Can We Change the Culture to Promote Psychological Health?

All of the issues in this book take place in the context of a competitive, overly individualistic environment. Many educators and journalists have suggested that this is stressful to students. A study of stress in in the United States confirms that students view college application stress as detrimental to their mental health. This chapter suggests that it is incumbent upon parents and educators to lead the way in reducing the pressure, to focus more on collaboration and less on competition and individual achievement. At the same time, we need to reduce the stigma of psychological problems in order to be more humane and to encourage young people to get help when they need it.

Self-Regulation

This chapter, on self-regulation, covers student sleep issues, nutrition, and physical activity. Most students in both high school and college are sleep deprived, and this can be a major disruptor of mood. Stress, school schedules, and too much screen time have disrupted sleep. The typical American diet with fast food, high sugar, fat, and additives has been a factor implicated in the development of depression. Americans get much less physical activity than is recommended for optimal health. This is unfortunate, because physical activity both helps prevent and has been shown to be a treatment for mild and moderate depression. Teaching and modeling self-regulation will help students as they go away to college. The relative lack of structure in college requires greater independence. Female body dissatisfaction, which can lead to self-criticism and distorted eating patterns, is identified as a major force of dysregulation, and suggestions are made for promoting body-positive attitude and behaviors.

Is Taking Time Off from College a Good Idea?

Is it a good idea to take time off from college? Or take time off before college? This question is examined in depth in this chapter. Two types of taking time off are a medical leave of absence or taking a gap year before college. A process is described of how to communicate about and understand college policies on taking time off. The advantages of a gap year are also described. A case of a minority student who wanted to and did take time off is discussed. He wasn’t sure what to do and needed to arrange productive activities and therapy while he was away, as well as consider how he would communicate with family and friends about his decision. The chapter ends with suggestions for how to best plan for a student taking time off from college.

“I Got This!”

This chapter discusses the role of self-efficacy and confidence as foundations for student success and well-being. Based on the work of Albert Bandura and social learning theory, the goal is for individuals to feel that they are able to identify and solve problems on their own. Low self-efficacy can lead to depression because a lack of control causes disappointment and pessimism. Academic self-efficacy is identified as one of the factors that is necessary for a positive college experience. A case of a student with limited social self-efficacy is examined, with suggestions of how parents can help, including how to give accurate and optimistic feedback based on strengths and weaknesses. There is also a section on how bias and stereotyping undercut the feeling of self-efficacy and how parents can encourage their teens to push back and not internalize these prejudices.

Getting Help on Campus

If a student is suffering from depression or anxiety, going to the counseling center is the best plan of action. Staff there are usually able to see students on a short term basis and refer them to a psychotherapist and psychiatrist if necessary. Availability can vary by the college’s resources, however. There are many other sources of support on campus including resident advisers, student support groups, deans, college chaplains, and faculty mentors. There are also specific services for victims of sexual assault. The process of getting help is revealed by the story of a young woman returning from the semester abroad and her challenges reintegrating into the college campus. Issues of confidentiality and family involvement are also discussed.

No Shame, No Stigma

This chapter helps parents decide when their student needs psychological help and, if so, how to arrange it. The role of the primary care professional is crucially important, to examine medical illnesses and medications that might cause depression. In addition, primary healthcare professionals are increasingly able to diagnose psychiatric disorders and provide referrals for mental health problems. Parents need to ensure that a mental health professional is licensed, experienced with adolescents, and trained in cognitive behavior therapy or interpersonal therapy, the therapies with effectiveness in treating depression. The advantages and disadvantages of antidepressant medications are detailed. The chapter also includes a section on suicide and how to talk about it. Two cases of teens seeking consultation are described, along with their parents’ concerns. Vignettes about talking to reluctant teens about therapy are included.

Growing Up Different

Most adolescents are worried about being different and not fitting in. In this chapter, two groups that are subject to ostracism and harassment are described—LGBTQ and overweight students. Both groups have higher rates of depression, and LGBTQ students have higher rates of suicide attempts, with more than half of transgender males and nearly a third of transgender females reporting having attempted suicide in their lifetime. Included in this chapter is a description of current vocabulary about LGBTQ issues. There are conversations parents can have with both groups of students, and the chapter suggests comments to avoid making. Parents also need to self-reflect on their own biases. Overweight teens frequently are harassed, shamed, and discriminated against. Bullying of both groups is also described, along with a current college student’s story of his torturous days in high school. The need for family support is emphasized as well as the role of advocacy. For example, school systems need to establish a zero-tolerance policy toward bullying and be consistent in its implementation.

Social Power

Social forces affect all of us in positive and negative ways, and adolescents and emerging adults are especially sensitive to them. Positive social support forces include close relationships with family members and friends. Social isolation is a risk factor for depression. The power of the media is examined through a study that was done in Fiji with young women before and after the introduction of television. The role of social media and its negative impact on the mood of teenagers and young adults is documented, yet one reason it may be difficult to limit social media in students is that parents are over-involved in digital media as well. A final set of negative social forces are bullying, cyberbullying, body shaming, and harassment of people who are different from the perceived norm. Included in the chapter are strategies for limiting social media and responding to bullying.

Communication Skills

This chapter is an in-depth exploration of communication between parents and teens. This foundation becomes important when difficult topics like depression, substance use, or family conflict need to be discussed. Communication strategies, including open-ended questioning, validation, empathy, and optimal timing, are detailed. The chapter illustrates why lecturing and immediate problem-solving are not helpful. Assertive communication within the family is discussed as well as cultural barriers to effective communication. The skills of motivational interviewing are applied to parent–child interactions about decisions. The family dinner is examined as an opportunity for shared communication and connection. Divorce is seen as a severe breakdown in communication, with 25–30% of children suffering negative effects. Arizona State University’s New Beginning Program for parents going through a divorce is presented as a proactive model that has reduced psychological problems in children and emerging adults.

How the Principles of Cognitive Behavior Therapy (CBT) and Other Evidence-Based Therapies Can Help Your Family

Several evidence-based types of therapy discussed in this chapter have been shown to be effective treatments for depression. These include cognitive behavior therapy, interpersonal therapy, and behavioral activation therapy. Third-wave forms of therapy are also detailed, including dialectical behavior therapy and acceptance and commitment therapy. These have less evidence for their effectiveness but show promise. Mindfulness-based cognitive therapy has been shown to prevent relapse of depression. The techniques from all of these schools can be used in plans for the prevention of depression. Detailed attention is given to such techniques from cognitive behavior therapy as decatastrophizing; challenging negative assumptions, all-or none thinking, and overgeneralizations; and cognitive reframing and restructuring. Knowledge of these techniques can make parents better informed consumers when arranging treatment for their children. as well as identify ways they might be directly helpful to a distressed teen.