Editor's note: The following is a transcript of the ninth episode of Therefore, What? — a podcast from Deseret News opinion editor Boyd Matheson. It's been edited for clarity.
Boyd Matheson: Anxiety, depression and teen suicide are rising at an alarming rate. The Deseret News is committed to enabling teens and empowering parents with the tools and resources to effectively deal with anxiety. Helping teens recognize and cope with stress, avoid the downward spiral of depression, while maximizing their talents, opportunities and potential will be our focus this week on Therefore, what? Welcome once again, this is Boyd Matheson on Therefore, what? We're very pleased to be joined today by Jenny Howe. Jenny is a licensed therapist with degrees in psychology and child and family studies. She spent over 20 years working extensively with youths and adolescents, both in criminal justice and the public school system, in addition to working for the Utah State Division of Youth Corrections. Most important, Jenny has been working with teens and anxiety. The Deseret News has been thrilled to tag-team with Jenny on some screenings of an independent film called "Angst," about teens and anxiety. We've been able to take that across the state of Utah — we have seven or eight of those coming up in the fall. We’ll also be screening the film back in Washington, D.C., because this is such a critical topic. And when we say teens, it's not just early teens, I really look at it from, you know, 12 to 28, I think we all fit into this anxiety. So, Jenny, welcome to the program.
Jenny Howe: Thank you so much for having me. I'm excited to be here today.
BM: Well, this is such a critical discussion. Obviously, people are getting back in school, kids are starting to feel the stress and the anxiety that goes with going into grade school or junior high or high school or on to college. There's a lot of stressors out there. In your work, Jenny, what are you seeing in terms of how is this really playing out? When are people seeing it? What are you seeing in your patients? What are the things we should be aware of when it comes to teens and anxiety?
JH: You know, it's funny you say that. My practice is slammed this week with kids getting fearful of entering school again. I think there's a little bit of a break from all the commitments and obligations during the summer for kids. And they feel that kind of surge of pressure beginning right now for sure. But something that, you know, has kind of been a common thread in my practice lately has really been teens specifically feeling a lot of anxiety socially — about how to initiate conversations and how to speak to one another, and also how to ask people to hang out. Everything is over electronics now. And so when they go back into school settings and they're actually seeing people face-to-face, they kind of don't know what to say. So that's a real common thread that I'm hearing just kind of across the board really recently, the last couple of weeks in private practice.
BM: Very interesting. And so let's take a deeper dive on that as it relates to the technology portion of the program. You raise such a good point that teens today seem to be having more difficulty having those face-to-face, real-life interactions. Talk to us a little bit about how our screens and our technology and social media play into this whole concept of angst and anxiety in teens.
JH: Sure, I think, you know, there's been a lot of studies done over the last few years that have really tried to figure out what the rise in anxiety that we're seeing professionally is contributing to. And one of the biggest factors contributing to that is the electronic use. And teens are reporting that they feel like "FOMO," a fear of missing out on things. You know, they'll even hashtag that on their Instagram pages sometimes. But they feel like they're missing out, that they're not included. There's this constant comparison between themselves and their peers that they're totally flooded with all day long, and they always are feeling like they're not enough. That what they're doing is less than what somebody else is doing. And that picture-perfect model that is on our social media pages is what they are considering to be the actual truth, when we all know that it's not. It's really hard for teenagers, at their stage of development, to kind of see that realistically.
BM: And that's such an important point I think that you raised, Jenny. I think there's two elements I'd love to dig into a little bit. And that is first, this idea of comparison. I've always said that viewing your life through comparison is always fatal vision. And I know that it's really hard for teenagers, especially teenage girls, I think really struggle with that comparison syndrome. So maybe you could drill down on that. And then I want to talk a little bit about communication with parents. But let's start with the comparison component first,
JH: Right? You know, I think comparison is actually the driving force of social anxiety, specifically. It's when you are in a setting and you're looking around the room and you're thinking man, everybody else in here looks like this or everybody else can do this, or everybody else can. And I can't. And the perspective is always skewed because we never know what's going on in somebody else's life. But with social media and with that constant comparison that is in the palm of our hand, or in our teens' hands, and we as adults do it, too. I mean, we're talking about teens, but I know I'm guilty of this, that comparison in our hands is like, gosh, it's like a death sentence for a teenager to be able to look in the palm of their hand and say, man, I didn't get invited to this, or I didn't do this, or so-and-so didn't want me to be a part of that. The assumptions that we make as a result of those comparisons are really kind of the nail in the coffin for us, so to speak.
