Welcome to sheep Resisted, I'm your host Sadie Sutton, a 19
year old from the Bay Area studying psychology at the
University of Pennsylvania. Sheep resisted is the teen
mental health podcast made for teenagers by a teen.
In each episode I'll bring you authentic, accessible and
relatable conversations about every aspect of mental Wellness
you can expect. Evidence based teen approved
resources, coping skills including lots of DBT insights
and education, and each piece of content you consume.
She Persisted offers you a safe space to feel validated and
understood in your struggle while encouraging you to take
ownership of your journey and build your life worth living.
So let's dive in. This week on She Persisted.
I like to think about this as needs not being met.
You know, there's universal needs that we need, we need to
love, we need to be loved. We need to have a sense of
respect. We need boundaries and we need
space. We need meaning in our lives.
And if something's gotten in the way of us being able to meet
those needs, depression's going to come up and tell us about
that, and it's going to try to tell us that at least it might
not be so obvious what it's trying to tell us.
Hello, hello and welcome to She Persisted.
If this is your first episode, so happy you're here.
We have a great one today. If you're a returning listener,
I'm so glad you're back. I really hope you enjoyed the
episode. We have a very exciting guest
today that I actually met at ADAA, which is the Anxiety and
Depression Association of America.
It was in my first psychology conference and I presented a.
Poster which was really exciting.
With my lab and attended a bunch of different talks about
different topics related to mental health.
There was a training on validation.
There was this talk about research on how we talk about
mental illness and specifically depression.
There is ones about ethics and clinical practice.
Exposing clinicians to what exposure therapy was like, which
actually one of my favorite doctors, Blaze Aguirre from
Three E, spoke at that one, which is so fun.
We got to do a little reunion. But all this to.
Say I learned a lot and was really inspired from a podcast
and academic perspective. And after hearing this panel, I
was like, I absolutely need to have this clinician on the
podcast because it is so relevant to the idea of the
podcast as a whole, which is all about talking about mental
health. And so I of course want to make
sure that I'm doing that in an effective way.
And also I think for you guys listening, you're obviously very
aware of your mental health. You want to be intentional, you
want to be effective. You want to give yourself the
best chance possible when it comes to recovery and building
your life worth living. And so I just thought this was
so on the nose and relevant and would create such an incredible
conversation. So our guest today is Hans
Schroeder. He is a clinical assistant
professor of psychiatry at the University of Michigan.
And his research is on the beliefs and messages about
mental health and the impacts that those have.
So as a clinical psychologist, he works both on the research
side of things like I just mentioned, but he also works in
practice. So he does exposure, he does
group therapy with clients. And so this was just a really
well-rounded, incredible conversation.
But how do we talk about depression to give people hope
and help them feel seen and validated, while also
encouraging growth and giving them the best chance at recovery
and engagement in therapy? And so we talked about things
like the chemical imbalance theory.
We talked about the school of thought, the depression is a
signal that something is going wrong in your life and that it's
telling you that something needs to be adjusted or fixed and
there's a need that's not being met.
We talked about identifying with mental illness diagnosis that
I'm sure a bunch of you can relate to.
And then we. Also talked about how we can
validate while also encouraging agency and accountability in
mental health. This was a really incredible and
cool conversation. I absolutely loved it.
I know you guys will as well and if you.
I have thoughts, definitely DM me, e-mail me all the things.
I can't wait to hear them. And this interest is getting
long, so let's just dive in. Well, thank you so much for
joining me today. And she persisted.
I'm so excited to have you on the podcast.
I got to hear you speak at ADAA, which was so fun.
And I immediately was like, more people need to hear about this
and understand the implications of your research.
So I'm so excited to have you here today.
Oh, I'm so excited to be here, Sadie.
Thanks so much for having me. Of course.
So to start with, people that are not deeply invested in the
psychology world and are not paying attention to all the
research that's coming out regularly, can you give a little
bit of some background on your career and how you got to these
specific research interests and the specific area of study?
Sure. So I'm a clinical psychologist
and I work in. It's kind of confusing.
I work in a psychiatry department at the University of
Michigan, but I'm a psychologist.
So I see people for therapy. I provide talk therapy, I do
cognitive behavioral therapy. And my research focuses on how
essentially how people think and talk about mental health with a
particular focus right now on depression, how people talk
about depression. And I got interested in this in
undergrad, actually at Michigan State, learning about fixed and
growth mindsets. I don't know if you've ever
heard of that. It's Carol Dweck at Stanford.
