Marginalized Groups & Telework: Transforming Workplace Culture

Covid-19:Working from Home

Three years into the pandemic, the average American’s workday has significantly changed. Remote work, which emerged for many companies as the needed response to the mounting cases of COVID-19, now appears to be here to stay. Pew Research Center found that prior to the pandemic, only 17% of Americans worked from home.[1] But their follow-up study found that by the end of the pandemic’s first year, over 71% of people were engaged in remote work; from 2021 to 2023 these numbers have remained steady and a 2022 study by Phillips noted 74% of surveyed workers expect remote work to endure.[2,3] In particular, marginalized groups are embracing the teleworking boom as minorities face a greater risk of microaggressions, pay gaps, and other forms of discrimination in office environments.

DIFFERENCES BETWEEN DEMOGRAPHICS IN WORKPLACE NAVIGATION

Remote work has created a new consideration: Even if I enjoy my job, do I enjoy being physically there? For the average person, the answer is “No.” Only 21% of White and 3% of Black Americans are interested in returning to the office full-time, favoring a hybrid or full-time remote schedule. Further, Latinx and Asian Americans report experiencing a higher sense of belonging within their work culture when they are able to work hybridly or remotely. In a 2021 survey of 100,000 workers conducted by the Future Forum, results showed that 80% of Black, 78% of Latinx, and 77% of Asian respondents wanted a flexible working experience, either through a hybrid or remote-only model.[4]

Much of the apprehension racial minorities feel towards returning to full-time office culture comes in response to many of the unwritten professional biases that favor White American values and can leave people of color to face discrimination and exclusion.[5] According to the Stanford Social Innovation Review, regardless of industry, American work spaces tend to promote certain cultural norms: speak in standard English, communicate without an accent and with little emotion, and adhere to Western standards of dress such as straight hair and heteronormative clothing.[6] For the straight, White American male, these expectations began in child-rearing and many felt a seamless transition into the workforce. However, rooting professionalism in the dominant Western culture compounds stress for minorities, many of whom find themselves code-switching in daily interactions with peers and at the brunt of frequent verbal or behavioral slights (e.g., “You speak so well” to a person of color, or “You’re very demanding” to a female leader).[7]

Commonly referred to as microinvalidations or microaggressions, these behaviors are aimed at racial, ethnic, and gender-nonconforming minorities; while they may be short-lived and even unintentional, they represent larger implicit biases and in the long-term they impact minorities’ self-image, sense of belonging within a space, physical and mental health.[8] In a study by Hall & Fields (2015) of American Indians, individuals who were victims of microaggressions reported feeling tension, anxiousness and digestive issues such as reflux disease and GI conditions.[9] A study conducted by Torres & Driscoll (2010) found that microaggressions are also extremely disruptive to one’s work: the energy a person expends deciding if comment was a slight against them takes away from other potentially important, work-related tasks.[10]

Remote work, then, can act as a protective barrier from microinvalidations or microaggressions, allowing for marginalized communities to work without the distractions that can be detrimental to both their health and productivity.  

Differences amongst demographics in managerial roles further explain why marginalized groups feel less attached to in-person work. 2021 Census data found that 67% of managers are White Americans; Hispanic, Asian, and Black Americans collectively hold less than 25% of managerial roles and only 10% of managers identify as LGBTQ+.[11] Further, minorities and female employees make up the majority of blue-collar and service jobs, both of which are often highly physical forms of employment that further limit these marginalized groups’ access to remote jobs.[12] With limited managerial roles, women, people of color, and other minorities have less representation in decisions within their companies, and as a result, they often feel less inclined to be physically present in the workspace. 

DIFFERING VIEWS ON TELEWORK AMONG LEADERS 

Nearly seven-in-ten employees (68 percent) said they would rather look for a new job than return to the office, according to a 2023 survey from Clarify Capital (a financial consultancy in New York City that surveyed more than 1,000 remote workers).[13] However, some CEOs and other business leaders of high profile companies have come out with arguments in favor of workers returning to the office. Disney’s Bob Iger, Starbucks’ Howard Schultz, and Goldman Sachs’ David Solomon are a few of the CEOs who spokehave come out in early 2023 requiring workers to spend a dedicated number of weekly hours in the workplace.[14] Cumulatively, their arguments in favor of on-site labor are a call to return to normalcy. Of the challenges COVID-19 has brought senior leadership, managers cite decentralized management, challenges to accountability, and the limitations that come alongside distance collaboration as major impediments to meeting their end-of-year goals.[15]

Conversely, some company leaders are coming forward as advocates for working from home. Facebook’s CEO Mark Zuckerburg explained midway through 2022 that he would spend at least half of his year working from home, attributing his ability to accomplish more on a daily basis and spend more time with his family to remote work.[16] Elsewhere, Twitter, Spotify, and Kaiser Permanente are also embracing remote work for its positive impact on work productivity and employee satisfaction. Working from home is a transformational change that can cause disagreements between employees and managers, but the managers that accommodate and adapt to workers’ needs are already seeing more success in employee retention and satisfaction.[17] 

CHANGING THE WORKSPACE FOR URBAN & RURAL WORKERS THROUGH TELEWORK

Remote work even has the potential to build a sense of community and lessen social isolation in rural communities and regions facing economic decline.[18] Between 10 to 25 percent of adults in rural areas experience anxiety and depression; in addition to limited local access to mental health treatment, the financial burdens of unemployment and limited job market often exacerbate their mental health issues. With the introduction of remote work comes employment opportunities for these individuals, who are no longer limited geographically and require little more than internet access and a space within their home, local library or coffee shop to work. Thus, rural remote workers gain comparable employee benefits to those of their commuting counterparts, but often without the added stressors of a high monthly gasoline bill, wear and tear on their vehicle (or comparable high public transportation costs), an extensive work wardrobe and extended time away from family.

Further, with remote workers remaining in their original communities, their salaries in-turn stimulate the local economy, often creating new jobs and encouraging economic growth. The phenomenon of the growing workforce in rural areas became so popular during the pandemic that it was coined “Zoom towns”, with cities like Moab, Utah and Jackson, Wyoming experiencing record migration and revenue.[19]

Remote work’s positive impact is also felt in the urban employee, whose access to remote jobs also becomes an opportunity to relocate from a heavily congested area, and evade stressors such as pollution, long commutes, and constant stimuli.[20] While racial and ethnic minorities make-up about 43% of the American population, they comprise only 22% of the rural population while 48% inhabit urban regions.[21] City living comes with a variety of mental and physical challenges, exposing its inhabitants to heightened risks of elevated stress levels, respiratory issues, cancer, and depression.[22] In the long term, leaving urban populations has the potential to extend an individual’s lifespan and quality of life, and telework offers a clear route to this healthier lifestyle.

WORK CULTURE IS ADJUSTING, AND FOR THE BETTER

Workplace dynamics provide a window into larger societal issues and are also a key space to identify solutions for these disparities. Embracing remote work is just one example of the opportunity to do so. Addressing the array of experiences workers of different backgrounds face is also a step in the direction of creating organizations that value diversity, equity, and inclusion, and in doing so company leaders prove to marginalized workers that they are valued team members. As society continues to embrace remote work as the new-normal, managers and workers alike will continue to revisit its impact on productivity, eliminating disparities, and building a better work culture.

Contributed by: Kate Campbell

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

References

1 Parker, K., Horowitz, J.M., Minkin,R. How the Corona virus outbreak Has-And Hasn’t- Changed the Way Americans Work. Pew Research Center Website. 2020. https://www.pewresearch.org/social-trends/2020/12/09/how-the-coronavirus-outbreak-has-and-hasnt-changed-the-way-americans-work/. Accessed March 14, 2023.

2 Ibid.

3 Phillips, T. The Ultimate List of Remote Work Statistics. Code Summit Website. 2022. https://codesubmit.io/blog/remote-work-statistics/. Accessed March 21, 2023. 

4 United Nations. (2022). 3rd Meeting, 15th session of the Forum on Minority Issues. United Nations Website. https://media.un.org/en/asset/k1f/k1fx05gdea. Accessed March 17, 2023.

5 Gray, A. The Bias of “Professionalism Standards.” Stanford Social Innovation Review Website. 2019.  https://ssir.org/articles/entry/the_bias_of_professionalism_standards. Accessed March 21, 2023.

6 Ibid. 

7 Ibid.

8 Montoya, E. The Effects of Microaggressions on One’s Health. University of California, Irvine Medicine Website. 2021. https://sites.uci.edu/morningsignout/2021/03/09/the-effects-of-microaggressions-on-ones-health. Accessed March 14, 2023.

9 Hall, J.M., Fields, B.“It’s Killing Us!” Narratives of Black Adults About Microaggression Experiences and Related Health Stress. Global Qualitative Nursing Research. 2015;2. doi:10.1177/2333393615591569

10 Torres L., Driscoll M. W. (2010). Racial microaggressions and psychological functioning among highly achieving African-Americans: A mixed methods approach. Journal of Social and Clinical Psychology, 1074–1099.

11 Hall, J.M., Fields, B.“It’s Killing Us!” Narratives of Black Adults About Microaggression Experiences and Related Health Stress. Global Qualitative Nursing Research. 2015;2. doi:10.1177/2333393615591569

12 Ibid.

13 Mayer, K. Will Employees Quit if They are Forced Back into the Office? SHRM Website. 2023.https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/will-employees-quit-if-they-are-forced-back-into-the-office.aspx. Accessed March 18, 2023.

14 Ugincius, L. Is a return to the office inevitable? Should it be? Virginia Commonwealth University Website. 2023. https://news.vcu.edu/article/2023/01/is-a-return-to-the-office-inevitable-should-it-be

15 Ibid.

16 Stropoli, R. Are We Really More Productive Working from Home? Chicago Booth Review Website. 2021. https://www.chicagobooth.edu/review/are-we-really-more-productive-working-home. Accessed March 20, 2023. 

17 Mayer (2023)

18 Reynolds, B.W. The Mental Health Benefits of Remote and Flexible Work. Mental Health America Website. 2020. https://mhanational.org/blog/mental-health-benefits-remote-and-flexible-work. Accessed March 21, 2023.

