Perceived Social Support in School Environments During Adolescence

Nurturing Growth

Adolescence is one of the most formative periods of human development, a stage wherein many long-term habits and lifestyles are developed. It is marked by significant physical, cognitive, and socio-emotional changes.[1] Hellström & Beckman (2021) explain how understanding the needs and special challenges of this stage of life will bring about great benefits for solving and preventing unique problems in society.[2] As the majority of changes in adolescence come about through a combination of social, hormonal, cognitive circumstances (most of which occur in the environment of middle-high schools) Verhoeven et al. (2019) note this is an ideal time period to examine when looking for answers for questions about brain-behavior development.[3] 

As we increasingly concern ourselves with improving child educational environments and outcomes, Zhao et al. (2021) note that one of the biggest risk factors for adolescents’ academic motivation and achievement is the environment in their academic setting.[4] As Wang et al. found in 2020, positive classroom climate has been essential to many school reform efforts hoping to promote youth’s academic and psychological well-being.[5] Especially, the role of teacher support as a moderator for academic achievements among various types of learner is highlighted in importance. Supportive student-teacher relationships can help improve students’ self-schema and sense of belonging, and therefore enable them to productively achieve their personal goals.[6] So, how can we best support students and provide significant developmental opportunities?

Adolescent Social Support 

Farmer & Farmer (1996) explain how social support is the “processes of social exchange that contribute to the development of individuals’ behavioral patterns, social cognitions, and values”.[7] Hogan et al. (2002) have theorized two forms of social support, natural and formal, in which a natural social support network would consist of family and friends, while formal networks would include health professionals, religious or other social communities.[8] Specifically within an academic setting, social support refers to the perception of belonging and feeling cared for within a  support network of peers and teachers.[9] 

Perceived social support includes an individual's feeling of the availability and adequacy of support from their social network. Further, perceived social support is dependent on how individuals gauge the amount of emotional, informational, or tangible assistance they receive from their community.[10] Feeling a sense of social support is critical for promoting positive social, psychological, academic outcomes for students, and especially during adolescence with multiple transitions happening at once.[11] In an academic setting, where adolescents tend to spend much of their time (learning, socializing) this sense of perceived social support is especially important to find and be encouraged. According to Allen and Gregory (2018), social support is a significant buffer against negative experiences in life and stressors in the school environment, thus crucial in helping students cope with challenges, fostering a positive school climate, and ultimately promoting their academic and emotional well-being.[12] Danielsen et al. (2008) suggested that indirect support from teachers, classmates and parents can lead to student life satisfaction, and school-related support from teachers, classmates, parents have a direct effect on school satisfaction and scholastic competence in students.[13] 

Similar to social support, teacher’s confirmation positively predicts and has a noticeable influence on students’ emotional outcome. When teachers engage more, students seem less likely to exert unnecessary emotional efforts in the classroom; in contrast, if teachers display less or no interest or engagement in the classroom, students have a greater likelihood to expend emotional work, which bodes negatively for students achievement, motivation and other learning outcomes.[14] Specifically, emotion work is draining for students as it describes the extent to which students must expend emotional energy and perform emotional labor (i.e., faking or feigning emotions). In the context of the classroom, this can mean suppressing authentic emotions (e.g., anger, frustration, boredom) and displaying more socially acceptable ones.[15] Similarly, Spera (2005) found that parent support provides adolescents with a positive learning environment and instills a sense of responsibility and motivation. Peers can also provide emotional support, help with academic tasks, and serve as role models for positive behavior and achievement.[16]

However, there are multiple factors that mediate or moderate perceived social support and its outcomes in an academic environment beyond the student-teacher interactions; such factors include: 

• Self-Esteem - Lau et al. (2018) conducted a study on the link between self-esteem and social support in first-year university students in Hong Kong and discovered that positive adjustments during the transition to college life increase when self-esteem is supported by peer and family social support. In particular, it offers a sense of security and represents an individual's importance to their social circle, in turn improving their self-esteem. Moreover, students with higher self-esteem may have higher aspirations and more resilience than those with lower self-esteem, therefore contributing to differing adjustment abilities.[17] These findings support those by Roman et al. in 2008, who found that self-esteem is positively correlated with effort and deep processing, which is the encoding of information in a meaningful and elaborate manner, facilitating long-term retention and retrieval. Vice versa, self-esteem is negatively related to shallow processing. It also has the strongest indirect positive effect on academic achievement through deep processing and effort.[18] 

• Personality Traits - Personality traits play a significant role in shaping individuals' perceptions and experiences within their social environments.[19,20] A commonly used construct for analysis is the Big Five model of personality. The Big Five personality traits, (i.e., the five-factor model of personality) is a suggested personality taxonomy for personality traits developed in 1992 which postulates that there are five universal dimensions: Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness to Experience.[21] According to Swickert (2009), various personality dimensions are related to social support, including all of the Big Five personality traits. For example, agreeableness and extraversion seem to be most strongly positively correlated, while neuroticism (anger, irritability, self-doubt) has a strong negative correlation, with the perceived availability of social support.[22] Those with higher life satisfaction are also more extraverted, more sociable and more likely to experience pleasant moods.[23,24] 

• Educational Goals - Hernandez et al. (2016) found that while social support has a positive and direct effect on academic performance, its influence also depends on the manner with which they treat this social support, like their personal goals and representation of this support.[25] In adolescents who mainly pursue social goals and neglect academic achievements, social support can influence inattention and lack of class participation. Additionally, social support predicts students’ investment and interest in work and success, but only if they are pursuing academic achievement.[26] This means that students’ effort in their school performance is in fact motivated by what they expect to get out of school, and attaching values to school for its emotional and relational opportunities detach students from academic expectations and demands. Therefore, in this way, social support can actually hinder them from achieving academic success. It is also important to note that elementary students report higher academic engagement and more social support from both family and school faculty than junior high school students.[27] It is therefore important that researchers and educators focus on the pleasures and importance of gaining knowledge throughout adolescence in order to redirect students’ motivation and achievement efforts in educational settings. 

• Socioeconomic Status (SES) - Regarding the relationship between SES and academic achievements, Malecki & Demaray (2006) found that adolescents with lower SES tend to have corresponding lower GPA than those with higher SES.[28] However as a mitigating factor, students with lower SES have a significant positive relationship between GPA and social support - especially the social support of teacher.[29] To support this finding, a study conducted on low-income students by Wen & Li (2022) concluded that despite additional difficulties and risk factors these students face, higher levels of social support improved their academic performance by increasing dispositional optimism, which reflects positive perception of disadvantaged situations and the tendency to expect positive outcomes.[30] This “learned hopefulness” therefore underlines that individuals with higher perceived social support have more positive self-perceptions, including positive evaluations of their environment and more optimistic expectations of success.[31] 