She studied like, do you think people can change their
personalities or, or their intelligence?
And it turns out that if we talk about attributes like
intelligence or personality in genetic language, like you're
born with it, that's pretty much all you've got.
People tend to believe that they can't do much to change that.
And I got really interested as a clinical psychology graduate
student that we talk about mental health and genetic and
biological terms all the time. You know, we even say things
like depressions due to a chemical imbalance.
And so I got curious thinking, does that mean then that people
think they can't change their depression if they think it's a
chemical imbalance? And so that's what my research
is essentially focused on is, is finding the right message for
the right people who resonates with what and what implications
those types of messages have. I think this is really
interesting because when I heard about this, I almost thought it
was counterintuitive because I think a lot of people, the
biological side of things can be very validating.
People hear that and they're like, it's not my fault.
This is something that's happening and it's not a choice
I've made or a way that I'm going about life.
Like this is something that's out of my control.
And that's almost a good thing. But I think what you're
mentioning is so important, which is that if you're saying
this is something that's happening to me and it's not
something I've done to myself, then you were less motivated to
make these changes to then improve your mental health and
makeshifts that might be necessary to overcome different
challenges or diagnosis or whatever it is.
Can you explain to people who are not familiar from like a
research perspective, this biological way that we talk
about depression? I think most of us have heard
about this at some point, but it's really far reaching.
And I think most people aren't fully aware with like the
language we use and how it comes up in things like therapy.
And also, like you mentioned, what that means when people talk
about getting better. Yeah, absolutely.
So we've been thinking and talking about mental health and
depression for a very long time. And if you look at the history
of psychiatry and medicine, there's been kind of a pendulum
in terms of thinking about it more biologically, thinking
about things more psychologically.
But in today's era, there's a lot of messages about mental
health as being due to a chemical imbalance.
This kind of thinking came out in the like, earliest forms in
the 50s and 60s when the first medications came out that were
prescribed for depression. And what they kind of put
together is that we have medication that we know
increases serotonin. We also know that that same
medication decreases depression symptoms.
So that must mean depression is caused by low serotonin.
OK, that logic kind of makes sense intuitively, right?
I mean, that kind of like the medication works to increase
serotonin. It must work in the same
mechanism. But that same logic would break
down very quickly if I said Tylenol helps my headache.
So my headache is caused by low Tylenol, right?
No one would ever say that. And so that's kind of the
origins of the chemical imbalance message.
But we've also seen this in pharmaceutical advertisements.
Media portrays depression as biochemical.
Even researchers who study the biology of depression kind of
espouse this view that depression is biological.
And I just want to clarify for everyone, I'm not anti biology.
There absolutely is biology and genetics involved with
depression. But I'm more curious about how
therapists and providers talk about depression.
Is that the first thing we want to tell patients that this is a
biological disease? And I'm curious about what are
the psychological impacts of hearing that which I can talk
about too. Yeah.
I think another really interesting piece of this puzzle
is over medication and how that has now become a key player in
mental health and especially mental health of a generally
younger generation. We know that with mild cases of
depression, antidepressants are as effective as the placebo.
And when you have more severe cases of depression, they can be
really effective and a really necessary piece of the puzzle.
And I imagine that in that physician having that belief
that it's only biological would be a huge challenge to overcome
within the treatment experience. But do you think that this
belief and mindset that it's a chemical imbalance, that's the
primary way that we conceptualize these diagnosis
has contributed to that, that rise in prescriptions and kind
of that being a more prominent tool in the tool kit that we're
reaching for? Yeah, that's a great question.
I think there's probably a lot of factors that have contributed
to people taking meds more than seeking therapy.
It's less time intensive for sure.
I think insurance companies have also prioritized shorter
treatments and cover medications more so than long term therapy.
They're more willing to do that. So sometimes it comes down to
practicalities like what's cheaper to get help faster?
But certainly the chemical imbalance narrative has come up
more with the introduction of antidepressant medications.
I just want to circle back to something you said earlier,
which I think is a really good point.
And the chemical imbalance belief does reduce blame.
And there's definitely some positives to that mindset.
Like when we're depressed, we blame ourselves for everything,
even being depressed in the 1st place.
So if we can have a narrative that decreases that blame, I'm
all for that. It also has a way of like,
legitimizing suffering in a very powerful way for some folks,
where it's like, if you can see or visualize my serotonin being
low or my brain misfiring, it makes it more real, like a real
thing that deserves treatment. And I'm all for beliefs that get
you into treatment and start changing your life, making
significant changes to overcome things like this.