BM: So that leads us to what can parents do about that. And so this gets into this communication component to it. As parents, first how do we — let's talk about communication first. How do we better communicate this to our teens? And then let's drill specifically into how do we help them understand something like comparison that teens are so apt to do anyway.
JH: You know, communication is such an interesting topic right now for me specifically, because what I'm finding is that parents are really hesitant to have kind of the difficult conversations inside their homes, for fear that they may be kind of implanting ideas into their kids' heads. So they hide a lot of the hard stuff because they want to shelter and provide, you know, kind of a safety net around their kids' lives. But what we're doing by helicopter parenting or creating these safety nets around our kids is we're giving them this false sense of security that when they go out into the real world, nothing's going to happen to them, and we all know that that's not true. So communication inside the home is crucial and key to not only preventing anxiety, but to maintaining that open dialogue and resiliency in our children. And I like to encourage parents, and I try to do it, although I'm not perfect as well, but to model socially, their ugly stuff. So rather than hide, you know, the fact that you had a really crappy day at work, or that you're not sure if your job’s going to be super stable over the next year, come home and talk about that with your teenagers. You don't have to like lay out all your dirty laundry, but you can say, hey, you know what, I've probably been a little bit edgy lately because this is going on at work and there's some uncertainty and it makes me feel a little bit nervous. I think so-and-so may get the job instead of me. So that modeling, I think, is key. So then our kids then can learn how to have those conversations with us and with others.
BM: I completely agree. I think that is so critical that we get to, I always like to get into the courageous vulnerability space. And so often as parents we try to, you know, show the stiff upper lip, and you just have to fight it through. And we often tell our kids the same things. They come home and they share a challenge or a problem with us. And our immediate reaction is, you'll get over it. It'll be OK. You gotta just tough this one out. But I love the way you brought it into the fact that if the parent comes home and says, maybe the child says, hey, you know, this was an awful day at school and my teacher’s terrible, being able to show some empathy and say, hey, I totally understand why you'd be frustrated with that. I had a boss that did the same thing today. And I wanted to curl up under my desk in the fetal position. I'm with you. And showing both vulnerability but also modeling that courageous vulnerability and then having a discussion about "Therefore, what?" — what do we do about it?
JH: Exactly, you know, and I think we're often afraid of conflict. Conflict has kind of a nasty connotation to it, you know, like, oh, I'm afraid of conflict, or I don't want to, you know, cause any conflict, and conflict is not something to be afraid of. Conflict is healthy. These conversations that may cause people to feel are a good thing to have and to model for our kids. Because when they go to school, you know, next week, and well, some of our schools have already started in Utah. When they go to school soon, that conflict is going to occur, without a doubt, by lunchtime. And when they have those types of experiences inside the home they can then bring them into their lives and feel capable. And anxiety really is a loss of capability. It's feeling incapable to be able to handle whatever uncertainty exists.
BM: Yeah you know, I worked for several years with a good friend and partner, Dr. Denis Waitley, who wrote "The Psychology of Winning," and he used to always compare this difference between stress. We often hear stress and we get stressed. We view it as a negative. But there's the distress, which is what we usually think about, which is the negative connotation. But there's also that eustress, E-U-S-T-R-E-S-S, which is that positive tension that helps you perform better and do that. And I think we often allow the distress, or the fear of distress, to lead to the anxiety. Are you seeing that as well?
JH: Oh, absolutely. It's funny you say that — I just had a conversation with a 5-year-old in the private practice about this. And I had the 5-year-old close their eyes and think about the last time they were really excited for something and then describe how their body was feeling. And this little guy went off to talk about the butterflies in his stomach and how his heart started racing fast and you know, pretty much outlines exactly what it feels like to have stress or distress or anxiety as well. And so then when he opens his eyes, I had him do the same thing about something he had been nervous about — the monster in the closet — and describe what his body felt like. And in he described it almost word for word the exact same ways he described excitement. And so the art of reframing those types of physical reactions that we have into something that can be fueling or positive is really a strong competitive cognitive behavioral therapy when we're treating anxiety. But it's something that I try to practice on a daily basis. You know, even before doing this or before doing one of our presentations, I really try to reframe those physical sensations as being something positive rather than negative. And our brain, you know, we are in control of it. Like I tell my little kids, we're in charge of our brains. So what we tell it goes, and if we reframe those feelings to be excited, then I think, you know, we're on the right track.
BM: That's great. So let's look then as a parent in particular, how do you tell when your teenager is just being lazy and sleeping in and maybe not going to the party or maybe, you know, not getting stuff done, or is just kind of an avoidance mode of their friends. What are the things that we should be looking for in our teens that may say, hey, this might be a little more than some distress or some discomfort, but might really be getting into the anxiety and depression and that cycle.
