Vol 1

#Anxiety: Social Media Use & the Maintenance of Mental Health

Engaging in a Healthy Manner

Social media use has been found to be associated with higher levels of anxiety and depression. Currently, anxiety disorders are the most common form of mental illness in the United States, while depression is responsible for the heaviest burden of disability among mental and behavioral disorders.[1] As found by the Royal Society for Public Health and the Young Health Movement (2017), the pervasiveness of anxiety and depression in young people has increased by nearly 70% in the past 25 years.[2] It is important to investigate the interaction between social media and adolescents as adolescents are the most common users of social media with at least 92% of teenagers using it;[3] 70% of whom use it more than once a day.[4] In addition to the prevalence of social media among adolescents, this cohort is also one of the most vulnerable populations to external influences as adolescence is a period of personal and social identity formation. Further, adolescence is a time period where individuals are most vulnerable to the onset of mental illnesses, such as anxiety and depression. On the same note, the tenets of social comparison theory (which involves people’s tendencies to compare themselves to others in order to assess their own worthiness) is most common in adolescence  and is therefore more important than ever to examine with the emergence of social media.[5] 

MECHANISMS FOR ANXIETY

Two primary mechanisms are responsible for the way social media can worsen one’s anxiety.[6] First, social media activates the human body’s fight or flight limbic system with the alerting of new messages. The constant alert of new messages and updates on social media activates the human body’s fight or flight limbic system in a way that resembles being on alert for predators. This state of alertness causes stress and releases the stress hormone cortisol. The constant release of this hormone can lead to chronic stress, perpetuating anxiety. Second, social media often portrays what is known as a ‘highlight reel,’ depicting the most positive aspects of people’s lives, creating an unrealistic and unachievable perception of perfection.[7] This online environment of perfection creates stress and pressure for users to maintain and project a state of perfection at all times. 

But how exactly does stress lead to anxiety? Over time, stress from social media usage and the subsequent continuous release of cortisol in the body causes damage to the gastrointestinal tract; the resulting immune-inflammatory response in one’s body and brain can lead to anxiety.[8] 

ENGAGING IN A HEALTHY WAY

In terms of improving our mental health, the simple answer is to dictate social media usage cessation; however, the prevalence of social media in the current digital age hampers this likelihood. Additionally, social media does have positive attributes: it allows people to connect with their loved ones, maintain relationships, keep up to date with the news, learn the arts and other creative outlets, etc. Thus, it is important to know how to use social media in a healthy way. Woods and Scott (2016) and Meshi and Ellithorpe (2021) offer several techniques to actively engage in social media use while helping ensure it does not negatively impact one’s mental health. 

  1. Mindfulness: When scrolling through social media, pay attention to your thought patterns by incorporating mindfulness. If you start to realize you are feeling stressed or are being critical of yourself, take a break from it. Remind yourself that social media is an unrealistic portrayal of real life. Consider putting your phone down and meditating for a few minutes by focusing on your breath. This will allow you to become aware of when social media is becoming toxic and will prevent you from using it in an unhealthy way. 

  2. Sleep Quality: Sleep quality has been proven to be involved in the relationship between social media and mental illness.[9] Significant correlations exist between the use of social media at night before bed, poor sleep quality, along with anxiety and depression. The use of social media at night time can result in postponed bedtimes and subsequent poorer sleep, worsening mental health. To avoid the negative impacts of social media on sleep quality and mental health, avoid using social media at least an hour before bedtime. 

  3. Social Support: Real-life social support is associated with reduced depression, anxiety, and social isolation.[10] Conversely, online social support has not had consistent positive results on its effect on mental health. It is therefore imperative to spend time with real-life social supports when feeling down, as opposed to scrolling on your phone or computer. Further, this data demonstrates that social media use and interaction are not adequate substitutes for real-life social support, and may be, in fact, detrimental to one’s mental health. 

For additional guidance on the management of social media usage, please reach out to a mental health professional or refer to here for more tips.  

Q&A

Psychologist Larry Rosen, who specializes in the psychology of technology, further explains how social media relates to mental health

1. Which is worse? - The anxiety of not knowing what others are doing on social media, or the anxiety from actually knowing  what others are doing on social media?

“Interesting question. I would definitely say the “not knowing” is worse because your brain ruminates about it, increasing as anxiety increases. When you ‘know’ your brain doesn’t have to ruminate unless it something that makes you anxious like not being invited to do something.”

2. Why are adolescents most vulnerable to the addiction of social media?

“The prefrontal cortex handles all of your decision making, working memory, attention etc. When we are born the neurons in the PFC are ‘raw’ and do not transmit very well. Slowly, over time, each neuron is coated with a myelin sheath which is like the rubber coating on wires so you don’t get shocked. That process isn’t complete until you reach your mid-20s or later. Teens are literally working with an incomplete brain.”

3. Why does social media cause or worsen anxiety? Specifically, what occurs in a person’s brain when they use social media?

“For many people, juggling several active social media accounts increases anxiety because you need to keep up with all of them. And much of social media is posting about exploits which makes one feel inferior or left out. This causes anxiety chemicals to flood into your brain.”

4. What is the best way to avoid anxiety from social media use?

“Tough question. The best strategy that I trust, is to train yourself to only check social media on a time schedule rather than on an anxiety-driven whim.”

5. If someone stopped using social media, how long would it typically take to adjust to the anxiety and the FOMO that results from no longer using social media?

“I’ve never seen a study, but it’s not easy. You can train your brain using a tech break where you set a timer for say 15 minutes and when it dings give yourself a minute on social media (timed or you’ll get sucked into the social media vortex) and keep doing 15-1-15 etc. until you feel comfortable doing it and then increase the break slowly up to 30 minutes or more.”

Contributed by: Preeti Kota

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

Click here to access our interview about technology and Parkinson’s Disease with Dr. Larry Rosen.

references

1 Shensa, A., Sidani, J. E., Dew, M. A., Escobar-Viera, C. G., & Primack, B. A. (2018). Social media use and depression and anxiety symptoms: A cluster analysis. American Journal of Health Behavior, 42(2), 116–128. https://doi.org/10.5993/ajhb.42.2.11

2 Keles, B., McCrae, N., & Grealish, A. (2019). A systematic review: The influence of social media on depression, anxiety and psychological distress in adolescents. International Journal of Adolescence and Youth, 25(1), 79–93. https://doi.org/10.1080/02673843.2019.1590851

3 Ibid.

4 Sussex Publishers. (n.d.). It's not how much screen time. Psychology Today. Retrieved July 22, 2022, from https://www.psychologytoday.com/us/blog/rewired-the-psychology-technology/201812/it-s-not-how-much-screen-time 

5 Keles (2019)

6 The impact of social media on society - Santa Clara University. (n.d.). Retrieved July 22, 2022, from https://scholarcommons.scu.edu/cgi/viewcontent.cgi?article=1002&context=engl_176 

7 Ibid.

8 Ibid. 

9 Woods, H.C. and Scott, H. (2016), #Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem. Journal of Adolescence, 51: 41-49. https://doi.org/10.1016/j.adolescence.2016.05.008

10 Meshi, D., & Ellithorpe, M. E. (2021). Problematic social media use and social support received in real-life versus on social media: Associations with depression, anxiety and social isolation. Addictive Behaviors, 119, 106949. https://doi.org/10.1016/j.addbeh.2021.106949

The Need for Novelty

Exposure to Novelty

Novel stimuli has been evolutionary and developmentally advantageous for humans throughout time.[1] As foragers, it was beneficial for early humans to move around a lot and explore new environments; those who did likely gained new knowledge and skills.[2] Additionally, exploring novel environments gave humans more possibilities of food and potential mates, increasing chances of survival and reproduction. In order for people to survive, innovation and evolution was needed and achieved through the pursuit of novelty.[3]

Novelty is defined as something that has not been previously experienced and/or deviates from one’s routine.[4] Such examples include: meeting a new person, experiencing a new smell, taste, environment, or recreational activity - essentially, this can include any aspect of perception that isn’t already present in an observer’s memory system.[5,6] When a new stimulus is encountered, the hippocampus is stimulated and releases dopamine into the body.[7,8] Acting as a reward system to encourage the pursuit of new stimuli and environments,[9] dopamine also activates long-term potentiation, facilitating learning and memory of the new stimulus.[10,11]

If there is repetitive exposure to a stimulus, the body adapts by reducing the response to it - a process known as habituation.[12] Habituation allows the brain to ignore unimportant information and focus on new and relevant stimuli.[13] Specifically, the brain inhibits a response to stimulus that is familiar and frequently encountered, allowing selective attention to novel stimuli.[14] For example, an individual exposed to a constant smell will gradually show a reduced response until the smell is no longer perceived.[15] To encourage novelty seeking (which is evolutionarily advantageous) the body produces less dopamine (i.e., less of a reward) for repeated exposure to a stimulus.[16]

 

Novelty as a psychological need

Research has demonstrated that novel exposure is positively associated with well-being.[17,18] The hedonic adaptation prevention (HAP) model developed by Sheldon et al., (2012) found that variety, unexpectedness, and surprise in everyday life promote an increase in well-being;[19,20] additionally, the repetition and continuation of these factors help maintain an increase in happiness over time.[21] Exposure to unfamiliar stimuli and environments are also linked to a decrease in stress, anxiety, and depression.[22]

A study done by Bagheri and Milyavskaya (2020), analyzed whether novelty can qualify as a psychological need within the self-determination theory.[23] This theory states that humans have three psychological needs -autonomy, competence, and relatedness- which underlie motivation and development.[24,25] The fulfillment of these psychological needs are essential for psychological growth, well-being, and optimal functioning.[26,27] In order for novelty to meet the criteria of a psychological need it must: have a positive effect on well-being; universally affect all people regardless of age and novelty preference; cause a decrease in well-being when absent; and cause benefits to most areas of life.[28] Novelty satisfies all of these criteria and thus behaves very similarly to other psychological needs in that it is essential for life satisfaction and fulfillment. Further, novelty is needed for humans to psychologically function and is essential for life satisfaction and fulfillment.[29]

 

Why new things are good for us

In addition to positively affecting one’s well being, exposure to novelty has been found to improve memory and brain plasticity,[30-32] facilitate learning,[33,34] and promote active decision making.[35] Crescentini et al. (2018) also found that novelty is associated with autonomy, positive relationships, and personal growth in adolescents.[36,37] Exposure to novelty introduces the brain to new information, in turn adjusting old conceptual categories and creating new mental representations.[38] This can create new perspectives and meaning, which can help individuals evaluate situations from numerous perspectives and adjust their behavior and emotional reactions accordingly.[39,40] Additionally, exposure to novelty can help people cope with challenges and find rational solutions, instigating growth and development.[41-43]

Exposure to novelty is linked to memory improvement.[44-46] When a new stimulus is encountered, dopamine is released. Since dopamine is responsible for memory enhancement, novelty therefore induces and strengthens memories.[47] Additionally, the violation of expectations leads to memory enhancement.[48] Humans compare incoming information with already existing knowledge and schemas to make predictions.[49] New stimuli are more likely to differ from previous mental concepts, negating expectations and becoming more memorable; the unpredictability and unexpectedness of novelty improves memory.[50] A study done by Ballarini et al. (2013) found that participating in a novel activity before learning school lessons improved long-term memory in elementary school students.[51] Seeking out and experiencing novelty is also linked to creativity.[52,53] Since creativity is characterized by the formation of novel cognitive content and ideas,[54] there is a cyclical between creativity and novelty: creativity is developed around the concept of novelty, and novelty-seeking often acts as a prerequisite for creativity.[55] 

 

Boredom’s effect on anxiety and mental health

Without the presence of novelty, environments can consist of unvarying and repeated stimulation;[56,57] consequently, boredom and loss of engagement are likely to exist.[58] A study done by Tze et al. (2015) found that when boredom was present in an academic setting, there was less motivation to learn, less effort put forward, and more disengagement in school.[59] Further, boredom negatively affects academic performance and goals,[60] and has been linked to a higher susceptibility to cognitive dysregulation,[61,62] depressive symptoms and anxiety,[63,64] increased usage of drugs,[65] hopelessness,[66] loneliness,[67] and aggression.[68]

 

Why time speeds up as we get older

A study done by Ferriera et al.(2016) found evidence that time feels like it passes by faster for older individuals;[69] further, the perception of time passage is accelerated as one ages.[70] One reason for this phenomenon could be a person’s lack of new experiences and novelty.[71]

In addition to the subjective feeling that time speeds up with age, adults also report a disproportionate recollection for events that occurred in childhood or early adulthood, known as the reminiscence bump.[72] Claudia Hammond (2013) argues that the reason behind the reminiscence bump is novelty.[73] When an individual is doing something new for the first time such as riding a bike, learning a new skill, or starting a new job, the moment is encoded strongly into memory, causing an individual to remember the event for many years to come.[74,75] Childhood and early adulthood contain a vast amount of new information and the learning of new skills, which in turn become encoded into memory;[76] in contrast, adults are more likely to have less new experiences as daily life becomes more routine and therefore encode less into memory.[77] This can cause an overrepresentation of childhood and early adulthood memories in autobiographical memory and can make that period of life feel longer.[78] This also explains why childhood and early adulthood may feel “slower” than older adulthood. 

 

How to slow down time and increase well-being

Novelty and new experiences can be used to slow down time and increase well-being.[79] Additionally, the subjective perception of time is based on the amount of new memories created over a time period.[80] For example, the more new memories created during a vacation, the longer the trip will seem when looking back on it.[81] Some examples of ways to keep one’s brain active and incorporate novelty into life include:[82,83]

  • Learn a new language.

  • Vacation to a new place.

  • Take a new route home from work.

  • Learn a new skill (e.g., skiing, sewing, cooking, or guitar).

  • Move and live in a different city.

  • Take a class on a subject that interests you.

  • Volunteer for a local or global organization.

  • Change the furniture or décor in your home.

  • Try a new restaurant or even a new meal.

  • Try a new physical fitness activity (e.g., biking, yoga, Pilates, or boxing).

  • Plant a garden.

  • Attend a new community event.

  • Go camping.

  • Read a new book.

  • Meditate.

  • Attend a new live music performance.

  • Visit a museum.

  • Make conversation with strangers.

  • Learn about a different culture.

  • Go wine tasting.

  • Try out a new look or hairstyle.

  • Join an intramural or club sports team.

  • Start biking to work or to the store.

  • Explore a new park or hike a new trail.

If you feel yourself suffering from boredom, feel disengaged in life, are suffering from anxiety or depression and the effects are not mitigated from increased experience of novelty, consider reaching out to a mental health professional for additional support.