The downside of these beliefs, though, is that implicitly and
intuitively, people feel a little less hope for making
changes on their own when they think it's a chemical imbalance.
Like I'm a therapist, so people might say, well, how are you
going to change my serotonin just by talking with me, right?
How are you going to change my brain, Right, right.
But actually there's studies that say that talk therapy does
change the brain, which is interesting too.
So it's really complicated, but it's definitely pros and cons of
these types of messages. Leaning into that clinical side
of this process, you mentioned that there are real implications
of the chemical imbalance theory and how that shows up when
people do pursue treatment and look for support and even when
they're in therapy at that point, how they see themselves,
how they might see how effective therapy is.
Can you speak a little bit to that and how the that theory
doesn't even impact just our general conceptualization but
also lived experience of people that are depressed?
Yeah, yeah. So in our studies, we're finding
that a couple things. One, people who've been in the
system more like been hospitalized, have had
medications or therapy or have a family member with depression or
have been diagnosed themselves. Those folks believe in the
chemical imbalance theory more, which is interesting.
And I'm very curious. This research is just starting,
but very curious where they're hearing these messages.
Is it from providers? Is it from being in the doctor's
office? Does it seem like some medical
thing? So exposure matters to these
beliefs. We're also finding that people
who have strong chemical imbalance beliefs think that
therapy is going to be less effective and medications might
be more effective, but it's complicated.
Some studies show that. Some other studies don't show
that. I think there's mixed findings
there, but just from my clinical experience, folks that really
hang on to, I just got to change my brain.
Camels, I just got to do this. It kind of becomes a roadblock
sometimes in therapy where I'm trying to talk through problems
and offer skills and it feels like if I can just get my brain
chemistry right, then I could participate in this more.
And I think sometimes that's true for folks, but other times
I think it's it becomes like a fixation that there's got to be
something in my brain that's off.
And sometimes that can take away our sense of autonomy and
agency. Like if it's my genes, it's my
chemicals, I don't have any control over that stuff.
Which then actually feeds into depression.
Yeah. Do you think there's an element
of cognitive dissonance here where people see how the way
they feel and think and act has changed significantly because of
depression, and they don't want to be like, this is now who I am
and how I feel and how I think and how I'm interacting with
people. And so being like this is a
cognitive imbalance. This is something that's again
happening to me and not something that I'm participating
in is almost like a coping mechanism.
Absolutely, Absolutely yes. We're actually just about to get
a paper published on this very idea where we ask college
students, do you sometimes think about a chemical balance to make
yourself feel a little bit better when you're depressed?
Do you, do you remind yourself that your depression is
biological in order to blame yourself less?
And there's a small minority of participants that really endorse
that. They say, I do do that.
So we almost think of this. It can be sometimes used as an
emotion regulation strategy. And I think that gets tricky,
right? Because it can get really
overwhelming thinking about, OK, if my depression is really
coming from my relationships that I'm in or my family or this
job that I'm in. And I feel really stuck.
That is terrifying. So something like maybe deep
down intuitively, it's like if I view this as a serotonin
deficiency or a chemical imbalance, it's a little easier
to swallow than to than to start facing all the things that are
going on that I do that I am involved with.
Yeah, it's so interesting because when you logistically
think through it, if you were like, OK, it's a serotonin
imbalance, you're like, OK, maybe I can try medication, but
I can't will this to make a difference.
But if it's a job or a friendship or a family member,
you would think, OK, maybe it would be easier to adjust that
aspect in my life. And yet people do still, again,
gravitate towards this chemical imbalance theory.
And that seems to be more effective, like you were saying,
in terms of emotion regulation rather than the agency aspect.
Yeah, I think the trick is when it becomes like major depressive
disorder and really bad depression, the things that we
have to adjust are really big and really daunting, like
intimate relationships that need some serious boundary work or
leaving relationships. And that's scary for folks.
Or you know, we see this a lot, the overlap between something
like post traumatic stress and depression.
When we experience trauma, that's the last thing we want to
think about and revisit. And yet that's often one of the
the main things for recovery is accepting it, acknowledging it,
talking through the trauma and coming to a different
understanding. And so I think about that as
completely understandable apprehension to get into that
stuff, which might make us go towards these other types of
explanations that take us away from what's maybe really going
on or contributing a lot to it. And this is, I just want to
acknowledge this is all complicated because there is
biology involved, right? And there's life things
involved. We've known this for a very long
time. It's not.
It's not a simple thing. Yeah, yeah.