Negative effects of negating social support

Even though there has been limited research done on the direct influence of the lack of social support and academic achievements in adolescents, studies have been conducted that may clue us into the nature of this relationship. For instance, Orban et al. (2020) studied the effects of social deprivation on adolescents’ development through the animal model of adolescent rodents.[32] They discovered that at the behavioral level, even a short period of isolation (e.g., 24 hours) in adolescent rodents can lead to heightened anxiety, increased hyperactivity, and a heightened sensitivity to social rewards, which extends to seeking food or drug rewards, making them more susceptible to developing addictions. Rodents that are chronically isolated throughout their entire adolescent period display abnormal behaviors such as hyper-reactivity to stressful situations and increased aggression. Moreover, isolation-induced changes also affect cognitive processes, such as learning and attention, resulting in reduced performance on tasks involving these processes. Specifically, isolation during adolescence leads to deficits in cognitive flexibility, impairing reward learning, reversal learning, and attention shifting.[33] Even though these results do not replicate exactly to human adolescents, they still inform us of the possible consequences of social isolation in adolescents’ mental wellbeing and cognitive development, which both influence their academic outcomes.[34] 

On a less extreme level of social support deprivation, findings from an experimental study on adult humans by Tomova et al. (2022) also suggest that social isolation results in increased feelings of loneliness, craving for social contact, and decreased happiness.[35] This is further supported by Glozah and Pevalin in 2014, who found that teenagers experiencing low psychological and physical wellbeing tend to resort to unhealthy coping mechanisms, such as absenteeism, truancy, and a general lack of motivation towards their studies.[36] Additionally, compromised health and psychological well being can contribute to attention issues, subsequently affecting academic performance and making it challenging for students to cope with academic pressures.[37]

Considering these findings, it is possible that without a strong network of social support in school, adolescents may be negatively affected not only academically, but also in terms of cognitive development and mental well-being. Given the current gap in knowledge, however, further studies on the potential effects of social support deprivation in adolescents are imperative. 

Potential interventions 

It is thus crucial for us as individuals and institutions to focus on creating an academic space in which social support is optimally available to adolescents. 

In 2007, the World Health Organization (WHO) listed efforts that have been implemented globally to improve social support and help-seeking behaviors in adolescents in an international literature review and program consultation.[38] Some schools have reported a strategy for improving students’ health and attracting them to existing services by experimenting with making local services more “adolescent-friendly” by offering more suitable hours and hiring training staff in adolescent-specific needs.[39] Another way of offering more convenience for adolescents is by locating/relocating health services to attract them, such as building more school-based health clinics. In addition to this, some countries offer adult outreach or community health promoters, who have been employed to bring health services and information to adolescents at home or at school.[40] However, they point out that in already overburdened public education systems, it can be difficult to aid adolescents’ use of public health resources.[41] 

The report also noted the use of peer promoters, which includes the training and supervising of adolescents or young adults to introduce health-related information to their peers to promote help-seeking.[42] Dougherty & Sharkey (2017) has also provided literature in favor of these peer programs and peer support groups for those with specific health needs, such as substance use or violence.[43] Along this line, information campaigns, hotlines and information centers have also long been carried out to increase awareness on support resources for adolescents and can provide youth with information on existing local resources, services, job training, and recreational activities.[44] 

In several countries, service integration also exists, which is the formal or informal networks among existing services, as a strategy for promoting help-seeking by adolescents with the goal of casting a broader net for social support.[45] However, this service is often built upon the premise that infrastructure exists and can be integrated to increase access. The underlying framework is that through collaboration, this social support network can become larger than the sum of its parts, thus in theory more effective.[46] 

In support of this, a study conducted by Lee et al. (1999) in Chicago found that when seeking to improve students’ academic performance, school systems should not ignore social support as a pertinent factor that contributes to students' success.[47] For those who may receive especially little support from their local community, peers, and at home, it is even more important that school staff create academic environments that are supportive for learning. Similarly, looking to improve students’ achievements by fostering supportive environments alone is insufficient. The report found that without academic press in school, social support alone may not lead to meaningful improvements in academic performance.[48] 

Specifically for social support, some schools within the Chicago Annenberg Research Project have created smaller, more personalized classrooms (e.g., school-within-schools, teachers teaching the same cohort for multiple grades, supplemental one-on-one tutoring with teacher assistants). Some schools provide teachers with professional development opportunities to encourage supportive relationships with students, others strengthen support through parent education programs, engaging parents in classroom activities and one-on-one student mentorships. Several schools have given students the opportunities to develop relationships with local community members who can support and guide them as role models, or increase peer relationships through extracurricular activities.[49] 

For academic purposes, schools have turned to communicating high learning expectations and clear responsibilities for students. This has also been accomplished by professional development for teachers aiming at improving quality of instruction and guiding students towards more challenging work and critical thinking. Some schools have developed incentive systems to reward students for high academic achievements or student assessments that have a double-pronged purpose: student-teacher accountability and the teacher’s own examination of their teaching style for improvements.[50] 

While these options can offer increased social support for students, they do not come without substantial challenges and school systems may not have the time and resources currently available to enact these changes.[51,52] 

Therefore, more research should be done to bring awareness to these approaches and develop more easily applicable and less costly methodologies. The WHO notes that these efforts, whether it be research or application, should also involve meaningful participation of adolescents, as junior researchers.[53,54] As the Kellogg Foundation cited in 1998, some of the key needs when it comes to initiatives promoting support-seeking from adolescents include the need to:[55] 

• Identify service barriers 

• Have detailed written agreements and plans to services 

• Consider culturally appropriate models of support 

• Work with existing community resources.

Through increased awareness and opportunities, social support within school environments can help adolescents’ mental health and educational opportunities.

If you or your loved ones are looking for ways to provide additional support for your child, or if they seem to be struggling in school, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for guidance. 

Contributed by: Mai Tran

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

1 National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Division of Behavioral and Social Sciences and Education; Board on Children, Youth, and Families; Committee on the Neurobiological and Socio-behavioral Science of Adolescent Development and Its Applications. The Promise of Adolescence: Realizing Opportunity for All Youth. Backes EP, Bonnie RJ, editors. Washington (DC): National Academies Press (US); 2019 May 16. PMID: 31449373.

2 Hellström L, Beckman L. Life Challenges and Barriers to Help Seeking: Adolescents' and Young Adults' Voices of Mental Health. Int J Environ Res Public Health. 2021 Dec 12;18(24):13101. doi: 10.3390/ijerph182413101. PMID: 34948711; PMCID: PMC8700979.

3 Verhoeven, M., Poorthuis, A.M.G. & Volman, M. The Role of School in Adolescents’ Identity Development. A Literature Review. Educ Psychol Rev 31, 35–63 (2019). https://doi.org/10.1007/s10648-018-9457-3

4 Zhao, K., Chen, N., Liu, G., Lun, Z., & Wang, X. (2023). School climate and left-behind children’s achievement motivation: The mediating role of learning adaptability and the moderating role of teacher support. Frontiers in Psychology, 14. https://www.frontiersin.org/articles/10.3389/fpsyg.2023.1040214

5 Wang, M.-T., L. Degol, J., Amemiya, J., Parr, A., & Guo, J. (2020). Classroom climate and children’s academic and psychological wellbeing: A systematic review and meta-analysis. Developmental Review, 57, 100912. https://doi.org/10.1016/j.dr.2020.100912

6 Zhao et al. (2023)

7 Farmer, T. W., & Farmer, E. (1996). Social relationships of students with exceptionalities in mainstream classrooms: Social networks and homophily. Exceptional Children, 62, 431-450.