JH: Yeah, there are three things that I have parents look for. But before I describe those, I want to kind of qualify this with the first thing we need to ask ourselves as parents is, am I projecting my own stuff onto them? Does it make me anxious if they're not going to this party? Maybe they're actually not anxious, maybe I'm the one who thinks that they're not going to this party with the popular kids. So always kind of check yourself first, is a good rule of thumb. But I think since the three things that I say across the board, and this goes with most mental health issues, but especially with anxiety and depression are intensity, frequency and duration. So if your child's behavior changes in intensity, let's say they're avoiding, they're hiding out in their room a large amount more than they were a few weeks ago, or even a couple of months ago. That would be a sign. If the frequency of their avoidance or their mood-shifting is increasing. That's a big sign. If the intensity is increasing. If they're all of a sudden a lot more adamant that they're absolutely not going to go to that party or they're not going to get in the car and go with you and your family to dinner. If you can see that they're starting to become more irritable, irritability is a huge sign of depression and anxiety in both children and teens, which we often miss. Misdiagnosed as opposition or ADHD or some of these other things. That's also a big sign too. Intensity, duration, frequency are the three rules of thumb to be able to understand if your child's behavior is becoming problematic.
BM: Those are great tools just to be able to be aware and sensitive. I think, you know, having those conversations, as you said before, we've got to make sure we've got the communication lines open. And I love the fact you mentioned the projecting your own stuff onto your kids. I see a lot of parents who are really stressed out about the behavior of their children, not because the behavior itself is necessarily that bad, but it makes the parent uncomfortable or the parent is reliving their teenage years or their junior high experience. So that's an important one to keep in mind as well. What are some of the other trends that you are seeing in your practice?
JH: Well, one thing I'm seeing a lot of, both in Utah and nationally, is the trend of juuling.
BM: When you say juuling, a lot of guys are gonna think is that like accessorizing or bedazzling? What exactly is juuling? And why should we be worried about it?
JH: I wish it was. You know, interesting, it's a really strong nicotine. It is like a vape but it's very, very small. So it looks like a computer flash drive. So kids can really hide it like very, very easily. It's not more than an inch or two. And so that is something that is scary because of how small it is and how accessible it is. But also because of this strong amount of nicotine that kids are using inside this juuling. It's, I think, I read somewhere it's like three times the amount of a cigarette. So that is something I'm seeing a lot of kids really use to combat their anxiety in social situations, or feeling kind of pressure to do so. And not knowing how to manage that conflict, that saying no, in the moment. That's something that I'm probably seeing at least weekly in my practice right now.
Something else that I'm seeing kind of across the board in my practice is this idea of, and I kind of talked about it a little bit earlier, but this idea of being afraid of conflict. I have a lot of kids who will text me in the middle of the night because they're up and obviously I don't get them. But a lot of my clients have my number and they'll text me and say, I can't sleep, I can't sleep. I've got to go have this conversation with this girl tomorrow. And I don't know how to have it. And they're afraid that they're going to escalate a situation and that that means it's bad.
This fear of conflict is something that I don't know if we could speculate on this for a lot of different reasons. But it's something that is really prominent in our teens and kids right now, at least, especially in Utah and the kids that I'm seeing outside of Utah as well.
BM: Fascinating. Let's talk for a minute about the kids that are making that transition from high school to college. I met not too long ago with a university president and asked, you know, what is it? What's the biggest barrier for a student who is entering your school as a freshman today and walking out with that diploma four years from now? And without a nanosecond of a hesitation, he said, it's anxiety, stress and depression. And so they're looking at what resources can they bring to bear? Or are these kids just showing up not prepared? How are you seeing that issue?
JH: I actually have quite a few young adults on my caseload or late teens on my caseload that have had this problem become super prominent in their lives when they left home and entered the real world, so to speak, of college. The biggest issue I'm seeing is this feeling of incapability. They're very reliant and co-dependent on others to validate their uncertainty, and what I mean by that is they've had a lot of rescuing parents. They've had a lot of success, but they haven't had much experience with failure. And as you and I know, the moment you go out into the real world you're really turned on to the fact that hey, you know, maybe I'm not the MVP of my class anymore. There may be other people here that can do something better than I can, and kids who have been really sheltered from failure are struggling to maintain a sense of identity, without their successes, in college. I have many kids on my caseload who really have no idea who they even are without their successes. If we were to take those things away from them, who would they be? How would they be known? And they're left pretty wide open and pretty uncertain about their abilities and their identity. And so we lose a lot of the opportunity for identity development, which is a key component of our teenage years. We lose the opportunity to develop that identity when we shelter our kids. When we rescue them, when we don't allow them to talk to the teacher about the homework and we send the email instead, they don't have those experiences to formulate for themselves what they're capable of, and who they are when things get rough. And as you and I know, we really shape our identity during hard times. There's a refining fire that happens when things are difficult and when we struggle. And when we don't allow our children or our teens to have those experiences, we're really setting them up for a hard time in college.