OK. So now that we kind of
understand what the experience of the individual is when
they're hearing these messaging, kind of how they're relating to
these beliefs and how that might affect how they're coping with
things or thinking about them or seeking help.
What is your best case scenario moving forward with how we talk
about these things? Because we're definitely moving
into a position where people are more generally aware of
depression and they're more generally aware of mental health
challenges. And that's amazing.
But like you're saying, how we talk about these things also
potentially might have consequences.
So I guess from like a medical and public health perspective,
what is your best case scenario with how we're having these
conversation? Yeah, it's a great question,
Sadie. So what I've been studying for
the last seven years and experimenting with in the clinic
is not talking about depression as a chemical imbalance right
away, but instead talking about it as a signal that something in
your life might need more attention.
So I'm actually trying to kind of reframe this as maybe your
body is telling you something is going on in your life that needs
more attention. By the way, this is not new at
all. People have been actually
talking about depression in this way for a very long time, like
hundreds of years. It's just that we're not aware
of these types of messages. And so this comes really from
interesting research by Aaliyah Crumb, who looks at stress and
people's beliefs about stress. Is stress right before a test
helpful or is it completely debilitating?
And if people believe that stress is helpful, they actually
do better on the standardized tests.
They do better in challenging situations, even like Navy SEAL
training. You do better in those really
high stress environments if you think that stress is helpful.
So I'm trying to apply that concept to the concept of
depression. Is depression actually trying to
tell you something? And I've been working with
patients with depression in in Group settings basically saying
this message. And it's been really interesting
hearing their feedback. Some patients hate it.
They'll they'll say, no, no, no, this is this is not a signal.
I have a chemical balance, right?
It's a chemical balance. And I'm like, hey, you know
what, if you're in treatment and you're doing the things that you
need to do and living a meaningful life, I've got no
problem with that. I'm not going to argue with you
other folks that will say, you know, I've been in treatment for
like 30 years. Never heard the idea that
depression could have a function.
And for the first time, I'm having some hope.
First time in a while, I've got some ideas about how to manage
this thing. And that's the piece that I
really want to, I really want to understand is, are there
different ways of framing depression from the get go?
When people first come into therapy or first come in to see
their doctor? Can we get people curious about
their lives to make some adjustments on their own before
doing things like therapy and then maybe medications and then
some other types of interventions?
Yeah, I love that so much. I think it's so important.
And I think that was one of the biggest elements of my own
experience. I was like 1314, so I wasn't
really leading into the chemical imbalance.
I don't think I really knew what serotonin was at that point.
But there was the validating aspect of like, this is
something wrong to the point where I'm seeing a doctor and
there is no interventions for this thing.
Like there's a diagnosis, this happens.
This isn't just me experiencing this thing and I'm the only one
that's ever been in this position, but that was a very
common narrative that I struggled with was that there
wasn't a reason why I was depressed.
There was no big loss. There was no big change in my
life. There was nothing that shifted
and then resulted in these experiences.
And of course, hindsight's 2020, when you look at it as a signal,
it was different belief systems. It was how I showed up in my
relationships. It was not being vulnerable and
so you're not able to feel seen, which is so important and how we
function and not having that sense of community or whatever
these different things that were at play that were showing up
were. But I didn't hear that messaging
early on that this is a signal. What is this potentially telling
us about your life? And ended up kind of finding
what those signals were through all the therapy and all the
things. But I think that what you're
saying is really very true is that it provides a lot of hope
for people. When you say this is a signal,
this is saying something isn't effective or going the way it
should be, and this might be the reason why you're feeling this
way because the worst is when it's like you're feeling this
way. It's horrible.
It's taking over your entire life and there's no reason.
We don't really know how it's going to get better.
And I think a lot of people struggle with that experience
because it is very disorienting and very hopeless.
Wow, I'm so glad that you've, it sounds like you've done a lot of
work to uncover some of these signals along the way.
And it is interesting, like the dysfunction disorder framing
does get people into treatment, and that's helpful for a lot of
folks. And so if it's like something's
wrong, I got to go in and, you know, get this looked at.
And yeah, I think it's really hard.
It's not obvious. I tell folks it's not obvious
what the signal is, and it's going to take some
introspection. It's always easier to do with a
therapist. None of this is easy, but it can
be helpful to work with someone else and to dig a little bit to
understand what's going on. I like to think about this as
needs not being met. You know, there's universal
needs that we need. We need to love.
We need to be loved. We need to have a sense of
respect. We need boundaries and we need
space. We need meaning in our lives.