19 Potter, L. (2020, October 14). The rise of ‘Zoom Towns’ in the rural west. The University of Utah Magazine.https://magazine.utah.edu/issues/summer-2021/zoom-towns/

20 Hoffman, E. Stress and the City: Is Your City Making You Sick? Life Intelligence Website.  (2020). https://www.lifeintelligence.io/blog/stress-and-the-city-is-your-city-making-you-sick. Accessed March 26, 2023.

21 United States Department of Agriculture. (2020). Racial and Ethnic Minorities made up about 22 percent of the rural population in 2018, compared to 43 percent in urban areas. 

https://www.ers.usda.gov/data-products/chart-gallery/gallery/chart-detail/

22 Hoffman (2020)

Exploring the Recent Rise of Social Anxiety Disorder

The Telltale Signs

An uncomfortable flutter of the heart…sweaty palms…an uneasy turning of the stomach... Although they present with similar symptoms, experiencing anxiety and having an anxiety disorder are two different things. For example, someone might experience a jolt of nervousness when standing in a large, bustling crowd - but not every person who feels that jolt will have social anxiety disorder. While there are a variety of specific differences that set the two conditions apart, one of the main determinants is how frequently and consistently one’s anxiety is experienced. For a person to be diagnosed with social anxiety disorder (SAD), their anxiety surrounding social situations must persist for at least six months and cause them significant distress or impairment; they must also show other qualifying symptoms, such as fear that their behavior will be judged or cause them humiliation, and that social situations are either avoided or endured with great fear.[1] Notably, recent studies have found that the number of people meeting this criteria/who do have social anxiety disorder has been steadily increasing. 

THE RISE OF SOCIAL ANXIETY DISORDER

Not only is social anxiety disorder becoming increasingly common each year, its prevalence is growing fast. Approximately 15 million adults in the United States are diagnosed with social anxiety disorder every year, totaling about 7.1% of the population.[2] As staggering as that number is, it’s likely that the number of individuals afflicted with social anxiety disorder is even higher than the number of those officially diagnosed. While the afore-mentioned statistic only represents adults, social anxiety disorder is actually more common among teens and adolescents. According to the Anxiety and Depression Association of America (2022), in most cases of social anxiety disorder, the individual began experiencing symptoms when they were only around 13 years old.[3] Furthermore, 36% of those who have social anxiety disorder report that they experienced symptoms for ten years or more before seeking help.[4] Combined with the fact that many people never get their social anxiety disorder diagnosed,[5] it’s likely that the number of people with social anxiety disorder is much higher than currently on record.

Jeffries and Ungar (2020) conducted a self-reported study of nearly 7,000 individuals, aged 16-29, across seven countries selected for their cultural and economic diversity: Brazil, China, Indonesia, Russia, Thailand, the United States, and Vietnam. They found that 36% of participants met the threshold for social anxiety disorder.[6] Despite previous research showing the U.S. had a 12% lifetime prevalence rate of SAD in 2005,[7] just fifteen years later Jeffries and Ungar found that participants in the U.S. reported the highest rate of this disorder - nearly 58%. Conversely, participants in Indonesia reported the lowest rates in the study, at 22.9% (which is still remarkable at nearly 1/4 of that cohort).[8] 

It’s necessary to emphasize that Jefferies and Ungar’s study did not only ask participants whether or not they had social anxiety; they were also asked to rank statements describing common thoughts and fears experienced by those with SAD, based on how true the statement was for them. For example, statements participants were asked to rank included:[9]

• “I get nervous if I have to speak with someone in authority.” 

• “I feel tense if I’m alone with just one other person.” 

• “I feel I’ll say something embarrassing when talking.” 

As such, they were not only able to consider the amount of people who recognized themselves as having SAD, but also determine how many people did not consider themselves as having SAD yet still met the benchmarks to qualify. According to their findings, 18% of those interviewed claimed that they did not have SAD, but still exceeded the threshold needed to qualify. This statistic highlights the prevalence of SAD and how people may be experiencing it, but don’t recognize it, or view themselves as someone who does not have it.[10] Possible universal reasons for this situation include: 1) a lack of understanding what SAD is and/or how it presents and 2) cognizance of a perceived lack of societal acceptance of the disorder and subsequent denial of the condition.

WHY IS IT RISING?

There is no simple answer for what’s causing social anxiety disorder to increase in prevalence the way it has been, as dozens of factors are at play. One of the most prominent among these is the rise of social media. Because social media inherently offers us so many methods for connection that don’t require any face-to-face interaction, our over-reliance on it is causing us to become more socially anxious every year.[11] This is especially relevant when it comes to younger generations, who have increasingly liberal access to social media at younger and younger ages. With this shift toward virtual interaction during stages of life where we are developing our social functioning skills and abilities, the growing prevalence of social anxiety disorder in children and adolescents seems to be a natural consequence.

Fischler (2021) notes that another potential contributor to the rise of social anxiety disorder is that, for much of the population, there is less of a pressure for survival than there have been in previous generations. While not true in every case, it is generally (comparatively) easier to access food, water, and other necessities than it has been within the last few generations. Because of this, people’s attention has tended to shift more toward material goods, since there is, at large, less concern about where the essentials will come from.[12] Fischler adds this higher emphasis on material goods, money, and social appearance have a documented link to anxiety and depressive symptoms, and thus can be linked to the increase in SAD.[13]

The recent pandemic has also contributed to the growing prevalence of SAD. Much like the increasing commonality of social media, extended quarantine situations enacted during the pandemic resulted in people either not being able to normally socialize, or having to socialize through technology, such as via Zoom meetings or social media. People have grown accustomed to not having to interact in person; now that the public is starting to open again and business are returning to on-ground work policies, many are struggling to acclimate.[14] This is especially true of children who have, to some degree, grown up in the pandemic, since they had less opportunity to socialize than children in the generations before them.[15] Medina (2021) notes it is expected that young students who are experiencing in-person education for the first time will have much higher levels of anxiety about their schooling than previous generations, mainly because of the increased socialization required.[16]

WHO DOES IT AFFECT?

While there is no one clearly defined profile for the type of person who will develop social anxiety disorder, research has found that certain demographics have a higher likelihood of developing this disorder than others. Jefferies & Ungar (2020) note that those who are unemployed, have lower educational levels, and/or live in rural areas are more-likely to present with SAD. Conversely, the prevalence rates of social anxiety disorder are the lowest in low-income countries, and the highest in high-income countries,[17] despite the fact that it’s more common in individuals who are unemployed and have lower educational levels.

Gender, too, can play a role in the development of social anxiety. Females are more likely to qualify for social anxiety disorder than males[18] and report a higher number of social fears.[19] Further, the ways in which social anxiety manifests are often also affected by gender. Women are more apt to experience social anxiety in a professional setting than men are; they’ll be more likely to be anxious about speaking to authority figures or going through the process of interviews.[20] Men, on the other hand, are more likely to have social anxiety around issues such as dating.[21] There is also a difference in comorbidity based on gender, with men more likely to have comorbid externalizing (observable) disorders, while women are more likely to have comorbid internalizing disorders.[22]

However, possibly the clearest trend in the increase in prevalence of social anxiety disorder is age. On average, younger demographics, such as children and teens, are more likely to meet the benchmark for social anxiety disorder than older adults. Jefferies & Ungar (2020) found that 90% of new cases of social anxiety were reported to have occurred by the time the individual reached 23 years old,[23] with additional contributing factors comprising a higher reliance on the individual’s family unit as well as greater emphasis on peer acceptance.[24]

HOW CAN WE TREAT IT?

In most cases, social anxiety disorder is treated through talk therapy, medication, or a combination of the two. Most commonly, cognitive behavioral therapy (CBT) is used as the primary method of treatment.[25] Through CBT, the individual learns different ways of thinking about the difficulties that they face and find different (generally more productive) ways of behaving and reacting to troubling situations. Although it isn’t a quick-fix solution, CBT is considered to be the most effective treatment option for those with social anxiety disorder. In cases where an individual is prescribed medication to help mitigate symptoms of their social anxiety, they will be in the form of antidepressants, beta blockers, or anti-anxiety medications.[26]

If you are experiencing symptoms of anxiety or social anxiety, please reach out to a licensed mental health professional for guidance and treatment options.

Contributed by: Jordan Rich

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

1 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental 

disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

2 Anxiety and Depression Association of America. (2022, October 28). Anxiety Disorders - Facts and Statistics. https://adaa.org/understanding-anxiety/facts-statistics

3 Ibid.

4 Ibid.

5 Jefferies, P., & Ungar, M. (2020). Social anxiety in young people: A prevalence study in seven countries. PLoS ONE, 15(9), 1–18. https://doi-org.baypath.idm.oclc.org/10.1371/journal.pone.0239133

6 Ibid.

7 Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry, 62(6), 593-602. 

8 Jefferies & Ungar (2020)

9 Ibid.

10 Ibid.

11 Ibid.

12 Fischler, S. (2021). The Rise Of Anxiety Over The Past 100 Years. CBT Baltimore. 

https://www.cbtbaltimore.com/the-rise-of-anxiety-over-the-past-100-years/

13 Ibid.

14 Medina, E. (2021). How Young People’s Social Anxiety Has Worsened in the Pandemic. The New York Times. https://www.nytimes.com/2021/09/27/us/social-anxiety-pandemic.html

15 Ibid.

16 Ibid.

17 Stein, D. J., Lim, C. C. W., Roest, A. M., de Jonge, P., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Benjet, C., Bromet, E. J., Bruffaerts, R., de Girolamo, G., Florescu, S., Gureje, O., Haro, J. M., Harris, M. G., Yanling He, Hinkov, H., Horiguchi, I., Chiyi Hu, & Karam, A. (2017). The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative. BMC Medicine, 15, 1–21. https://doi-org.baypath.idm.oclc.org/10.1186/s12916-017-0889-2

18 Jefferies & Ungar (2020)

19 Asher, M., & Aderka, I. M. (2018). Gender differences in social anxiety disorder. Journal of Clinical Psychology, 74(10), 1730–1741. https://doi-org.baypath.idm.oclc.org/10.1002/jclp.22624

20 Ibid.

21 Ibid.

22 Ibid.

23 Jefferies & Ungar (2020)

24 Ibid.

25 National Institute of Mental Health. (2022). Social Anxiety Disorder: More Than 

Just Shyness. https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness

26 Ibid.

Brain Changes in Autism Spectrum Disorder: Emerging Research & Potential Treatments

Expanding Our Understanding of ASD

Over the past year, new research emerged that deepened the scientific community’s understanding of brain changes in autism spectrum disorder (ASD). In 2018, the National Institute of Health (NIH) estimated that among eight-year-old children in the United States, 1 in 44 are diagnosed with ASD (males 3 to 4 times more likely to be diagnosed than females).[1] Since those with ASD often struggle with ongoing social difficulties throughout life, the latest studies may provide insights and implications for ground-breaking potential treatments.