BM: Yeah, absolutely. And I think there's another thing, this actually ties back into the electronics component of all of this — as I listened to you talk about the identity and identity development I think there's also this inability for young people today to be still. That they're so used to being on social media or on their devices 24/7 that they're not comfortable with themselves. They're not comfortable with the silence, they're not comfortable thinking through a problem without having 27 other texts and tweets going on at the same time. How do we help, our teenagers in particular, how do we help them learn to be still and to be comfortable with themselves first, so they can deal with some of these external things that you're describing?
JH: I mean you're exactly right, Boyd. I think that the whole — I don't know if, you know, I'm thinking right now as you're speaking there about my own 16-year-old daughter and she has a very difficult time sitting still or even listening to the quiet in a room. I'm not sure, I know she would be super uncomfortable with any kind of meditation or practice like that. But I think that the biggest issue is the immediacy of gratification that our teenagers have. The electronic use has provided that. I'm going to text a friend right now and see what they're doing. And if they don't respond in five minutes, then they must not like me.
BM: Or hate me.
JH: Yeah, exactly. Exactly. And,you know, I'm going to look on social media and see what people are doing. And if I'm not there, that means I'm not cool. It's the immediacy in gratification, whether that's negative or positive. They know within seconds the answer to anything that they have on their mind. I remember having to look at encyclopedias when I was a teenager, just to kind of figure out where countries were — they don't have to do that anymore. So the sense of being still is almost a lost art within them because they don't even know what that feels like, or looks like. And so to get our teenagers to practice that, I think we as parents have to really be deliberate about initiating that. About making sure there are times of the day that everybody, not just your kids, because if you have the rule, you've got to follow it. But everybody puts their phones away and kind of sits together and either enjoys, you know, the quiet in the car, listening to music or whatever, but does something that's not necessarily as immediate as we're used to now in our society.
BM: Wonderful. All right, well, Jenny, we've got just a couple of minutes left. And I just wanted to give you a minute to just put out any other thoughts or ideas or tools that parents ought to be thinking about as it relates to their teens and this challenge with anxiety. Because so often we focus on the back end of all of this and the awful things of dealing with long-term depression and teen suicide and all of those components, but there's also this immense element of lost opportunity that happens. What are some of the things parents can do or should be doing or helping their students and young people understand so that they can have that strong mental health so they can maximize their talents and their opportunities?
JH: I think the biggest key to developing resiliency, which I think is the cornerstone of development for kids and teens, is allowing them opportunities to figure out who they are. Rather than jumping in and saving them, and I know I'm a little bit beating a dead horse here, but this is just something I see so frequently in my practice. I think that we need to create opportunities and give them the chance to have these experiences that may or may not be what we would want for them. I have a client right now who is really struggling to assert herself with her family and in this debacle between her and her mother, her mother has said often, well, you know, I know if I just let her do this, that it's not going to work out. And, you know, it just, it gives me so much anxiety to watch this happen. And in the course of this whole process, and several conflicts later which have been healthy conflict, this young girl, she figured it out, she ended up getting 105 percent in the class that her mom was really certain she was going to fail. So I think allowing our kids and our teens to show us what they're made of, rather than us telling them what they're made of, is going to be a huge, huge shift in their ability to be resilient and to feel capable later on in life.
BM: That's fantastic. Jenny Howe, thank you so much for joining us talking about the critical issue of teens and anxiety. We appreciate you being with us on this week's "Therefore, what?"
As I sat there listening to Jenny, I couldn't help but think of all of the bad parenting that I have done over the years, and hopefully my kids will forgive me as they've gone through that. But I think she hit a really critical point in terms of this idea of comparison. And that whole social media pressure to fit in, to be cool, to have big things going on in your life. So you can put them on Instagram and Facebook and everywhere else. But that comparison is always fatal vision that keeps coming back to me. And so we have to be careful — how are we comparing our children to other children, to their siblings, in our own families?