And if something's gotten in the way of us being able to meet
those needs, depression is going to come up and tell us about
that. And it's going to try to tell us
that at least It might not be so obvious what it's trying to tell
us. But yeah.
And I think your experience is so common, it takes a while to
put the pieces together. And that's where like CBT or DBT
can be really helpful to learn to manage uncomfortable emotions
along the way while you're putting all the pieces together
about what, where did this come from?
What is this all about? And it's funny because that's
always the most frequent question people ask, especially
parents will be like, what happened in your childhood?
What caused this? And I'm like, if I knew we like
no one would be in therapy or need multiple providers or be in
this lifelong journey. But I think what you're saying
is so important, which is that we all have unmet needs in the
degree to which they are unmet and how sensitive we are to
those needs being unmet and how much people we fill those needs
ourselves versus rely on others or our environment to kind of
fill those gaps has a really big impact on our mental health and
then how we are able to show up in these different commitments
that we have. Yeah, that's, that's exactly
right. I really like how you framed
that. It's frustrating.
Well, it's frustrating to multiple levels.
It's frustrating to not know yourself what's going on.
And then it's frustrating when people want to know,
understandably, like what? What what happened to get you to
this point. And yeah, I always joke with
patients, like, if we knew and I wouldn't have a job, yeah.
I wouldn't exist. Yeah.
So it's, it's complicated, which
makes it, you know, hard. The best question is always what
can I as a parent do to prevent any mental health problems?
And I'm like, I could not tell you as a junior in college, I
could not tell you. But maybe someday people will
have that answer. Yeah, I think, I don't think
it's possible. And part of the reframing with
all of this is that it's not inherently bad to be depressed
every once in a while. It's definitely not inherently
bad to feel sad or really angry or really guilty.
These are emotions that have evolved, that tell us things.
They're signals that or telling us about our environment,
telling us about our lives and what's important to us.
If we didn't have those, life would be very boring.
We probably wouldn't be around very much longer.
Yeah. Before we dive into immediate
interactions with friends and family members and even just
conversations that we have about mental health and how we can
best have those in a way that's productive and effective, I
would love to get your thoughts on the DSM and the diagnostic
model that we currently operate within.
And I think what you're saying with thinking about depression
as a signal and being really conscious of these unmet needs
is really important. And it leans into this idea that
like all mental health challenges kind of exist on a
spectrum. And maybe if it's really low
level depression and subclinical, there's still is so
much benefit understanding, OK, like what needs aren't met?
What signal am I being told? And the same can be true for
people that are really severely depressed with recurrent
episodes. But what do you think about the
DSM and how we kind of categorize those things?
Because this is another big barrier for people when they're
maybe getting treatment or maybe considering asking for help is,
well, it's not bad enough. I'm not on medication.
Other people have it worse. It's another barrier that people
are navigating. Yeah, it's a great question.
So the history of the DSM is really interesting here.
So the first two editions came out in the 1950s, and they had
words like depressive reaction, anxious reaction.
And the assumption was, yeah, people get depressed because
something happened in their lives.
And it was coming from a psychoanalytic perspective where
we're not exactly sure. There might be some unconscious
conflicts going on that might contribute to someone's
depression, but it qualifies as a diagnosis.
So we should get treatment. And in those days, of course,
this was prior to certainly all of the major SSRI's that are out
now that are effective for treating depression.
DSM three came out in 1980 and got rid of all of that reaction
language. So it would now became major
depressive disorder. And there's no reaction to it.
It's just its own thing. And that was really
revolutionary in the field of psychiatry where from a
diagnostic perspective, like a purely DSM perspective, we got
less curious about what contributed to that and more
just like, can you count the checklist to see like, do they
add up to qualify as a, for a diagnosis?
It's definitely an imperfect model.
I have lots of problems with the DSM.
I think there is a place for diagnosis and conceptualization
only to get people into the most effective treatment.
I was just having a conversation today with some psychiatry
interns about this and we were talking about how diagnosis is
really only useful for getting you into the best fit treatment,
not for explaining your entire life.
You know, we used to say like even the language was, oh, she's
a depressive, right? We don't use that type of
language anymore. You know, she might have some
depression right now. She's experiencing a major
depressive episode. It's person first language.
I think we're shifting away from defining you as a person, as
your disorder, and contextualizing.
That is, this is one part of your life.
Yeah, I think that's so interesting.
And I, you spoke a little bit to this at ADAA, but I think this
is another really interesting aspect of this whole puzzle,
which is people really strongly identifying with these diagnosis
and seeing them with the growth mindset research, seeing them as
permanent and not something that can change or evolve.
