191. How Should We Talk About Depression? feat. Hans Schroder

May 25

listen to this episode:

Today's guest is Hans Schroder— a Clinical Assistant Professor of Psychiatry at the University of Michigan Medical School and Adjunct Assistant Professor of Psychology at the University of Michigan who currently researches beliefs and messages about mental health and their impacts. As a licensed clinical psychologist, he provides psychotherapy and exposure-based therapies to individuals and groups with anxiety and depressive disorders.

In this episode, we discuss:

+ Popular beliefs about why people are depressed & why they're not always accurate

+ Medication as a popular treatment for depression compared to talk therapy

+ Pros and cons of endorsing the "chemical imbalance theory" behind depression

+ How believing that your depression is caused by biology affects your recovery

+ The best way to think about your depression, according to psychology

+ What your depression is actually trying to tell you

+ How depression was diagnosed in the past & problems with the current diagnostic criteria for depression

+ What happens when people strongly identify with their mental health condition

+ Effective ways that high schoolers & college students can view their depression

+ Positive changes in how Gen Z talks about mental health compared to previous generations

+ Ways to validate your loved one's mental health struggles

+ so much more!

Mentioned In The Episode…

+ ADAA

+ Email Hans

+ Hans' Google Scholar page

SHOP GUEST RECOMMENDATIONS: https://amzn.to/3A69GOC

About She Persisted (formerly Nevertheless, She Persisted)

After a year and a half of intensive treatment for severe depression and anxiety, 18-year-old Sadie recounts her journey by interviewing family members, professionals, and fellow teens to offer self-improvement tips, DBT education, and personal experiences. She Persisted is the reminder that someone else has been there too and your inspiration to live your life worth living.

a note: this is an automated transcription so please ignore any accidental misspellings!

Sadie: Welcome to She Persisted. I'm your host, Sadie Sutton, a 19 year old from the Bay Area studying psychology at the University of Penn. She Persisted 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 D B T insights and education in. 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. 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. It's going to try to tell us that, at least. It might not be so obvious what it's trying to tell us It

Speaker: Hello, hello, and welcome to She Persisted.

If this is your first episode, I'm 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 A DAA, which is the Anxiety and Depression Association of America. It was 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, Blaise Aguirre from 3E, spoke at that one, which was 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 about 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 that 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 talk about identifying with mental illness diagnoses, which I'm sure a bunch of you can relate to.

And then we also talk 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 have thoughts, definitely DM me, email me, all the things. I can't wait to hear them.

And this intro is getting long, so let's just dive in

Sadie: Well, thank you so much for joining me today on 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 this 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, depression is 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 make shifts that might be necessary to overcome different challenges or diagnoses 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. 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. Okay. 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's 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?

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 a 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 position, 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 diagnoses, has contributed to that, that rise in prescriptions and kind of that being a more prominent tool in the toolkit 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 first 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 You 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, for treatment.

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 gonna change my serotonin just by talking with me, right? How are you gonna change my brain? 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 there'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 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 that, that theory doesn't even impact just our general conceptualizations, but also the 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 it's a 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 chemicals, 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 gotta 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, 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 imbalance to make yourself feel a little bit better?

When you're depressed, 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, okay, if my depression's 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, some, 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.

Yeah. 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, okay, it's a serotonin imbalance, you're like, okay, 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 , okay, maybe it would be easier to adjust that aspect in my life. And yet people. Do you 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 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. Okay. 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 conversations?

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 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 Crum 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, Hans, this is, this is not a signal, I have a chemical balance. This is not a me thing. 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, though, 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, and I think it's so important, and I think that was one of the biggest elements of my own experience.

I was like 13, 14, so I wasn't really leaning 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 known 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, you know, 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 in 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, and we don't really know how it's going to get better. And I think a lot of people struggle with that experience disorienting and very hopeless. Wow, well 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 gotta go in and, you know, get this looked at. , , and, , yeah, I, 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 as 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.

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.

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. They'll be like, what happened in your childhood? what caused this? And I'm like, if I knew we've 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 and the degree to which they are unmet and how they're going to sensitive we are to those needs being unmet and how much maybe 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 It's frustrating on 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? Yeah, I always joke with patients, like, if we knew, , I wouldn't have a job.

Yeah. I wouldn't exist. Yeah. 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. Yeah. Part of the reframing with all of this is that it's possible. 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 , to tell us things.

They're signals that are 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 there still is so much benefit to understanding, okay, 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 SSRIs that are out now that are, you know, effective for treating depression?

DSM 3 came out in 1980 and got rid of all of that reaction language. So, it, 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 it for a diagnosis It's definitely an imperfect model. I have lots of problems with the DSM. Yeah, I think there is a place for diagnosis and Conceptualization only to get people into the most effective treatment. Yeah, 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 You , 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, right?

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 diagnoses 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 me 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 furthers that issue of people really identifying and 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 ten 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, this is just 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. 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's my diet? How's my sleep? How's my fitness or movement exercise going on right now? What's 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've 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 was arts and crafts as therapy.

And one of the things that we did was like drawing and collaging our identities. And we would like share around 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.

And 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. it 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 in to 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 from a mental health perspective, that becomes another piece of the puzzle as well when we are identifying with those things so strongly. Yeah, you're making me think of a growth mindset who worked with Carol Dweck named David Yeager, who's in Texas, and he has interventions for adolescents.

I'm interviewing him! He just sent me his book! What? Yeah, I'm interviewing him in August when his book comes out. No kidding. Okay, so he'll tell you way more. It's right there. 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, , You'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 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. Yeah. we need to feel like we're part of the group. Yeah. and things like depression and anxiety and other mental health concerns can make us feel very outside of the group and ostracized and othered.

Yeah. So it's funny that you bring that up. That's a good idea. No, it's, it's so, challenging. And Penn has like a positive psychology spin on that. They have a resilience program and they did pilot testing with Penn freshmen 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 It's 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.

Yeah. No, I think it is health, because I think these are 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 to somebody, the goal should be, I'm vulnerable.

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 people are doing that on Tik TOK now for 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 it, 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 now.

We're not quite at like, raise your hand in 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.

And I'm like, 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 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.

I agree. 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 lean more towards. the chemical imbalance theory. I'm wondering what your 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 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 hear invalidating statements, like, oh, 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. It sounds good.

Would play Amazon music orchestra, volume 10. And he would be like, surely this will get her to start her day and go to school. This is a hundred percent 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, It 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 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 doing it. 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, oh, you got this.

You have to have the validation and the, , 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. We're getting the exclusive. I love it. 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, 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. And, , 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, 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? It, you know, I, and I understand this 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, like, oh no, no, no, no, it's okay, it's okay. We're going to calm both ourselves down. but what we, I think most of us probably can. So, you know, the last thing I can benefit from is mindfulness, sitting with uncomfortable emotions. And I certainly can benefit from that. Just sitting with, yeah, I'm uncomfortable right now, but 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 it reminds me of this tip I learned on internship which is, for every psychotherapy group we do, we want two things to come across to every participant.

but you're not alone and there's hope. I'm just putting that together now that the 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 you make a my wife has told me for years that, yeah, I have to have a website.

I just did that for my dad, because my mom was like, Jason, you need a website. And he was like, Sadie, can you help me? Yeah, but, , on Google Scholar, all my research papers are on there. And people, feel free to email me if, you know, want to talk more about this stuff. Amazing. Well, thank you so much. This was absolutely incredible.

Sadie. It's been a pleasure. It's been fun.

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