Contributed by: Amelia Worley

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

REFERENCES

1  Schomaker, J. (2019, March 9). Unexplored territory: Beneficial effects of novelty on memory. Neurobiology of Learning and Memory. Retrieved July 23, 2022, from https://www.sciencedirect.com/science/article/pii/S1074742719300516

2  Bagheri, L., & Milyavskaya, M. (2019, October 22). Novelty–variety as a candidate basic psychological need: New evidence across three studies - motivation and emotion. SpringerLink. Retrieved July 23, 2022, from https://link.springer.com/article/10.1007/s11031-019-09807-4

3  González-Cutre, D., Sicilia, Á., Sierra, A. C., Ferriz, R., & Hagger, M. S. (2016, July 8). Understanding the need for novelty from the perspective of self-determination theory. Personality and Individual Differences. Retrieved July 23, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S0191886916307863

4  Bagheri, L., & Milyavskaya, M. (2019)

5  Reichardt, R., Polner, B., & Simor, P. (2020, April). Novelty manipulations, memory performance, and predictive coding: The role of unexpectedness. Frontiers. Retrieved July 23, 2022, from https://www.frontiersin.org/articles/10.3389/fnhum.2020.00152/full

6  Barto, A., Mirolli, M., and Baldassarre, G. (2013). Novelty or surprise? Front. Psychol. 4:907. doi: 10.3389/fpsyg.2013.00907 

7  Shohamy, D., and Adcock, R. A. (2010). Dopamine and adaptive memory. Trends Cogn. Sci. 14, 464–472. doi: 10.1016/j.tics.2010.08.002

8  Reichardt, R., Polner, B., & Simor, P. (2020)

9  Costa, V. D., Tran, V. L., Turchi, J., & Averbeck, B. B. (2014). Dopamine modulates novelty seeking behavior during decision making. American Psychological Association. Retrieved July 16, 2022, from https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0037128

10  Shohamy, D., and Adcock, R. A. (2010)

11  Reichardt, R., Polner, B., & Simor, P. (2020)

12  Trinity College Dublin. (2014, June 18). Groundbreaking model explains how the brain learns to ignore familiar stimuli. ScienceDaily. Retrieved July 23, 2022 from www.sciencedaily.com/releases/2014/06/140618131957.htm

13  Ibid.

14  Ramaswami, M. (2014, June 18). Network plasticity in adaptive filtering and behavioral habituation. Neuron. Retrieved July 12, 2022, from https://www.cell.com/neuron/fulltext/S0896-6273(14)00350-X?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS089662731400350X%3Fshowall%3Dtrue

15  Ibid.

16  Costa, V. D., Tran, V. L., Turchi, J., & Averbeck, B. B. (2014)

17  Li, W. W., Yu, H., Miller, D. J., Yang, F., & Rouen, C. (2020, December). Novelty seeking and mental health in Chinese university students before, during, and after the COVID-19 pandemic lockdown: A longitudinal study. Frontiers. Retrieved July 23, 2022, from https://www.frontiersin.org/articles/10.3389/fpsyg.2020.600739/full

18  Pirson M. A., Langer E., Zilcha S. (2018). Enabling a socio-cognitive perspective of mindfulness: The development and validation of the Langer Mindfulness Scale. J. Adult. Dev. 25 168–185. 10.1007/s10804-018-9282-4 

19  Sheldon, K. M., & Lyubomirsky, S. (2012). The Challenge of Staying Happier: Testing the Hedonic Adaptation Prevention Model. Personality and Social Psychology Bulletin, 38(5), 670–680. https://doi.org/10.1177/0146167212436400

20  González-Cutre, D., Sicilia, Á., Sierra, A. C., Ferriz, R., & Hagger, M. S. (2016, July 8).

21  Sheldon, K. M., & Lyubomirsky, S. (2012)

22  Li, W. W., Yu, H., Miller, D. J., Yang, F., & Rouen, C. (2020)

23  Bagheri, L., & Milyavskaya, M. (2019)

24  Self-Determination Theory. Self-Determination Theory of Motivation - Center for Community Health & Prevention - University of Rochester Medical Center. (n.d.). Retrieved July 18, 2022, from https://www.urmc.rochester.edu/community-health/patient-care/self-determination-theory.aspx

25  González-Cutre, D., Sicilia, Á., Sierra, A. C., Ferriz, R., & Hagger, M. S. (2016)

26  Ibid.

27  Ryan, R., & Deci, E. (2000, January). Self-determination theory and the facilitation of intrinsic motivation ... Retrieved July 23, 2022, from https://selfdeterminationtheory.org/SDT/documents/2000_RyanDeci_SDT.pdf

28  Bagheri, L., & Milyavskaya, M. (2019)

29  Ibid.

30  Düzel, E., Bunzeck, N., Guitart-Masip, M., & Düzel, S. (2009, August 26). Novelty-related motivation of anticipation and exploration by dopamine (NOMAD): Implications for healthy aging. Neuroscience & Biobehavioral Reviews. Retrieved July 23, 2022, from https://www.sciencedirect.com/science/article/pii/S0149763409001298?casa_token=Rf_tN1X1AtsAAAAA%3AGL_C25SnzfKB2Hf-0lCzV85aYjrSzwZxXITd91xcpUkN6tpVl35mEZst2kJa-JaKyCbqGSU0_aA8

31  Schomaker, J. (2019)

32  Ballarini, F., Martínez, M. C., Perez, M. D., Moncada, D., & Viola, H. (2013). Memory in elementary school children is improved by an unrelated novel experience. PLOS ONE. Retrieved July 17, 2022, from https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0066875

33  Schomaker, J. (2019)

34  Porubanova, M., Shaw, D. J., McKay, R., & Xygalatas, D. (n.d.). Memory for expectation-violating concepts: The effects of agents and cultural familiarity. Retrieved July 23, 2022, from https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0090684

35  Schomaker, J. (2019)

36  Reichardt, R., Polner, B., & Simor, P. (2020)

37  Düzel, E., Bunzeck, N., Guitart-Masip, M., & Düzel, S. (2009, August 26). Novelty-related motivation of anticipation and exploration by dopamine (NOMAD): Implications for healthy aging. Neuroscience & Biobehavioral Reviews. Retrieved July 23, 2022, from https://www.sciencedirect.com/science/article/pii/S0149763409001298?casa_token=Rf_tN1X1AtsAAAAA%3AGL_C25SnzfKB2Hf-0lCzV85aYjrSzwZxXITd91xcpUkN6tpVl35mEZst2kJa-JaKyCbqGSU0_aA8

38  Li, W. W., Yu, H., Miller, D. J., Yang, F., & Rouen, C. (2020)

39  Ibid.

40  Haigh, E. A. P., Moore, M. T., Kashdan, T. D., and Fresco, D. M. (2011). Examination of the factor structure and concurrent validity of the Langer Mindfulness/Mindlessness Scale. Assessment 18, 11–26. doi: 10.1177/1073191110386342

41  Li, W. W., Yu, H., Miller, D. J., Yang, F., & Rouen, C. (2020)

42  González-Cutre, D., Sicilia, A., Sierra, A. C., Ferriz, R., and Hagger, M. S. (2016). Understanding the need for novelty from the perspective of self-determination theory. Pers. Indiv. Differ. 102, 159–169. doi: 10.1016/j.paid.2016.06.036

43  Jagtap, S. (2019). Design creativity: refined method for novelty assessment. Int. J. Des. Creativity Innov. 7, 99–115. doi: 10.1080/21650349.2018.1463176

44  Schomaker, J. (2019)

45  Porubanova, M., Shaw, D. J., McKay, R., & Xygalatas, D. (n.d.).

46  Ballarini, F., Martínez, M. C., Perez, M. D., Moncada, D., & Viola, H. (2013)

47  U.S. Department of Health and Human Services. (2016, September 27). How novelty boosts memory retention. National Institutes of Health. Retrieved July 4, 2022, from https://www.nih.gov/news-events/nih-research-matters/how-novelty-boosts-memory-retention

48  Porubanova, M., Shaw, D. J., McKay, R., & Xygalatas, D. (n.d.).

49  Ibid.

50  Schomaker, J. (2019)

51  Ballarini, F., Martínez, M. C., Perez, M. D., Moncada, D., & Viola, H. (2013)

52  Li, W. W., Yu, H., Miller, D. J., Yang, F., & Rouen, C. (2020)

53  Goclowska, M. A., Ritter, S. R., Elliot, A. J., and Baas, M. (2019). Novelty seeking is linked to openness and extraversion, and can lead to greater creative performance. J. Pers. 87, 252–266. doi: 10.1111/jopy.12387

54  Cropley, A. J. (1990). Creativity and mental health in everyday life. Creativity Res. J. 13, 167–178. doi: 10.1080/10400419009534351

55  Li, W. W., Yu, H., Miller, D. J., Yang, F., & Rouen, C. (2020)

56  Ibid.

57  Langer, E. (2014). Mindfulness. Boston: Da Capo Press.

58  González-Cutre, D. et al., (2016)

59  Tze, V.M.C., Daniels, L.M. & Klassen, R.M. (2016). Evaluating the Relationship Between Boredom and Academic Outcomes: A Meta-Analysis. Educ Psychol Rev 28, 119–144 https://doi.org/10.1007/s10648-015-9301-y

60  Ibid.

61  Tutzer, F., Frajo-Apor, B., Pardeller, S., Plattner, B., Chernova, A., Haring, C., Holzner, B., Kemmler, G., Marksteiner, J., Miller, C., Schmidt, M., Sperner-Unterweger, B., & Hofer, A. (2021, January 10). Psychological distress, loneliness, and boredom among the general population of Tyrol, Austria during the COVID-19 pandemic. Frontiers. Retrieved July 23, 2022, from https://www.frontiersin.org/articles/10.3389/fpsyt.2021.691896/full 

62  Isacescu J, Struk AA, Danckert J. Cognitive and affective predictors of boredom proneness. Cogn Emot. (2017) 31:1741–8. doi: 10.1080/02699931.2016.1259995 

63  Tutzer, F. et al., (2021)

64  Vodanovich SJ, Verner KM, Gilbride TV.(1991) Boredom proneness: its relationship to positive and negative affect. Psychol Rep. 69:1139–46. doi: 10.2466/pr0.1991.69.3f.1139

65  Yan L, Gan Y, Ding X, Wu J, Duan H. The relationship between perceived stress and emotional distress during the COVID-19 outbreak: Effects of boredom proneness and coping style. (2020) 77:102328. doi: 10.1016/j.janxdis.2020.102328

66  Goldberg, Y. K., Eastwood, J. D., Laguardia, J., & Danckert, J. (2011). Boredom: An emotional experience distinct from apathy, anhedonia, or depression. Journal of Social and Clinical Psychology, 30(6), 647–666. https://doi.org/10.1521/jscp.2011.30.6.647 

67  Ibid.

68  Ibid.

69  Ferreira, V. F. M., Paiva, G. P., Prando, N., Graça, C. R., & Kouyoumdjian, J. A. (2016, April 1). Time perception and age. Arquivos de Neuro-Psiquiatria. Retrieved July 20, 2022, from https://www.scielo.br/j/anp/a/d6SvJK5tM6kCFPTmpVj5pSz/?lang=en

70  Ibid.

71  Ibid.

72  Koppel J, Rubin DC. Recent Advances in Understanding the Reminiscence Bump: The Importance of Cues in Guiding Recall from Autobiographical Memory. Psychol Sci. 2016 Apr 1;25(2):135-149. doi: 10.1177/0963721416631955. PMID: 27141156; PMCID: PMC4850910.

73  Hammond, C. (2013). Time warped: Unlocking the mysteries of time perception. Harper Perennial.

74  Ibid.

75  Popova, M. (2022, February 25). Why time slows down when we're afraid, speeds up as we age, and gets warped on vacation. The Marginalian. Retrieved July 22, 2022, from https://www.themarginalian.org/2013/07/15/time-warped-claudia-hammond/

76  Robison, E. (2016, July 1). Why does time seem to speed up with age? Scientific American. Retrieved July 15, 2022, from https://www.scientificamerican.com/article/why-does-time-seem-to-speed-up-with-age/

77  Ibid.

78  Ibid.

79  Ferreira, V. F. M. et al., (2016)

80  Robison, E. (2016)

81  Ibid.

82  Friedman, R. A. (2013, July 20). Fast time and the aging mind. The New York Times. Retrieved July 18, 2022, from https://www.nytimes.com/2013/07/21/opinion/sunday/fast-time-and-the-aging-mind.html

83  Try! 35 ideas for doing something new & different in your life. Allan Karl | Keynote Speaker. (2015, September 4). Retrieved July 23, 2022, from https://www.allankarl.com/try-something-new-35-ideas-for-doing-something-new-different-in-your-life/

Back to School: How Students and Parents Can Cope with Anxiety in the Wake of the Uvalde Tragedy

In the Wake of Uvalde

The nation was shaken following the traumatic Uvalde school shootings on May 29, 2022, resulting in the fatality of 19 students and 2 adults.[1] Parents, students, and teachers listened in shock to the reports of a joyous day of honor roll celebrations ending in such startling tragedy.[2] Annual preparations for a relaxing summer slowed to a halt as the country took time to mourn.

In the days that followed, parents across the nation chose not to send their children to school.[3-5] This abrupt transition to summer now leaves some parents wondering how to reconcile these events and approach the coming school year. Even though most students and parents were not in physical proximity to this crisis, evidence shows that repeated exposure to school shootings on the news is having an impact on mental health.

It's important to recognize that these events are not occurring in isolation but are instead following a series of national struggles including the COVID-19 pandemic, devastating wildfires, destructive hurricanes, economic uncertainty, and equal rights protests.[6] Roxane Cohen Silver, PhD describes these experiences as “a cascade of collective trauma,” in which, “our reserves are depleted as a nation, and our young people are suffering.”[7]

In an interview with US News, the director of the Child and Adolescent Mood Disorders Program at UCLA’s Semel Institute explained that the increase in violence at schools is impacting all children, saying, “You don’t have to be where the acute distress occurred to get acute stress reactions or PTSD… Nationally, kids are asking more and more if it’s safe to go to school.”[8] Repeated exposure to these events on the news has been increasing in recent years. Education Week’s most recent report states that as of July, there have already been 27 school shootings resulting in 83 people either killed or injured in 2022.[9] Additionally, over 900 school shootings have taken place since the tragedy at Sandy Hook Elementary almost ten years ago.[10]

As these events become more common, they can chip away at the sense of safety and security that would normally be expected in a school environment. Even those who are indirectly exposed to a traumatic event, through hours of media exposure, can contribute to the development of PTSD-like symptoms.[11] In a 2018 survey conducted on “Generation Z,” (the generation born between 1997-2012 that is most directly impacted by the rise in these events) 72% of students surveyed stated that they considered school shootings to be a significant source of stress.[12] Adding to the devastation is the sense of loss and confusion at the end of an event. Since these shootings often result in the suicide of the shooter, the public is left without answers as to the motivation of the violence or what could have been done to prevent it, which can have long-term psychological impact even to those who do not directly experience it.[13] The persistent exposure to these topics in the media can lead to a cycle called, “perseverative cognition,” in which exposure to violence in the media causes distress, leading an individual to worry about future violence, which causes the individual to consume more media.[14]

The impact school shootings have on children throughout the nation can be found dating as far back as the Columbine tragedy in 1999; when a sample of high school students who were not directly involved with the event indicated a 30% increase that they “did not feel safe returning to school” and absences of students due to safety concerns were 2.6 times higher in the days that followed the tragedy.[15] This statistic is backed by a 2014 analysis of Twitter accounts following the 2012 Sandy Hook Elementary tragedy in Newton, Connecticut, which showed that while distance and time from the physical event may have decreased the use of words related to sadness, the use of words related to anxiety actually increased.[16] This increase in anxiety may be due to a phenomenon called, “psychological proximity,” which can cause people to become more severely impacted by an event if they are able to identify with the victims.[17]

Increased access to instant news and updates through social media is broadening the impact these events have on a national level.  In the week following the Sandy Hook Elementary shooting in 2012, three million tweets circled the globe with some providing instant access to graphic images of the scene.[18] Recent decades have drastically changed our access to information, with the emergence of devices that allow people to simultaneously receive and stream information about tragic events twenty-four hours per day.[19] This was illustrated when teenagers caught  in the middle of the Stoneman Douglas High School shooting used their personal smartphones to live stream and tweet their own experiences.[20] These events illustrate how the public is increasingly gaining access to details in near real time, which can simulate personally experiencing the tragedy.  

All of this raises the question of how to move forward. In the wake of yet another school tragedy, how can students and parents address the fear that arises from beginning another school year?

Preparing Students to Return

While the initial instinct may be to shelter children from school tragedies, current evidence indicates that children are able to better process the news when it comes from parents than when they learn about it through peers or social media.[21] Parents need to approach the topic of returning to school differently with children depending on their age. Kary Kunzelman, who supervises a mental health outpatient program in Butler County, Ohio, called Community First Solutions, warns that parents should monitor how they are reacting to the news of events because even if parents believe they are shielding children by not discussing the news, children can often tell that something is wrong and that their parents are behaving differently.[22] 

For younger children, parents can start the discussion by asking them how they feel about returning to school and helping them find words that describe their feelings such as sad, angry, or frightened.[23] Experts recommend discussing these topics, in a simple factual manner, because it is important for them to see that there is language that can be used to describe these feelings.[24]

Children should be reassured that adults in their lives have plans in place to keep them safe.[25] They will trust adults more if they provide truthful answers, so it’s important to state that even though schools are generally safe places, there are still risks.[26] Parents can review with their children the plans that are in place at school if a dangerous situation develops and allow children to explain what they would do.[27] This is not only an opportunity to review safety procedures but can also empower students by helping them understand that they have some control in the situation.

With younger children, it’s also important to limit exposure to the news when new events occur since they may lack the skills to process events in the way they were intended to be perceived. For example, in the days following September 11, 2001, children watching the events unfold on television interpreted the replayed footage to mean that hundreds of planes were repeatedly flying into buildings.[28] If elementary school children want to see images of an event to know and understand what is going on, parents can choose photos that focus on positive contributions, such as showing relief efforts aimed at helping the families.[29] This will provide reassurance that there are people helping in bad situations and that things can be done to make a situation better.

Tweens and young teens are likely already familiar with recent tragic events and have heard various versions from friends and social media. Start by checking in with them about their feelings towards returning to school. It’s best to hear what they have to say and discuss any concerns they have while being careful not to interrupt and respectfully correcting misunderstandings.[30] At this age, if students are concerned, they can look for ways to get involved that would be age appropriate.[31] Based on their interests, they can volunteer in the community or work with school clubs to find solutions for concerns they have about the school environment.

With teenagers who are aware of these events and are learning about them on social media, it is alright for caregivers to share feelings about the situation, while also modeling positive ways to cope with these feelings.[32] Natalie Lareos, a teenager in South Los Angeles told the press that whenever she enters the classroom, or any public place, she now looks for a place to hide.[33] Teens are reaching the age where they are trying to solve their own problems, and adults in their lives can help them find proactive ways for them to advocate for solutions. Parents can speak with teenagers about what solutions they think would help to solve the problem and search together to find organizations that are advocating for that approach.[34] By volunteering, donating, and learning about solutions, teens focus their energy on advocacy - which is a mature coping mechanism to help address their concerns.[35]

Another common reaction for children of all ages is having no reaction. While some children may want to discuss these events, others may take a while to process their thoughts and will not exhibit reactions until much later.[36] Children who were not initially affected by this tragedy may now express new concern about returning to the school building in the fall. In this case, make sure they know a parent or guardian is available to talk or answer questions if they want to discuss it later.[37] A 2020-2021 analysis (utilizing survey data from 2015 and 2016) of 2,263 teenagers showed that concern about school shootings was correlated with “heightened odds of meeting borderline/clinical criteria for generalized anxiety disorder and panic disorder six months later,”[38] illustrating how the impact may be extended over longer periods of time.