And being like, I am a depressive.
I'm just depressed regardless of what happens around being rather
than I am depressed currently. But like everything in life,
these change in intensity and there's many things that I can
do to adjust how I'm feeling. You obviously are working with
patients. You have a lot more experience
with what this looks like and how this shows up.
But do you think this is also connected to how we're speaking
to individuals about depression and anxiety?
And that this kind of where there's that issue of people
really identifying being like, I'm depressed and it's very
validating for them to have those labels, but it almost
becomes a negative with how much people hold on to them.
Yeah, it's really interesting these days, especially with
social media and short videos about how you know you have
ADHD. Like, these are the top 10
signs. And it's interesting because I
feel that there's a natural pull for people to want to not feel
alone. Someone else is experiencing
this too. Wow.
That is super validating in and of itself.
I'm not alone in this experience.
And we can take that too far and say, oh, this is my identity
now. This is who I am.
So we're seeing the entire world as I, this is just through my
depression. I am depressed.
I'm a depressive person. And this is how it's going to
be. The depression experience in and
of itself is, you know, by definition, it engenders a sense
of hopelessness as a low energy, low motivation to address the
things that you might need to address.
So it becomes kind of this reinforcing cycle where I don't
even know where to start and I'm too tired to do anything about
it. So then depression lasts for a
lot longer, and then we think this is just how it's going to
be. So instead I would say, can we
think about depression like emotions in a way?
The first blush, let's say maybe this is telling me something.
What is going on? Let's do an assessment about my
values. Am I living according to my
values? How are my relationships doing?
Is there trauma or stressful life events that I haven't quite
come to terms with yet? How is my diet?
How is my sleep? How is my fitness or movement
exercise going on right now with my work life balance?
Doing an assessment around those things, taking some time, being
curious, I think would be a helpful starting place.
And I, I do think that's how we can talk about depression.
Yeah, it's, it's so funny because I very vividly remember
in outpatient it was like adolescent outpatients.
You go after school, you do the activities, lots of snacks,
incentivizing kids to be there when they don't want to be.
And we would do occupational therapy, which of course with
arts and crafts as therapy. And one of the things that we
did was like drawing and collaging our identities and the
new like share around the group. Here are the aspects of my
identity and almost everyone had is like a very prominent and
stagnant sense of self was I'm depressed, I'm anxious or fill
in the blank with whatever disorder it was.
They were like drawing these dark storm clouds or this
representation that was so prominent in their life.
And it obviously was a very relevant emotional experience
was impacting them enough that they were seeking help multiple
hours a day. But it really was synonymous
with who they were as a person. They were depressed, they were
anxious, they were whatever it was.
And I still look back at that and I think that's one of the
most challenging aspects of adolescent mental health,
especially because as you seek support, which is so helpful to
feel validated and I'm not alone and other people have been here
too. You then end up in this echo
chamber because unlike adults who are crazy with all the self
help podcasts and there's a book on anything and you can tune
into anyone talking about how to solve any problem in your life,
adolescents aren't really doing that.
And they definitely aren't talking about how they're
maintaining their mental health or how they reduce their stress
and how they live a happy and fulfilled life.
It's not a conversation that happens.
But the converse issue is that once you are depressed, you are
in Group therapy. You're consistently interacting
with individuals that are in the same position.
And there's no one that's really saying to fellow teens, I've
been here, I know what it's like and I have made the changes that
I need to make and I'm no longer depressed.
And so it's such a challenging experience to be in.
And of course, there's so many clinicians and adults that say
it will get better. Maybe anecdotally, I've
struggled and things have shifted.
I've seen other kids experience recovery.
I promise this is possible. But it's so challenging to
identify with that. And teens are already resistant
enough, and they're like, I don't believe you.
You're an adult. You have more autonomy, you have
more agency. And so it's this really
interesting aspect of identity because so much of our
relationships are dependent on our identity.
And I think we're a mental health perspective that becomes
another piece of the puzzle as well.
And we are identifying with those things so strongly.
Yeah, you're making me think of a growth mindset researcher who
worked with Carol Direct named David Yeager, who's in Texas,
and he has interventions for adolescence.
Viewing him, he just sent me his book.
What? Yeah.
Really reviewing him in August when his book comes.
Out. No kidding.
OK, so he'll tell you way more. I'm so excited.
Yay. I'm like I know that name.
That's amazing. Yeah.
That's perfect. Yeah.