8 Hogan, B. E., Linden, W., & Najarian, B. (2002). Social support interventions: Do they work? Clinical Psychology Review, 22(3), 381–440. https://doi.org/10.1016/S0272-7358(01)00102-7

9 Grapin, S.L., Sulkowski, M.L. & Lazarus, P.J. A Multilevel Framework for Increasing Social Support in Schools. Contemp School Psychol 20, 93–106 (2016). https://doi.org/10.1007/s40688-015-0051-0

10 Farmer, A. & Farmer, S. (1996). Motivational Influences on Social Cognition and Aggressive Behavior. In D.J. Pepler & K.H. Rubin (Eds.), The Development and Treatment of Childhood Aggression (pp. 433-455). Hillsdale, NJ: Lawrence Erlbaum Associates.

11 Bauer A, Stevens M, Purtscheller D, Knapp M, Fonagy P, Evans-Lacko S, Paul J. Mobilising social support to improve mental health for children and adolescents: A systematic review using principles of realist synthesis. PLoS One. 2021 May 20;16(5):e0251750. doi: 10.1371/journal.pone.0251750. PMID: 34015021; PMCID: PMC8136658.

12 Allen, J. P., & Gregory, A. (2018). Social support as a buffer for perceived racial discrimination stress among African American youth. Journal of Research on Adolescence, 28(4), 1015-1030. doi:10.1111/jora.12385

13 Danielsen, A. G., Samdal, O., Hetland, J., & Wold, B. (2009). School-related social support and students' perceived life satisfaction. The Journal of Educational Research, 102(4), 303–318. https://doi.org/10.3200/JOER.102.4.303-320

14 Goldman, Z. W., & Goodboy, A. K. (2014). Making students feel better: Examining the relationships between teacher confirmation and college students' emotional outcomes. Communication Education, 63(3), 259–277. https://doi.org/10.1080/03634523.2014.920091

15 Titsworth, S., Quinlan, M. M., & Mazer, J. P. (2010). Emotion in teaching and learning: Development and validation of the Classroom Emotions Scale. Communication Education, 59, 431–452. doi:10.1080/03634521003746156

16 Spera, C. (2005). A review of the relationship among parenting practices, parenting styles, and adolescent school achievement. Educational Psychology Review, 17(2), 125-146. doi:10.1007/s10648-005-3950-1

17 Lau, E.Y.H., Chan, K.K.S., & Lam, C.B. (2018). Social Support and Adjustment Outcomes of First-Year University Students in Hong Kong: Self-Esteem as a Mediator. Journal of College Student Development 59(1), 129-134. doi:10.1353/csd.2018.0011.

18 Román, S., Cuestas Díaz, P., & Fenollar, P. (2008). An examination of the interrelationships between self-esteem, others’ expectations, family support, learning approaches and academic achievement. Studies in Higher Education, 33, 127–138. https://doi.org/10.1080/03075070801915882

19 Ali, I. (2019). Personality traits, individual innovativeness and satisfaction with life. Journal of Innovation & Knowledge, 4(1), 38–46. https://doi.org/10.1016/j.jik.2017.11.002

20 The Importance of Personality Traits in Students' Perceptions of Metacognitive Awareness. (2016). Procedia - Social and Behavioral Sciences, 232, 655–667. https://doi.org/10.1016/j.sbspro.2016.10.090

21 Costa, P T. & McCrae, R. (1992) Revised NEO Personality Inventory (NEO-PI-R) and NEO Five Factor Model (NEO-FFI) Professional manual. Odesa, FL; Psychological Assessment Center.

22 Swickert, R. (2009). Personality and social support. In P. Corr & G. Matthews (Eds.), Cambridge handbook of personality (pp. 524–540). Cambridge, England: Cambridge University Press.

23 Potash M.. Noppe 1. and Noppe L. (1981) The relationship of personality factors to life satisfaction among the elderly. Paper presented at the Annual Meeting of the Gerontological Society of America, Toronto.

24 Emmons R. A. and Diener E. (1986) Influence of impulsivity and sociability on subjective well-being. J. Person. sot. PsJchol. 50, 121 I-1215. family environment generalized to new social relationships? Cognitive Therapy and Research, 18, 39–53.

25 Hernandez, L., Oubrayrie-Roussel, N. & Prêteur, Y. Educational goals and motives as possible mediators in the relationship between social support and academic achievement. Eur J Psychol Educ 31, 193–207 (2016). https://doi.org/10.1007/s10212-015-0252-y

26 Ibid.

27 Rueger SY, Malecki CK, Demaray MK. Relationship between multiple sources of perceived social support and psychological and academic adjustment in early adolescence: comparisons across gender. J Youth Adolesc. 2010 Jan;39(1):47-61. doi: 10.1007/s10964-008-9368-6. Epub 2008 Dec 9. PMID: 20091216.

28 Malecki, C. K., & Demaray, M. K. (2006). Social support as a buffer in the relationship between socioeconomic status and academic performance. School Psychology Quarterly, 21(4), 375–395. https://doi.org/10.1037/h0084129

29 Ibid.

30 Wen, X., & Li, Z. (2022). Impact of Social Support Ecosystem on Academic Performance of Children From Low-Income Families: A Moderated Mediation Model. Frontiers in Psychology, 13. https://www.frontiersin.org/articles/10.3389/fpsyg.2022.710441

31 Ibid.

32 Orben A, Tomova L, Blakemore SJ. The effects of social deprivation on adolescent development and mental health. Lancet Child Adolesc Health. 2020 Aug;4(8):634-640. doi: 10.1016/S2352-4642(20)30186-3. Epub 2020 Jun 12. PMID: 32540024; PMCID: PMC7292584.

33 Ibid.

34 Ibid.

35 Tomova L, Wang KL, Thompson T, Matthews GA, Takahashi A, Tye KM, Saxe R. Acute social isolation evokes midbrain craving responses similar to hunger. Nat Neurosci. 2020 Dec;23(12):1597-1605. doi: 10.1038/s41593-020-00742-z. Epub 2020 Nov 23. Erratum in: Nat Neurosci. 2022 Mar;25(3):399. PMID: 33230328; PMCID: PMC8580014.

36 Glozah, F. N., & Pevalin, D. J. (2014). Social support, stress, health, and academic success in Ghanaian adolescents: A path analysis. Journal of Adolescence, 37(4), 451–460. https://doi.org/10.1016/j.adolescence.2014.03.010

37 Barriga, A., Doran, J., Newell, S., Morrison, E., Barbetti, V., & Robbins, B. (2002). Relationships Between Problem Behaviors and Academic Achievement in AdolescentsThe Unique Role of Attention Problems. Journal of Emotional and Behavioral Disorders - J EMOTIONAL BEHAV DISORD, 10, 233–240. https://doi.org/10.1177/10634266020100040501

38 Barker, Gary. (‎2007)‎. Adolescents, social support and help-seeking behaviour : an international literature review and programme consultation with recommendations for action / Gary Barker. World Health Organization. https://apps.who.int/iris/handle/10665/43778

39 Ibid.

40 Ibid.

41 Ibid.

42 Ibid.

43 Dougherty, D., & Sharkey, J. (2017). Reconnecting Youth: Promoting emotional competence and social support to improve academic achievement. Children and Youth Services Review, 74, 28–34. https://doi.org/10.1016/j.childyouth.2017.01.021

44 Barker (2007)

45 Ibid.

46 Costello J, Pickens L & Fenton J (2001). Social supports for children and families: A matter of connections.Chicago, Chapin Hall Centre for Children at the University of Chicago (Draft manuscript).