If a child has a history of anxiety or trauma, parents should monitor the child for signs of difficulty coping such as physical complaints, changes in behavior, or difficulty sleeping, to see if professional services may be needed.[39] Even if a child does not have a history of trauma or anxiety, exposure to a singular traumatic event can have lasting consequences. Professionals trained to work with youth can use specialized techniques, like play therapy, which can help children who may not be able to form words to explain what they are feeling.[40] If parents or guardians believe their children are struggling to process their feelings, it is best to seek out professional assistance to determine if counseling or other services may be needed.

There is no easy solution to the issue of gun violence in schools. While parents debate their comfort levels of sending their children back into a school environment, it is worth remembering the need to provide consistency. Unpredictable situations can cause fear for children, so it is important for parents to try to keep their routines as normal as possible, whether in a home or school environment, so that they can experience the comfort of normalcy that can be found through consistency.[41]

Helping Parents Cope with Fear

Prior to Uvalde, in 2018, reports already showed that parental concern over school shootings had reached a two-decade high. In the same year, 54% of parents surveyed reported that additional funding to increase school safety was a top priority, and 44% reported they were “very worried” about an active shooter.[42] With the recent events at the end of the last school year, these fears have only increased. The morning after the Uvalde tragedy, parents throughout the country grappled with the decision of whether to send their children to school. Stories filled the media from places like Encino, where the mother of two elementary school boys chose to keep them home that day, while another mother in Long Beach dropped off her first grader at school and then went to her car and cried.[43] Now, as a new school year approaches, parents find themselves struggling with the decision to either send their children back to the school environment, or return to the homeschool option that many families grew accustomed to during the pandemic.[44] Interest in homeschooling has grown so much this summer that the Deputy Director of the Texas Homeschool Coalition, Jeremy Newman, told NBC News that a June convention showcasing their program was “packed to the brim this year,” and explained that school shootings have historically led to a rise in inquiries.[45]

Yet parents may find themselves questioning this instinctive desire to switch back to a home environment when they hear multiple reports from experts warning of the damaging mental health impacts that missing in-person education has had on youth. On December 7, 2021, the US Surgeon General issued an advisory warning that the youth’s mental health crisis is growing due to the COVID-19 pandemic.[46] This statement is supported by a global study of 80,000 children which found that symptoms of depression and anxiety doubled during the pandemic, and attributes part of these impacts to the months of missed in-person education, as well as missing significant events such as first days of school or graduation ceremonies.[47] Similarly, a recent CDC survey found that high school students who reported having a close relationship with someone at school during the pandemic had “significantly lower prevalence of poor mental health,” (28.4% versus 45.2%)[48] Trying to resolve this simultaneous and seemingly contradictory information on both the dangers and benefits of in-person education can leave parents feeling confused as they struggle to determine how to protect both the physical and mental health of their children.

As parents search for the balance between these two choices, more products are emerging on the market to address these fears, such as the production of bulletproof backpacks, which adds more options, and perhaps more confusion, to this already difficult decision. The day after the Uvalde shooting the company Bulletproof Zone reached their highest sales record to date.[49] This purchase trend continued over the summer with Steve Naramore, owner of TuffyPacks, a company which produces bulletproof backpacks and inserts, stating his company has seen an increase in sales of 300 to 500 percent.[50] These products add more options for parents to consider while navigating the complex choices of the coming school year as they are often still working through processing their own fears.

While navigating this complex barrage of decisions, parents should be careful to monitor their own levels of anxiety and mental health.[51] If someone finds themselves obsessively thinking about potential school threats, and it is beginning to manifest in ways that are unhealthy, the first step is to limit any exposure to news or social media sources that may be drawing their attention back to the topic and repeatedly reminding them of their fears.[52] It’s important for parents to question sources of information and try to evaluate whether this information is helping them move forward and make important decisions or holding them back and reminding them of why they are afraid.

Parents need to make time to process their own feelings and fears that arise from these situations. Monitoring thoughts and listening to their bodies can help to become aware of how they are personally responding.[53] Mental health counselor Stephanie Moir recommends experiencing these emotions, but warns about the dangers of getting stuck, advising that listening to music, writing about thoughts, or drawing a picture may help to pull a person out of the overthinking phase.[54] Talking to friends and making plans together to work through what is happening in the world is also a productive approach.[55] If a parent is having difficulty and experiencing problematic anxiety and/or depressive symptoms, contacting a mental health professional, such as a psychotherapist, psychologist, or psychiatrist, would also provide additional support.  

School psychologist Kay Streeter advises caregivers to deal with these events using the Five Ks:[56]

  1. Keep Talking (Talk as a release and to process your own feelings)

  2. Keep Thanking (Appreciate that you are here and there are things in life that are good)

  3. Keep Planning (Engaging in planning provides a sense of control and hope)

  4. Keep Forgiving (Forgiving allows you to let go of anger and move forward)

  5. Keep Breathing (Deep intentional breaths can reduce stress and anxiety)

Parents should take time to process their feelings by using their network of support and avoid making any major life-altering decisions in the immediate days that follow an event.[57] With time, as parents work through their thoughts and talk through situations with their support systems, they will be able to sort through the pros and cons of the coming school year and create a plan that meets the needs of their children and themselves.

Working towards a Solution

One of the debilitating effects of experiencing a traumatic event is the feeling of helplessness and despair that can follow.[58] Strickland (2022) states, “Anxiety is meant to prepare us for action, so channel the worries you are feeling into something proactive you can do.”[59] While the specific solution to school shootings in America is hotly debated, there does not seem to be a disagreement that something needs to change. Parents and older teenagers can use the energy generated from anxiety to work towards solving this problem; getting involved with an organization working to mitigate school shootings in a way that makes sense to them, can be a productive approach. 

Advocating for a solution can help to regain a sense of empowerment and remember that it is possible for things to improve. There are multiple organizations working to address this issue at both the local and national level. Finding a group of others who are like-minded to collaborate with and work towards solutions can provide a sense of empowerment. People often make progress towards recovering from trauma when they feel that they have some ability to fight back and take control.[60]

Contributed by: Theresa Nair

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

* If you or someone you know is experiencing signs of PTSD, click here to access our PTSD Self-Care Tips inforgraphic.

References

1 Strickland M. Idaho capital sun - states newsroom: Parents must be prepared to talk to their kids about school shootings. here are tips on how. Idaho Capital Sun. 2022.

2 Anderson N, Lang MJ, Elwood K, et al. What we know about the victims of the school shooting in Texas. The Washington Post. 2022.

3 Gomez M, Hailey Branson-Potts, Shalby C, Watanabe T. Touched by a tragedy; texas school shooting stirs anxiety, fear in L.A.-area parents. The Los Angeles times. 2022.

4 Chuck E. Bulletproof backpacks, homeschool: With no new gun laws, parents make changes of their own. NBC News. June 12, 2022. Available from: https://www.nbcnews.com/news/us-news/uvalde-shooting-parents-feel-no-safe-place-children-rcna32534. Accessed Jul 15, 2022.

5 Weekman K. Parents are facing the "nightmare" choice to send their kids to school after another mass shooting. BuzzFeed News Web site. https://www.buzzfeednews.com/article/kelseyweekman/uvalde-texas-shooting-parent-reactions-social-media. Updated 2022. Accessed Jul 15, 2022.

6 Silver RC, Holman EA, Garfin DR. Coping with cascading collective traumas in the United States. Nature human behaviour. 2021;5(1):4-6. doi:10.1038/s41562-020-00981-x

7 Abrams Z. Stress of mass shootings causing cascade of collective traumas. https://www.apa.org. 2022. https://www.apa.org/monitor/2022/09/news-mass-shootings-collective-traumas. Accessed Jul 15, 2022.

8 School shootings and their effect on student mental health. Curriculum Review. 2018;58(4):8

9 School shootings this year: How many and where. Education Week. -01-05T18:16:47.67 2022. Available from: https://www.edweek.org/leadership/school-shootings-this-year-how-many-and-where/2022/01. Accessed Jul 11, 2022.

10 Li, Jones & Livingston, Kelly. Teachers face mental health challenges dealing with school shootings. ABC News Web site. https://abcnews.go.com/Politics/teachers-face-mental-health-challenges-school-shootings/story?id=85069493. Updated 2022. Accessed Jul 11, 2022.

11 Silver et al., 2021

12 Ibid.

13 Cimolai, Schmitz, J., & Sood, A. B. (2021). Effects of Mass Shootings on the Mental Health of Children and Adolescents. Current Psychiatry Reports, 23(3), 12–12. https://doi.org/10.1007/s11920-021-01222-2

14 Abrams Z., 2022

15 Cimolai et al., 2021

16 Doré B, Ort L, Braverman O, Ochsner KN. Sadness shifts to anxiety over time and distance from the national tragedy in newtown, connecticut. Psychol Sci. 2015;26(4):363-373. doi: 10.1177/0956797614562218.

17 Abrams Z., 2022

18 Cimolai et al., 2021

19 Silver et al., 2021

20 Cimolai et al., 2021

21 Abrams Z., 2022

22 Denise GC. In wake of mass shootings, health experts warn of mental toll. Knight-Ridder/Tribune Business News. 2022.

23 Pearson C. A guide to talking to your children about mass shootings: National desk. The New York times. 2022.

24 Denise GC., 2022

25 Ibid.

26 Strickland M., 2022

27 Ibid.

28 Ibid.

29 Stout C. Chalkbeat: Gun violence: Resources for students, parents, and teachers. Chalkbeat. 2022.

30 Pearson C., 2022

31 Stout C., 2022

32 Pearson C., 2022

33 Gomez et al., 2022

34 Pearson C., 2022

35 Ibid.

36 Stout C., 2022

37 Pearson C., 2022

38 Riehm KE, Mojtabai R, Adams LB, et al. Adolescents’ concerns about school violence or shootings and association with depressive, anxiety, and panic symptoms. JAMA network open. 2021;4(11):e2132131-e2132131. doi:10.1001/jamanetworkopen.2021.32131

39 Strickland M., 2022

40 Hateli B. The effect of non-directive play therapy on reduction of anxiety disorders in young children. Counselling and Psychotherapy Research. 2021;22(1):140-146. https://onlinelibrary.wiley.com/doi/abs/10.1002/capr.12420. Accessed Jul 19, 2022. doi: 10.1002/capr.12420.

41 Strickland M., 2022

42 Sign of the times: Parents so concerned about school safety they are willing to pay for it themselves: New survey shows kids and parents agree: Anxiety runs high over school shootings with the start of new school year; experts cite need for more safe-school solutions. NASDAQ OMX's News Release Distribution Channel. 2018.

43 Gomez et al., 2022

44 Chuck E., 2022

45 Ibid.

46 U.S. surgeon general issues advisory on youth mental health crisis further exposed by COVID-19 pandemic. HHS.gov Web site. https://www.hhs.gov/about/news/2021/12/07/us-surgeon-general-issues-advisory-on-youth-mental-health-crisis-further-exposed-by-covid-19-pandemic.html. Updated 2021. Accessed July 17, 2022.

47 Protecting Youth Mental Health : the U.S. Surgeon General’s Advisory. [U.S. Department of Health and Human Services]; 2021.

48 Jones SE, Ethier KA, Hertz M, et al. Mental Health, Suicidality, and Connectedness Among High School Students During the COVID-19 Pandemic - Adolescent Behaviors and Experiences Survey, United States, January-June 2021. Morbidity and mortality weekly report Supplement. 2022;71(3):16-21. doi:10.15585/mmwr.su7103a3

49 Picket K. Bulletproof backpack companies see record sales hours after texas school shooting. The Washington Times Web site. https://www.washingtontimes.com/news/2022/may/31/bulletproof-backpack-companies-see-record-sales-ho/. Updated 2022. Accessed Jul 18, 2022.

50 Chuck E., 2022

51 DOnofrio M. Axios: Coping tips for parents and teachers after the uvalde school shooting. Axios. 2022.

52 Strickland M., 2022

53 DOnofrio M., 2022

54 Vazquez L. Managing your mental health through crises. WFTS Web site. https://www.abcactionnews.com/news/region-hillsborough/cascading-tragedies-reinforce-need-to-take-care-of-mental-health. Updated 2022. Accessed Jul 18, 2022 

55 DOnofrio M., 2022

56 Stout C., 2022

57 Ibid.

58 Strickland M., 2022

59 Ibid.

60 Curriculum Review.

PTSD Self-Care Tips

A Path to Healing

Post-traumatic stress disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a terrifying event. Currently experienced by approximately 3.5% of the U.S. adult population; it is estimated that 1-in-11 people will be diagnosed with PTSD in their lifetime.[1]

The most common types of events leading to the development of PTSD include:[2]

  • Combat exposure

  • Childhood physical abuse

  • Sexual violence

  • Physical assault

  • Being threatened with a weapon

  • A serious accident (e.g., vehicle crash)

Many other traumatic events also can lead to PTSD; these include: the sudden, unexpected loss of a loved one,[3] life-threatening medical diagnosis, natural disaster, fire, mugging, robbery, plane crash, torture, kidnapping, terrorist attack, mass shooting and other extreme or life-threatening events.[4] 

Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.[5] Most people who go through traumatic events may have temporary difficulty adjusting and coping, but with time and proper self-care, recovery can occur. If symptoms worsen, last for months or years, and interfere with your day-to-day functioning, you may have PTSD.

While trauma-focused psychotherapies are the most highly-recommended type of treatment for PTSD and provide the greatest evidence for recovery, you may wish to include some supportive self-care strategies. These include:

  1. Journaling

    Writing (including expressive, transactional, poetic, affirmative, legacy, and mindful writing) can increase resilience, and decrease depressive symptoms, perceived stress, and rumination.[6] Specifically, when people write and translate their emotional experiences into words, they may be changing the way their experiences are organized in the brain, resulting in more positive outcomes.[7] Guided, detailed writing can help people process what they’ve been through and help envision a path forward. Additionally, it can lower blood pressure, strengthen immune systems, and increase one’s general well-being. Resulting in a reduction in stress, anxiety, and depression, expressive writing can additionally improve the quality of sleep, leading to better focus, clarity and performance.[8]

    Research has found that the most healing of writing must contain concrete, authentic, explicit detail. Linking feelings to events, such writing allows a person to tell a complete, complex, coherent story, with a beginning, middle, and end. In this retelling, the writer is transformed from a victim into something more powerful: a narrator with the power to observe. In the written expression of what occurred, people can reclaim some measure of agency and control over what happened.[9]

    The following tips may help getting started with journaling:[10]

    • Make it a habit – try to stick to a routine.

    • Keep it simple – journal only for a few minutes; consider setting a timer. ‌

    • Do what feels right – find what’s best for you and go with it.

    • Write about anything, with any type of pen/pencil, in any type of book – there are no rules, this journal is yours.

    • Get creative – write lists, make poetry, draft a letter to someone, doodle or draw art.

    • Aim small, win big keep in mind that journaling isn’t a “magic fix”, but it will help and provide benefit, and will give back the effort you put in.

  2. Grounding and 4-7-8 Breathing Techniques

    Grounding strategies can help a person who is dissociating or overwhelmed by memories or strong emotions and help them become aware of the “here and now”. Examples of grounding techniques include:[11]

    • Stating what you observe around you (e.g., what time is it, what pictures are on the wall, how many books are on the table, etc.)

    • Decreasing the intensity of affect - clenching fists can move the energy of an emotion into fists, which can then be released; visualize a safe place; remember how you survived and what strengths you possess that helped you to survive the trauma.

    • Distract from unbearable emotional states - focus on the external environment (e.g., name red objects in the room or count objects nearby). Somatosensory techniques (e.g., toe-wiggling, touching a chair) can remind people of their current reality.

    4-7-8 breathing techniques - controlled breathing is one way to move our systems out of a state of panic. Inhaling activates the sympathetic nervous system (fight-or-flight), while exhaling activates the parasympathetic nervous system (rest and digest).[12] To employ the 4-7-8 breathing relaxing technique:

    • breathe in for 4 counts

    • hold the breath for 7 counts

    • exhale for 8 counts

    Note that any variation on these numbers should still elicit a calming response as long as the exhale is noticeably longer than the inhale.

  3. Peer Support Groups

    Within a peer support group, a person can discuss day-to-day problems with other people who have also been through trauma. While support groups have not been shown to directly reduce PTSD symptoms, they can help you feel better by giving a sense of connection to other people with similar, shared experiences. Further, peer support groups can help people cope with memories of a trauma or other parts of their life they are having difficulty dealing with as a result of the event. Dealing with and processing emotions such as anger, shame, guilt, and fear becomes easier when talking with others who understand.[13]

    Similarly, group therapy may be another outlet one can employ to receive support as they recover from trauma.

