Better Mental Health

How to improve mental health using ideas from the book

First, let's dig deeper into the data, deeper than we went in chapter 7 of the book (the chapter titled "Anxiety and Depression"). Jon is currently curating two semi-open-source literature reviews on two claims that we made in the book, but for which there is not full agreement among researchers:

1) Is there a mental health crisis among American and British teenagers? In chapter 7 we asserted that there is, and we showed graphs of rising depression and suicide rates for American teens. But some skeptics claim that self-report measures (of depression and anxiety) are unreliable, and that the suicide statistics are more complicated than it seems from our Figure 7.2. Please see this Google Doc, where Jon has laid out the various kinds of evidence, along with critiques from skeptics. If you are a researcher, please request access to the doc and add your comments.

     So far, the conclusion seems to be that there is indeed a large increase in rates of anxiety, depression, and self harm among Gen Z girls in the USA and in the UK. (The Google doc also includes evidence of all three trends for Canadian girls, and evidence of rising anxiety and depression in adolescent girls in Australia and New Zealand.)  There is also a large increase in the suicide rate for teen girls in the USA (up 77% for older teen girls; up 151% for younger teens, when you compare 2017 to the average of 2000-2009). There is a smaller increase in the suicide rate for teen girls in the UK (up "only" 30%) 

     For boys, there is evidence of increases in depression and anxiety as well, although the overall rates are lower and the increases are smaller and less consistent across studies, compared to girls. There is little evidence of an increase in deliberate self-harm (such as non-lethal cutting) for boys in the USA or UK. The suicide rate for teen boys in the USA is up substantially, but it is not out of line with the increasing rates for older men.  The suicide rate for teen boys in the UK is not rising (although for older men, it is falling).

     In other words: There are large, consistent, and alarming trends for girls in the USA and the UK (as well as in Canada, Australia, and New Zealand). The trends are smaller and less consistent for boys, but they too are doing worse today than before 2010. 

 

2) Is there evidence that social media contributes to anxiety and depression, particularly among teen girls? On p. 159 we asserted that "the rise in adolescent mental illness is very large and is found in multiple datasets, but the percentage of that rise that can be attributed to smartphones and screen time is small, and the evidence is more indirect." We also wrote that:

"we don’t want to create a moral panic and frighten parents into banning all devices until their kids turn twenty-one. These are complicated issues, and much more research is needed. In the meantime... there is enough evidence to support placing time limits on device use (perhaps two hours a day for adolescents, less for younger kids) while limiting or prohibiting the use of platforms that amplify social comparison rather than social connection."

Were we right, or did we overstate the evidence or overreact to correlational studies? Please see this Google Doc, where Jon and Jean Twenge have laid out the various kinds of evidence, including studies that find no relationships or tiny relationships. You'll find comments added by researchers on both sides of the debate. If you are a researcher, please request access to the doc and add your comments. So far the conclusion emerging from the debate seems to be that the problem is not so much "screen time" as it is social media, for which links to bad mental health are larger and more consistently found for girls than for boys. Correlational studies generally show curvilinear relationships with measures of anxiety and depression, meaning that light to moderate use of social media is not associated with bad outcomes, but heavy use is. (The percentage of variance accounted for is usually small, and there is some debate about how to interpret that.) Some time lag and longitudinal studies show links to bad outcomes, others don't. The few true experiments that used random assignment to condition all show that reducing or eliminating social media time causes improvements in variables related to mental health, but not necessarily on all measures. In other words: multiple kinds of evidence suggest that there is a causal connection between heavy social media use and bad mental health, but the evidence is not entirely consistent, and the size of the effect is debated. We also don't know how social media affects pre-teens -- the group that shows the biggest percentage-wise increases in self harm and suicide. Light to moderate daily "screen time" (in contrast to social media) does not seem to be associated with harmful mental health outcomes at all. We did not know that when we wrote the book.

Here are some of the resources we mentioned in the book, augmented by resources we found after publication.

A) Books to help you learn how to do Cognitive Behavioral Therapy

  1. Cognitive Behavioral Therapy Made Simple: 10 Strategies for Managing Anxiety, Depression, Anger, Panic, and Worry. By Seth Gillihan.

  2. Feeling Good: The New Mood Therapy by David Burns

  3. The Worry Cure: Seven Steps to Stop Worry from Stopping You by Robert Leahy

  4. Get Out of Your Mind and in to Your Life by Steven Hayes

  5. Full Catastrophe Living by Jon Kabat-Zinn

B) Websites and apps to help you learn how to do Cognitive Behavioral Therapy

  1. www.findcbt.org (find a therapist via the Association for Behavioral and Cognitive Therapies)

  2. www.academyofct.org   (find a therapist via the Academy of Cognitive Therapy)

  3. The MindTrails program at the University of Virginia (a free training program in "cognitive bias modification)

  4. If you want to get expert guidance on which mental health apps are based on empirical research, visit PsyberGuide.org. The blog has a lot of info on how social media affects mental health.

C) Advice from Marcus Aurelius, who identified the Three Great Untruths and offered advice to counteract them. Seriously. It's CBT from 170 CE. Which untruth is captured by each of these 3 quotations?

  • Just as nature takes every obstacle, every impediment, and works around it—turns it to its purposes, incorporates it into itself—so, too, a rational being can turn each setback into raw material and use it to achieve its goal. 

  • Today I escaped from anxiety. Or no, I discarded it, because it was within me, in my own perceptions—not outside. ​

  • To feel affection for people even when they make mistakes is uniquely human. You can do it, if you simply recognize: that they’re human too, that they act out of ignorance, against their will, and that you’ll both be dead before long. 

In fact, just reading Marcus Aurelius is helpful in reducing anxiety. Jon recommends the Gregory Hays translation.

D) Additional ideas and resources for improving mental health

  • Get more exercise! We should have mentioned this in the book. Social media and overprotection are bad for mental health in many ways, one of which is that they both lead kids and teens to be less physically active, and regular exercise reduces rates of depression (see Spark, by John Ratey; more refs to come)

  • Read Jon's first book, The Happiness Hypothesis, and then see this list of ideas Jon offered for using positive psychology to become happier.

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