47 Lee, V. E., Smith, J. B., Perry, T. E., & Smylie, M. A. (1999). Social Support, Academic Press, and Student Achievement: A View from the Middle Grades in Chicago. Improving Chicago’s Schools. A Report of the Chicago Annenberg Research Project. Consortium on Chicago School Research, 1313 E. https://eric.ed.gov/?id=ED439213

48 Ibid.

49 Ibid.

50 Ibid.

51 Griffith, M. (2018). What is the cost of providing students with adequate psychological support. National Association of School Psychologists (NASP). https://www.nasponline.org/research-and-policy/policy-matters-blog/what-is-the-cost-of-providing-students-with-adequate-psychological-support  

52 Barker (2007)

53 Ibid.

54 Bauer, A., Stevens, M., Purtscheller, D., Knapp, M., Fonagy, P., Evans-Lacko, S., & Paul, J. (2021). Mobilising social support to improve mental health for children and adolescents: A systematic review using principles of realist synthesis. PLOS ONE, 16(5). https://doi.org/10.1371/journal.pone.0251750  

55 Kellogg Foundation (1998). Safe Passages through Adolescence: Communities Protecting the Health and Hopes of Youth. In Lessons Learned from WK Kellogg Foundation Programming. Battle Creek,MI, USA.

"I Don’t Remember Last Semester" - Examining the Normalcy of Blacking Out On College Campuses

A Truth of College Life

College life is often associated with memorable experiences and substance experimentation. However, an alarming phenomenon has taken root on college campuses: "blacking out." Miller et al. (2018) note that 49% of college students who drink experience alcohol-induced blackouts.[1] In a society where excessive alcohol consumption has become commonplace among college students, it is crucial to explore the associated underlying influences and mental health issues, in addition to spreading support to those affected.

Understanding Blacking Out

Blacking out refers to a state of temporary amnesia triggered by excessive alcohol consumption, in which memories from experiences of heavy alcohol consumption cannot be recovered. Binge drinking (i.e., excessive drinking in short periods of time) is as prevalent as alcohol-induced blackout experiences among college students.[2] This indicates the link between college cultures of normalized, excessive drinking and frequent blackout experiences. In her memoir, “Blackout: Remembering the Things I Drank to Forget,” University of Texas alumni Sarah Hepola shares that through her research and interactions with current college students, she discovered that blacking out is now considered more casual than it once was 40 years ago, when she was attending UT.[3] In many college cultures, blacking out is often perceived as an inevitable rite of passage, trivializing its potential dangers as it is employed through peer pressure or initiations, particularly in fraternities and sororities.[4]

The National Institute on Alcohol Abuse and Alcoholism (NIAA) notes that blackouts can be separated into two categories:[5]

1. Fragmentary Blackouts - Fragmented memories from events during alcohol consumption exist, but without the ability to connect them.

2. Complete Amnesia - Memories from events during alcohol consumption cannot be recovered.

It is crucial to differentiate between occasional alcohol-related memory lapses and chronic blackouts, which might indicate underlying alcohol use disorder (AUD). Identifying these distinctions early-on can significantly impact an individual's mental well-being and prevent future difficulties with alcohol addiction. It is also important to distinguish blacking out from passing out following alcohol consumption. While “passing out” is the loss of consciousness or falling asleep from excessive drinking, “blacking out” refers to the loss of memories and the inability to create new memories while in a state of excessive alcohol consumption.[6] While a person can blackout and subsequently pass out, it’s also possible to blackout while still remaining completely awake (but unaware).

Your Brain When You Blackout

The amount of alcohol that one's body can withstand depends on blood alcohol concentrations (BACs). The NIAA reports that BACs of about 0.16 percent (about twice the legal driving limit) and above can induce blackouts.[7] However, this value can vary and become lower among:[8]

• Those who consume anti-anxiety medications 

• Those who consume common anti-inflammatories (e.g., Advil/ibuprofen)

• Those who consume alcohol more frequently (indicative of a tolerance)

Many other substances like opioids and antidepressants, in combination with alcohol, can lessen the BAC threshold as well, increasing risks related to these drugs or medications (e.g., overdose or liver failure).[9]

This excessive amount of alcohol results in the temporary block of the transfer of memories, or memory consolidation, from short-term to long-term memory storage via brain structures including the hippocampus.[10,11] Specifically, blackouts lead to anterograde amnesia: the prevention of the formation or storage of new memories.[12] Banerjee (2014) notes that alcohol’s interaction with neurons in the brain leads to the enhancement of inhibitory neurotransmitters and pathways like GABA while lowering the function of excitatory neurotransmitters like glutamate.[13] Such processes lead to heavy intoxication symptoms of poor motor function, altered reward systems, slurred speech, impulsive behavior and poor memory.

From a long-term lens, Nunes et al. (2019) found that frequent blackouts and binge drinking can lead to degenerative and functional deficit trends in the brain through hippocampal and frontal brain damage.[14] Additionally, going to sleep intoxicated shortens the REM (Rapid Eye Movement) phase of sleep [15] which Peever & Fuller (2016) found is responsible for consolidating memories and information in the brain from that day.[16] Exacerbating the issue, this loss of REM sleep may contribute to both short-term and long-term memory/cognitive issues.[17]

Mental Health Consequences 

In addition to impacting cognitive functioning, blackouts inflict significant effects on one’s emotional well-being. Miller et al. (2020) found that in heavy-drinking college students, blackouts were related to increased symptoms of depression.[18] Further, students who experience blackouts may already struggle with anxiety and depression, and abuse alcohol as a coping tool. For example, alcohol can often be employed as a social anxiety “buffer”, as alcohol alleviates behavioral inhibitions.[19] In a survey of 772 college students by White et al. (2002), increased frequencies of blackouts were associated with lower grades, increased heavy drinking and increased frequencies of high-risk behaviors like vandalism.[20] College student blackouts can also impact many aspects of a young person's life including academics, physical health, depression and anxiety risk, memory and cognition, sexual assault risk, and even suicide.[21] 

Pertaining to the college cultures that promote the normalization of blackouts, Greek Life subpopulations are of particular interest. Turrisi et al. (2006) note that these organizations are linked to heavier alcohol consumption.[22] Further, Estaban et al. (2018) found that male fraternity engagement predicted high levels of binge drinking and other drug use in young adulthood as 45% of participants experienced alcohol use disorder (AUD) by age 35.[23] These rates were significantly higher when compared to non-fraternity-associated adults.[24] Additionally, as Cara Rosenbloom in The Washington Post (2019) remarks, eating disorder rates are increased for these college subgroups, and the term “drunkorexia” (purging before excessive alcohol consumption) has arisen on campuses.[25] This phenomenon has created tendencies of heavy and high-risk drinking to replace normal eating, particularly among women struggling with body image.[26] The lack of food in one’s system when consuming alcohol makes binge drinking even more dangerous, as it increases the rate of intoxication.