  4. Meditation & Mindfulness

    Meditation practices can combat symptoms of PTSD as they have elements of exposure, cognitive change, attentional control, self-management, relaxation, and acceptance.[14] Specifically, mindful meditation orients one’s attention to the present with curiosity, openness, and acceptance. Experiencing the present moment non-judgmentally and openly may lead to the approach of (and not avoidance of) distressing thoughts and feelings, thus potentially leading to the reduction of one’s cognitive distortions.[15]

  5. Healthy Diet & Exercise

    A healthy neuro-nutritional diet is beneficial for both your mind and body. Good neuro-nutrition, based on a holistic and healthy diet of fresh fruits and vegetables, lean proteins, whole grains, nuts and seeds and spices and herbs, can improve moods and cognitive function, help reduce the risks of cognitive decline due to ageing as well as provide healthy nutrients to the rest of your body. Further, healthy neuro-nutrition can help improve the brain’s neuroplasticity (i.e., its ability to change) as well as neurogenesis (i.e., its ability to create new neurons.) Additionally, healthy neuro-nutrition helps to mitigate inflammation, which has been linked to a myriad of health deficits. Animal meats, hydrogenated oils, and many of the chemical and preservatives in processed foods have inflammatory qualities.[16] A healthy diet can also help address physical health conditions associated with PTSD, including diabetes, hypertension, and metabolic syndrome.[17]

    Glucose is a critical nutrient to fuel a healthy mind and brain, with the healthiest sources of glucose found in unprocessed plant-based complex carbohydrates. By incorporating a steady, balanced supply of these vegetables, fruit, beans, nuts, seeds and whole-grain products, one can additionally achieve better mood regulation. The PTSD Association of Canada notes: blood sugar is balanced by having meals spaced fairly evenly, and eating every three to four hours. Choosing unrefined carbs and balancing those meals with protein and fat help delay the absorption of the glucose into the bloodstream. This can help keep your blood sugar level even, for both mood stability and appetite control.[18]

    Exercise and other physical activity has been found to lessen the symptoms associated with PTSD. A 2022 meta-analysis by McKeon et. al., found that physical activity and structured exercise are inversely associated with PTSD and its symptoms. Moreover, exercise interventions may lead to a reduction in symptoms among individuals with, or at risk of PTSD.[19] Additionally, a 2021 meta-analysis by McGranahan and O'Connor notes that exercise training has promise for improving overall sleep quality, anxiety, and depression symptoms among those with PTSD.[20] The duration of exercise does not need to be significant in order to be effective. In fact, Pontifex et al., (2021) report that just twenty minutes of moderate intensity aerobic exercise has been shown to improve inhibitory control, attention and action monitoring.[21] To get the most out of one’s exercise, physical activity enjoyed outdoors has been shown to boost these beneficial effects.

It is important to keep in mind that the benefits of the afore-mentioned self-care tips will likely develop over time, following a consistent approach. Try not to get discouraged in the process and remember that some self-care tips will be more effective than others. Everyone’s path to recovery and healing will be different.

To learn more about PTSD, click here to access our interviews with experts on the subject; click here to access a multitude of articles including additional ways to recovery.

Contributed by: Jennifer (Ghahari) Smith, Ph.D.

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

REFERENCES

1 “What is Post-traumatic Stress Disorder (PTSD)?” American Psychiatric Association (accessed 7-5-22) psychiatry.org/patients-families/ptsd/what-is-ptsd

2 Ibid.

3  “Post-traumatic Stress Disorder,” National Institute of Mental Health (accessed 6-22-20) www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

4 “Post-traumatic Stress Disorder (PTSD),” Mayo Clinic (accessed 6-22-20) www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

5 Ibid.

6 Glass, O., Dreusicke, M., Evans, J., Bechard, E., & Wolever, R. Q. (2019). Expressive writing to improve resilience to trauma: A clinical feasibility trial. Complementary therapies in clinical practice, 34, 240–246. https://doi.org/10.1016/j.ctcp.2018.12.005

7 “Writing Can Help Us Heal from Trauma,” Harvard Business Review (accessed 7-6-22) hbr.org/2021/07/writing-can-help-us-heal-from-trauma

8 Ibid.

9 Ibid.

10 “The Benefits of Journaling for Mental Health,” Diversified Rehabilitation Group (accessed 7-6-22) ptsdrecovery.ca/the-benefits-of-journaling-for-mental-health/

11 Melnick SM, Bassuk EL. Identifying and responding to violence among poor and homeless women. Nashville, TN: National Healthcare for the Homeless Council; 2000.

12 “Proper Breathing Brings Better Health,” Scientific American (accessed 2-16-22) www.scientificamerican.com/article/proper-breathing-brings-better-health/

13 “PTSD: Peer Support Groups,” U.S. Department of Veterans Affairs (accessed 7-6-22) www.ptsd.va.gov/gethelp/peer_support.asp

14 Baer RA. Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice. 2003;10:125–143. doi: 10.1093/clipsy.bpg015.

15 Gallegos AM, Cross W, Pigeon WR. Mindfulness-based stress reduction for veterans exposed to military sexual trauma: Rationale and implementation considerations. Military Medicine. 2015;180:684–689.

16 “Neuro-Nutrition for a Healthier Brain,” PTSD Association of Canada (accessed 7-6-22) www.ptsdassociation.com/nutritional

17 McKeon, Grace; Steel, Zachary; Wells, Ruth; Fitzpatrick, Alice; Vancampfort, Davy; Rosenbaum, Simon. Exercise and PTSD Symptoms in Emergency Service and Frontline Medical Workers: A Systematic Review, Translational Journal of the ACSM: Winter 2022 - Volume 7 - Issue 1 - e000189 doi: 10.1249/TJX.0000000000000189

18 PTSD Association of Canada

19 McKeon, et. al.

20 McGranahan, M. J., & O’Connor, P. J. (2021). Exercise training effects on sleep quality and symptoms of anxiety and depression in post-traumatic stress disorder: A systematic review and meta-analysis of randomized control trials. Mental Health and Physical Activity, 20, 100385. doi:10.1016/j.mhpa.2021.100385

21 Pontifex, M. B., Parks, A. C., Delli Paoli, A. G., Schroder, H. S., & Moser, J. S. (2021). The effect of acute exercise for reducing cognitive alterations associated with individuals high in anxiety. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 167, 47–56. https://doi.org/10.1016/j.ijpsycho.2021.06.008

Manifestations of Childhood Trauma in Adults

Understanding Trauma

More than 70% of adults have experienced a traumatic event at some point in their lives.[1] Trauma exposure is classified as any event that threatens or causes death, injury, or personal integrity.[2] Such experiences can include: emotional, psychological, physical and/or sexual abuse, natural disasters, war, injuries, or neglect. Further, traumatic events can occur as repeated, long-term experiences or as one single incident.[3]

As discussed by Majer et al., (2010), children are particularly receptive to traumatic experiences due to the heightened plasticity of a developing brain,[4] as well as their reliance on the environment for emotional and cognitive development. A child’s environment directly influences gene expression and brain growth; the stress that one’s environment imposes can help or hinder development.[5] While a normal amount of stress is crucial for the strengthening of important neural connections involved in emotional regulation and response to stress,[6] extreme, frequent, or long-lasting stress, will cause the body to adapt by sending a myriad of chemical and hormonal stress signals throughout the brain, altering its functional components.[7,8] Specifically, the overabundance of the stress hormone cortisol, will weaken bodily functions, including immune function, memory, learning, and emotional regulation.[9] Therefore, if childhood trauma occurs and is not properly addressed, it can lead to cognitive impairment and psychological disorders in adulthood.[10] 

When a child's environment feels unsafe or threatened, there are various ways they will adaptively react in order to maintain a feeling of safety and protection. Such reactions include the development of extreme reactivity to stimulation, heightened sense of vulnerability, and the addition of attachment & neediness behaviors.[11] Additionally, research done by The National Scientific Council on the Developing Child (2005/2014) found that the adjustment of the stress-response system, through the strengthening of neural connections involved in fear and anxiety, causes the child to become stressed at a lower threshold.[12] Further, if a child doesn’t receive the proper emotional support and comfort following a traumatic experience, it can disrupt normal brain development and cause issues with emotional regulation and response to stress in adulthood.[13]

Symptoms of childhood trauma in adults

The intensity and type of traumatic exposure in childhood affects how it will appear in adulthood.[14] Traumatic experiences involving one’s caretaker pose the greatest risk to harming the child’s psychological state and development.[15] Additionally, traumatic experiences that are repetitive are more detrimental than a single episode;[16] as the rate of negative childhood experiences increases, so does the likelihood that the adult will experience symptoms.[17]

As it can be difficult for an adult to disclose childhood trauma,[18] the best indication of its existence is through the expression of conscious and unconscious symptoms. While the effects of childhood trauma manifest differently in everyone, common symptoms include: difficulty controlling emotions, impulsiveness, an increased response to stress, relationship instability, development of mental illnesses, dissociation, avoidance, and heightened anger.[19,20]

Many adults who experienced childhood trauma also suffer from memory and learning deficits.[21] Additionally, some adults are found to have high blood pressure and increased inflammation.[22] Childhood trauma can also lead to interpersonal relationship problems including the creation of a “disorder of hope”, in which new relationships are either idealized or hated.[23] Moreover, Su & Stone (2020) note that if traumatic experiences involve a toxic relationship with a caregiver or trusted adult, those dynamics can also be reenacted in the adult’s life, such as involvement with an abusive partner or becoming abusive themselves.[24]          

Link between childhood trauma and mental health

Traumatic experiences that occur during childhood can cause disruptions in adult psychological function and lead to depression, anxiety, post-traumatic stress disorder (PTSD), and dissociation.[25]

Adverse experiences in early childhood can cause changes to the structural and functional components of the body, including increased sensitivity to stress, increased cortisol, glucocorticoid resistance, and decreased hippocampal volume. All of these changes closely parallel the features present in depression, suggesting traumatic experiences increase the risk of developing depression in adulthood.[26] Consequently, there is a high prevalence of childhood trauma in people with depression. It is also common for anxiety symptoms to develop following a traumatic experience, due to the heightened sensitivity to stress and production of cortisol.[27] Further Berber Çelik Ç, Odacı H (2020), found that childhood trauma can lower self-esteem, indirectly leading to the development of depression and anxiety.[28]

In some cases, typically those involving interpersonal violence or assault, traumatic experiences can lead to post-traumatic stress disorder.[29] PTSD refers to the development of symptoms following a traumatic exposure;[30] these symptoms include the re-experiencing of the traumatic event through nightmares, recollections, intrusive images, or reactions to reminders of the event. It also includes avoiding stimuli related to the traumatic event, increased arousal, and mood and thinking disruptions. To qualify as a diagnosis of PTSD, the duration of these symptoms must transpire for more than one month.[31]      

Dissociation also can occur as a result of a childhood trauma, especially if the experience is life-threatening or imposed by a caretaker. Dissociation is a feeling of disconnect towards psychological constructs, including the body, environment, behavior, and memory.[32] Dependent on where the disconnection is occurring, an absence of emotions, disorientation with surroundings, feelings of separation from the body, problems with self-recognition, or disruptions in hearing can transpire.

 

Treatment

It is never too late to seek help for trauma that occurred during one’s childhood. Although every treatment will not be effective for everyone, options exist.[33] Exposure therapies such as exposure and response prevention (ERP) and prolonged exposure (PE) are some of the modalities used to treat trauma. Individuals are “exposed” to reminders of the traumatic event, but in a safe and comfortable setting. It is common to develop avoidance and fear for stimuli related to one’s traumatic experience, and exposure therapy gradually decreases those negative reactions.[34] Another treatment for trauma is cognitive-processing therapy (CPT). This type of treatment involves recognizing detrimental thought patterns and behaviors related to the trauma, and implementing healthier beliefs about the self, others, and the world. This process can be done through the use of writing assignments and Socratic questioning.[35] Other possible treatments include eye movement desensitization and reprocessing (EMDR), psychoeducation, and support therapy. 

Image Sources [36,37]

Q&A

SAS’ Psychotherapist, Dr. Brittany Canfield, discusses childhood trauma

1. In your experience, how does childhood trauma typically present itself in adults?

“Based on the literature, there are many physical and psychological manifestations of childhood trauma in adults. What we often see in clinical settings is individuals coming in to treat unmanageable anxiety symptoms, depression, mood dysregulation, attentional issues, and challenges maintaining daily functioning. For many, the catalyst for treatment is suffering from personal relationships or difficulty managing their workload. Childhood trauma also hides within the confines of addiction, both in substance and behavioral as well as within personality disorders. Common symptoms reported when seeking treatment include the following:

  • Difficulty falling asleep, staying asleep, or sleep disturbances (i.e. sleepwalking, sleep talking, nightmares, and night terrors).

  • Anxiety, panic attacks, social anxiety, and obsessive-compulsive symptoms.

  • Depression, suicidal ideation, history of suicidal ideation, plans, and/or attempts, self-harm, and/or mood dysregulation, often including anger.

  • Attentional issues such as difficulty focusing, retaining information and/or other issues with recall, increased distractibility, decreased memory, losing time, and/or other symptoms commonly associated with ADHD.

  • Physical or somatic symptoms called somatization, include but are not limited to frequent headaches, body aches, gastrointestinal issues, chronic fatigue, decreased immune function, and effects related to chronic stress.

  • Other symptoms may include diminished self-esteem and self-worth, poor outlook, compassion fatigue or burnout, codependence, poor boundaries, disturbances in interpersonal relationships, and the need to stay busy.”

 

2. Are there any ways to prevent childhood trauma from affecting adulthood? If so, what are the most effective ones?

“While there is no single preventive tool, one of the biggest factors mitigating the impact of childhood trauma is resilience. The research highlights the protective qualities that resilience has on childhood trauma, especially when that includes a stable and safe connection with just one adult during childhood. Support has also been shown to mitigate the impact of trauma in the way the individual is able to process the experience and progress toward posttraumatic growth.”


3. What types of treatments are most effective in helping adults who are suffering from childhood trauma?

“Given the differences in how children and adults process trauma, further explained below, bottom-up therapies accessing the part of the brain that was impacted during the trauma have been shown to be the most successful. These therapies include somatic-based or somatic experiencing therapies, EMDR, sensorimotor therapy, and expressive arts. Individuals may also benefit from more traditional talk therapies such as cognitive-behavioral therapy (CBT), mindfulness-based CBT, and dialectical behavior therapy (DBT), the latter focusing on resource-building. Additionally, therapy will focus on building skills that can assist the individual in regulating their nervous system and learning to utilize other mind-body activities such as yoga, meditation, and polyvagal techniques, all of which have been shown in the research to mitigate the effects of trauma.”


4. Are there any differences in how children process traumatic experiences compared to adults?

“This is an excellent question and a very important aspect of the impact of trauma on the brain in human development. In childhood, the prefrontal cortex is still developing and will continue to do so well into the mid-20s. With that being said, we process trauma from the bottom-up, that is, from the base or "bottom" of our brain. Bottom-up processing includes our sensory system, meaning that we experience and store the trauma from our senses, thus somatically. Other parts of our brain impacted by trauma include our limbic system and peripheral nervous system. When we experience trauma as an adult and often when childhood trauma is not a precipitating factor, we do so from our prefrontal cortex, which allows us to process the trauma using higher cortical thinking including cognitive processes such as reasoning, language, and awareness. You may wonder why this is so important? People who experience childhood trauma often do not have the words to describe or process what they experienced, because the part of the brain that is engaged in those processes was not the primary part of the brain in use when the trauma occurred. This makes it difficult for childhood trauma survivors to even acknowledge that the trauma happened let alone impacted them.”


5. Do you have any advice or anything you want to share with someone who may be suffering from childhood trauma?

“There is often fear and shame associated with childhood trauma, which can prevent individuals from seeking help. We often internalize social stigma (self-stigma) of seeking help out of fear of being invalidated, shamed, pathologized, or perceived as "crazy." You do not have to go at this alone, feel ashamed for what you have gone through, or carry the burden of your childhood trauma well into adulthood. If you have a childhood trauma history, it is recommended that you seek the help of a professional, join a support group, educate yourself on childhood trauma and often complex PTSD, and engage in activities that regulate the nervous system.”

If you have experienced childhood trauma and would like to explore possible treatment options, please reach out to a licensed mental healthcare provider who specializes in trauma recovery.

For more information, click here to access an interview with Psychologist Michele Bedard-Gilligan on trauma & recovery.

Additionally, you may click here to access an interview with Psychologist Bethany Brand on trauma & dissociation.

To access our PTSD Self-Care Tips, click here.