So he'll be great. He'll tell you way more about
this. But he has interventions where
he'll have students who are depressed, high school students,
and they'll read blurbs or narratives from other students
and they'll say, like, hey, look, I was in your shoes last
year and I'm way better now. I learned some skills.
I did these things. And that that element of those
interventions is so powerful to resonate with.
Like this is someone who's just like me.
And it's a sense of belongingness that increases.
And, and having a sense of belongingness in and of itself
is really helpful. Like that's built into our DNA.
We need to feel like we're part of the group, and things like
depression and anxiety and other mental health concerns can make
us feel very outside of the group and ostracized and other.
Yeah. So it's funny that you bring
that up. It's it's a good idea.
No, it's it's so challenging. And Penn has like a positive
psychology spit on that. They have a resilience program
and they did pilot testing with Penn freshman and they had them
read blurbs like that where freshman year is really hard.
You're not going to feel like you know your people.
You're going to feel really overwhelmed.
You're going to feel like you're doing everything wrong.
And I was in the same position and I'm now graduating senior
and I found my people and I have my purpose and it all gets
better and you'll be able to handle the stress.
And they followed them for for years and they looked at career
outcomes and job satisfaction and relationships.
And the impact that that really simple minute intervention had
is wild. It had an extremely positive
impact. And the way that we speak about
these things is so important because it does have a really
meaningful impact on not only how people feel, but also the
action steps that they take to make changes in their life.
And it's not health promoting behaviors, but it's like mental
health promoting behaviors. No, I think it is health because
I think that you're all the same thing.
Health and mental health, really, really, it's part of the
same thing. And I, you're making me think of
the concept of vulnerability. Being vulnerable with each other
actually makes connections stronger.
And one phrase I learned at an OCD conference actually is when
you're disclosing a diagnosis to somebody, the goal should be I'm
trying to deepen and strengthen our relationship versus like
sharing a shameful secret. And I really like that spin on
it. Not to say that you're going on,
I don't know if anybody uses Facebook anymore, but I'm old
not to go on Facebook and say, hey everybody, I have MDD, but
they're. Doing that on TikTok now for.
People are doing, people are doing that.
And it's funny, like, I work with college students and I'm,
you know, quite a few years out of college now, but they're
saying, oh, yeah, I talked about this with my therapist and I
said, I just met you. I don't know.
I'm surprised that you're telling me this.
I would when I was in college, you would never talk about
because it's so like shameful, don't don't see a therapist and
don't certainly don't talk about it.
I think there are some positive changes happening.
People are opening up a bit more, but I think vulnerability
is a piece here that makes us feel more connected, less alone.
Yeah, no, it's so true. I was in multiple classes this
semester and it's seminars to out.
We're not quite at like raise your hand and lecture and say
these kinds of things, but people be like, oh, I was
talking to my therapist about this or I mentioned that we
learned this thing in class and it's really cool how people see
it very positively. And it's a really cool thing.
I want to be in therapy. Like, how did you do that?
Tell me what the steps are. And so it's, I think it's a good
direction overall that we're moving in.
Yeah, my pipe dream with all of this is that, well, I don't know
if this has all ever happened because of insurance, but
therapy should be like the dentist.
You go every year to do a checkup and if you need more
attention, you get a referral to a specialist.
And everybody sees a mental health person every year.
That would really put medical care and mental health care on
the same page because it is hard to find a therapist and with
therapy it's hard to find the right fit, which is of course
the most important part. Yeah.
Well, circling back to the way that we can speak about these
things and how we can be most effective, I'm wondering if the
conversations that we have with family members or friends or
even peers or general acquaintances, how we can be
most effective in those interactions.
Because you mentioned that people that have a relative that
has struggled with depression in the past, they tend to learn
more towards the chemical imbalance theory.
I'm wondering what you're like best practices, best case
scenario is for having these conversations so we can validate
and help people feel seen and like they have that sense of
belonging, but also increase agency as much as possible.
Yeah, it's a really good question and and I don't have a
definitive answer yet. A couple thoughts though.
One is it's interesting that with depression, it's tricky
because sometimes depression might be telling us about the
very relationships that you're talking about, that even within
the family, there are things that are going on that I'm
unable to meet my needs because of you, something is going on
or, or you're not helping me meet my needs.
And so family members might be a little resistant to the idea
that this is a signal that might be telling something that
they're contributing to your loved ones depression.
So one thing I just learned about is this.
It's very quick, easy to understand intervention, which
is validate what you're going through.
I think so many people with depression here invalidating
statements like you just gotta take a walk outside or you just
gotta get up and go to work or in one of my.