Shedding the Light on Blacking Out

Due to societal stigmas surrounding mental health, many students hesitate to seek help or support. Wombacher et al. (2019) add that most college students rationalize frequently blacking out while completely acknowledging that the habits are unhealthy.[27] It is crucial to normalize help-seeking behavior and offer accessible resources to those facing alcohol-related issues and potential mental health concerns. By promoting responsible drinking and educating students about the risks, universities can foster a safer environment conducive to positive mental health, both relevant to long and short-term life. Integrating mental health support into college curricula and readily available campus resources empowers students to address their concerns proactively.

Harm reduction approaches may target the engrained social norms on college campuses. In this way, resources may be provided to reduce high rates of negative consequences such as emergency room visits due to alcohol poisoning, anxiety and depression and dangerous behavior. Such educational approaches may spread information about:

• Substances to avoid combining with alcohol

• Ways to be mindful when partaking in alcohol consumption

• Safe sexual practices like consent

• Awareness to avoid situations of peer pressure

• Accessibility to counseling and medical care

• Bystander awareness training 

Additionally, student accessibility to forms of psychotherapy would lead to beneficial effects for students struggling with alcohol use. For example, Ehman & Gross (2019) found that Acceptance and Commitment Therapy (ACT), a modality used to focus on awareness of mental states and thoughts, in addition to Motivational Interviewing (MI), lead to reductions in alcohol consumption and less heavy drinking in college students.[28]

Blacking out might be perceived by many as an “ordinary part of college life”, but its implications on physical, mental and cognitive health require urgent attention. By raising awareness about the normalcy and consequences of blacking out, it is possible to dismantle the harmful aspects of social cultures that perpetuate this behavior. 

If one is experiencing excessive alcohol use, binge drinking, addiction, or blackouts that impair well-being and/or daily life, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for guidance and support.

Contributed by: Phoebe Elliott

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

1 Miller, M. B., Merrill, J. E., DiBello, A. M., & Carey, K. B. (2018). Distinctions in Alcohol-Induced Memory Impairment: A Mixed Methods Study of En Bloc Versus Fragmentary Blackouts. Alcoholism, clinical and experimental research, 42(10), 2000–2010. https://doi.org/10.1111/acer.13850 

2 Juergens, J. (2023, April 17). Binge Drinking. AddictionCenter. https://www.addictioncenter.com/alcohol/binge-drinking/ 

3 Walsh, K. (2015, November 25). UT Unspoken: Students Reflect on Blackout Drinking Culture. The Daily Texan. https://thedailytexan.com/2015/11/25/ut-unspoken-students-reflect-on-blackout-drinking-culture/

4 Ibid. 

5 National Institute on Alcohol Abuse and Alcoholism. (2023 February). Alcohol’s Effects on Health: Research-Based Information on Drinking and its Impact. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/interrupted-memories-alcohol-induced-blackouts

6 Ibid.

7 Ibid. 

8 Ibid.

9 National Institute on Alcohol Abuse and Alcoholism. (2022, May 6). The Healthcare Professional’s Core Resource on Alcohol: Alcohol-Medication Interactions. https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/alcohol-medication-interactions-potentially-dangerous-mixes#:~:text=Nonsteroidal%20anti%2Dinflammatory%20drugs%20(NSAIDs,alcohol%20significantly%20increases%20the%20risk. 

10 Wetherill, R. R., & Fromme, K. (2016). Alcohol-Induced Blackouts: A Review of Recent Clinical Research with Practical Implications and Recommendations for Future Studies. Alcoholism, clinical and experimental research, 40(5), 922–935. https://doi.org/10.1111/acer.13051 

11 National Institute on Alcohol Abuse and Alcoholism

12 American Addiction Centers. (2023, July 12). Blackout Drunk: Signs, Causes, and Dangers of Blackout Drinking. https://americanaddictioncenters.org/alcoholism-treatment/blackout 

13 Banerjee N. (2014). Neurotransmitters in alcoholism: A review of neurobiological and genetic studies. Indian journal of human genetics, 20(1), 20–31. https://doi.org/10.4103/0971-6866.132750

14 Nunes, P. T., Kipp, B. T., Reitz, N. L., & Savage, L. M. (2019). Aging with alcohol-related brain damage: Critical brain circuits associated with cognitive dysfunction. International review of neurobiology, 148, 101–168. https://doi.org/10.1016/bs.irn.2019.09.002

15 Brower K. J. (2001). Alcohol's effects on sleep in alcoholics. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 25(2), 110–125.

16 Peever, J., & Fuller, P. M. (2016). Neuroscience: A Distributed Neural Network Controls REM Sleep. Current biology : CB, 26(1), R34–R35. https://doi.org/10.1016/j.cub.2015.11.011

17 Brower (2001)

18 Miller, M. B., DiBello, A. M., Merrill, J. E., Neighbors, C., & Carey, K. B. (2020). The role of alcohol-induced blackouts in symptoms of depression among young adults. Drug and alcohol dependence, 211, 108027. https://doi.org/10.1016/j.drugalcdep.2020.108027 

19 Locco, A. (2021, March 15). Alcohol and Blacking Out. Resurgence Behavioral Health. https://resurgencebehavioralhealth.com/blog/alcohol-blacking-out/ 

20 White, A. M., Jamieson-Drake, D. W., & Swartzwelder, H. S. (2002). Prevalence and correlates of alcohol-induced blackouts among college students: results of an e-mail survey. Journal of American college health : J of ACH, 51(3), 117–131. https://doi.org/10.1080/07448480209596339 

21 Juergens (2023)

22 Turrisi, R., Mallett, K. A., Mastroleo, N. R., & Larimer, M. E. (2006). Heavy Drinking in College Students: Who Is at Risk and What Is Being Done About It? The Journal of general psychology, 133(4), 401. https://doi.org/10.3200/GENP.133.4.401-420 

23 Esteban, S., Veliz, P., & Schulenberg, J. E. (2018). How collegiate fraternity and sorority involvement relates to substance use during young adulthood and substance use disorders in early midlife: A national longitudinal study. The Journal of adolescent health : Official publication of the Society for Adolescent Medicine, 62(3 Suppl), S35. https://doi.org/10.1016/j.jadohealth.2017.09.029

24 Ibid. 

25 Rosenbloom, C. (2019, March 11). New Concern on College Campuses: ‘Drunkorexia,’ a Combination Drinking and Eating Disorder. The Washington Post. https://www.washingtonpost.com/lifestyle/wellness/new-concern-on-college-campuses-drunkorexia-a-combination-drinking-and-eating-disorder/2019/03/08/093cf47c-4028-11e9-9361-301ffb5bd5e6_story.html 

26 Ibid.

27 Wombacher, K., Matig, J. J., Sheff, S. E., & Scott, A. M. (2019). "It Just Kind of Happens": College Students' Rationalizations for Blackout Drinking. Health communication, 34(1), 1–10. https://doi.org/10.1080/10410236.2017.1384351 

28 Ehman, A. C., & Gross, A. M. (2019). Acceptance and Commitment Therapy and Motivational Interviewing in the Treatment of Alcohol Use Disorder in a College Woman: A Case Study. Clinical Case Studies, 18(1), 36–53. https://doi.org/10.1177/1534650118804886

Imprisioned Youth: Mental Health Impacts of the Juvenile Justice System

The Goal & The Current Reality

Established in 1899, the U.S. Juvenile Justice System was created with the goal of deterring youth offenders from the damaging punishments of criminal courts while encouraging rehabilitation based on the individual juvenile’s needs.[1,2] Although the number of arrests of minors has been decreasing since 1997, nearly 60,000 minors are incarcerated daily in the United States. While roughly two-thirds of youth in juvenile facilities are 16 or older, more than 500 confined children are no more than 12 years old.[3-5] Youth who are incarcerated may be exposed to negative circumstances such as overcrowding, physical and sexual violence, risk of suicide and death.[6] 

Violence and abuse

Youth are exceptionally susceptible to many types of abuse during incarceration.[7] Many types of violence may occur in youth prisons, including:[8]

• physical violence amid detainees

• excessive violence committed by prison staff towards detainees amounting to torture or ill-treatment

• sexual assaults of inmates by other inmates or by prison staff

• psychological violence (e.g., verbal aggression, intimidation, etc.)