Study 1: Vocal Prosody

Vocal prosody refers to changes in speech that include volume variations, stress patterns, pauses, intonation, and rhythm.[2] These types of verbal emotional cues are an important aspect of child development, and the inability to pick up on them is considered a prominent component of ASD behavior. There are currently two theories explaining why individuals with ASD have difficulty with verbal cues.[3] The sensory deficit model proposes that the auditory regions of the brain are processing sounds differently when an individual has ASD.[4] A second theory uses social cognition to hypothesize that individuals with autism process auditory sounds normally, but then interpret them differently in the social regions of the brain.[5]

 A recent study conducted by Stanford School of Medicine used MRI brain scans to show that both children with autism and a neurotypical control group used the auditory processing region of the brain when listening to voices– but there were differences in how the signal reached the social region of the brain.[6] This supports the social cognitive approach that the auditory processing in both groups is the same, but that sounds are then interpreted differently by individuals with ASD.[7]

Researchers believe that they may now be able to incorporate this knowledge into techniques for treatment. Dr. Simon Leipold, one of the authors of the study, explains these findings indicate that, “the temporoparietal junction might be a promising brain region to target” when looking at future treatments.[8] For example, it is possible that techniques previously examined by Stanford Medicine to help ASD children recognize facial expressions may now be applied to accurately identifying vocal cues.[9]

Study 2: Changes in the Cerebral Cortex

A study led by UCLA found that brain changes in those diagnosed with autism are more pervasive than previously realized.[10] Gandal et al., (2022) conducted RNA sequencing analysis to evaluate differences in 11 distinct brain regions by matching samples from individuals with idiopathic ASD to neurotypical controls.[11] The researchers found changes in all 11 cortical regions, indicating widespread differences at the molecular level.[12] Until this study, it was previously believed that brain changes in ASD only took place in the specific regions believed to affect language and behavior.[13] 

These comprehensive findings are the result of more than a decade of research which culminated in developing a full analysis of the autistic brain.[14] Further, Gandal et al., determined the largest differences were found in the visual and parietal cortex, which may help explain the sensory hypersensitivity that is often reported by individuals with ASD. Dr. Daniel Geschwind, a professor of Human Genetics, Neurology and Psychiatry at UCLA who authored the study, stated that these findings can now serve as a starting point to develop new pharmaceutical therapies that specifically address these mechanisms.[15]  

Study 3: Neuroinflammation

Neuroinflammation is an immune response that takes place in the central nervous system, and it is believed to be activated by infection, psychological stress, toxins, trauma, aging, and ischemia.[16] Though neuroinflammation does have normal function during the processes of protection and repair, acute or chronic inflammation can result in altered behavior and cognition.[17] A recent study of 1,275 immune genes showed atypical expression patterns that varied by condition in the brains of adults diagnosed with: autism; depression; bipolar disorder; schizophrenia; Parkinson’s disease; and/or Alzheimer’s disease.[18] 

Lead researcher, Dr. Chunyu Liu, explains these expressions are “signatures” for each diagnosis that could potentially be used as markers of inflammation, indicating the immune system may be a “major player” in brain disorders.[19] However, from the current study, it is not possible to tell whether these conditions altered immune activation or whether immune activations contributed to the development of these conditions.[20]

The brains of those diagnosed with autism specifically showed 275 genes with varied expression levels compared to controls, with autistic males presenting more variation than autistic females.[21] This study’s analysis also found that ASD was clustered more closely with the neurological disorders of Alzheimer’s Disease and Parkinson’s Disease than psychiatric conditions such as major depressive disorder, bipolar disorder, or schizophrenia.[22] Chen et al., note these findings indicate that different types of immune-related treatment strategies may be needed for different clusters of diseases.[23]

Study 4: Differences Among Males & Females

There are new indications that autism may shift the brain towards typically male characteristics.[24] To evaluate this question, Floris et al., conducted research predicting the sex of a brain based on brain images and found that the accuracy of sex prediction was higher for autistic males compared to both autistic females and neurotypical males. More accurate predictions were also found in adults than children, indicating these differences may vary throughout developmental stages. Specifically, researchers found that visual and auditory processing areas normally associated with facial and speech recognition indicated a shift towards male brain structure. A comparison of neurotypical and autistic female brains further reinforced this idea, with autistic females showing sensory pathways that are normally seen in neurotypical males. This finding supports sensory-based theories which suggest that early disruptions to motor and sensory processing may lead to some of the social symptoms seen in ASD.[25]

It is also important to note that a similar test conducted on the brains of those diagnosed with attention deficit hyperactivity disorder (ADHD) did not produce the same results.[26] This research by Floris et al., furthers the biological understanding of ASD and creates the groundwork for a deeper understanding of differences in ASD between sexes.[27]

Study 5: Genetic Mutation

A seven-year study conducted by Rutgers University analyzed a gene mutation in ASD known as R451C in the gene Neurologin-3.[28] Prior to this research, studies on the mutation in the synapses of mice indicated there was a causative relationship between the mutation and the pathophysiology of ASD, but it was not clear if these findings could be extended to humans.[29] Wang et al., (2022) conducted this study with the goal of understanding whether the mutation would have a similar effect on the function of synapses in human neurons.[30]

The research team used CRISPR (a unique gene editing technology) to alter the genetic material of human stem cells and derive human neuron cells, which carried the mutation they wanted to analyze.[31] They then implanted human cells both with and without the mutation into the brains of mice to compare the results.[32] Evidence from their research showed a burst of electrical activity (indicating an overstimulation) in the mutated genes which was more than double what was observed in the non-mutated cells.[33] The results were consistent with earlier hypotheses and indicate there may be a physiological path between increased excitatory synaptic activity and the development of ASD.[34] Senior author of this study, Dr. Zhiping Pang, hopes that the unique techniques developed to perform this experiment will be used by future researchers to not only conduct further studies on mental disorders, but also potentially develop new therapeutics.[35]

Study 6: Phelan-McDermid Syndrome

A team of researchers at Northwestern University Feinberg School of Medicine, led by Dr. Peter Penzes, developed a new therapy to treat a subtype of ASD, known as Phelan-McDermid syndrome (PMS). PMS, a rare genetic condition, is known to be caused by a specific mutation within the SHANK3 gene that is characterized by epilepsy, global developmental delay, and absent or delayed speech.[36,37]

Rohman (2022) notes the team developed a derivative of an insulin-like growth factor-binding protein (IGFBP2) that was previously shown to improve cognitive functions and neuroplasticity.[38] Researchers administered the derived peptide (JB2) to mice with similar mutations and evaluated the results with brain imaging.[39] The treatment showed improvement in ultrasonic vocalization, learning, memory, synaptic function and plasticity, and motor functions in addition to normalizing seizure susceptibility and neuronal excitability.[40] Dr. Penzes believes this study may lead to a pediatric treatment that could be used to address symptoms while the brain is developing, though acknowledges it is difficult to get revolutionary types of treatment approved.[41]

The afore-mentioned studies conducted over the past year illustrate significant gains in the scientific understanding of ASD. As technologies such as CRISPR become more commonplace, the potential exists to develop new biomarkers to diagnose ASD and develop novel treatments that can intervene early in the process of development by addressing the root cause of symptoms. These studies serve to clarify our understanding of the unique needs of individuals with autism and provide hope for families in the future.

Contributed by: Theresa Nair

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

REFERENCES

1 Autism spectrum disorder (ASD). National Institute of Mental Health (NIMH) Web site. https://www.nimh.nih.gov/health/statistics/autism-spectrum-disorder-asd. Updated 2022. Accessed Feb 4, 2023.

2 Meredith A. Prosody and articulation. Apraxia Kids Web site. https://www.apraxia-kids.org/apraxia_kids_library/prosody-and-articulation/. Accessed Feb 4, 2023.

3 Leipold S, Abrams DA, Karraker S, Phillips JM, Menon V. Aberrant emotional prosody circuitry predicts social communication impairments in children with autism. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. 2022. https://www.sciencedirect.com/science/article/pii/S2451902222002452. doi: 10.1016/j.bpsc.2022.09.016.

4 Digitale E. Brain wiring explains why autism hinders grasp of vocal emotion, says stanford medicine study. News Center Web site. http://med.stanford.edu/news/all-news/2023/01/brain-autism-speech-emotion.html. Updated 2023. Accessed Jan 20, 2023.

5 Digitale (2023)

6 Ibid.

7 Leipold et al. (2022)

8 Digitale (2023)

9 Ibid.

10 Brain changes in autism are far more sweeping than previously known, study finds: The study is the most comprehensive effort yet to study how autism affects the brain at the molecular level -- ScienceDaily. Science Daily. 2022. https://www.sciencedaily.com/releases/2022/11/221102123603.htm. Accessed Jan 17, 2023.

11 Gandal MJ, Haney JR, Wamsley B, et al. Broad transcriptomic dysregulation occurs across the cerebral cortex in ASD. Nature. 2022;611(7936):532-539. https://www.nature.com/articles/s41586-022-05377-7. Accessed Jan 18, 2023. doi: 10.1038/s41586-022-05377-7.