Groups, I heard. Have you tried yoga?
One of my groups this made me so mad.
They said their dad said just have an ice cream cone.
This is the basic thing. Sounds good.
Would play Amazon Music orchestra volume Ted and he
would be like surely this will get her to start her day and go
to school. This is 100% work.
Yeah, yeah. And it's tricky because of
course our parents and family love us and they want, they're
trying to be helpful, but it's kind of actually makes us feel
less connected, more alone, less understood when we use the J
word, just just do this, Just do that.
So validating. Oh my gosh, I see you as really
struggling right now. This sounds awful.
Even something like that can go a long way to, to get that one
connection going back. The other piece that I'm a
really big fan of and I just learned about this actually on
Monday is validating and then giving language that says
something along the lines of, and I believe that you can get
through this. So it's very growth mindset
actually. I know that with effort you can
get through this, that with support, I have no doubt that
you can overcome whatever it is that you're going through and
you need both. You need both.
You can't just have the validation and you can't just
have the you got this. You have to have the validation
and kind of the messaging that says let's talk through this.
I think the application makes a lot of sense with kids with
anxiety and I just learned about this from a colleague on Monday.
So. Getting exclusive.
I love it. Yeah.
Exactly. So it's, you know, let's say
someone's afraid of thunderstorms or snakes or
something, and you say, oh, my gosh, yeah.
You look really scared. It sucks.
It's really it's it's hard. It's scary to feel this much
anxiety all at once about something.
And you know what? I bet there's ways that we can
work around this, that we can work through this so that you
can learn to cope with that anxiety and maybe have a
different relationship with snakes or thunderstorms and
change that. So it's, it's a very growth
mindset message. This can change, but also the
emotional validation piece. I love it.
And so DBT, which was what I found to be so helpful because
those two pieces are absolutely essential.
And when you just have one, people respond not very well.
They're like, what are you saying?
Like how dare you suggest that? And the idea that it's
acceptance and change, you're doing your best and you can do
better. You didn't create these
problems, but you do have to solve them.
You have that validation piece, which is so important.
And for a lot of people who feel so misunderstood.
And if they don't feel like that need is met, there's just so
much resistance to doing anything to move forward.
And so having that initial, like I see you, I get it, this is
really challenging and you're trying your best.
And I have so much faith that you can and will continue to
overcome this. And I think that if we spoke to
everyone that way, I think there would be a lot of positive
changes that took place, but we're not quite there yet,
unfortunately. We're not there yet, and I think
there's lots of reasons why we're not there.
And I think part of it is that we're uncomfortable when we see
our loved ones suffering, right? And I understand it's way more
now that I have a son. It is hard when he's crying his
eyes out, like he's really just really upset.
It sucks. It breaks my heart.
I am also sad and anxious and I want to make it stop for both of
us. There's a natural pull to like
reduce the anxiety. Oh no, no, no, it's OK.
It's OK. We're going to calm both
ourselves down. But what we, I think most of us
probably can benefit from his mindfulness, sitting with
uncomfortable emotions. And I certainly can benefit from
that. Just sitting with, yeah, I'm
uncomfortable right now, but we can, we can get through this
together. Emotions aren't something that
we need to run away from it. Also, the last thing I'll just
say is reminds me of this tip I learned in an internship, which
is for every psychotherapy group we do, we want two things to
come across to every participant.
You're not alone and there's hope.
I'm just putting that together now.
That's message that we're talking about does that.
You're not alone. I get it.
And I think you can do this. There's hope.
Yeah, it's, it's so important and it goes back to the unmet
needs again. Like if you're seeing someone
else in distress, your need is to try and fix that and problem
solve. And that's the best thing you
can offer is like, I can try and get rid of this pain for you.
But then the person that's actually struggling, that
biggest unmet need that they're navigating is not feeling seen
or understood or feeling alone in that.
And so it's balancing both of those things and being aware of
what people's experience, like you said.
Yeah, yeah. Amazing.
Well, if people want to read your research, continue to
follow along with all the amazing work you're doing.
Where can they do that? Well, I have a Google Scholar
page. I don't have a website.
I can help people. My wife, my wife has told me for
years that yeah, I have to have a website.
I just. Didn't have my dad because my
mom was like Jason need a website and he was like so
unique can you help me? Yeah, but on Google Scholar.
All my research papers are on there, and people feel free to
e-mail me if I wanna talk more about this stuff.
Amazing. Well, thank you so much.
This was absolutely incredible.