online, watching TV, or playing video games,” Zafirides said. “Be active, get plenty of sleep and exercise. If medications will continue over the summer, make sure kids are taking them regularly. Again, summer is less structured, so compliance may not be as consistent, resulting in a worsening of a mental health condition. Always speak to your medical professional before either discontinuing or reducing the dosages of medication.”

Communication is key for healthy relationships and lives. “I think the most important aspect between parents and children in the summer months is to establish clear and respectful lines of communication without either side getting defensive or feeling they are not being heard,” Zafirides said. “An occasional small discussion may be all that is needed to avoid big problems over the summer.”

John Duffy, a clinical psychologist and author of The Available Parent: Radical Optimism for Raising Teens and Tweens said in an email that depression can be more noticeable during the summer. “I have found that depression driven by loneliness often becomes more pronounced in the summer,” Duffy said. “This may be due in part to the fact that people are more obviously out, about, and social in the summertime. For many young people, summer is a far less-structured time of year than any other season.”

Anxiety issues can also come to the surface. “We often find that anxiety-based issues become apparent due in part to the lack of structure,” Duffy said. “Though most young people claim this is the time of year they most look forward to, many become listless and irritable because of a lack of structured activity.”

The solution to these issues is to provide somewhat consistent structure during the summer. “This might include participation in a sport, a play, a camp or other club, volunteer activity, or a job,” Duffy said. “Kids do better when they are part of something. They are happier, less restless, and more driven. Summer also presents a unique opportunity for young people to investigate strengths and interests, and opportunity that is less open to them during the very-structured school year.”

Adults can experience the same mental health issues as children during the summer, especially depression and anxiety. “Depressed adults are more aware, for example, of the degree to which others are socially connected during the summer, and this can serve to amplify the depression,” Duffy said. “Many adults also tell me that, though they want to be more active, limitations imposed by work and other obligations prevent them from doing so. This can contribute to feelings of depression and anxiety as well.”

The National Alliance on Mental Illness website suggests that some people can actually experience seasonal affective disorder (SAD) during the summer. SAD is characterized by depressive episodes that occur during certain times of the year (typically during the winter). In the case of seasonal affective disorder that is experienced during the summer, symptoms tend to be weight loss, minimal appetite, anxiety, irritability, and insomnia. Heat and humidity could worsen this “reverse SAD,” according to the website. Some adults with bipolar disorder are more likely to experience the mania part during spring and summer as well, he said.

William Oswald, the CEO and director of Summit Malibu, a behavioral and addiction treatment center in California, said in an email that all types of mental health issues can occur more often during the summer, such as agoraphobia, addictions and compulsions, as well as the more common depression and seasonal affective disorder.

“When people have a purpose, or curriculum in this case, their minds stay occupied, and boredom is not as prevalent of an issue,” Oswald said. “When they go from being extremely busy to having nothing to do, oftentimes this boredom results in mild, or in some cases severe, forms of depression. Once untreated, depression sets in, people (teens and college students especially) end up self-medicating with drugs or alcohol as a means to simply feel better. This is true of seasonal affective disorder as well—some may not want to be outside, and in turn isolate, resulting in isolative behaviors and a depressive state.”

Oswald has specific preventative tips for each age group during the summer:

Children: “Setting play dates with other kids or sending them to a day-care program where they do outside activities can keep their minds occupied and also help with socialization. This is key to preventing isolating behaviors later on in life.”

Teens: “Having a part-time summer job is the most important thing they can do to protect their mental health. They will learn the importance of a work ethic, earn money (which they can then spend on fun activities), and [prevent] boredom—the number one offender during summer breaks.”

College students: “Having an internship or continuing to work on their educational goals will keep them focused and driven, preventing depression and other detrimental behaviors associated with the disorder.”

Unfortunately, these suggestions will not always work, and in that case it’s best to seek a mental health professional to keep any mental health issues from worsening.

For adults, it can be unfortunate to be stuck inside working when the weather is gorgeous (at least in some places). This can be just another trigger for depression and other mental illnesses like substance-related disorders. “Adults need to utilize their vacation days properly so they have something to look forward to and get to experience summertime weather on days other than the weekend,” Oswald said. “Making time for outdoor activities on the weekend and starting an exercise program will keep one’s mood elevated.”

Bride and groom smiling The word bridezilla has become an oft-used part of our lexicon, and many people who have never been married are confused by the panic and stress that seems to surround wedding planning. But a newly engaged couple quickly learns that the stress of wedding planning is not the overexaggerated fantasy of people who simply have no stress tolerance. Wedding planning is stressful for almost everyone, and yet people never stop to think about why this is. Here’s what is really going on.

Expectations vs. Reality
A wedding is a major rite of passage, and many people—especially women—have been raised to expect their wedding to be a perfect fairy tale. But nothing can be perfect, even a wedding, and the drive for perfection can be profoundly stressful and emotionally fraught. Many people use their wedding as an opportunity to take stock of their lives so far. If they can’t afford a dream wedding, they may feel like failures. Some people have a specific list of things they intended to do before they got married. No matter how unreasonable this list might have been, unfulfilled dreams can still cause stress when you’re planning a wedding.

A Stressful Engagement
The time before you get married should be one of the happiest, most romantic times in your life. Instead, many people spend this period frantically planning a wedding, stressing about finances, and fretting over guest lists. Wedding planning can cause you to pull away or turn on your future spouse, and constant planning certainly eliminates any opportunities for romantic time together. Thus some people arrive at their wedding day feeling pretty humdrum about their future marriage and pretty frustrated with the process that got them to the altar.

Finances
Disagreements about money are among the most common marital problems. When surveyed, people indicate that financial problems are one of the biggest stressors in their lives. Weddings are expensive, with the average wedding in the United States costing well over $30,000, so it’s no wonder people can be driven to a state of panic by weddings. Couples frequently must make huge sacrifices, compromise with their parents, and work extra hours to get the money to pay for their weddings, and all of this effort can take a toll.

Requests of Others
Many newlyweds report that it wasn’t the wedding planning itself that was stressful. It was the constant pressure, opinions, and criticism from other people, such as the mother who’s enraged that you’re keeping your maiden name or the father who insists on a traditional wedding ceremony. A wedding frequently puts the differences between parents and their children on full display. Many engaged couples worry about their parents making snide remarks just before their wedding, or spend the entire time they’re engaged bending over backward to please their parents, only to find out that nothing they do is enough.

Relying on Others
No matter how much you might want it to be just you and your fiancée, a wedding is a group event. From bridesmaids to florists, officiants to flower girls, you must coordinate with many people, not all of whom will be cooperative. Trying to get everyone to understand your vision for your wedding can be like herding cats. And even simple tasks such as getting your best man to finally get fitted for a tux can be extremely stressful. When people have to rely on others to get tasks done, their stress levels tend to rise. This reliance on others is made even worse by the stress most couples feel to create a perfect wedding.

So, no matter how simple you may try to keep the wedding plans, there will still be stressors that you should anticipate and plan for, just as you plan for your cake and photographer. Start thinking about the people and events that may create stress for you and your fiancé, and take steps to reduce those predictable conflicts. Acceptance of the things you can and cannot change is key, and practicing now can only help once you become a partner in a marriage.

Sources:

Miller, R. S. (2011). Intimate relationships. New York, NY: McGraw-Hill.
Reis, H. T., Rusbult, C. E. (2004). Close relationships: Key readings. New York, NY: Psychology Press.