12 SD (2022)

13 Ibid.

14 Ibid.

15 Ibid.

16 Chen Y, Dai J, Tang L, et al. Neuroimmune transcriptome changes in patient brains of psychiatric and neurological disorders. Mol Psychiatry. 2022. doi: 10.1038/s41380-022-01854-7.

17 Ibid.

18 Dattaro L. Immunity-linked genes expressed differently in brains of autistic people. Spectrum | Autism Research News Web site. https://www.spectrumnews.org/news/immunity-linked-genes-expressed-differently-in-brains-of-autistic-people/. Updated 2023. Accessed Jan 21, 2023.

19 Ibid.

20 Ibid.

21 Ibid.

22 Chen et al. (2022)

23 Ibid.

24 Hernandez L. Sex-differential neuroanatomy in autism: A shift toward male-characteristic brain structure | american journal of psychiatry. . 2023. https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.20220939. Accessed Jan 20, 2023.

25 Ibid.

26 Ibid.

27 Ibid.

28 MacPherson K. Gene mutation leading to autism found to overstimulate brain cells. Rutgers | The State University of New Jersey Web site. https://www.rutgers.edu/news/gene-mutation-leading-autism-found-overstimulate-brain-cells. Updated 2022. Accessed Jan 29, 2023.

29 Wang L, Mirabella VR, Dai R, et al. Analyses of the autism-associated neuroligin-3 R451C mutation in human neurons reveal a gain-of-function synaptic mechanism. Mol Psychiatry. 2022:1-16. https://www.nature.com/articles/s41380-022-01834-x. Accessed Jan 29, 2023. doi: 10.1038/s41380-022-01834-x.

30 Ibid.

31 MacPherson (2022)

32 Ibid.

33 Ibid.

34 Wang et al. (2022)

35 MacPherson (2022)

36 Rohman M. Northwestern investigators develop new therapy for autism subtype. Northwestern Medicine News Center Web site. https://news.feinberg.northwestern.edu/2022/12/26/northwestern-investigators-develop-new-therapy-for-autism-subtype/. Updated 2022. Accessed Jan 21, 2023.

37 Burgdorf JS, Yoon S, Dos Santos M, Lammert CR, Moskal JR, Penzes P. An IGFBP2-derived peptide promotes neuroplasticity and rescues deficits in a mouse model of phelan-McDermid syndrome. Mol Psychiatry. 2022:1-11. https://www.nature.com/articles/s41380-022-01904-0. Accessed Jan 25, 2023. doi: 10.1038/s41380-022-01904-0.

38 Rohman (2022)

39 Ibid.

40 Burgdorf et al. (2022)

41 Rohman (2022)

Perceptions of Play: A Theoretical/Qualitative Discussion on the Necessity and Manifestations of Play

Introductory Op-Ed

Something that I have noticed as I have moved through adult and clinical spaces is that adults do not play, nor is it prioritized as an important part of our lives. Play in adulthood is a concept that is worth exploring, especially as it relates to increasing levels of burnout in working adults. For an extremely burnt-out generation of adults, there needs to be a remedy that both alleviates the effects of burnout and safeguards against future instability. Play is an activity that, from a clinical standpoint, reduces stress levels in the body and correlates to better qualities of life. From a social and more philosophical standpoint, play is a connective event that guides a person to see the imaginative possibilities in front of them. Imagination, joy, and hope are all parts of ourselves that play bolsters. My question concerning play is one that comes from the belief that joy is healing and that such joy is in of itself revolutionary. Drawing from Ross Gay’s exploration into daily joy in The Book of Delights and bell hooks’ analysis of love as both a salve and deconstructive tool in All About Love, I ask, what does prioritizing joy through the tangible act of playing look like? What does play give us access to? Rather than making the burden of understanding and identifying play’s potentials a solely individual responsibility to discover and figure out, I wanted to see what clinicians themselves had to say on the matter. With the perspective that therapy and healing are communal events that draw from the experiences of both client and clinician alike, it is important to me to consider this specific perspective.

METHODology

I conducted an online survey announced through therapist groups on social media, with a series of questions asking respondents to reflect on play in their personal lives as well as in their clinical practices. The phrasing of these questions were intentionally open-ended so that participants were free to interpret play as it relates to them. Conducting a survey on play in an open-ended and non-defined inquiry method allowed me access to experiences and theories I would have otherwise been completely blind to. Allowing the definition of what “play” itself signifies to remain undefined or asking people to reflect and report on their experience of play in their own lives without scales were decisions I made intentionally, for the act of taking this survey might be itself an exercise in play. Were I to delineate any specific mode in which I was imagining play, the lush horizon of what a participant could consider as play would be harshly limited. Keeping in mind the critiques of clinical analysis that stem from a critique of rigidity and inaccessibility, this survey was in of itself an exercise in playing with inquiry that opened the space for stories and anecdotes from playing clinicians. 

I asked clinicians working in Seattle to take time and reflect on their experience of play inside and outside of their clinical rooms. I created a survey split into two sections (personal and clinical), asking participants to describe what play looks like and what they notice happens as a result of play in these realms of experience. In the first section regarding play in a participant’s personal life, I asked them to self-report on how much they felt they currently played on a scale from 1 (none at all) to 10 (multiple times a day), and then I asked them to describe a specific time they remembered playing. I asked similar questions in the clinical section, inquiring into whether participants felt they tried to incorporate play into their sessions and what a specific moment looked like. I received a total of eight responses, and will use selected quotations from those submissions below.

Data/Discussion

Play in Clinicians’ Personal Spheres

After asking people to think about how much they felt they played in their personal lives with the intention of opening the door to deeply thinking about play, I asked people to tell me about what play looks like to them and about a specific memory. While some people were pretty succinct in their answers, they gave glimpses into a variety of playful moments. One person responded with a small list of their playful acts: “Writing, cooking, baking, skipping.” Compared to other responses, this answer is considerably shorter and simpler. Skipping itself is not a game that has rules or a form of play that comes with a set of expectations or goals; rather, skipping is fundamentally about movement. The whole “goal” of skipping is to play with movement itself and to do so with joy. Had I defined play and presented this participant with any single conception, this person may not have even given themselves room to consider skipping as a consideration nor would I have been able to experience the joy of knowing this person skips.

Play in the simple and lived present was a theme I noted throughout reading these responses, as others too noticed that the play in their lives existed in moments of movement and spontaneity. One person recalled a memory of their morning walk in which they passed by a jungle gym and ultimately played on it. “It was fast and definitely made me woozy,” they said after remarking on the type of equipment they played on. Another admitted that play is difficult for them, saying “I don’t always think of what I do as play. Last week, I called a friend to meet me for an impromptu walk. She has a 4-year-old who joined us. We played while we walked around the park.” This person did not specify what form this play in the park took, just that it occurred while in motion and with others. The simplicity of this memory leaves a lot for us to imagine, but it is not hard to envision the spontaneity a child can bring to something as normal as a walk in the park. In all three of these responses, these participants seem to happen upon play, or rather, play happened upon them. Within moments in which they were least expecting it and most likely not searching for play, they found something within themselves and their environments that inspired an excursion, a diversion from the norm, an adventure! 

One other theme running through many responses was the centrality of community and relationship in peoples’ recollection of play. One such respondent described their conception of play with an anecdote about a moment between themselves and their partner:

“Being silly or spontaneous or creative. I love to surprise (but not scare) a laugh out of people, or support healing with humor.

More specifically? I had a break at work so I bought my wife something special for lunch, brought it home (she works from home), and arranged it on the kitchen counter for her to find on her lunch break 15 minutes later.”

For this person, play takes the form of a connective moment between themselves and their wife, one that does not necessarily involve a specific game or script but purely the element of kind surprise. What makes this moment playful is the irony of one person knowing something another does not and using fun to connect, which is not something we often think of when we try to define play. This anecdote may stand as an example of how the action of being in community with others may be an act of play all by itself, for it is through our interactions with others that we somewhat step out of our hard shells. Many others noted that their play involved other people in their lives, whether that be children/family or friends, and I am keen to make note of the way in which other people bring about or make up the space for play in our lives. One person said play looks like “being silly with [their] cat and partner” or “playing games with online friends,” leaving up to our interpretation what “silly” means or what constitutes these games. Another participant described play in a few words, saying “goofing around with my son this morning.” One simply just responded, “with my infant and toddler…” without a description of what occurred between them and their children. For these people, their connection to another person (or being, in the case of pets) was enough to encapsulate what play meant to them, so much so that they did not feel the need to go into any specifics. Instead, they seemed to say, here we were together, we did something together, and what we did brought me joy. For these participants, play takes on the form of connection, of quality time, of loving another person. Play is not necessarily a highly individualized and independent action; it may even be inherently social. 

A final and somewhat unexpected theme was the percentage of responses that included something along the lines of table-top roleplay games (TTRPGs) like Dungeons & Dragons (DnD) or video games. In their answer, one participant simply named such games as “imagination play” while two others specifically named DnD, the increasingly popular tabletop roleplay game. Two responses mentioned some form of online or video games, and one named general board games as part of their play as well. To play in such a way requires immense imaginative capabilities, as this type of play asks the player to purely be in an entirely different manner. In taking on the character of a being existing in an entirely different realm than our own, these people begin to fully embody the play itself. Especially for those players who, when playing, use accents or cultural habits different to their own, such imaginative play asks a player to step completely outside of themselves and into someone new.