I'll never forget my two oldest daughters are as different as night and day — my daughter Rachel is right brain, creative, free thinker, and my daughter Lindsey is a hard-charging, left brain, plow it right through, sequential person. And they ended up having the same teacher in consecutive years in the second grade and I'll never forget going the second year to parent-teacher conferences. And so this teacher had had Rachel for a year. And now she'd had my daughter Lindsay for a few months. And my wife and I walked into the classroom and she immediately burst out laughing just how different these two girls were. And she said, you know, Rachel would get A's on things because she loved to write and she'd love to create a story and a poem and she'd do this whole thing and then she said, and Lindsay’s just not gonna let anybody beat her. And she said nobody is more dangerous with a list than Lindsay. She can plow it through, check the boxes, get the validation. But that was a really important lesson for me because I think what the teacher was really saying is, don't treat them the same way because they're very different. And when we fuel, as parents, as we fuel the comparison game, we're often setting our children up for that kind of challenge.
Or how many times do we praise a neighbor child or another child that's maybe in our student’s class and creating these false comparisons, rather than just validating the positive behavior and performance of our child. And so we have to be careful. Remember, comparison is always fatal vision, it's always fatal. And so we need to be careful and help our children understand that.
I also love that Jenny said that you need to model your ugly and be honest about your ugly. One of the things that I can't stand about social media is even people who are in their ugly, it's like the best ugly ever, you know, it's that person down the street who's doing this selfie. Oh, I didn't put my makeup on. I look so awful today. And everything is perfect. Or my house is such a mess today. And everything is perfect. And so we have to be careful and be willing to have that courageous vulnerability and actually show our ugly and be OK with our ugly and say, hey, you know what, sometimes life is ugly, and we need to be OK with that and help our kids become OK with that.
Jenny also mentioned this idea of healthy conflict, that conflict is not a negative thing. It's a neutral thing. How we deal with it is often what becomes negative. And I think if we can help our children in particular understand how to navigate conflict, that it's OK to feel uncomfortable and to embrace that and step into it. Lean in as opposed to lean out or completely avoid, can help them. Because as you look at all of the pressures that come with a society that is growing and moving forward that is ever accessible. There is a lot of that pressure, and helping teenagers in particular recognize that is really vital. I also think we do need to be careful that we often get caught only in the back end of the story. The negative thing. We talk about teen suicide and depression and anxiety, but we often don't talk about potential and opportunity and giving our kids the confidence to embrace their dreams.
They may fail. But that's OK. That's a good thing because they're going to learn and grow. And then they're going to take another step and they're going to find something else. They're going to learn something about themselves and about the world around them. And also, sometimes we wait too long. Sometimes we wait till the very end. And it is that sad suicide of a young person and dreams lost and opportunities lost.
It's often like the old saying, you can either build a fence at the top of the cliff or you park the ambulance down in the valley. And sometimes I fear we just kind of are content to park a lot of ambulances down in the valley rather than building the fence at the top. And that's where schools and resources and state agencies and families and communities need to rally and to be more aware of what's going on and what is influencing our teenagers today.
You know, the Deseret News has taken this on as a significant project. For the last six months we've been moving through and we actually have on Deseret News.com/anxiety — a series from our InDepth team that cover everything from will pills cure a teen's anxiety, and what is the proper role of medication in helping a young person who has anxiety or depression, technology, dating, college and career, how do you navigate that. Our team has also opened up on Facebook a group where you can submit questions about anxiety and depression, and we can get experts from around the country to respond with ideas.
And as I mentioned early in the program, that we really have this focus and taking around the state of Utah and across the country, this "Angst," the movie, which talks about teens and anxiety. And one of the things that I've noticed as we've done some of these screenings of this movie is the exhale moment that people have when they realize, many for the first time, either as a parent or as a teenager, that they're not alone. That they aren't the only one who deals with that stress or that worry or that frustration. That there are other people around them who also deal with that same thing.
It's been wonderful to see Olympic athletes like Michael Phelps talk about his battle with anxiety and depression, Kevin Love from the Cleveland Cavaliers, an NBA player and his coach. Also, interestingly, both have come out and said, hey, we deal with serious mental illness in terms of stress and anxiety. And so modeling it is so important and reaching out and being able to see that. So we encourage if you have questions, engage with us, again, on Deseret News.com/anxiety. You can follow on Facebook as well. Look for a screening of the movie "Angst" in your community or request one so that the conversation can continue. For me, that's one of the most important things is that we have a conversation about mental health. What it is, Therefore, what? it means, how we can best prepare our young people to engage as they move things forward.
Remember after the story is told, and after the principal is presented, after the discussion and debate has been had, the question for all of us is Therefore, what? Don't miss an episode — subscribe to this podcast on Apple podcast or wherever you're listening today and be sure to rate this episode and leave us a review. Follow us on desertnews.com/podcast and subscribe to our newsletter. This is Boyd Matheson, opinion editor for the Deseret News. Thanks for engaging with us on Therefore, what?