• suicides, attempts and other self-harm.

In “Victims Behind Bars: A Preliminary Study on Abuse During Juvenile Incarceration and Post-Release Social and Emotional Functioning,” researchers Dierkhising, Lane and Natsuaki (2014) examined the consequences of abuse while incarcerated. Of the youth surveyed, 96.8 percent had experienced at least one type of abuse during their incarceration (e.g., neglect or witnessing of abuse); 77.4 percent experienced a direct form of abuse, including physical injury.[9] The most common forms of direct abuse were the excessive use of solitary confinement, peer-to-peer physical assault between youth and psychological abuse of youth by staff.[10,11] Although violence is difficult to assess and address due to it being underreported, roughly approximately 25% of incarcerated youth are victimized by violence each year; 4-5% of whom experience sexual violence, with 1-2% subject to rape.[12] Psychological and physical effects of abuse may persist after the release of inmates.[13]

The abuse endured and exposure to violence in prisons and jails are associated with long term problems. These long term issues include post-traumatic stress symptoms, such as anxiety, depression, avoidance, hypersensitivity, hypervigilance, suicidality, flashbacks, difficulty with emotional regulation, and increased risk of criminal involvement.[14,15] Quandt & Jones (2021) note that the lasting effects of the trauma experienced while incarcerated can lead to Post-Incarceration Syndrome.[16] Similar to Post-Traumatic Stress Disorder (PTSD), Post-Incarceration Syndrome is a set of symptoms present in many currently incarcerated and recently released prisoners; it is caused by being subjected to prolonged incarceration in environments of punishment with few opportunities for education, job training, or rehabilitation.[17] In addition, a study conducted by Piper & Berle (2019) examined the relationship between trauma experienced during incarceration and PTSD outcomes. They found that incarcerated people experience high rates of potentially traumatic events, and that there was a relationship between experiencing these events behind bars and the rate of PTSD upon release.[18] The National Child Traumatic Stress Network (2007) found an average of 30% of previously incarcerated youth develop some form of PTSD.[19]

 

Mental Health in the Juvenile Justice System

The National Conference of State Legislatures found that the juvenile justice system is ill-equipped to handle minors with mental health needs.[20] Approximately 1-in-4 children and adolescents arrested each year suffer from a mental illness so severe it impairs his or her ability to function as a young person and grow into a responsible adult.[21] The lack of treating a minor’s mental illness can increase the chances of delinquency transforming into adult criminality.[22] It is estimated that 60 to 70 percent of the 2 million children and adolescents that enter the juvenile justice system have one or more diagnosable disabilities (e.g., learning disabilities, emotional and behavioral disorders and developmental disabilities).[23] The most common diagnoses found in incarcerated youth include: Attention-Deficit Hyperactivity Disorder (ADHD), learning disabilities (LD), depression, developmental disabilities (DD), conduct disorder, anxiety disorders, Post-Traumatic Stress Disorder (PTSD), and substance abuse.[24] 

Many youth experience conduct, mood, anxiety and substance disorders that frequently put them at risk for troublesome behavior and delinquent acts.[25] Symptoms of mental health disorders often start in childhood; behavior disorders such as ADHD impact about 9-10 percent of children in America and emotional disorders (e.g., depression) impact 1 in every 33 children.[26] Mental health disorders in youth can be difficult to treat; however, assessing and treating issues early can create positive outcomes.[27] 

Many youth with mental health disorders also engage in substance abuse and there is an overrepresentation of this co-occurrence within the juvenile justice system.[28] Two-thirds of juveniles within the system with a mental health diagnosis also had dual disorders; this most often involves substance abuse in addition to another diagnosis.[29] 

Methods of Reform

In order to reform the juvenile justice system, the subsystems within it need to be addressed. While reform is a long process that can take many years, Sander (2021) notes that many states have already made such reforms over the last 15 years to reduce youth incarceration.[30]

Eliminating violence and abuse while incarcerated poses a difficult task, however there are many policies currently in place that can accomplish this. Jocelyn Fontaine, Director of Criminal Justice Research at Arnold Ventures believes that, “The pathway to reform is in opening them, making the invisible more visible so by revealing what’s happening, then we hope that people would be motivated to change them.”[31] Fontaine considers transparency and accountability of  reform as shedding light on a situation due to the public and policymakers wanting to change it because they didn’t know about it before.[32] Other suggested reforms include increasing programs in order to keep juveniles focused to avoid violence. This notion, Social Bond Theory, was founded by Travis Hirschi and is based on the basic assumption that humans naturally tend towards delinquency.[33] Hirschi states that the stronger amount of social control and the denser the network of social bonds are, the more likely people are to behave in accordance with standards.[34]

The Healthy Returns Initiative is another way to combat the juvenile mental health crisis. This initiative was created to strengthen the capacity of county juvenile justice systems to improve health and mental health services, and ensure continuity of care as youth transition back to the community.[35] The Healthy Returns Initiative, created by The California Endowment, follows practices considered critical to any systems reform effort.[36,37] Life-changing reform practices have been implemented by the Initiative, such as: screening using validated mental health screening tools; connecting youth and families to benefits and resources (e.g., health care, housing assistance, and food stamps); collaboration and integration across services; and providing funding and resources to sustain multi-disciplinary, collaborative, holistic approaches.[38]

In addition to HRI, the Comprehensive Systems Change Initiative (CSCI) is a model that brings together juvenile justice and mental health systems to identify youth with mental health needs at their earliest point of contact with the juvenile justice system to develop an effective service delivery system to meet their needs.[39] This includes collaborating among all relevant youth-serving agencies and families, identifying youth with mental health needs through use of standardized screening and assessment tools, diverting youth from the justice system to community programs where possible and treating youth who remain in the system using a continuum of evidence-based mental health services.[40,41] 

By applying and executing reform in the juvenile justice system, society as a whole can better understand, assess and treat mental health disorders in children and adolescents. This implementation will allow youth in America to remain on-track to do better academically and subsequently have better odds at leading healthier and more fulfilling lives. 

Contributed by: Ariana McGeary

Editor: Jennifer (Ghahari) Smith, Ph.D.

REFERENCES

1 Juvenile Justice History. (n.d.). Retrieved from Center on Juvenile and Criminal Justice: http://www.cjcj.org/education1/juvenile-justice-history.html

2 McCord, Joan; Spatz Widom, Cathy; Crowell, Nancy A.; National Research Council. (2001). Juvenile Crime, Juvenile Justice. Washington: National Academy Press.