After asking people to recall a moment of play in their personal lives, I asked people if they noticed any changes in themselves as a result. Specifically, I asked participants, “did you notice any changes in yourself, emotional or physical, as a result of this play?” A few people recalled feeling lighter and “[getting] outside of [their] brain for a bit” as a result of play, while others specifically recorded feeling recharged in some way. The feeling of being weighed down or even held down is common for those experiencing intense stress or struggling with their mental health. From this place, future plans even as far as the next step feel burdened and impossible. For these participants, play acted as a way of revitalizing, a way of re-accessing energy and life to move through the next moments with renewed energy or outlooks. Other responses noted the feeling of being happier, of smiling, of feeling “a bit more ‘fun’ inside” when they played. Two answers touched on the joy of slowing down, of becoming “less rigid and goal-oriented, less linear” after their moments of play. As adults, we are sometimes asked to choose between what is practical and what makes us happy. In some cases, someone may not even have a choice but must do what will best support themselves or their communities. Play may be antithetical to a world that forces people to sacrifice joy for survival by letting joy exist even in the smallest moments. We may not have the answer to creating an entirely new world in which people do not have to choose surviving over thriving yet, but play may bring us to a place where imagining such a world is more possible.

Play in Clinicians’ Professional Spheres

After asking people to recall play in their personal lives, I specifically shifted the conversation towards play in participants’ clinical lives, starting with simply asking participants if they intentionally try to incorporate play into their therapeutic sessions. The majority of clinicians reported yes, they do try to intentionally play in their therapeutic spaces, although what form this play takes varies. A couple respondents reported that they integrated play into the general organization of the session itself, rather than as a distinct event. One respondent said, “I like to take the formality (not professionalism) out of therapy, so my office is about getting comfy,” and described the ways in which they try to invite their clients to play with environmental tools. In these instances, play becomes a way of inherently experiencing the therapeutic space as a playful and familiar space, so that the space itself becomes a source of comfort. A few respondents also reported that they aim to intertwine humor into their conversations with clients, both for themselves and for their clients’ sakes. One respondent said they preferred “using humor to address uncomfortable topics” with their clients and making assignments “playful” in what feels to be an effort to make the therapeutic conversation more accessible. Another person said, “I love to laugh with clients” and that if they can laugh with their clients about anything, then “that feels playful,” while another clinician mentioned “gently teasing clients and being open to being teased.” In these sessions, humor becomes an invitation into the therapeutic space as well as a processing tool that encourages both clinician and client to engage with the subject of the session in a playful manner.

A few people described play in their sessions as some distinct form of creative or artistic event offered to their client. For these clinicians, the play they brought in was a separate activity for their clients to do alongside therapeutic conversation. One such activity was “creating and decorating a worry box” for one clinician. For the clinician who reported that they try to make their space a source of comfort, they gave the following example:

“My client let me teach them how to make a string bracelet (like what some people call a friendship bracelet). We spent a lot of session just working on it back and forth together.”

This playful activity acts as a bridge between client and clinician and helped make the clinician a source of comfort for the client as well. Play in this instance took the form of connection and bonding, so that the very tie between client and clinician was filled with play. One clinician who reported being trained in therapeutically applied TTRPGs said that they incorporate games and other forms of play therapy into their sessions.

While most clinicians who responded to this survey were able to pinpoint and describe some form of play in their practice, one person responded saying they do not intentionally bring play into their sessions as they “don’t have the training to feel comfortable with play.” It is intriguing to classify play as something that necessitates training, which implies a level of standardized rigor or structure. This is not to say that there are no unhealthy forms of play and every form of play in a clinical space is beneficial, however the concept of play as a specific modality raises a question about how we define play. Perhaps the definition of play in certain clinical spaces is too narrow, and this conception of play makes playing in the clinical space unachievable for these clinicians. Considering that this response included the notion of comfort in playing, it is interesting to think about what makes a clinician uncomfortable or lack confidence in bringing play into their sessions. When we view play as an act or event, which is therefore something that can be practiced or developed, a lack of confidence here may point to an underlying lack of support for the development of play in clinical development. To be clear, this is not a negative reflection on these clinicians, but more a critical inquiry into clinical definitions of play.

At this point, I asked clinicians to similarly reflect on whether they noticed any changes in their clients as a result of this play. Many of the responses stated that clients generally felt “more open” and “more engaged” after play as though play took the form of a respite or reinvigoration in the midst of hard work. In these sessions, play became a source of energy with which to continue the conversation or to explore concepts more deeply. For the clinician who described the playful act of making friendship bracelets with their client, they mused that play “helped [clients] build trust in [them]” as clients felt more able to “be clumsy” and then “get better” at something with their clinician. This clinician even noted that “they felt really proud to wear the bracelet” after making them. For this clinician and their client, play acted not only as a healing activity but a prerequisite to healing conversation, without which this clinician may not have been able to connect and work with their client at the level needed. In almost every response to this question, clinicians reported some kind of reinforced and bolstered connection between themselves and their client or between their client and the healing work.

After reflecting on any changes they may have observed in their clients, I asked clinicians to reflect specifically on changes they may have noticed in themselves as a result of play in their clinical spaces. These responses described similar observations to those of the changes observed in their clients, as a few clinicians responded saying they felt a reprieve from the heaviness of session, ranging from responses saying play made the session “feel less heavy” to being “emotionally rewarding” for the clinician themselves. These responses give us an insight to the emotional weight held by the clinicians when endeavoring to work with clients and encourages us not to forget that healing work is a two-way street and one that requires full engagement from both client and clinician. Play, then, is not only important for the health of the client but also for the wellbeing of the clinician, on which a lot of responsibility rests. Additionally, play may act as a cathartic release within the clinical space itself, such that clears the air between clinician and client and allows them to genuinely meet. Another main theme running through the responses to this question revolved around connection and trust between the clinician and their client. One respondent answered this question by saying that play “took some of the pressure off [them] to ‘build trust’” with their client. Another responded by saying that play in session “helps [them] relate as people” to their clients. Play in these moments became a way of humanizing the clinicians for their clients, enabling them to be accessible and comforting sources of healing for these clients. One clinician simply stated that playing in session made them feel like they and their client “are on the same level when we play.” For therapeutic work, which may often seem daunting or cold to clients, play is not only a tool for healing but also a tool for making space for healing. 

Conclusions

It may sometimes be easier to sit behind the curtain and expound on what play could mean theoretically for us, but to think on play purely from a theoretical perspective blocks us off from play itself. To think about play, to imagine what play is, to remember and keep play alive in our lives - these are all ways of playing as well. I asked people to recall a memory of play to open their minds back up to a moment in which play was fully available and accessible. I asked them to tell me about this memory to make the play stronger by bringing another person into it, by allowing it to live in another moment. It is important to ask ourselves to come back down to the ground and think about play from a truly practical and tangible perspective, because then we can see how available play is to us. 

The themes running throughout these responses are not themes wholly devoid from our lives: spontaneity, curiosity, connection, love. They may be harder to reach or make room for in our highly structured and regulated lives, but they are not extinct. If we can recognize that the fundamental building blocks of play can be things as basic as spontaneity or love, we can find an entire world of play at our fingertips. One participant perfectly encapsulated this in their response to the question about whether play changed anything inside of them. They simply responded, “I’m not sure. This is just how I am! :)” In the entirety of this survey, no answer made me pause as long as this one did, nor did any one make me smile as hard. It is not difficult to imagine that this respondent smiled as they wrote this, and my own smile mirrors theirs while reading it. In their answer, they embody being playful, they embody the experience of living in the moment, of connecting, of caring. his person may be able to see play in more moments when they hold the components for play in themselves at any given moment. One other response from a clinician seems especially poignant in this final reflection, as they said “I believe play looks and feels different for each person. It also evolves as they find healing.” Play is not something stagnant and monolithic but vibrantly human and something that is constantly shifting. With this response, the question stops being “how do we play?” but perhaps morphs into something closer to “how do we stay playful?”

Contributed by: Neha Hazra

Editors: Jennifer (Ghahari) Smith, Ph.D. and Jerome Veith, Ph.D.

---

Appenix

* The following survey was referenced in the article above:

Clinicians & Play Survey Questionnaire

This survey invites you to elaborate on what role play holds in your personal life and clinical work. It is part of a larger project inquiring into play as an avenue for healing in adults. The survey is not based in a specific definition of play, so you are encouraged to respond according to your own resonances. For this reason, your descriptions in qualitative portions will be especially useful. If a question does not apply to you, please indicate this. There will be two sets of questions, each with its own area of focus.

Play in Personal Life:

1. On a scale from 1 (none at all) to 10 (multiple times a day/every day), rate how much you feel you play currently in your own life.

2. What does play look like in your life? Describe a time you can remember playing recently.

3. Did you notice any changes in yourself, emotional or physical, as a result of this play?

Play in Clinical Life:

4. Do you intentionally try to incorporate some form of play into your therapeutic sessions?

• Yes

• No

• I’m not sure

5. What does play look like in your practice? Describe a time you can remember playing during a session.

6. Did you notice any changes in your client, emotional or physical, as a result of this play?

7. Did you notice any changes in yourself, emotional or physical, as a result of this play?

8. If any, what modalities do you primarily work in?

Revamping the Conversation on Love Languages

“What’s your love language?” is a Pigeonhole

As a quick and simple way to try and glean compatibility or greater understanding of another, it has become trendy to ask people the question, “What’s your love language?” In order to talk about love languages in a way that builds deeper connection and understanding, the question we should really be asking is “Which love languages do you speak and what is your favorite to communicate in?” Investigating the interactive patterns we fall into as a society allows us to identify areas in which we can strengthen the quality of our relationships and our overall health and well-being.[1-3]

The love languages so ubiquitously recognized today were introduced in 1992 by a Southern Baptist Pastor, Gary Chapman, who wrote mostly for an audience of married Christian couples. What has been lost from Chapman’s original texts as his book rose to widespread fame, is his urging toward learning to communicate in other people’s love languages.[4]

There are several issues with the way in which people broach the contemporary conversation about love languages, starting with the oversimplicity of the well-known question: “What’s your love language?” People often feel compelled to answer with one-- maybe two-- of the five options:[5] 

• Quality time 

• Acts of service 

• Physical touch 

• Words of affirmation 

• Gift giving  

As a result of having to identify one singular language, their significant others may begin expressing affection in one singular way; a pigeonhole effect emerges and context is no longer considered. This is a loss because the way in which we communicate and behave is always impacted by our context; so, the way in which we each want to receive love probably shifts depending on circumstances, too.