Contributed by: Amelia Worley

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

References

1 Benjet, C., Bromet, E., Karam, E. G., Kessler, R. C., McLaughlin, K. A., Ruscio, A. M., Shahly, V., Stein, D. J., Petukhova, M., Hill, E., Alonso, J., Atwoli, L., Bunting, B., Bruffaerts, R., Caldas-de-Almeida, J. M., de Girolamo, G., Florescu, S., Gureje, O., Huang, Y., Lepine, J. P., … Koenen, K. C. (2016). The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychological medicine, 46(2), 327–343. https://doi.org/10.1017/S0033291715001981 

2 Bedard-Gilligan, M., & Worley, A. (2022, May 13). Psychologist Michele Bedard-Gilligan on Trauma & Recovery - Psychology and Psychiatry Interview Series. Seattle Anxiety Specialists, PLLC: Psychiatry & Psychology. Retrieved May 17, 2022, from https://seattleanxiety.com/psychology-psychiatry-interview-series/2022/5/5/q6oxgila8beysefwg0qvb7gve9pb46

3 Harms, L. (2015). Understanding trauma and resilience. Macmillan Education. 

4 Majer, M., Nater, U.M., Lin, JM.S. et al. Association of childhood trauma with cognitive function in healthy adults: a pilot study. BMC Neurol 10, 61 (2010). https://doi.org/10.1186/1471-2377-10-61 

5 Stien, P., & Kendall, J.C. (2004). Psychological Trauma and the Developing Brain: Neurologically Based Interventions for Troubled Children (1st ed.). Routledge. https://doi.org/10.4324/9781315808888 

6 Ibid.

7 National Scientific Council on the Developing Child. (2005/2014). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper 3. Updated Edition. http://www.developingchild.harvard.edu

8 Stien, P., & Kendall, J.C. (2004)

9 Excessive Stress Disrupts the Architecture of the Developing Brain. (2005/2014)

10 Majer, M., Nater, U.M., Lin, JM.S. et al. Association of childhood trauma with cognitive function in healthy adults: a pilot study. BMC Neurol 10, 61 (2010). https://doi.org/10.1186/1471-2377-10-61 

11 Van der Kolk, B. (2003). Psychological Trauma. American Psychiatric Pub. 

12 Excessive Stress Disrupts the Architecture of the Developing Brain. (2005/2014)

13 Stien, P., & Kendall, J.C. (2004)

14 Van der Kolk, B. (2003).

15 Everett, B., & Gallop, R. (2001). The link between childhood trauma and mental illness effective interventions for mental health professionals. SAGE. 

16 Su, W.-M., & Stone , L. (2020, July). Adult survivors of childhood trauma. Australian Journal of General Practice. Retrieved May 16, 2022, from https://www1.racgp.org.au/ajgp/2020/july/adult-survivors-of-childhood-trauma

17 Ibid.

18 Ibid.

19 Ibid.

20 Thatcher, T. (2018, November 20). Healing childhood trauma in adults. Highland Springs Clinic. Retrieved May 8, 2022, from https://highlandspringsclinic.org/blog/healing-childhood-trauma-adults/  

21 Stress disrupts the architecture of the developing brain. (2005)

22 Ibid.

23 Van der Kolk, B. (2003).

24 Su, W.-M., & Stone , L. (2020, July). 

25 Van der Kolk, B. (2003).

26 Christine Heim, D. Jeffrey Newport, Tanja Mletzko, Andrew H. Miller, Charles B. Nemeroff, The link between childhood trauma and depression: Insights from HPA axis studies in humans, Psychoneuroendocrinology, Volume 33, Issue 6, (2008), Pages 693-710, ISSN 0306-4530, https://doi.org/10.1016/j.psyneuen.2008.03.008.

27 Robert S Pynoos, Alan M Steinberg, John C Piacentini, A developmental psychopathology model of childhood traumatic stress and intersection with anxiety disorders, (1999), Pages 1542-1554, ISSN 0006-3223, https://doi.org/10.1016/S0006-3223(99)00262-0.

28 Berber Çelik Ç, Odacı H. Does child abuse have an impact on self-esteem, depression, anxiety and stress conditions of individuals? International Journal of Social Psychiatry. (2020)171-178. doi:10.1177/0020764019894618

29 Bedard-Gilligan, M., & Worley, A. (2022, May 13)

30 Ibid.

31 Wilson, J. P., & Keane, T. M. (2006). Assessing psychological trauma and Ptsd. The Guilford Press. 

32 Brand, B., & Worley, A. (2022, May 9). Psychologist Bethany Brand on Trauma & Dissociation- Psychology and Psychiatry Interview Series. Seattle Anxiety Specialists, PLLC: Psychiatry & Psychology.

33 Bedard-Gilligan, M., & Worley, A. (2022, May 13)

34 American Psychological Association. (2017, July). What is exposure therapy? American Psychological Association. Retrieved May 10, 2022, from https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy  

35 American Psychological Association. (2017, July). Cognitive processing therapy (CPT). American Psychological Association. Retrieved May 9, 2022, from https://www.apa.org/ptsd-guideline/treatments/cognitive-processing-therapy

36 Bowman, J. (2017, February 9). Socratic questions revisited [infographic] · James Bowman. James Bowman. Retrieved May 17, 2022, from http://www.jamesbowman.me/post/socratic-questions-revisited/  

37 R. W. Paul, L. Elder: The Thinkers Guide to The Art of Socratic Questioning, 2007

Racial Trauma: Experiences and Implications for Therapeutic Settings

Mental Health Disparities 

Persistent and serious health disparities exist in the United States. Minorities suffer poorer health outcomes when compared to the majority, their White counterparts.[1] While there is conflicting evidence in the literature as to whether minorities suffer greater mental health consequences, a general consensus is that they report more psychological symptoms. Even without official diagnoses, minorities present with more subthreshold symptoms, which may reflect the poorer functioning reported within these marginalized groups.[2] 

When it comes to disparities in mental health care, the results are transparent. Numerous studies have found that individuals from minority groups, such as African Americans and Latinx, are less likely to receive treatment.[3] Even when they do receive it, they are less likely than Whites to receive the best care.[4] African Americans are also more likely to terminate treatment prematurely.[5] The most common reasons cited for dropout are not believing the treatment will work, not believing their problems are severe, and not being able to afford treatment.[6]

Racial trauma

Racial trauma (also called race-based traumatic stress) is defined as “the mental and emotional injury caused by encounters with racial bias and ethnic discrimination, racism, and hate crimes.”[7] In the United States, BIPOC (Black, Indigenous, People of Color) individuals are at a heightened risk of experiencing this trauma. Research has shown that race-based discrimination has a profound and detrimental psychological impact. It has even been reported to result in PTSD (post-traumatic stress disorder) symptoms.[8] 

Racial trauma comes in many different forms: microagressions, racism, discrimination (e.g., in the workplace), and police violence/brutality. Each of these will be defined and elaborated on further in the sections below. 

Racial trauma can be a direct experience of racism towards someone or transmitted intergenerationally (from generation to generation). The latter is referred to as generational trauma, which the American Psychological Association (APA) defines as “a phenomenon in which the descendants of a person who has experienced a terrifying event show adverse emotional and behavioral reactions to the event that are similar to those of the person himself or herself.”[9] Although most intergenerational trauma work has been done on Japanese individuals whose ancestors were forced into internment camps during World War II and ancestors of Holocaust survivors, a growing body of research is focusing on current generations of African-Americans and the ongoing discrimination they face.[10] Dr. Monicca WIlliams from the University of Connecticut has extensively focused on this issue and formulated a measure to assess anxiety stemming from racial discrimination. Out of 123 African-American students who took this survey in a study conducted by Williams et al. (2018), perceived discrimination correlated with higher rates of “uncontrollable hyperarousal, feelings of alienation, worries about future negative events and perceiving others as dangerous.”[11] Additionally, a meta-analysis by Pascoe and Smart Richman (2009), which consisted of 134 studies with multiracial samples, demonstrated an association between perceived discrimination and heightened stress responses, poorer physical health, and participation in unhealthy behaviors.[12]

Microaggressions

While most people would not consider themselves to be racist (e.g., do not commit hate crimes nor express blatantly racist sentiments), they may still hold racial biases and engage in subtle racially-motivated behaviors.[13] Harvard psychiatrists have characterized these as “brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward People of Color.”[14] While microaggressions are often less visible than macroaggressions, they can be just as detrimental.

Examples of Microaggressions in Speech:

Can I touch your hair? It looks so exotic.

That's so gay.

You'd be pretty if you lost some weight.

You speak pretty good English, I am surprised. 

You aren’t really American.

Examples of Microaggressions in Action:

A White woman clutching her purse as a Black man walks past her. 

Mistaking a Person of Color as a service/blue-collar worker

Microaggressions are linked to a plethora of negative outcomes, including depression, fatigue, anger, chronic infections, and high blood pressure. Research addressing the relationship between microaggressions and mental health has consistently found that subtle forms of racism have a detrimental impact on the mental health of BIPOC individuals.[15] Participants in numerous studies reported feeling immediate stress after encountering microaggressions.[16] Additionally, the accumulation of such experiences has had a detrimental impact on their well-being.[17]

Results of a study by Nadal et al. (2014), which included 506 participants, found that higher frequencies of racial microaggressions predicted negative mental health outcomes.[18] Higher rates of racial microaggressions were also significantly correlated with depressive symptoms and negative affect. Nadal et al. also investigated whether race influenced the experience of microaggressions. Significant differences were found between White participants and all other minority group participants. Between minority groups, no difference was found, suggesting that Black, Asian, Latinx, and multiracial people experience similar amounts of cumulative microaggressions.[19] However, differences were found in the types of racial microaggressions that racial groups reported: Black and Latinx participants reported more inferiority-related microaggressions; Black participants reported more criminality-related microaggressions; and Asian participants reported more environmental (i.e., disease- and contamination-risk association) and exoticization microaggressions.[20]

In a 2015 study that focused on the psychological impact of microaggressions on Black women, Fay et al. measured their anxiety and depression symptoms. They found that the women who reported higher levels of racial microaggressions also reported greater symptoms of depression and anxiety.[21] Age or level of education caused no significant effects.[22]

In a study consisting of Black participants, Liao et al. (2016) demonstrated that perceived racial microaggression positively correlated with anxiety symptoms. Investigators were particularly interested in the roles of ethnic social-connectedness and intolerance of uncertainty as moderators between microaggressions and anxiety.[23] “Intolerance of uncertainty” has been described as a core feature of Generalized Anxiety Disorder (GAD) and can be defined as the “tendency to react negatively on an emotional, cognitive, and behavioral level to uncertain situations and events.”[24] Individuals with a high intolerance to uncertainty find situations that are “uncertain” catastrophically threatening and upsetting, regardless of the actual probability of a negative event to occur.[25] They also found that social connectedness to one’s ethnic community was a protective factor, while intolerance of uncertainty was an exacerbating factor.[26] The importance of social connectedness to one's community leads to clinical implications: clinicians can implement these findings into treatment plans, thus likely leading to better outcomes for their clients.

Less work has been done on microaggressions experienced by Latinx individuals. In 2020, Choi et al. sought to bridge this gap and conducted a meta-analysis to determine how microaggressions impacted Latinx well-being. They found that Latinx racial microaggressions were linked to behavioral stress, perceived stress, psychological distress, psychological well-being, and symptoms of depression.[27]

Other research has focused on the impact of microaggressions in younger populations, such as children. Children are in a particularly vulnerable developmental period and studies have shown that racism, like other physical environmental toxins and stressors, can adversely impact one’s developmental trajectory in the socioemotional and behavioral domains. For example, a meta-analysis conducted by Berry et al. (2021) found that racism can have a detrimental impact on children as young as preschoolers, particularly through intergenerational avenues.[28] In fact, it can even impact the child in utero. Racial microaggressions can increase maternal stress, which is linked to preterm delivery.[29]

Macroaggressions

Microaggressions (sometimes referred to as aversive racism) and overt racism must both be taken into account. The studies discussed in the following section focus more on overt instances of discrimination: macroaggressions.

More broadly, the APA defines racism as “generally including negative emotional reactions to members of the group, acceptance of negative stereotypes, and discrimination against individuals, with some cases even leading to violence.”[30] It is important to note that racism is also systemically embedded into existing institutions. At the end of this section are examples of both individual and systemic racism. 

Studies with samples of African-American individuals have found that racism is highly correlated with both mental health issues (depression and stress) as well as physical health consequences (cardiovascular disease and obesity).[31,32] A meta-analysis by Paradies et al. (2015) synthesized the health impacts of racism (293 studies) and found that racism was associated with poorer mental health. BIPOC participants reported experiencing depression, stress, emotional distress, anxiety, PTSD, and suicidal thoughts.[33] 

Studies focusing on Latinx, Asian American, and Native American individuals have indicated that perceived discrimination is correlated with mental health problems. Whitbeck et al. (2022) found that perceived discrimination was a powerful indicator of depressive symptoms in a Native American adult sample, with participants who reported experiencing discirmination being two times more likely to report a greater number of depressive symptoms.[34] Another study by Hwang and Goto (2008) found that among its Asian American and Latinx participants, those who perceived discrimination were more likely to exhibit “symptoms of psychological distress, suicidal ideation, state and trait anxiety, and clinical depression.”[35]

Stress due to racism not only elevates blood pressure, but also leads to risky coping mechanisms that further impact physical health, such as drinking and smoking. For example, Cuevas et al. (2014) found that stress (as a result of discrimination) was linked to smoking and other behavioral risk factors for cancer.[36] Racism and discrimination have also been found to impact inflammation and sleep. A study conducted in 2019 by Thames et al. found that exposure to racial and discriminatory acts activates threat-related molecular processes that stimulate inflammation, which makes people more vulnerable to heart and kidney diseases.[37] Another study by Ong and Williams (2019) found that discrimination interferes with sleep quality in middle-aged adults, further increasing the risk for systemic inflammation.[38]

Examples of Individual Racism:

COVID-19 pandemic: approximately 1,500 reported incidents of anti-Asian racism per month (e.g., physical and verbal attacks and anti-Asian discrimination in private businesses).[39]

2018: 38% of Latinx reported being verbally attacked for speaking Spanish (e.g. told to go back to their countries and racial slurs).[40]

Examples of Systemic Racism:

Despite only making up 12% of the United State’s population, Black people make up nearly 33% of the total prison population.[41] 

BIPOC are less likely than Whites to own their homes regardless of level of education, income, location, marital status, and age due to previous and current policies of displacement, exclusion, and segregation.[42]

Rates of suicide in Native American communities are 3.5 times higher than racial and ethnic groups with lowest rates of suicide. Existing barriers to access appropriate mental health resources for this demographic include lack of financial incentives and cultural competence in as well as geographical isolation.[43]

Assari et al. (2017) aimed to investigate if perceived discrimination in adolescence predicted mental health deterioration a decade later.[44] This longitudinal study followed 681 Black participants from age 15 to age 32. Psychological symptoms of anxiety and depression were measured in 1999 (during adolescence) and again at the follow-up in 2012 (in young adulthood). They only found a positive correlation between perceived discrimination at adolescence and negative psychological symptoms later on for Black males, but not Black females.[45] This may be due to the internalization of masculine norms. Another study by Caldwell et al. (2013) found that masculinity moderates the relationship between discrimination and depressive symptoms plus high-risk drinking behaviors.[46] Discrimnation seems to be more harmful for Black men who hold strong masculine attitudes. Men also report higher rates of discirmination compared to Black women so this could also be another factor accounting for the gender differential.[47] 

In another longitudinal study, this time with a sample of 674 Mexican-origin youth, Stein et al. (2019) investigated whether peer discrimination in 5th grade predicted greater depressive and anxiety symptoms in 12th grade. Peer discrimination was defined as “direct biased mistreatment by peers due to race/ethnicity and also indirect experiences (e.g., hearing classmates make jokes about racial groups).”[48] The results showed that peer discrimination in 5th grade did predict greater symptoms of both depression and anxiety in 12th grade, highlighting the long-term negative impact of these experiences across adolescence.[49] 

Regardless of genetic risk, exposure to discrimination plays a significant role in the development of anxiety disorders. A study in 2020 by Cuevas et al. concluded that even after controlling for genetic factors, discrimination continued being a strong risk factor for anxiety and related disorders.[50] Studies like this confirm that discrimination operates like any other environmental stressor, highlighting its impact on psychiatric disorders and overall well-being. 

Police violence and brutality 

With the high-profile deaths of George Floyd, Breonna Taylor, and Ahmaud Arbery, some researchers have focused on the impact of police brutality and violence as environmental stressors. One such study by Alang et al. (2021) examined the relationship between police brutality, depression, and anxiety across races. They found that negative encounters with police were associated with depressed mood and anxiety, with a stronger association among Black and Latinx participants than Whites.[51] A national survey by Graham et al. (2020) that consisted of 1000 respondents measured the extent to which different racial and ethnic groups in America worried about police brutality. The results demonstrated that Black participants were five times more likely than White people to report fear of such violence.[52] Similarly, Latinx respondents were four times more likely than White people to experience the same fear.[53] Even the anticipation of police brutality (no direct encounter, just concern that one might be a victim) was also associated with depression and anxiety.[54] 

Translating these findings to therapeutic settings: racial socialization theory 

Given all the data regarding the relationship between racism and mental health, it is essential to translate the findings above into therapeutic settings. Clinicians must assess and address racial discrimination within therapy sessions. Further, clinicians should be aware of racial microaggressions and their clinical implications on mental health. 