3 ACLU. (n.d.). America’s Addiction to Juvenile Incarceration: State by State. Retrieved from ACLU: https://www.aclu.org/issues/juvenile-justice/youth-incarceration/americas-addiction-juvenile-incarceration-state-state#:~:text=On%20any%20given%20day%2C%20nearly,prisons%20in%20the%20United%20States.

4 Youth Involved with the Juvenile Justice System. (n.d.). Retrieved from Youth.gov: https://youth.gov/youth-topics/juvenile-justice/youth-involved-juvenile-justice-system

5 Ibid.

6 Stephens, R. (2021, May 28). Trauma and Abuse of Incarcerated Juveniles in American Prisons. Retrieved from Interrogating Justice: https://interrogatingjustice.org/prisons/trauma-and-abuse-of-incarcerated-juveniles-in-american-prisons/

7 Modvig, J. (n.d.). 4. Violence, sexual abuse and torture in prisons - WHO/Europe. Retrieved from WHO/Europe: https://www.euro.who.int/__data/assets/pdf_file/0010/249193/Prisons-and-Health,-4-Violence,-sexual-abuse-and-torture-in-prisons.pdf

8 Dierkhising, C. B., Lane, A., & Natsuaki, M. N. (2014). Victims Behind Bars: A Preliminary Study on Abuse During Juvenile Incarceration and Post-Release Social and Emotional Functioning. Psychology, Public Policy, and Law, 20(2), 181-190.

9 Repka, M. (2014, March 26). Confronting an Unseen Problem: Abuse and Its Long-Term Effects on Incarcerated Juveniles . Retrieved from Chicago Policy Review: https://chicagopolicyreview.org/2014/03/26/confronting-an-unseen-problem-abuse-and-its-long-term-effects-on-incarcerated-juveniles/#:~:text=The%20most%20common%20forms%20of,staff%20was%20also%20widely%20reported.

10 Dierkhising, C. B., Lane, A., & Natsuaki, M. N. (2014)

11 Modvig, J. (n.d.). 

12 Dierkhising, C. B., Lane, A., & Natsuaki, M. N. (2014)

13 Repka, M. (2014)

14 Quandt, K. R., & Jones, A. (2021, May 13). Research Roundup: Incarceration can cause lasting damage to mental health . Retrieved from Prison Policy Initiative: https://www.prisonpolicy.org/blog/2021/05/13/mentalhealthimpacts/#:~:text=Exposure%20to%20violence%20in%20prisons,and%20difficulty%20with%20emotional%20regulation.

15 Ibid.

16 Post Incarceration Syndrome (PICS). (2021, October 16). Retrieved from BarNone, Inc.: https://barnoneidaho.org/resources/post-incarceration-syndrome/#:~:text=Post%20Incarceration%20Syndrome%20(PICS)%20is,%2C%20job%20training%2C%20or%20rehabilitation.

17 Piper, A., & Berle, D. (2019). The association between trauma experienced during incarceration and PTSD outcomes: a systematic review and meta-analysis. The Journal of Forensic Psychiatry & Psychology, 30(5), 854-875.

18 Bierkhising, C. B., Ko, S. J., Woods-Jaeger, B., Briggs, E. C., Lee, R., & Pynoos, R. S. (2013). Trauma histories among justice-involved youth: findings from the National Child Traumatic Stress Network. European Journal of Psychotraumatology, 4.

19 National Conference of State Legislatures. (2012, May 25). Mental Health Needs of Juvenile Offenders. Retrieved from NCSL: https://www.ncsl.org/documents/cj/jjguidebook-mental.pdf

20 Ibid.

21 Sawyer, W. (2019, December 19). Youth Confinement: The Whole Pie 2019. Retrieved from Prison Policy Initiative: https://www.prisonpolicy.org/reports/youth2019.html

22 Juvenile Justice Issues. (n.d.). Retrieved from Pacer Center: https://www.pacer.org/jj/issues/

23 Ibid.

24 National Conference of State Legislatures. (2012)

25 Ibid.

26 Ibid.

27 Substance Abuse and Mental Health Services Administration. (2022, March 22). Criminal and Juvenile Justice . Retrieved from SAMHSA: https://www.samhsa.gov/criminal-juvenile-justice

28 National Conference of State Legislatures. (2012)

29 Sanders, C. (2021, July 27). State Juvenile Justice Reforms Can Boost Opportunity, Particularly for Communities of Color. Retrieved from Center on Budget and Policy Priorities: https://www.cbpp.org/research/state-budget-and-tax/state-juvenile-justice-reforms-can-boost-opportunity-particularly-for#:~:text=Though%20much%20work%20remains%2C%20several,shifting%20to%20community%2Dbased%20approaches.

30 D'Abruzzo, D. (2020, August 24). How Can Prisons Eliminate Violence? One Researcher Is Determined to Find Out. Retrieved from Arnold Ventures: https://www.arnoldventures.org/stories/how-can-prisons-eliminate-violence-one-researcher-is-determined-to-find-out

31 Ibid.

32 Wickert, C. (2022, April 18). Social bonds theory (Hirschi). Retrieved from SozTheo: https://soztheo.de/theories-of-crime/control/social-bonds-theory-hirschi/?lang=en

33 Ibid.

34 Healthy Returns Initiative. (n.d.). Retrieved from i.e. communications, llc: https://www.iecomm.org/healthy-returns-initiative/

35 Reform Trends: Mental Health & Substance Use. (2022)

36 Healthy Returns Initiative.

37 Reform Trends: Mental Health & Substance Use. (2022)

38 Ibid.

39 Chayt, B. (2012, December). Juvenile Justice and Mental Health: A Collaborative Approach. Retrieved from ModelsforChange: https://www.modelsforchange.net/publications/350/Innovation_Brief_Juvenile_Justice_and_Mental_Health_A_Collaborative_Approach.pdf

40 Reform Trends: Mental Health & Substance Use. (2022)

Therapeutic Benefits of Play Therapy

Source: Canva

What is Play Therapy and How Does It Work? 

Play therapy is a type of therapy, primarily used with children, to enter their world and understand what kinds of things they are processing at any given moment. It can look like placing a child in a circle of toys, role playing imaginary characters, or using a sandtray to depict scenes. The key is to let the child lead and not to interfere with the direction in which they want to go. 

Sandplay therapy (SPT) is one common medium used in play therapists’ offices. Foo & Pratiwi (2021) have measured a significant decrease in anxiety related symptoms when SPT is optimized. Choline, an advantageous metabolite marker linked to learning, memory, and concentration, was found to increase in participants with childhood trauma after receiving SPT treatment.[1] For children who experience trauma such as divorce, hospitalization, or loss of a loved one, play therapy can mitigate the accompanying negative effects and act as a buffer to prevent severe psychosocial or emotional issues from developing.[2]

Why Play Therapy?

Children will often repeat certain narratives over and over again until they’ve processed them through play. For example, if a child’s best friend suddenly stops playing with them at school, the child may need to work through that confusion through reenactment. When something in the world is frightening or traumatizing in any way, the child can make better sense of the situation by acting it out and having the ability to anticipate what will happen next. They can set the pace of the reenactment as well as gain distance from the situation because rather than the child re-experiencing the fear, the toy or doll can now stand in for them. 