A Tangent on Gift Giving

Of the five popularized love languages, it’s often most unpopular to say that one’s love language is gift giving-- it can sound shallow, frivolous, and meaningless. In actuality, gift giving is as legitimate and communicative a love language as any other. Gift giving does not have to mean your loved ones are running out to buy you a new watch or the latest iPhone, slapping a bow on it, and declaring your need for love fulfilled. Gift giving can look like your mom going grocery shopping, stumbling upon a new item that has candied almonds-- your favorite-- and buying them because she’s excited to make your day better. It can look like your roommate remembering that you mentioned you needed new sheets and then ordering them for you in your favorite color because they know you’re too stressed to deal with that yourself right now. And, it could be your partner picking up the latest iphone, putting a bow on it, and giving it to you because your current phone battery doesn’t last more than two hours. 

Gift giving can be incredibly thoughtful, nurturing, connecting, and kind. It shows that you’re alive in people’s minds and hearts even when you’re not physically together; it shows that they were thinking of you and wanted you to feel their care, so they bought something to symbolize their desire for your happiness and wellbeing. Shankar Vedantam, the host of the Hidden Brain podcast, interviewed Jeff Galak (a Professor of Marketing at Carnegie Mellon University) about the secret of gift giving. Galak shared that he and his wife have kept an ongoing google doc for 12 years with items they’d like to one day receive or acquire. With this list, they eliminate the guessing inherent in much of our gift giving norms and are empowered to reliably purchase gifts for each other with complete certainty it will make the other happy. Galak reports success with this method, as neither joy nor surprise are extinguished as a consequence to explicitly recording what they want.[6]

The Multiplicity of Expression

Some people do not find it comforting to have a hand on their back when feeling sad. They may also find it irritating or unpleasant to hug others. That’s okay. Physical touch is generally not how they like to receive or show care. Some people have an extremely difficult time accepting compliments or do not feel supported by verbal validation. Words of affirmation probably tend to fall flat for them. Some people find that the bedrock of a good relationship is to have time together where both parties are fully present and undistracted by screens (i.e., quality time)… and also need physical touch and acts of service to feel seen and cared for. For many, there isn’t as clear a distinction between the categories as their different labels might imply. As an example, some people might define quality time as time spent cuddling or touching. Some of the languages might overlap or be part and parcel of each other. 

There also exist people who feel comfortable and capable of communicating love in any and all of the five Chapman ways. The manner in which they choose to express themselves on a given day or in a given moment can depend on their mood, energy levels, financial situation, and who they are with. To ask a person, “What is your love language?” is to force that person to place the five options into a hierarchical ranking that fails to capture the complexity of the ways that person likes to receive and spread love. The question compels someone to have to select a single method of expressing love (out of an actual multitude of nuanced ways) above the rest. By having to whittle away the rich and important aspects of communicating love in order to give the questioner an extremely digestible response, with which they are likely using to simply sprinkle more of into the relationship, all of the depth and potential for greater understanding of one another is lost. 

A Richer Conversation

Therefore, it is extremely limiting to ask someone to identify their one love language. Due to the fact that there are people who are versed in multiple languages and find joy in some, most, or all of the five (however that looks for them), more illuminating and exploratory avenues of conversation would be:

• The languages expressed around them growing up; what languages did they learn from their parents/ caregivers?

• Which situations do they prefer an emphasis on one language over another? 

• Which languages, if any, they struggle to feel safe or seen in; do any just never resonate?

• Which languages, if any, do they want to learn or are trying to become more fluent in?

• Which ones they like to receive more than give, or give more than receive (potential follow up question: how did that unidirectionality come to be?)

The Question About Love Languages Is Merely a Starting Point

While it makes sense that people would assume utility in the love language question as a concrete determinant of compatibility, research findings have been mixed. Ashley Fetters, a former staff writer at The Atlantic, explains that “If you sit down and read Chapman’s book, it’s clear that the love language you’re meant to think about isn’t your own, but your partner’s.”[7] The rushed way in which people discuss love languages today reflects an intention to find a partner with the same language, or at least to find someone willing to communicate in their preferred ones. We have lost sight of Chapman’s mission in having this conversation-- which was to learn how to express love in the language of the other-- in order to expedite the process of assessing compatibility. One study that tested the hypothesis that couples with the same love language would report higher relationship satisfaction found that self-regulatory behaviors had a greater impact on relationship satisfaction than having aligned languages.[8]

The ambiguity of the five terms also typically goes un-probed and assumed; what does “quality time” or “words of affirmation” even mean, if not explicated on an individual and personal level? By accepting an interlocutor’s answer at face value, one is projecting their own definition of those phrases onto the other, without learning what it means to them. A simple remedy for that is to ask the follow up question: What does that mean to you?/ What does that look like for you? Asking another about love language(s) is useful as a starting point, rather than as a conclusion. 

The various styles in which we crave tenderness also begs a bigger conversation about the importance of relying on community for love and support, rather than just one’s primary partner. It can be burdensome, unrealistic, and unsustainable to expect one’s romantic partner to fulfill all of one’s needs. Love languages are relevant not just to the romantic realm, but the platonic and familial realms as well. Communication and expression are requisite for building and maintaining strong relationships while nurturing good mental health. The ways in which we give and receive love impact all relationships, and therefore are worthy of consideration in a much more expanded and thoughtful sense than society currently does.

Contributed by: Maya Hsu

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

REFERENCES

1 Canavello, A. & Crocker, J. (2010). Creating good relationships: Responsiveness, Relationship Quality, and Interpersonal Goals. Journal of personality and social psychology, 99(1), 78-106. https://doi.org/10.1037/a0018186

2 Downs, V. C. & Javidi, M. (2009). Linking communication motives to loneliness in the lives of older adults: An empirical test of interpersonal needs and gratifications. Journal of Applied Communication Research 18(1), 32-48. https://doi.org/10.1080/00909889009360313

3 Yanguas, J., Pinazo-Henandis, S., & Tarazona-Santabalbina, F. J. (2018). The complexity of loneliness. Acta bio-medica: Atenei Parmensis, 89(2), 302-314. https://doi.org/10.23750/abm.v89i2.7404

4 Fetter, A. (2017). It isn’t about your love language; it’s about your partner’s. The Atlantic, https://www.theatlantic.com/family/archive/2019/10/how-the-five-love-languages-gets-misinterpreted/600283/

5 Chapman, G. D. (1995). The five love languages: How to express heartfelt commitment to your mate. Northfield Publishing. 

6 Vedantam, S. (Host). (2022). The secret to gift giving [Audio podcast episode]. In Hidden Brain. NPR. https://hiddenbrain.org/podcast/the-secret-to-gift-giving/

7 Fetter, A. (2017)

8 Bunt, S. & Hazelwood, Z. J. (2017). Walking the walk, talking the talk: Love languages, self-regulation, and relationship satisfaction. Personal Relationships 24(2), 280-290. https://doi.org/10.1111/pere.12182 

Expression Over Suppression: Why We Need Emotions

It’s More Than Just Feels 

Ancient schools of thought propagated by various philosophers, such as Plato, the Stoics, and the Puritans, have suggested for thousands of years that emotions are irrational, primal, and potentially even destructive.[1] However, newer research suggests that this is not the case— in fact, it suggests the opposite. Emotions have been found to play many vital roles in the human experience, from increasing chances of survival in ancient times to helping us connect with each other in the modern day.[2,3] Emotions guide our decisions, actions, relationships, and friendships. They provide roadmaps to help navigate the complexities of human challenges, the ones that exist within the self as well as those impacting society as a whole. In these ways, emotions act as key components of not only our social lives, but also our internal lives, through building our identities and moral judgments.[4]

Unfortunately, despite the important role emotions play in various aspects of our lives, many societies seem to favor the suppression rather than expression of emotions— Western, individualistic cultures tend to suppress negative emotions in an attempt to maximize positive emotions while collectivist cultures, such as that of many Asian countries, tend to suppress both positive and negative emotions.[5,6] This suppression stems from beliefs that emotions are unnecessary byproducts of life, the result of individual choices, or spawns of irrationality.[7-9] However, emotional suppression is neither effective nor helpful to us— and a greater emphasis needs to be placed on the idea that emotions are vital, unavoidable, and important to guiding the human experience.[10,11]

Functions of Emotions

Evolutionary Functions: 

Basic emotions, such as anger and sadness, have historically helped our ancestors increase their chances of survival by resulting in adaptive behavior that help subvert specific evolutionary issues (e.g., fear motivates escaping behaviors in the face of danger).[12,13] Although times have changed significantly since then, the overarching themes of emotion-eliciting stimuli have remained the same (e.g., sadness is caused by suffering a loss, while anger is caused by perceived injustice).[14,15] Additionally, these basic emotions remain consistent in their expression across cultures.[16] This universality that transcends both space and time highlights the importance of emotions in solving dilemmas that arise in every person's life.[17] 

Social Functions:

Emotions help with both the creation and maintenance of various interpersonal relationships— such as intimate, platonic, and filial relationships. Towards the beginning of interpersonal relationships, emotions help determine the nature of the relationship being established: for instance, feelings of sympathy and love may drive parents to adopt the role of caregivers. Additionally, interacting with specific people results in specific emotional responses based on the nature of the relationship: for instance, seeing a friend may evoke joy while seeing an authoritative figure may evoke fear. This specific emotional response that occurs upon meeting a certain person acts as a maintenance mechanism for the established relationship.[18] 

Emotions also help us communicate with others through expression, whether it be vocal, tactile, or facial displays. Emotions provide others with information not only about one’s current affect, but also their intentions and perspectives. Emotional expressions also help trigger certain responses from others (e.g., tears trigger concern and caregiving, which can help bond people together).[19]

Lastly, emotions determine and impact group dynamics, for both intra-and inter-group relations. Within groups, positive emotions promote a sense of belonging and create stronger, tight-knit bonds between members.[20,21] Between different groups, negative emotions such as anger and disgust can act as catalysts of inter-group conflict.[22]

Intrapersonal Functions:

Emotions guide vital and interconnected aspects of ourselves, such as our actions, memories, personalities, and moralities. In human life, wherein most situations lack the scope for objective, calculated rationality, emotions allow us to still respond appropriately by promoting quick, intuitive action. Additionally, emotions guide what we pay attention to and what we remember, thus impacting the way in which we perceive the world. In this way, emotions guide the creation of our intuitions and beliefs about right and wrong, as well as our temperaments and traits— consequently guiding the development of our moral judgements and personalities.[23]

Expression vs. Suppression

Emotional suppression involves the deliberate inhibition of expressive behaviors during emotional arousal. It specifically involves preventing external, physical displays in an attempt to both conceal and subvert a feeling.[24] Suppression is often seen as an effective way to regulate emotions— however, pure suppression is neither efficacious nor beneficial, and is actually destructive towards physical and emotional well-being.

