Thursday, December 10, 2020

Q&A with Carol Landau



Carol Landau is the author of the new book Mood Prep 101: A Parent's Guide to Preventing Depression and Anxiety in College-Bound Teens. A psychologist, she is clinical professor of psychiatry and human behavior and clinical professor of medicine at Brown University's Alpert Medical School.


Q: Why did you decide to write Mood Prep 101?


A: I had been seeing young people, especially college students, in outpatient psychotherapy for many years.


At one point the thought occurred to me that I wished I could psychologically “retrofit” some of my patients to have been more prepared for college. So many parents send their teens off to college without some of the basic psychological skills that we need for success, not only for college but for life.


I then started working more with high schoolers and their parents to help them develop some of the skills, which include self-efficacy, self-advocacy, and distress tolerance.


That’s why we came up with the name “Mood Prep” for the book because many parents and teens work so hard on academic prep that they lose sight of other important goals like psychological development and well-being.


Not that I blame any parent. At the beginning of the book I write that I hope it will be an opportunity for parents to learn, not for blame or shame but to help them increase protective factors and to reduce the risks for depression and anxiety in their children.


I also wanted the book to provide information about secondary prevention, that is, early identification of psychological problems, so there are sections about how to identify depression and anxiety in your teen and how to get help.


Q: You write, "Depression and anxiety are struggles for many families, but as a society we often treat them as shameful secrets." Do you think this societal shaming will continue, or are things changing at all?


A: Shame is a major problem for everyone dealing with depression and anxiety and is one of the reasons that so many teenagers (60 percent) who are anxious or depressed do not receive treatment.


However, there is definite hope here. Many celebrities and public officials, including Michelle Obama, have come forward to say that they had been depressed and that has had a big impact on reducing stigma. There is also evidence that Gen Z, those born after 1996, are much more open to identifying stress and getting involved in therapy.


The National Association for College Counseling Center Directors has been reporting in recent years that there is a significant increase in demand for their services. 


Among other things, this reflects the expectation of students and their families that they should get professional help when they experience anxiety or depression or similar difficulties. There is still a gender difference here, however, men are less likely to seek help than are women. 


In my teaching at Brown Medical School, I have been involved in training primary care physicians to identify and treat psychological problems so the medical community is much more aware and can initiate and normalize discussions with their patients.


Q: What impact do you see the pandemic having on high school and college students, and on their parents?


A: It’s not hyperbole to stay that the pandemic has had a catastrophic negative effect on the mental health of most Americans, especially young people and mothers. The rates of anxiety and depression that were already high have skyrocketed.


This makes perfect sense when you see depression as a disorder or “disconnection” as I do, and that uncertainty fuels anxiety.


For most adolescents, being with their friends and other students--learning with them and from them--is a major necessity for development. This process has been disrupted by shutdowns, unpredictable school schedules, and remote learning. Our young people are losing ground academically and socially.


This is a pandemic on top of an untreated epidemic of psychological problems in teens and young people.


The pandemic has taken a serious toll on all mothers but especially mothers who work outside  the home and women of color. They are now performing three shifts of work, one at work, one with the usual care for home and family and now scheduling, rescheduling, and reorganizing space and supervising education.


This is one of the fault lines in American society. While at least 70 percent of mothers with young children are employed, the necessary supports are minimal, so the primary burden has been on them. Single mothers, and those with partners who do not do their share of family work, are exhausted.


The situation is unsustainable. The United States has virtually no integrated child care or support system for families and mothers, so families are now paying the price.


This is not to say that fathers are not affected, nor that they are not contributing to household work. Some fathers are also single parents and in fact, much progress has been made. However, we have a long way to go.


That said, for some fortunate families, the pandemic has revealed their strengths. Some students, especially those who have been bullied at school, are actually doing better with virtual learning. And some families have more time together, eat dinners together, which are protective factors.


Q: What do you hope readers take away from the book?


A: The first takeaway is that as parents, we should acknowledge and value how powerful our support can be for children. A parent who listens with attention, validates, and acknowledges a teen’s feelings provides a lifelong buffer to stress.


Granted, I know that this is not easy. Teens can be moody and resist communication but it is our role to work through that and do our best to be patient.  


In addition, there are a few behaviors that are best avoided -- lecturing, authoritarian control, and invalidating remarks. We know from psychological research that lecturing does not work to change anyone’s opinion or behavior and tends to shut down communication. The authoritarian style of parenting, which involve overcontrol and a demand for obedience, takes self-efficacy away from teens.


In addition, some parents, in the hopes of making their child feel better, make invalidating remarks in response to a concern, like, “Oh that’s not so bad, cousin Mary...” But it is so bad for the teen at that moment


With communication and support as a foundation I’d also like parents to understand that they can help their children in a paradoxical way by allowing them to experience some distress and learning to manage their feelings themselves rather than stepping in.


This process can help teens feel that they can handle their schedules, their studies, their bodies, and be ready to move on to college or another phase of young adulthood. The book also details what stresses can occur during  college and how parents can help their children be more psychologically prepared for them.


The final take-home message is that mental health services are more available now so parents and teens alike can feel comfortable reaching out for help. The book includes step-by-step processes for getting psychological help, whether teens are living at home or at college.


Q: What are you working on now?


A: Some people talk with people in order to write books. I write books in order to talk with people. So my primary efforts right now are aimed at using the book to communicate with parents and teens through as many public presentations as possible.


I am also thinking a lot about two issues I raise in the book — teens who are marginalized, “growing up different,”  and the impact of American culture and politics on personality development and mental health.


Q: Anything else we should know?


A: Although the book was written primarily for parents and teens, children need at least one validating adult in their lives. So, members of the clergy, coaches and especially teachers, can provide a major force for resilience. I think we should all value secondary educators much more. 


--Interview with Deborah Kalb

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