Many evidence-based trauma treatments are not culturally tailored to address racism and intergenerational trauma.[55] Moreover, African-American adolescents are more likely than their peers to experience traumatic racist and discriminatory encounters. Therefore, not only is this marginalized group more likely to experience these stressors, but they also do not receive the adequate treatment for it, further exacerbating the impact of these encounters.

African American youth are disproportionately impacted by trauma. Finkelhor et al. (2013) found that 65% of African American youth report traumatic experiences.[56] However, only 30% of their peers from other racial and ethnic groups reported the same.[57] These rates may be due to the unique race-related stressors that African American communities experience. Over the course of a single year, 38% of African American teens (13-18 y/o) reported an average of six racist encounters.[58] If these experiences and their associated outcomes (poor mental health) are not addressed and treated, they are at an increased risk of developing PTSD.[59] Existing therapies that aim to provide clients with coping mechanisms (e.g., progressive muscle relaxation and diaphragmatic breathing) for traumatic experience lack culturally-specific strategies necessary to treat the racial stressors unique to African American individuals. The absence of this cultural awareness and implementation most likely reflects the tendency for poor engagement and subsequent dropout among African American patients who undergo therapy.[60]

Racial socialization is a process that transmits culture, attitudes, and values to help youth overcome stressors associated with their ethnic minority status.[61] Researchers like Metzger et al. (2021) have incorporated racial encounter coping appraisal and socialization theory into trauma-focused cognitive behavioral therapy (TF-CBT). By incorporating these techniques into the framework of an already existing evidence-based treatment for children and adolescents, racial trauma can be addressed in clinical settings.[62] Additionally, Metzger et al. integrated racial socialization (RS) into TF-CBT to improve outcomes specifically for African American youth since RS has been associated with lower internalizing and externalizing symptoms in children of color, positive parent-child interactions, self-esteem, resilience, lower rates of depression and stress, reduced behavioral problems, stronger racial identity, and better use of coping skills during race-related traumatic experiences.[63] 

There are several components under the RS umbrella. For example, racial pride messages are those that teach African American children about their heritage and culture. These messages promote group unity and combat negative majority opinions.[64] An example of this is talking about important historical figures. Racial barrier messages are about discrimination and racism; they also warn about difficulties in social interactions with majority populations, such as White communities.[65] An example of this RS technique is encouraging and aiding parents in the police violence and brutality talk. This process also takes advantage of the social connectedness protective buffer mentioned under the “Microaggression” section. Incorporating religion into the TF-CBT framework as a source of resilience has also proved to be helpful for many African American families.[66] 

Another important practice under RS is the acknowledgement and appreciation of extended family members, such as grandparents, aunts/uncles, and other non-blood relatives (e.g., pastor, mother’s childhood best friend who is like an aunt). In African American cultures, extended family involvement is common, with other people outside the immediate family network helping with child-rearing.[67] By including them in treatment plans, outcomes can be optimized. In TF-CBT, parents and guardians are actively involved in administration, given that they are responsible for making sure appropriate coping strategies are practiced outside of therapy sessions. 

Emotion regulation 

A 2015 study by Graham et al. found that the relationship between racist experiences and anxiety symptomatology was moderated by emotion regulation in a Black American sample.[68] In other words, better emotion regulation resulted in fewer anxiety symptoms due to racist experiences. Emotional regulation acted as a buffer to the development of anxiety symptoms. Some researchers even label emotional dysregulation as the core of mood and anxiety disorders.[69]

These results have clinical implications, demonstrating the importance of emotion regulation skills. Reducing racist experiences is ideal, but difficult to tackle. Systemic and institutional issues would need to be fixed, and this could take decades to improve. However, a more short-term strategy that clinicians could assist minorities implement is emotion-focused coping. This strategy could lead to reduced emotion dysregulation and subsequently lower levels of anxious arousal. Such emotion regulation skills include: curbing impulsivity; accepting emotions; and setting goals. Moreover, Graham et al. (2021) note that therapists should pay particular attention to creating a supportive context for their clients so that they can discuss race-based traumatic experiences and the effects of these experiences on their clients’ lives.”[70] By more deeply understanding the prejudicial and discriminatory injustices associated with racial trauma, clinicians can more appropriately serve their clients to create lessened suffering and better therapeutic outcomes.

If you are experiencing anxiety or depression due to racism in any form (microaggressions, intergenerational trauma, workplace discrimination), please reach out to a mental healthcare provider.

For more information, click here to access an interview with Psychologist Michele Bedard-Gilligan on trauma & recovery.

Additionally, you may click here to access an interview with Psychologist Robyn Walser on trauma & addiction.

To access our PTSD Self-Care Tips, click here.

Contributed by: Nicole Izquierdo

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

References

1 Williams D. R. (2005). The health of U.S. racial and ethnic populations. The journals of gerontology. Series B, Psychological sciences and social sciences, 60 Spec No 2, 53–62. https://doi.org/10.1093/geronb/60.special_issue_2.s53

2 U.S. Department of Health and Human Services. Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; 2001.

3 Wells, K., Klap, R., Koike, A., & Sherbourne, C. (2001). Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. The American Journal of Psychiatry, 158(12), 2027–2032. https://doi.org/10.1176/appi.ajp.158.12.2027

4 Young, A. S., Klap, R., Sherbourne, C. D., & Wells, K. B. (2001). The quality of care for depressive and anxiety disorders in the United States. Archives of general psychiatry, 58(1), 55–61. https://doi.org/10.1001/archpsyc.58.1.55

5 Sue S, Zane N, Young K. Research on psychotherapy with culturally diverse populations. In: Garfield AEBSL, editor. Handbook of psychotherapy and behavior change. 4th edition. Vol 4. NY: Wiley & Sons; 1994. pp. 783–820.

6 Green, J. G., McLaughlin, K. A., Fillbrunn, M., Fukuda, M., Jackson, J. S., Kessler, R. C., Sadikova, E., Sampson, N. A., Vilsaint, C., Williams, D. R., Cruz-Gonzalez, M., & Alegría, M. (2020). Barriers to Mental Health Service Use and Predictors of Treatment Drop Out: Racial/Ethnic Variation in a Population-Based Study. Administration and policy in mental health, 47(4), 606–616. https://doi.org/10.1007/s10488-020-01021-6

7 Helms, J. E., Nicolas, G., & Green, C. E. (2010). Racism and ethnoviolence as trauma: Enhancing professional training. Traumatology, 16(4), 53-62. doi:10.1177/1534765610389595  

8 Carter, R. T., Mazzula, S., Victoria, R., Vazquez, R., Hall, S., Smith, S., . . . Williams, B. (2013). Initial development of the Race-Based Traumatic Stress Symptom Scale: Assessing the emotional impact of racism. Psychological Trauma: Theory, Research, Practice, and Policy, 5(1), 1-9. doi:10.1037/a0025911  

9 https://dictionary.apa.org/intergenerational-trauma

10 Deangelis, A. (2019, February). The legacy of trauma. American Psychological 

Association. Vol 50, No. 2. Retrieved April 24, 2022, from https://www.apa.org/monitor/2019/02/legacy-trauma

11 Williams, M. T., Printz, D. M. B., & DeLapp, R. C. T. (2018). Assessing racial trauma with the Trauma Symptoms of Discrimination Scale. Psychology of Violence, 8(6), 735–747.

12 Pascoe, E. A., & Smart Richman, L. (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 135(4), 531–554. https://doi.org/10.1037/a0016059

13 Gaertner, S. L., & Dovidio, J. F. (2006). Understanding and addressing contemporary racism: From aversive racism to the common ingroup. Journal of Social Issues, 61, 615–639. doi:10.1111/j.1540-4560.2005.00424.x.

14 Gehrman, E. (2019, November 20). Big Impact of Microaggressions. The Harvard Gazette. Retrieved April 24, 2022, from https://news.harvard.edu/gazette/story/2019/11/microaggressions-and-their-role-in-mental-illness/

15 Nadal, K. L., Griffin, K. E., Wong, Y., Hamit, S., & Rasmus, M. (2014). The impact of racial microaggressions on mental health: Counseling implications for clients of color. Journal of Counseling & Development, 92(1), 57–66. https://doi.org/10.1002/j.1556-6676.2014.00130.x

16 Ibid. 

17 Ibid. 

18 Ibid. 

19 Ibid.

20 Ibid. 

21 Fay, C. (2015). Effects of racial microaggressions on anxiety and depression in black and african american women (Order No. 3732015). Available from ProQuest Central; ProQuest Dissertations & Theses Global. (1734864063). Retrieved from https://login.proxy.lib.duke.edu/login?url=https://www.proquest.com/dissertations-theses/effects-racial-microaggressions-on-anxiety/docview/1734864063/se-2

22 Ibid. 

23 Liao, K. Y.-H., Weng, C.-Y., & West, L. M. (2016). Social connectedness and intolerance of uncertainty as moderators between racial microaggressions and anxiety among Black individuals. Journal of Counseling Psychology, 63(2), 240–246. https://doi.org/10.1037/cou0000123

24 Dugas, M. J., Buhr, K., & Ladouceur, R. (2004). The role of intolerance of uncertainty in the etiology and maintenance of generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: advances in research and practice (pp. 143–163). New York: Guilford Press.

25 Dugas, M. J., Gagnon, F., Ladoceur, R., and Freeston, M. H. (1998). Generalized anxiety disorder: a preliminary test of a conceptual model. Behav. Res. Ther. 36, 215–226. doi: 10.1016/S0005-7967(97)00070-3]

26 Liao et al. 2016

27 Choi, S., Clark, P. G., Gutierrez, V., Runion, C., & R, M. (2020). Racial microaggressions and Latinxs' well-being: A systematic review. Journal of Ethnic & Cultural Diversity in Social Work, 31(1), 16–27. https://doi.org/10.1080/15313204.2020.1827336 

28 Berry, O.O., Londoño Tobón, A. & Njoroge, W.F.M. Social Determinants of Health: the Impact of Racism on Early Childhood Mental Health. Curr Psychiatry Rep 23, 23 (2021). https://doi.org/10.1007/s11920-021-01240-0

29 Ibid. 

30 https://dictionary.apa.org/racism

31 Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., Gupta, A., Kelaher, M., & Gee, G. (2015). Racism as a Determinant of Health: A Systematic Review and Meta-Analysis. PloS one, 10(9), e0138511. https://doi.org/10.1371/journal.pone.0138511

32 Ibid. 

33 Ibid. 

34 Whitbeck, L. B., McMorris, B. J., Hoyt, D. R., Stubben, J. D., & Lafromboise, T. (2002). Perceived discrimination, traditional practices, and depressive symptoms among American Indians in the upper midwest. Journal of health and social behavior, 43(4), 400–418.

35 Hwang, W. C., & Goto, S. (2008). The impact of perceived racial discrimination on the mental health of Asian American and Latino college students. Cultural Diversity and Ethnic Minority Psychology, 14, 325–335. doi:10.1037/1099-9809.14.4.326.

36 Cuevas, A. G., Reitzel, L. R., Adams, C. E., Cao, Y., Nguyen, N., Wetter, D. W., Watkins, K. L., Regan, S. D., & McNeill, L. H. (2014). Discrimination, affect, and cancer risk factors among African Americans. American journal of health behavior, 38(1), 31–41. https://doi.org/10.5993/AJHB.38.1.4

37 Thames, A. D., Irwin, M. R., Breen, E. C., & Cole, S. W. (2019). Experienced discrimination and racial differences in leukocyte gene expression. Psychoneuroendocrinology, 106, 277–283. https://doi.org/10.1016/j.psyneuen.2019.04.016

38 Ong, A. D., & Williams, D. R. (2019). Lifetime discrimination, global sleep quality, and inflammation burden in a multiethnic sample of middle-aged adults. Cultural Diversity and Ethnic Minority Psychology, 25(1), 82–90. https://doi.org/10.1037/cdp0000233

39 Asian Pacific Policy and Planning Council (2020). In one month, STOP AAPI HATE Receives almost 1500 incident reports of verbal harassment, shunning and physical assaults. http://www.asianpacificpolicyandplanningcouncil.org/wp-content/uploads/Press_Release_4_23_20.pdf

40 Lopez, M. H., Gonzalez-Barrera, A., & Krogstad, J. M. (2020, May 30). Latinos' experiences with discrimination. Retrieved June 25, 2020, from https://www.pewresearch.org/hispanic/2018/10/25/latinos-and-discrimination/

41 F. (2019, September 22). Table 43. Retrieved June 25, 2020, from https://ucr.fbi.gov/crime-in-the-u.s/2018/crime-in-the-u.s.-2018/tables/table-43

42 Integrated Public Use Microdata Series, U.S. Census Data for Social, Economic, and Health Research, 2013-2017 American Community Survey: 5-year estimates (Minneapolis Minnesota Population Center, 2017), available at https://usa.ipums.org/usa/

43 Leavitt, R. A., Ertl, A., Sheats, K., Petrosky, E., Ivey-Stephenson, A., & Fowler, K. A. (2018). Suicides Among American Indian/Alaska Natives — National Violent Death Reporting System, 18 States, 2003–2014. MMWR. Morbidity and Mortality Weekly Report, 67(8), 237-242. doi:10.15585/mmwr.mm6708a1

44 Assari, S., Moazen-Zadeh, E., Caldwell, C. H., & Zimmerman, M. A. (2017). Racial discrimination during adolescence predicts mental health deterioration in adulthood: Gender differences among blacks. Frontiers in Public Health, 5. https://doi.org/10.3389/fpubh.2017.00104 

45 Ibid.

46 Caldwell, C. H., Antonakos, C. L., Tsuchiya, K., Assari, S., & De Loney, E. H. (2013). Masculinity as a moderator of discrimination and parenting on depressive symptoms and drinking behaviors among nonresident African-American fathers. Psychology of Men & Masculinity, 14(1), 47–58. https://doi.org/10.1037/a0029105

47 Sellers, R. M., & Shelton, J. N. (2003). The role of racial identity in perceived racial discrimination. Journal of Personality and Social Psychology, 84(5), 1079–1092. https://doi.org/10.1037/0022-3514.84.5.1079

48 Stein, G. L., Castro-Schilo, L., Cavanaugh, A. M., Mejia, Y., Christophe, N. K., & Robins, R. (2019). When Discrimination Hurts: The Longitudinal Impact of Increases in Peer Discrimination on Anxiety and Depressive Symptoms in Mexican-origin Youth. Journal of youth and adolescence, 48(5), 864–875. https://doi.org/10.1007/s10964-019-01012-3

49 Ibid.

50 Cuevas, A. G., Mann, F. D., Williams, D. R., & Krueger, R. F. (2020). Discrimination and anxiety: Using multiple polygenic scores to control for genetic liability. Proceedings of the National Academy of Sciences, 118(1). https://doi.org/10.1073/pnas.2017224118 

51 Alang, S., McAlpine, D., & McClain, M. (2021). Police Encounters as Stressors: Associations with Depression and Anxiety across Race. Socius. https://doi.org/10.1177/2378023121998128

52 Graham, A., Haner, M., Sloan, M. M., Cullen, F. T., Kulig, T. C., & Jonson, C. L. (2020). Race and worrying about police brutality: The hidden injuries of minority status in America. Victims & Offenders, 15(5), 549–573. https://doi.org/10.1080/15564886.2020.1767252 

53 Ibid. 

54 Alang et al. 2021

55 Metzger, I. W., Anderson, R. E., Are, F., & Ritchwood, T. (2021). Healing Interpersonal and Racial Trauma: Integrating Racial Socialization Into Trauma-Focused Cognitive Behavioral Therapy for African American Youth. Child maltreatment, 26(1), 17–27. https://doi.org/10.1177/1077559520921457

56 Finkelhor, D., Turner, H. A., Shattuck, A., & Hamby, S. L. (2013). Violence, crime, and abuse exposure in a national sample of children and youth: an update. JAMA pediatrics, 167(7), 614–621. https://doi.org/10.1001/jamapediatrics.2013.42

57 Ibid.

58 Sellers, R. M., Caldwell, C. H., Schmeelk-Cone, K. H., & Zimmerman, M. A. (2003). Racial identity, racial discrimination, perceived stress, and psychological distress among African American young adults. Journal of health and social behavior, 44(3), 302–317.

59 Metzger et al. 2021

60 Ibid. 

61 Lesane-Brown, C. L., Brown, T. N., Caldwell, C. H., & Sellers, R. M. (2005). The Comprehensive Race Socialization Inventory. Journal of Black Studies, 36(2), 163–190. https://doi.org/10.1177/0021934704273457

62 Metzger et al. 2021 

63 Ibid. 

64 Ibid. 

65 Ibid. 

66 Stevenson, H. C., Jr., Cameron, R., Herrero-Taylor, T., & Davis, G. Y. (2002). Development of the Teenager Experience of Racial Socialization scale: Correlates of race-related socialization frequency from the perspective of Black youth. Journal of Black Psychology, 28(2), 84–106. https://doi.org/10.1177/0095798402028002002

67 Grills, C., Cooke, D., Douglas, J., Subica, A., Villanueva, S., & Hudson, B. (2016). Culture, racial socialization, and positive African American youth development. Journal of Black Psychology, 42(4), 343–373. https://doi.org/10.1177/0095798415578004

68 Graham, J. R., Calloway, A. & Roemer, L. The Buffering Effects of Emotion Regulation in the Relationship Between Experiences of Racism and Anxiety in a Black American Sample. Cogn Ther Res 39, 553–563 (2015). https://doi.org/10.1007/s10608-015-9682-8

69 Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety,29, 409–416. doi:10.1002/da.21888.