Although emotional suppression reduces outward expressions of emotions, it does not impact the actual experience or the intensity of the emotion.[25-27] In fact, it has been found that suppression can actually increase stress more than natural emotional expression.[28] This is because suppression increases rumination and fixation around the repressed emotion, amplifying distress.[29] Consequently, suppression results in an increased risk of a plethora of negative psychological outcomes, such as depression, anxiety, stress-related conditions, impaired memory, suicidal tendencies, and substance abuse.[30,31]

Emotional suppression has been linked not only to negative mental health impacts but also to worsened physiological outcomes.[32,33] In a study by Derogatis et al., higher mortality rates were found in cancer patients who tended to repress their emotions as compared to their more emotionally expressive counterparts.[34] Furthermore, among patients suffering from chronic illnesses, those who express rather than suppress emotions tend to report less pain.[35] These effects arise because emotional suppression impacts various systems in the human body. As a result, it can lead to various conditions, such as: heart conditions, thyroid dysfunction, muscular pain, and sexual dysfunction.[36,37]

Additionally, emotional suppression can impact one’s social life, by impacting both the suppressor as well as surrounding people. When someone is suppressing their emotions during a social interaction, both people experience more anxiety and negative affect, and also wind up feeling less connected to each other.[38,39] This is likely due to the communicative role emotions play in social interactions as they provide insight into the other person— about their thoughts, intentions, and personality traits— to both people involved.[40]

In general, emotional expression promotes better health and well-being while suppression tends to do the opposite. Although emotional suppression is often seen as the easier and more effective coping mechanism in the short-term, choosing emotional expression instead can lead to not just better physical and mental health, but also more emotional stability as well as a deeper understanding of the self and others.[41]

Image Source: Canva

Yes, We Need Emotions— But Also, Their Regulation

Then should we forego all societal norms and constantly express all our emotions as we feel them? Not necessarily. Despite the clear benefits of emotional expression, there are times when it may be helpful to regulate or even eliminate aspects of an emotion— situations wherein emotional responses are extreme, unwarranted, or undesirable. For instance, emotional regulation is adaptive in disorders that provoke abnormally high levels of certain emotions— such as anxiety in phobias and generalized anxiety disorder, or anger in borderline personality disorder.[42, 43] In general, strong bursts of emotion in daily life result in negative feedback from surrounding people.[44] In such contexts, emotional regulation could be the most effective or desirable response. 

However, emotional regulation is not the same as suppression. Emotional regulation involves attempting to alter the intensity or duration of an emotion. This can be achieved through strategies that aim to change either the cognitive aspects of emotion or its physiological manifestations.[45] 

Emotional regulation, when done properly, avoids the negative consequences of suppression, while also being far more effective in alleviating negative emotions and promoting positive affect.[46,47] This is because effective emotional regulation involves targeting all aspects of the emotional response from start to finish— it involves re-assessing and re-framing the triggering context and occurs early on in the process of feeling an emotion. On the other hand, suppression only targets expression, a mechanism that occurs later on in the emotional response. Furthermore, healthy emotional regulation specifically targets negative emotion whereas suppression impacts positive emotions as well. Since it is likely that the resultant loss of positive affect is what causes suppression to inhibit interpersonal connections, emotional regulation does not lead to any negative social consequences.[48,49] As a result, emotional regulation results in improved affect without negative outcomes such as impaired memory, loss of positive affect, and risk of negative psychological outcomes.[50]

Regulating emotions using strategies such as re-appraisal or mindful acceptance can actually be beneficial, both in the short-term as well as the long-term: it not only helps alleviate suffering in the moment, but it can also lead to a broader perspective that can help guide future personal growth. In fact, healthy emotional regulation is key to emotional well-being, while imbalances in regulation make up the primary symptoms of many disorders (e.g., major depressive disorder, phobias, generalized anxiety disorder, and borderline personality disorder).[51] Overall, emotional regulation enables us to learn and grow from stressful situations, mitigate disordered emotions, and to exist harmoniously with others, even in the face of hardship.

Why This Matters

Emotional suppression has a host of consequences for individuals that go beyond the short-term. Resulting in issues across the board, from increased risk of psychopathology to physiological symptoms, emotional suppression is an unhealthy habit that is unfortunately promoted by many societies. While some level of emotional regulation is a requisite of living harmoniously in society, suppression is not the best way to go about achieving this.[52]

Promoting focus on emotions and healthier coping strategies could enhance not only individual well-being, but also the well-being of society as a whole. Healthy emotional regulation can help improve mental and physical health outcomes, resulting in social benefits such as more positive affect, more social connection, and reduced suffering, while also reducing strain on the economy. For instance, depression— a condition primarily involving impaired emotional regulation and heightened emotional suppression— is currently the world’s largest cause of disability, incurring billions of dollars in costs to U.S. employers every year.[53,54] Additionally, putting emotions at the forefront of solving societal issues can provide multiple benefits to society. The Emotion Revolution 2020, an international psychotherapy conference, promotes the idea that emotions are integral, rational processes that are central to human psychology and that emotions should be centered when designing systems.[55] This approach can result in a wide variety of societal benefits such as a more restorative justice system, new healthcare solutions, new approaches in law, and less violence.[56]

Centering emotions as relevant and vital aspects of human life will not only help us cope with them in a healthier manner but can also allow us to recognize their wisdom and use them to grow as individuals and a society. Emotions exist and persist for a reason— and perhaps it is time that we stop encouraging their suppression.

Contributed by: Sanjana Bakre

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

REFERENCES

Keltner, D., Oatley, K., Jenkins, J.M. (2018). Understanding Emotions. (4th ed.). Wiley. 

1 Gu, S., Wang, F., Patel, N. P., Bourgeois, J. A., & Huang, J. H. (2018). A Model for Basic Emotions Using Observations of Behavior in Drosophila. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2019.0078

2 Dacher Keltner & Jonathan Haidt (1999) Social Functions of Emotions at Four Levels of Analysis, Cognition and Emotion, 13:5, 505-521, DOI: 10.1080/026999399379168

3 Keltner et al. (2018)

4 Tsai, W. (2019). Culture and Emotion. In J.A. Cummings, L. Sanders (1st ed.), Introduction to Psychology. University of Saskatchewan. https://openpress.usask.ca/introductiontopsychology/chapter/culture-and-emotion/ 

5 Tsai, W., Sun, M., Wang, S.-w., & Lau, A. S. (2016). Implications of emotion expressivity for daily and trait interpersonal and intrapersonal functioning across ethnic groups. Asian American Journal of Psychology, 7(1), 52–63. https://doi.org/10.1037/aap0000043

6 Emotion Revolution. (2022). About Emotion Revolution. Emotion Revolution. https://www.emotionrevolution.no/about-emotion-revolution

7 Keltner et al. (2018)

8 Tsai (2019)

9 Cullen, M. (2020, January 30). How to Regulate Your Emotions Without Suppressing Them. Greater Good Science Center. https://greatergood.berkeley.edu/article/item/how_to_regulate_your_emotions_without_suppressing_them

10 Keltner et al. (2018)

11 Ekman, P. (1992). An argument for basic emotions. Cognition and Emotion, 6(3-4), 169–200. https://doi.org/10.1080/02699939208411068

12 Lench, H.C. (2018). The Function of Emotions: When and Why Emotions Help Us. (1st ed.). Springer. https://doi.org/10.1007/978-3-319-77619-4

13 Ibid.

14 Keltner et al. (2018)

15 Ekman (1992)

16 Ibid.

17 Keltner et al. (2018)

18 Ibid.

19 Stellar, J. E., Gordon, A., Piff, P. K., Anderson, C.L., Cordaro, D., Bai, Y. & Maruskin, L. & Keltner, D. (2017).Self-transcendent emotions and their social functions: Compassion, gratitude, and awe bind us to others through prosociality. Emotion Review, 9(3), 200–207.

20 Keltner et al. (2018)

21 Ibid.

22 Ibid.

23 Gross JJ, Levenson RW. (1993). Emotional suppression: physiology, self-report, and expressive behavior. J Pers Soc Psychol.64(6):970-86. doi: 10.1037//0022-3514.64.6.970. PMID: 8326473.

24 Cullen (2020)

25 Ehring, T., Tuschen-Caffler, B., Schnulle, J., Fischer, S., & Gross, J. J. (2010). Emotion regulation and vulnerability to depression: Spontaneous versus instructed use of emotion suppression and reappraisal. Emotion, 10, 563–572.

26 Keltner et al. (2018)

27 Butler EA, Egloff B, Wilhelm FH, Smith NC, Erickson EA, Gross JJ.(2003). The social consequences of expressive suppression. Emotion. 3(1):48-67. doi: 10.1037/1528-3542.3.1.48. PMID: 12899316.

28 Cullen (2020)

29 Ibid.

30 Gross, Levenson (1993)

31 Cullen (2020)

32 Jainish Patel, Prittesh Patel (2019) Consequences of Repression of Emotion: Physical Health, Mental Health and General Well Being. International Journal of Psychotherapy Practice and Research - 1(3):16-21.