Research has shown that play therapy is an effective intervention for decreasing anxiety in elementary school aged children, improving disorders like generalized anxiety disorder, agoraphobia, social anxiety, and separation anxiety.[3-5] With adults, the brain is typically more developed, so talking is usually an effective method for processing issues. Despite the fact that talking is a viable and reliable option for adults working through problems, the incorporation of playful elements can still be tremendously beneficial for the average person. Similar to how bringing pinecones into a session (as a form of ecotherapy) can spark memories, ideas, and conversations about nature that might not otherwise have organically arisen, using painting or crafts can elicit unique feelings or thoughts in a client. Adults with developmental disabilities can also benefit immensely from toy-based play therapy, as the objects or role play can function as a bridge into their world. 

Drama, somatic, and art therapy are closely related to play therapy in that they all involve additional engagement from the body and mind than just speech. Drama therapy has been shown to improve self-awareness and help people materialize their hidden feelings through action.[6] Additionally, research has demonstrated how somatic experiencing can be therapeutic for people with PTSD, and how creative art-based expression has positive effects on physiological and psychological health.[7, 8] Play therapy is unique in its broadness, as it can encompass the other three as well. Due to its range, it is usually possible to find some form of play therapy that works for each child. Younger children may prefer to act as a dinosaur, while older kids may prefer to use a toy dinosaur in a sandtray. As the brain develops through childhood, analytical skills are built through the limbic brain, and a kid becomes better able to-- for example-- construct more complex sandtray arrangements and then discuss their choices.[9] 

Symbolism in Play Therapy

In the world of play therapy, symbolism is a key element for understanding the broader context of a child’s play. However, a delicate line must be walked: no selection of an object nor appearance of a recurring narrative is ever completely random or arbitrary (in other words, everything is clinically relevant), yet the therapist must be careful not to draw assumption-based conclusions about the symbolism. For example, a child may select a toy weapon. This does not necessarily indicate pathology or a history of abuse. Instead, it might represent desire on the child’s part for some power and control-- something children typically lack in the world. 

Figure 1: Themes of toy selection

Note: This table was produced by Andrewjeski (2019) [10]

Play Therapy Extends Beyond the Session

Parents sometimes place their children in play therapy to give them “me” time. Rachael Sofian, a psychotherapist at Seattle Anxiety Specialists trained in play therapy, notes that children rarely truly crave autonomy. Instead, they seek connection. When done mindfully, it can be effective for parents to engage in play therapy at home. In fact, the greatest results from having a child in play therapy come from the integration of certain attunement techniques into home life. “Reflecting” is a term for the non-directive play therapy technique where the adult or therapist verbalizes the choices of the child. “You’re brushing that doll’s hair” and “you’re moving the car really fast” are examples of reflecting that can help foster connection between the child and adult.[11] 

However, Sofian recommends consulting a professional play therapist for tailored advice before implementing techniques at home. By starting a child in play therapy, the therapist can get to know them and discover important patterns, and then communicate activities or exercises for the parent to try out with the child later. Without professional involvement a parent may run the risk of causing harm to the child, for instance, by setting aside play time but multi-tasking or forgetting to be fully present.

There is considerable evidence that supports the efficacy of play therapy for improving social and emotional skills, self-awareness, self-regulation, empathy, communication, increasing intelligence, decreasing anxiety, and helping with the recovery process after trauma.[12-14] By placing power into the child’s hands and allowing them to direct a play session, they gain an invaluable sense of control and autonomy. Trained professionals who can reflect, validate, and ask questions in a neutral and curious manner add to the power of play therapy. The therapeutic benefits are not limited to children or the brick-and-mortar therapy room, though. Elements of therapeutic play can be implemented into virtual therapy, home life between the parent and child, as well as psychotherapy sessions for adults.  

Contributed by: Maya Hsu

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

1 Foo, M., & Pratiwi, A. (2021). The effectiveness of sandplay therapy in treating generalized anxiety disorder patients with childhood trauma using magnetic resonance spectroscopy to examine choline level in the dorsolateral prefrontal cortex and centrum semiovale. International Journal of Play Therapy, 30(3), 177–186. https://doi.org/10.1037/pla0000162 

2 Li, W. H. C., Chung, J. O. K., Ho, K. Y., & Kwok, B. M. C. (2016). Play interventions to reduce anxiety and negative emotions in hospitalized children. BMC pediatrics. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4787017/ 

3 Hateli, B. (2021). The effect of non-directive play therapy on reduction of anxiety disorders in young children. Counselling and Psychotherapy research. Retrieved from https://www.researchgate.net/publication/352540147_The_effect_of_non -directive_play_therapy_on_reduction_of_anxiety_disorders_in_young_children

4 Kool, R., & Lawver, T. (2010). Play therapy: Considerations and applications for the practitioner. Psychiatry (Edgmont (Pa. : Township)). Retrieved January 13, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989834/ 

5 Ray, D. C., Armstrong, S. A., Balkin, R. S., & Jayne, K. M. (2014). Child-centered play therapy in the schools: Review and meta-analysis. Psychology in the Schools, 52(2), 107–123. https://doi.org/10.1002/pits.21798 

6 Chang, W.-L., Liu, Y.-S., & Yang, C.-F. (2019). Drama therapy counseling as mental health care of college students. International journal of environmental research and public health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801780/ 

7 Brom, D., Stokar, Y., Lawi, C., Nuriel-Porat, V., Ziv, Y., Lerner, K., & Ross, G. (2017). Somatic experiencing for posttraumatic stress disorder: A randomized controlled outcome study. Journal of traumatic stress. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5518443/ 

8 Stuckey, H. L., & Nobel, J. (2010). The connection between art, healing, and public health: A review of current literature. American journal of public health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804629/ 

9 Sokolowski, K., & Corbin, J. G. (2012). Wired for behaviors: From development to function of innate limbic system circuitry. Frontiers in molecular neuroscience. Retrieved January from https://www.frontiersin.org/articles/10.3389/fnmol.2012.00055/full 

10 Andrewjeski, K. (2019). The symbolism of play behavior in child-centered play therapy. UNLV Theses, Dissertations, Professional Papers, and Capstones. Retrieved from http://dx.doi.org/10.34917/18608580 

11 Allen, V., Folger, W., & Pehrsson, D.-E. (2007). Reflective process in play therapy: A practical model for supervising counseling students. Researchgate. Retrieved from https://www.researchgate.net/publication/234565195_Reflective_Process_in_Play_Therapy_A_Practical_Model_for_Supervising_Counseling_Students 

12 Mirahmadi, Z., & Hemmati, G. (2016). The effectiveness of group play therapy on social skills of female students with intellectual disability. Physical Treatments - Specific Physical Therapy, 6(2), 115–123. https://doi.org/10.18869/nrip.ptj.6.2.115 

13 Chinekesh, A., Kamalian, M., Eltemasi, M., Chinekesh, S., & Alavi, M. (2013). The effect of group play therapy on social-emotional skills in pre-school children. Global journal of health science. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825459/ 

14 Godino-Iáñez, M. J., Martos-Cabrera, M. B., Suleiman-Martos, N., Gómez-Urquiza, J. L., Vargas-Román, K., Membrive-Jiménez, M. J., & Albendín-García, L. (2020). Play therapy as an intervention in hospitalized children: A systematic review. Healthcare. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551498/