70 Graham et al. 2015

Gaslighting: A Q&A with SAS Therapists

Definitions and Origins

In January of 2022, a court case in the United Kingdom brought the topic of gaslighting to the forefront of public consciousness when a woman accused her partner of rape and domestic abuse. In response to her accusations, her partner convinced her, her family, and even other professionals that she had bipolar disorder in order to undermine her claims and cast doubt on her mental state.[1] Heightening matters was the fact that the woman's partner was a mental health worker, a position of knowledge and trust that he leveraged against her. In the ensuing court ruling, Justice Stephen Cobb put a name to this manipulation with the term 'gaslighting'–which he described as a "form of insidious abuse designed to cause the mother to question her own mental well-being, indeed her sanity.”[2] 

The idea of gaslighting in fact emerged from a 1930s play, Gaslight, that closely parallels this court case.[3] Set in Victorian London, the play follows a husband who systematically lies and deceives his wife through activities such as "secretly dimming and brightening a gaslight to unsettle and confuse her" in order to convince her she is insane so that he can take possession of her wealth.[4] Like in the court case, the husband weaponized psychological tactics to make his partner question their reality and mental stability–an abusive manipulation that becomes difficult to prove due to this uncertainty of reality.[5] 

Though only integrated into colloquial usage quite recently, gaslighting has been defined and fleshed out in greater scope in current literature. Stark (2019) describes gaslighting as a form of testimonial injustice, wherein a person's testimony about harms or wrongs done to them is denied, often on the basis of their social identity (e.g., women, non-binary people, and ethnic minorities).[6] Stark additionally discusses two main tactics used to facilitate gaslighting. "Sidestepping" involves avoiding evidence that supports testimony, which can involve such actions as ridiculing the accuser, turning the table and implying the accuser is a hypocrite, verbally attacking the accuser, or merely changing the subject. "Displacing" follows more of the court case and Gaslight storyline: the abuser makes it seem as if their partner has cognitive or characterological defects, displacing their partner's accusation back onto them and explaining the accusation with a supposed flaw.[7]

Gaslighting has also been defined in situations of microaggressions, where gaslighting is used to perpetuate oppression against marginalized groups. Johnson et al. (2021) define gaslighting as a phenomenon where "people of historically dominant groups negate the realities of people of marginalized groups … and [when] confronted for microaggressing, deny the existence of bias and convince their targets to question their own perceptions."[8] In doing so, those in privileged positions leverage their power to manipulate others, playing into patriarchal and racist labels of women and non-binary people of color as "crazy" and "hysterical."[9] Examples of these historical stereotypes include comments that marginalized groups are "always making things about race/gender," being "oversensitive" or "paranoid," or simply overly focused on negatives. As discussed by Oppenheim (2022), gaslighting can be difficult to bring to justice because often the discriminatory undertones of people's comments are subtly biased and even unknown to the perpetrator, making it easy for the accuser to question whether they are being overly sensitive.[10,11]


Psychological Effects

Having one's opinions, thoughts, and reality continually undermined can serve as a chronic stressor in a person's life and wear on a person's mental wellbeing. When gaslighters blame a person's memory and attack their character, they can completely undermine their target's sense of self, including their self-esteem and self-image. The self-doubt induced by persistent gaslighting has been associated with disorientation and depression.[12] As a form of psychological oppression, gaslighting causes its victims to internalize messages of inferiority. These messages can make victims doubt their moral status as a person able to discern harm and deserving of kind treatment.[13] 

Researcher Diana Dimitrova (2021) corroborated these claims in a study of working women in Sofia, Bulgaria over a period of ten years.[14] The study took the form of an anonymous survey of 2,000 working women with more than five years of work experience, who ranged in age from 30-65. Most significantly, the survey found that half of the women subjected to prolonged mental harassment presented with depression. Almost a third of those women were diagnosed with other conditions, including 5% with Hashimoto's thyroiditis, 10% with arterial hypertension, and 15% with ischemic disease–all conditions associated with chronic stress and a buildup of cortisol, a stress hormone.[15] Introverted women and women with less education were found to be the most vulnerable to gaslighting, indicating social implications for marginalized and unheard voices to be more affected by gaslighting. 


Power Imbalances and Social Implications

The social power differences leveraged in gaslighting can take on many forms. Gaslighting is most often seen in heterosexual relationships, where the investment in male approval makes victims invested in what the manipulator believes. However, gaslighting can also be perpetrated by groups with racial privilege as well as in nonheterosexual relationships. Because of the position of privilege that the perpetrator comes from, it is often easier to convince the victim and third parties to trust their judgment.[16] Due to this, privileged people are insulated from the repercussions of harming others because they can simply displace the blame by making it seem as if their victim is in the wrong for the act of "overreacting" by complaining or protesting. 

The privilege of those who perpetrate gaslighting often plays into existing hierarchical structures of misogyny, patriarchy, and racism.[17,18] The displacement component of gaslighting, wherein men accused of abuse often punish women for accusations by assigning defects to them that "explain" the accusation (e.g. oversensitivity, faulty memory, dishonesty), is itself a form of victim blaming and misogyny.[19] Attributing character flaws and uptight behavior to women creates a cycle of mistrust and feeds into stereotypes of women as frivolous and not to be taken seriously. The fact that marginalized people are often not believed or taken seriously when they come forward about gaslighting or other forms of abuse ironically demonstrates why they should be taken seriously. Marginalized people have few motives to fabricate harm at the same time as a strong motive not to: society is already biased against women and minorities, giving them little to gain from an accusation and everything to lose.[20] The act of gaslighting is in many ways a form of polyvictimization, where the harm done to a person who has already been victimized once is exacerbated by the refusal to believe them.[21] Living in a society where minorities are widely gaslit can bring about the same psychological harms as to those in gaslighting relationships, creating a culture of silence around abuse and reinforcing the norms of what groups remain in power.[22] 

Discussion of gaslighting is helpful to combat this harmful culture, which is why public cases such as the court case discussed previously are so important. By using the term "gaslighting" in its ruling, the justice gave this form of psychological abuse legal credibility against the way abusers warp victims' realities: language is an important tool to expose abuse and give it a name.[23] Because most cases of gaslighting often happen "behind closed doors" and shy away from the center light, the publication of this court case is an important step for posterity in understanding gaslighting.

Q&A 

SAS Therapists Discuss Symptoms and Interventions

1. How does gaslighting typically manifest in patients? What mental health conditions or symptoms are often associated with the experience of gaslighting?

“Gaslighting has become well-known for being used as a manipulative tactic that causes the individual to question their reality, judgment, and ultimately their sanity. It is considered emotional abuse and can be understood within the larger context of Duluth's Power and Control wheel. Not only are victims of gaslighting at greater risk of mental health issues such as depression and anxiety, challenges with self-esteem and self-worth, but also the effects of chronic stress and potentially Posttraumatic Stress Disorder. In addition, individuals with mood disorders, addiction, schizophrenia spectrum diagnoses, and even some personality disorders such as Dependent Personality Disorder are at greater risk of being a victim of gaslighting. These disorders all share characteristics of challenges in perception, self-trust, symptom management, memory, and emotional lability that compound and often confuse the symptoms related to gaslighting behavior, which can leave the impact unseen or disguised in the psychopathology of the disorder. Given that the nature of gaslighting is often being experienced within a proverbial vacuum, the individual may not be aware that anything the perpetrator is doing is wrong or that they begin questioning whether they are overreacting as a response. This creates confusion, self-doubt, and can even lead to isolation due to the convergence of these various factors.” (Brittany Canfield, Psy.D., LMHCA)

“The topic of gaslighting is inherently linked to relationships, right? There is a version of ‘gaslighting’ oneself, however, ‘self-gaslighting’ isn’t a very helpful term. So gaslighting ‘manifests’ in relationships of all kinds: from romantic to work-related to familial and even amongst friends. Because as therapists we are hopefully considering the ‘social’ ramifications or consequences of any kind of presentation in a client’s life, we could probably link gaslighting to any type of symptom. The most common, however, might include:

  • anxiety

  • racing thoughts / intrusive thoughts

  • depression

  • low self-esteem  

  • insomnia

  • dissociation

  • persistent guilt/shame  

  • difficulty concentrating/focusing

  • anger/mood swing

Of note: these are ‘associated’ only and in no way am I implying causality. That might be obvious but – it just isn’t helpful to think of associations that closely. I’d say in general, if someone comes in with difficulty in relationships, they’re likely to be experiencing any of the above symptoms, and gaslighting might be a part of that initial difficulty in relationships.” (Kate Willman, MA, LMHCA, HCA)



2. In what kinds of environments do you typically see patients experiencing gaslighting? What suggestions do you have to handle gaslighting in environments such as the workplace, and how do those differ from gaslighting in personal and family relationships? 

“Contrary to popular belief, gaslighting is prevalent in most social environments, not just within romantic or familial relationships, nor are these experiences exclusive to legal cases. What makes gaslighting challenging in diverse social situations is the power differentials that exist within the dynamic. For instance, individuals are more likely to discount gaslighting behavior within a work environment to maintain employment as the risk of loss, ridicule, and losing face is high. In any case, whether it is a friendship or a high stake relationship, gaslighting poses the ultimate challenge of the receiver being perceived as incompetent, irrational, unreliable, and/or ill. We may see a range of behaviors take place that involves lack of communication, starting conflict or silent treatments without known cause, use of back channels of communication, triangulation, and even taking away work, responsibility, and/or access to resources. It is important for the individual to know that the gaslighting behavior is an issue with the perpetrator, not the receiver (victim). It is often done out of an attempt to seek power and control within the dynamic.” (Brittany Canfield, Psy.D., LMHCA)

“I think the most typical experience of gaslighting is within a familial or romantic relationship. I haven’t had clients present with workplace gaslighting, so I don’t know that I can comment on the difference between these types of presentations. On a hypothetical level, I might consider the [general] workplace as an environment in which folks experience gaslighting or gaslighting tendencies on a subtler level, though much of this experience (even in intimate relationships) is pretty subtle.” (Kate Willman, MA, LMHCA, HCA)


3. What therapeutic techniques and types of therapy are most salient to help patients to address gaslighting? What resources are available to people who are or think they might be experiencing gaslighting? 

“Considering the impact gaslighting behavior has on an individual, therapies rooted in building self-trust, self-esteem/self-worth, and identity are strongly recommended. Some of these would include Acceptance and Commitment Therapy, Narrative Therapy, Interpersonal Therapy, and Internal Family Systems therapy. When individuals are showing symptoms of chronic stress and/or trauma, somatic therapy and other trauma-informed therapies could be beneficial in relieving those symptoms and developing a sense of safety.” (Brittany Canfield, Psy.D., LMHCA)

“The first step for me in these situations is acknowledgement and acceptance. Rarely do I have clients coming in saying “they’re gaslighting me!” Usually, it is something we learn over time with recollection of various behaviors and/or conversations within the relationship. Then, we are generally working via relationship- and/or attachment-focused therapies to address the situation at large. I have not experienced a client only presenting with having been gaslit and not have other issues in relationship, too. ACT (Acceptance and Commitment Therapy) is an excellent orientation for many types of presentation, including relational issues. ACT has an overall goal of a meaningful life for clients, and this includes a foundation of identity. Clients learn to decipher what their purpose is, the values on which they rely, and how they as an individual operate both apart from others and as a part of the whole. So for folks susceptible to relational issues like gaslighting, ACT may provide help by strengthening their sense of self, identity, worth + purpose from an intrinsic place, thereby facilitating a strengthening of clients’ ability to notice gaslighting or other red flags in a relationship.” (Kate Willman, MA, LMHCA, HCA)


4. Do you have any other advice or thoughts on dealing with gaslighting from a therapist's perspective? 

“Dealing with the effects of gaslighting behavior can be isolating and discouraging. With that in mind, seeking the assistance from a professional can help lessen the impact of the experience and gain useful tools to help now and in the future. Even seeking support from trusted friends, family, or colleagues can help create the sounding board needed to build confidence and a space to check-in with your feelings.” (Brittany Canfield, Psy.D., LMHCA)

“Gaslighting is an interesting term to have entered both the zeitgeist at large and the paradigm of evidence-based therapy. It is rare for a term from a movie to have such permeating effects! So yeah, it isn’t a clinical term, yet we’re now being trained to consider this as a major flag for relational and/or personal despair. My thoughts on this topic are: (a) yay! more information theoretically means more help for people, more access to overall wellbeing; (b) eek! sometimes words and concepts that trend (especially related to mental health) aren’t always the most helpful to people, because they may mis-apply such phenomena to their relationships when – though other issues might be present – said phenomena is not. This term – though highly dangerous when it is present, isn’t always present in difficult relationships; so, (c) education and discussion are BEST! Whether with friends, professionals (like your therapist) or other trusted sources, talking about something is almost always better than not. As an ACT-oriented therapist, it is also worth noting that I am not interested in mere symptom reduction (e.g. “I don’t get gaslit anymore.”) Rather, I am approaching clients’ presentations or symptoms (including gaslighting others or being gaslit) from a holistic perspective, taking-in not only the ‘problems’ that surface as a result, but the strengths and the meaning beyond those ‘problems’. In the case of gaslighting, some trauma-informed or other specific therapy might be warranted. However, I can’t say enough that experiencing gaslighting – though uncomfortable, demeaning, and difficult to admit – isn’t in and of itself a “problem”. In general, experiencing gaslighting is evidence of larger problems, either in the client who was gaslit or the person utilizing gaslighting behaviors (or both!). I believe it is best practice to approach such topics with different lenses on so as to provide the most evidence-based, non-biased + holistic care possible, and as often as possible!” (Kate Willman, MA, LMHCA, HCA)

​​”My perspective as a therapist is that I always have to be aware of what I do know and what I don't know. It can be hard to pin down when gaslighting is happening because (in my understanding) for something to be gaslighting it must be done with malicious intent. I usually cannot know the intent of the other person my client is interacting with. If two people have different perspectives or different understandings of the world, they can both feel gaslit by the other if they both assume a malicious intent behind the way the other person's assertion of truth differs from their own. Feeling gaslit may be a sign that someone is gaslighting you, or it may instead be a sign that you don't trust the other person to be honest with you and/or to not try to cause you harm.” (Case Lovell, LMHC)

Contributed by: Anna Kiesewetter

Brittany Canfield, Psy.D., LMHCA, Kate Willman, MA, LMHCA, HCA

& Case Lovell, LMHC

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

For more information, click here to access an interview with Psychologist Karin Sponholz on codependency.

Additionally, you may click here to access an interview with Psychologist Michele Bedard-Gilligan on trauma & recovery.

references

1 Oppenheim, M. (2022). 'He convinced her she had bipolar': Gaslighting used in High Court judgment for first time in 'milestone' hearing. The Independent, https://www.independent.co.uk/news/uk/home-news/gaslighting-high-court-judgement-family-courts-b2014708.html

2 Ibid. 

3 Johnson, V., Nadal, K., Sissoko, D. R. G. and King, R. (2021). "It's Not in Your Head": Gaslighting, 'Splaining, Victim Blaming, and Other Harmful Reactions to Microaggressions. Perspectives on Psychological Science, 16(5), 1024-1036. https://journals.sagepub.com/doi/10.1177/17456916211011963

4 Ibid.

5 Oppenheim, 2022. 

6 Stark, C. (2019). Gaslighting, Misogyny, and Psychological Oppression. The Monist, 102(2), 221-235. https://doi.org/10.1093/monist/onz007.

7 Ibid. 

8 Johnson, V., Nadal, K., Sissoko, D. R. G. and King, R. (2021). "It's Not in Your Head": Gaslighting, 'Splaining, Victim Blaming, and Other Harmful Reactions to Microaggressions. Perspectives on Psychological Science, 16(5), 1024-1036. https://journals.sagepub.com/doi/10.1177/17456916211011963

9 Ibid.

10 Oppenheim, 2022.

11 Johnson et al., 2021.

12 Stark, 2019. 

13 Ibid.

14 Dimitrova, D. (2021). The women in situations of gaslighting – risk identification in the work environment. European Journal of Public Health, 31(3), 462-463. https://academic.oup.com/eurpub/article/31/Supplement_3/ckab165.327/6406127

15 Ibid.

16 Stark, 2019.

17 Ibid.

18 Johnson et al., 2021.

19 Stark, 2019.

20 Ibid.

21 Johnson et al., 2021.

22 Stark, 2019.

23 Oppenheim, 2022.

Xenophobia and Mental Health in Asian Americans

Introduction

Although the rise of the COVID-19 pandemic has brought anti-Asian sentiments to the forefront of public consciousness, Asian Americans have long been cast as "perpetual foreigners" in a centuries-old history of discrimination.[1-3] The Trump administration's and many popular media sources' politicization of COVID-19 as the "Chinese virus" and "Kung flu," alongside the recent uptick in anti-Asian hate crimes, have only added fuel to an ongoing flame of xenophobia that dates back to the nineteenth century and has had lasting repercussions on the mental health of Asian Americans.[4]

History of Anti-Asian Racism: 1800s to Present

When the first wave of Chinese immigrants came to America during the California Gold Rush, they were harassed as foreigners who had come to take American jobs away, culminating in the signing of the Chinese Exclusion Act in 1882 which halted Chinese immigration for ten years and barred existing Chinese immigrants from naturalization.[5] During this ban, Chinese Americans were prohibited from interracial marriage and segregated into Chinatowns as the numbers of Chinese in America dwindled.[6] In the years following the ban, other Asian American groups faced yet more brutal discrimination. In 1930, Filipino American farm workers were assaulted and lynched by local California residents opposed to Asian immigration during the Watsonville Riots.[7] During World War II, hundreds of thousands of Japanese Americans were wrenched from their homes and imprisoned in internment camps across the western United States while racist caricatures circulated wartime propaganda.[8] 

Even after the doors were reopened to Chinese immigration in 1943, anti-Asian xenophobia has persisted into modern history and held a lasting impact on the mental health of Asian Americans. With the SARS (Severe Acute Respiratory Syndrome) outbreak in Asia in 2003, Asian Americans were often stereotyped as "dirty" or "disease-ridden foreigners," despite how long they had lived in the U.S.[9] These labels have resurged with the emergence of COVID-19. After the first outbreaks of the coronavirus in Wuhan, China, and its rapid spread around the globe, many Americans began scapegoating China for the pandemic. When news broke out that the disease had likely originated from an open-air wet market in Wuhan, outrage arose over the unsanitary conditions for meat and live animals that left the door open for zoonotic viral transmission.[10] This outrage snowballed into a form of hygienic racism that exacerbated stereotypes of Asian Americans as "dirty" and "disease-ridden," where tropes such as Asians "eating bats" from "filthy markets" were weaponized to shame China for practices that contributed to the pandemic.[11] With the eye of blame on China, people increasingly targeted any Asian American perceived to resemble a Chinese person, a dangerous generalization known as racial profiling that often accompanies hate speech and racial violence.[12,13] 

COVID-19 Discrimination

Startling numbers of anti-Asian hate have been reported in the two years since the pandemic began. During the first two weeks of the pandemic, 1,135 experiences of discrimination and harassment against Asian Americans were reported.[14] By December 2021, nearly two years since the pandemic's start, this number had risen to 10,905 reported hate incidents.[15] This problem has only been exacerbated throughout that time, with 42.5% of these incidents occurring in 2020 and 57.5% in 2021–a 15.2% increase.[16] Anti-Asian hate has taken many forms during the pandemic. Hate incidents have ranged from verbal harassment and xenophobic insults (such as the phrase "go back to your country"), to job discrimination and property vandalism, to being coughed on and physically assaulted.[17] 

Asian American elders are often the most vulnerable to violent attacks, and have made up the majority of prominent anti-Asian hate headlines. As reported by Bloomberg Equality, in 2020, 84-year-old Rong Xin Liao was kicked in the chest while using his walker in San Francisco. In April 2020, an attacker in New York stomped on the head of 61-year-old Yao Pan Ma, who was collecting cans. Ma died eight months later on December 31, 2020. In May of 2021, two senior Asian women were stabbed at a bus stop in downtown San Francisco after going afternoon shopping. The prevalence of these attacks can cause Asian American elders to feel frightened to leave their homes, which has led to difficulty getting necessities such as food and exercise.[18] The prolonged alienation and pain of seeing one's own elders brutally assaulted can be severely traumatic, and as put by National Alliance on Mental Illness CEO Daniel H. Gillison, Jr., the "effects of racial trauma on mental health are profound and cannot be ignored."[19]

Effects of Racism on Mental Health

Racism is extremely detrimental to mental health, and its effects are widespread in Asian American communities. A 2021 mental health report by the activist group Stop AAPI Hate revealed that 1-in-5 Asian Americans who have experienced racism display racial trauma, or severe psychological and emotional harm caused by racism. Racism and discrimination are highly correlated with stress, adverse health outcomes, and psychopathology, as well as a hesitancy to seek professional psychological help.[20] In Asian Americans, this has been seen to manifest in heightened symptoms of depression, anxiety, PTSD, suicidal ideation, and higher risk for substance abuse.[21,22] Beyond diagnosable mental health conditions, sustained discrimination can also result in more insidious harms to everyday wellbeing, including subclinical stress responses such as fear and sleep disturbances that can last for months and even years.[23] 

Being constantly demeaned as "foreign" and the cause of a disease additionally produces a form of traumatic stress that can be pervasive. The perpetuation of witnessing anti-Asian violence often leads to individuals internalizing other victims' trauma, a situation known as vicarious trauma.[24] The chronic stress and fear of endangerment resulting from vicarious trauma can predispose Asian Americans to experience long-term symptoms comparative to PTSD, such as hypervigilance, anxiety, persistent fear, anger, guilt, or shame.[25] In fact, Stop AAPI Hate's 2021 mental health report found that Asian Americans who have experienced racism feel more stressed by anti-Asian violence than about the pandemic itself, an anxiety that follows them into re-entering school and jobs as the pandemic begins to become normalized.[26] The compounding of severe xenophobia on top of a deadly pandemic burdens Asian Americans with a heavy and unjust weight to bear when their focus and energy should be centered on remaining healthy. 

Insidious Racism: Microaggressions and Gaslighting

Underlying more easily visible forms of racism are microaggressions, commonplace daily indignities that carry "hostile" or "derogatory" undercurrents toward their target, whether intentional or unintentional.[27] Microaggressions against Asian Americans tend to fall into several categories, which are by no means finite or fully independent of one another. One such category includes assumptions of inferiority, which can include statements or actions indicative of beliefs that all Asian Americans are foreigners, second class citizens, or criminals. Another category is exoticization, as evidenced by several brands, businesses, and caricatures oversexualizing Asian women.[28] Microaggressions additionally tend to ascribe to racial profiling through assumptions of similarity, making generalizations that invalidate interethnic differences (e.g., all Asians look the same; all Asians are intelligent). Other microaggressions can relate more to the environment in which they occur against Asian Americans, such as hostile comments in the workplace or school, as well as avoidance and disdain towards Asian businesses and restaurants.

Such subtle forms of discrimination can be quite insidious; because they often happen quickly (e.g., through offhand comments) and appear innocuous, it becomes difficult to react or even realize that the behavior was distressful and discriminatory.[29] In fact, the microaggression of microinvalidations gives rise to gaslighting, in both self- and societally-inflicted forms. Microinvalidations occur when Asian Americans' shared experiences of cultural friction or discrimination are discounted by others or made to seem like exaggerations–such as being told that they complain about race too much or that people of color do not experience racism anymore. Such sayings render one's experiences illegitimate and even invisible, which can lead Asian Americans to question the validity of their perceptions of reality. Doing so is a form of manipulation, i.e., gaslighting. 

Within-Group Differences

It is important to also remember that Asian Americans are not a monolith, and experiences of discrimination can compound and vary widely based on a person's unique intersection of identities. For Asian American women, anti-Asian hate has been particularly vehement: 74% of Asian American and Pacific Islander women respondents reported experiencing racism and/or discrimination over the past year, with 53% of perpetrators being a stranger, according to the National Asian Pacific American Women's Forum's 2022 State of Safety Report.[30] This number is up from previous years, with over half of women respondents reporting that they feel less safe today than when the pandemic first began and the majority of reports of discrimination being made by women.[31] 

This data additionally comes one year after the 2021 Atlanta spa shootings, where six out of eight murder victims were women of Asian American descent.[32] With the shooter's motivation cited as the "temptation" of massage parlors, Asian American women face a unique experience of hypersexualization and exoticization through the intersection of their gender and cultural identities, which renders them more susceptible to adverse mental health effects. In fact, Asian American women report more negative mental and physical outcomes than men when exposed to a lower threshold of discrimination, demonstrating the greater impact of the discriminations against their compounding identities.[33] 

Different levels of discrimination also exist based on environment. In the workplace, those without college degrees report poorer mental health scores alongside more exoticization and assumptions of similarity, while those with college degrees report more microinvalidations and workplace microaggressions.[34] Degrees are associated with different job experiences, causing different stereotypes–such as exoticism or assumption of intelligence–to become more present. Higher levels of education have also been correlated with greater perception of discrimination, due to a greater level of contact with white people as well as heightened racial awareness.[35] 

In schools, discrimination can often take the form of racial bullying, which has been on the rise with the onset of the pandemic and the spread of racist jokes about who carries the disease.[36] Racism can be particularly harmful for youth, who sit at a critical point in the development of their self-esteem and body image. When phenotypic features of Asians are ridiculed, Asian American young adults have been shown to experience body dissatisfaction and body shame, even after adjusting for controls like body mass index. The association between higher levels of racism and lower levels of self-esteem apply to ostracization as well: xenophobia often leads to exclusion of Asian Americans from social groups and activities in schools, and is shown to increase their self-consciousness, discontent, and shame about their body image.[37] 

The ostracization of Asian Americans in classrooms and workplaces often coincides with being a small minority in a class, which leads to some regional differences in experience of discrimination. In parts of the United States that have fewer Asian Americans, such as the Midwest, higher levels of microaggressions, assumptions of inferiority, exoticization, and assumptions of similarity are reported than on the West Coast.[38] This may be attributed to the fact that both the depth of Asian American history and the actual volume of Asian Americans are much greater on the West Coast than in other areas of the United States. The more familiarity and interactions with Asian Americans there are, the more harmful stereotypes are disproven and replaced with genuine relationships, an idea which could be implemented to help counter xenophobia in other areas of the U.S.[39] 

Ways to Combat Anti-Asian Hate: Culture, Therapy, and Policy

To aid in countering stereotypes, Misra & Le (2020) recommend presenting these generalizations as "unrepresentative or atypical." For example, to disprove the stereotype that individuals who look like they are from China are more likely to spread COVID-19, the media could disseminate images of Asian Americans who actively combat the spread of COVID-19 as frontline medical workers–an intervention that "has shown efficacy for reducing stigma previously."[40] In challenging social norms around race, Canady (2021) also discusses encouraging prosocial and proactive antiracism, which can include education about racial consciousness, advocacy for marginalized groups, and reactive bystander interventions. By confronting hate incidents and supporting victims afterwards, community members can foster a sense of solidarity and ease the pressures of isolation and ostracization associated with xenophobia.

For Asian Americans themselves, community can be particularly important in easing the mental burden of racial discrimination. In fact, research has found that sharing stories about one's racial discrimination experience is a protective factor for long-term traumatic stress in reaction to racial discrimination: about 28% of Asian Americans who experienced racial trauma after a hate incident no longer met criteria for race-based trauma after reporting their experience to Stop AAPI Hate.[41] It follows that it is important to openly discuss and understand the stories and histories of anti-Asian discrimination. Although disclosure can be hampered by cultural values and the minority myth, when Asian Americans are able to disclose their experiences to support groups and therapists, they are able to lift some of the burden of isolation. 

A healthy and supportive relationship with a therapist is then similarly important in navigating racial trauma. To best support Asian American clients, therapists should practice culturally competent therapy and maintain education and awareness on the intersectionality of identities.[42] Traditional Western psychological interventions tend to focus on what individual victims can and should do to combat their reactions racism, rather than "contextualizing individuals' vulnerabilities and reactions to sociocultural and structural disadvantages" in seeking broader ways to rectify the root causes of discrimination.[43] By doing so, they place a burden on individual victims who are already disadvantaged and strained by discrimination that can edge toward invalidating their experiences, gaslighting, and victim blaming. Similarly, therapists sometimes gaslight clients' experiences of racism through labeling seemingly "invisible" microaggressions that cannot be "proven" by a client as the results of being "too sensitive" or "paranoid."[44] Doing so is a microinvalidation itself that can be damaging to both the therapeutic alliance and the wellbeing of Asian American clients, demonstrating the need for therapists to cultivate cultural empathy and participate in education on culturally competent treatment.

Finally, policy interventions have the potential to enact the widespread change that individual and community actions cannot. During the SARS pandemic of 2003, the American Center for Disease Control led an initiative to counter anti-Asian sentiments by monitoring stigma in the public and media while collaborating with Asian American activists to create "culturally tailored" interventions.[45] To address the uptick in anti-Asian hate crimes, the federal government should look to the bigger picture of the long history of anti-Asian violence and enact similar interventions as in 2003. By investing in culturally appropriate mental health services and community-based outreach to the Asian American communities most affected by COVID-19 discrimination, the government can collaborate in cultivating culturally resonant responses that best combat the harm done to Asian American communities.   

Ultimately, whether overt or insidious, historical or current, anti-Asian racism has been extremely detrimental and often traumatic to the mental wellbeing of Asian American communities. In the face of the current pandemic-driven surge in anti-Asian discrimination, it is imperative to learn the history of the Asian American experience, listen to victims' stories, and foster discussion around available mental health resources. By cultivating empathy and standing up against discrimination wherever we see it, we can help build a more supportive, anti-racist, and healthy community.

If you or someone you know has experienced anti-Asian discrimination, you are not alone. You can report anti-Asian discrimination here at https://stopaapihate.org/reportincident/

For further mental health resources and community organizations addressing anti-Asian discrimination, please visit https://stopaapihate.org/resources/

For more information, click here to access an interview with Sociologist Peter J. Stein regarding genocide and discrimination.

Contributed by: Anna Kiesewetter

Editors: Jennifer (Ghahari) Smith, Ph.D. & Brittany Canfield, Psy.D.

References

1 Misra, S., Le, P. D., Goldmann, E., & Yang, L. H. (2020). Psychological impact of anti-Asian stigma due to the COVID-19 pandemic: A call for research, practice, and policy responses. Psychological Trauma: Theory, Research, Practice, and Policy, 12(5), 461–464. https://doi.org/10.1037/tra0000821 
2 Nadal, K. L., Wong, Y., Sriken, J., Griffin, K., & Fujii-Doe, W. (2015). Racial microaggressions and Asian Americans: An exploratory study on within-group differences and mental health. Asian American Journal of Psychology, 6(2), 136–144. https://doi.org/10.1037/a0038058 

3 Cheng, H. L. (2020) "Xenophobia and Racism Against Asian Americans During the COVID-19 Pandemic: Mental Health Implications," Journal of Interdisciplinary Perspectives and Scholarship: Vol. 3, Article 3. https://repository.usfca.edu/jips/vol3/iss1/3 

4 Ibid.

5 Yi, V. (2016, February 9). Model minority myth. The Wiley Blackwell Encyclopedia of Race, Ethnicity, and Nationalism. Retrieved February 22, 2022, from https://www.academia.edu/21743155/Model_Minority_Myth

6 Nadal et al., 2015

7 Ibid.

8 Yi, 2016

9 Misra & Le, 2020

10 Chuvileva, Y. E., Rissing, A., & King, H. B. (2020). From wet markets to Wal-Marts: tracing alimentary xenophobia in the time of COVID-19. Social anthropology: the journal of the European Association of Social Anthropologists = Anthropologie sociale, 10.1111/1469-8676.12840. Advance online publication. https://doi.org/10.1111/1469-8676.12840 

11 Ibid.

12 Misra & Le, 2020

13 Cheng, 2020

14 Misra & Le, 2020

15 Yellow Horse, A. J., Jeung, R., & Matriano, R. (2021, December 31). Stop AAPI Hate National Report. Stop AAPI Hate. Retrieved March 14, 2022, from https://stopaapihate.org/national-report-through-december-31-2021/  

16 Ibid.

17 Cheng, 2020

18 Bloomberg Equality 

19 Canady, V. A. (2021, March 26). Field condemns hate‐fueled attacks of Asian Americans, offers MH supports. Wiley Online Library. Retrieved February 22, 2022, from https://onlinelibrary.wiley.com/doi/10.1002/mhw.32736

20 Ibid. 

21 Misra & Le, 2020

22 Cheng, 2020

23 Nadal et al., 2015

24 Cheng, 2020

25 Ibid.

26 Saw, A., Yellow Horse, A., & Jeung, R. (2021, May 27). Stop AAPI Hate Mental Health Report. Stop AAPI Hate. Retrieved March 16, 2022, from https://stopaapihate.org/mental-health-report/ 

27 Nadal et al., 2015

28 Ibid. 

29 Ibid.

30 Pillai, D. & Lindsey, A. (2022). The State of Safety for Asian American and Pacific Islander Women in the U.S. National Asian Pacific American Women's Forum, Washington, DC. https://www.napawf.org/assets/download/napawf-state-of-safety-report.pdf 

31 Yellow Horse et al., 2021

32 Canady, 2021

33 Nadal et al., 2015

34 Ibid.

35 Ibid. 

36 Cheng, 2020

37 Ibid. 

38 Nadal et al., 2015

39 Misra & Le, 2020

40 Ibid. 

41 Saw et al., 2021

42 Canady, 2021

43 Ibid. 

44 Nadal et al., 2015

45 Misra & Le, 2020