33 Derogatis LR, Abeloff MD, Melisaratos N. Psychological Coping Mechanisms and Survival Time in Metastatic Breast Cancer. JAMA. 1979;242(14):1504–1508. doi:10.1001/jama.1979.03300140020016

34 Patel, Patel (2019)

35 Ibid.

36 Abbass A. (2005) The case for specialty-specific core curriculum on emotions and health. , Royal Coll Outlook 4, 5-7.

37 Butler et al. (2003)

38 Gross, J. J. (2001). Emotion Regulation in Adulthood: Timing Is Everything. Current Directions in Psychological Science, 10(6), 214–219. https://doi.org/10.1111/1467-8721.00152

39 Keltner et al. (2018)

40 Patel, Patel (2019)

41 Ibid.

42 Keltner et al. (2018)

43 Cullen (2020)

44 Keltner et al. (2018)

45 Ibid.

46 Gross (2001)

47 Ibid.

48 Butler et al. (2003)

49 Gross (2001)

50 Keltner et al. (2018)

51 Cullen (2020)

52 Keltner et al. (2018)

53 Meadows Mental Health Policy Institute. (2022). The Cost of Depression. Meadows Mental Health Policy Institute. https://mmhpi.org/topics/educational-resources/the-cost-of-depression/

54 Emotion Revolution (2022)

55 Keltner, D. (2022, August 24). Introduction to Human Emotion [PowerPoint Slides]. Psychology Department, University of California, Berkeley.

Post-Modernism & Spirituality: A Remedy for Depression

The Epidemic of Depression in the Post-Modern Age

Depression is one of the most common mental illnesses in the US. Among the 21 million adults that are affected by at least one major depressive episode, it is majorly prevalent in individuals aged 18-25, and higher among adult females.[1] Depression is still rising at an alarming rate despite the existence of multi-billion-dollar pharmaceutical companies and growing healthcare industry, as not everyone has access to care nor can afford it. Some of the signs and symptoms of depression include, but are not limited to:[2]

• Persistent sad, anxious, or “empty” mood

• Feelings of hopelessness, or pessimism

• Feelings of irritability, frustration, or restlessness 

• Feelings of guilt, worthlessness, or helplessness

• Loss of interest or pleasure in hobbies and activities

• Decreased energy, fatigue, or feeling "slowed down"

• Difficulty concentrating, remembering, or making decisions

• Difficulty sleeping, early morning awakening, or oversleeping

• Changes in appetite or unplanned weight changes

Hidaka (2012) notes that, using a retrospective methodology, modernity is a cause of the current predicament [2]. That is to say, the equivalent progress of physical well-being in mental health is lacking. For example, significant lifestyle changes have occurred over the past century due to technological advancements and urbanization, resulting in a decrease in individuals' physical activity.[3] Similarly, technological facilities like social media can become problematic wherein they contribute to psychological distress – manifesting as depression and anxiety – of adolescents and young adults by impairing their personal and social development.[4]

Daniel Goleman, who has written extensively on mindfulness, emotional intelligence, and depression, identified the consequences of modernity in 1992 as a cause for rising depression. He reported that the rise in divorce rates, loss of nuclear families, and increasing industrialization (which often results in parents spending less time with their children) prepared a breeding ground for a lack of self-identification, hopelessness, and social support for young adolescents as well as elderly people.[5]

Spiritually Integrated Psychotherapy

Treating depression with modern therapeutic measures (such as Cognitive Behavioral Therapy (CBT) and SSRIs) has been largely successful; one way to improve outcome efficacy may be to include Spiritually Integrated Psychotherapy (SIP). One difficulty with this implementation, however, is noted by Harris & Goldberg: modernity is, unfortunately, characterized by a conflict between religion and the secular world.[6,7]

Despite this characterization, a study by Pew Research in 2010 found that nearly 84% of the world’s 6.9 billion people still identified as religious.[8] As Rosmarin et al. noted, individuals facing mental health distress are showing a growing interest in practices that involve spirituality/religion.[9] As the religious needs of the population increase, the 21st century is seeing a rise in the integration of the mind, body, and spirit in the psychological field. Luchetti et al. (2021) identified a new interest rising among clinical mental health practices: integrating spirituality/religion into therapeutic measures;[10] as a result, SIP has become one of the major fields in psychology.[11]

To shed light on SIP, an understanding of ‘spirituality’ is in order. Defined by author Kenneth Pargament, as “the search for the sacred,”[12] it is not a concrete set of beliefs that are rooted in one religion - rather it is fluid and constantly changing. The word ‘sacred’ might prompt a notion of the individual’s relationship with God or a higher power; however, secular, psychological, physical, and social aspects can also be imbued with the sacred. As defined by Pargament, the ‘sacred’ is a significant object that is responsible for order and coherence in an individual’s life. Additionally, stages in an individual’s life that include discovery, struggle, and transformational coping can all be part of one’s spirituality.[13]

Psychotherapy (i.e., talk therapy) emphasizes building a relationship with the patient to relieve them of their mental strain. Even though this does not guarantee the complete eradication of a mental illness, it is especially helpful for patients to develop better strategies of their own, alleviate stress, and establish a better understanding of their obstacles. SIP builds upon traditional psychotherapy, enhancing it with the added component of spirituality.

Through SIP people can draw from psychological, religious, and spiritual perspectives to create and sustain a meaningful purpose in life. A client may choose to use music, art, poetry, church, ritual, prayer, meditation, and mindfulness to express their spiritual emotions. These methods can be used to examine if a client feels they have a spiritual emptiness and help them discover meaning in difficult life events, catering to any emotional/spiritual struggles.

SIP & Depression

Spirituality can be a coping mechanism when facing physical or psychological adversity, which has made spiritual intervention an important aspect of health care. In the event of physical adversity and in regards to mental health, spirituality-based interventions have shown promising results in the recovery from, and the prevention of, depression.[14] For example, In 2011, Delaney et al. examined patients suffering from cardiovascular diseases who took part in a 1-month intervention program focusing on spirituality. Participants demonstrated an increase in the overall quality of life as well as lower depression scores.[15] Similarly, Saisunantararom et al. (2015) found that patients with chronic kidney disease were better able to manage their depression with an understanding of spirituality.[16] A study by Bamonti et al. (2016) showed depressive older adults with high levels of spirituality reported levels of meaning in life equal to those who did not have depressive symptoms. This suggests that incorporating spirituality fosters a meaning of life, showing a link between the preservation of the meaning of life and spirituality.[17] 

In light of these studies, patients who indicate higher spirituality also indicate higher meaning in life and peace. As a result, most (if not all) types of spiritualities show common themes of a quest for deeper meaning and a kind of transcendence from the material aspect of life, resulting in a deeper sense of meaning. Considering the broad nature of spirituality, it encompasses many elements which can be used independently in psychotherapy based on the needs of the client. These elements help tackle the significant symptoms of depression such as hopelessness, loss of interest, or feelings of worthlessness. Such elements include:[18]

• Self-acceptance - Uncovering and accepting the real you; breaking through barriers

• Forgiveness - Dealing with past trauma and moving forward

• Self-Transcendence - Connecting with nature, others, and the divine

• Gratefulness - Counting your blessings; includes forgiveness of others

• Prayer - Counseling sessions, active listening, or asking for divine help

Spiritually integrated psychotherapy that is well-developed and fluid caters to the varying worldviews of individuals and often helps them gain a comprehensive methodology to overcome the challenges life throws at them. If you are interested in exploring SIP, reach out to a licensed mental health care provider who is versed in this methodology to discuss your options.

Contributed by: Musa Zafar

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

references

1 U.S. Department of Health and Human Services. (2022, January). Major depression. National Institute of Mental Health. Retrieved December 6, 2022, from https://www.nimh.nih.gov/health/statistics/major-depression 

2 Hidaka, B. H. (2012). Depression as a disease of modernity: explanations for increasing prevalence. Journal of affective disorders, 140(3), 205-214.

3 Lambert, K. G. (2006). Rising rates of depression in today's society: consideration of the roles of effort-based rewards and enhanced resilience in day-to-day functioning. Neuroscience & Biobehavioral Reviews, 30(4), 497-510.

4 Greenfield, S. (2015). Mind change: How digital technologies are leaving their mark on our brains. Random House.

5 Goleman, D. (1992, December 8). A rising cost of modernity: Depression. The New York Times. Retrieved December 6, 2022, from https://www.nytimes.com/1992/12/08/science/a-rising-cost-of-modernity-depression.html

6 Harris, S. (2005). The end of faith: Religion, terror, and the future of reason. WW Norton & Company.

7 Goldberg, M. (2006). Kingdom coming: The rise of Christian nationalism. WW Norton.

8 Author. (2022, April 14). The global religious landscape. Pew Research Center's Religion & Public Life Project. Retrieved December 6, 2022, from https://www.pewresearch.org/religion/2012/12/18/global-religious-landscape-exec/ 

9 Rosmarin, D. H., Forester, B. P., Shassian, D. M., Webb, C. A., & Björgvinsson, T. (2015). Interest in spiritually integrated psychotherapy among acute psychiatric patients. Journal of consulting and clinical psychology, 83(6), 1149–1153. https://doi.org/10.1037/ccp0000046

10 Lucchetti, G., Koenig, H. G., & Lucchetti, A. (2021). Spirituality, religiousness, and mental health: A review of the current scientific evidence. World journal of clinical cases, 9(26), 7620–7631. https://doi.org/10.12998/wjcc.v9.i26.7620

11 Smith, L. C. (2007). Conceptualizing Spirituality And Religion: Where We'Ve Come From, Where We Are, And Where We Are Going. Journal of Pastoral Counseling, 42.

12 Derezotes, D. S. (2009). Kenneth I. Pargament: Spiritually Integrated Psychotherapy: Understanding and Addressing the Sacred.

13 Ibid.

14 Baetz, M., & Toews, J. (2009). Clinical implications of research on religion, spirituality, and mental health. The Canadian Journal of Psychiatry, 54(5), 292-301.

15 Delaney, C., Barrere, C., & Helming, M. (2011). The influence of a spirituality-based intervention on quality of life, depression, and anxiety in community-dwelling adults with cardiovascular disease: a pilot study. Journal of Holistic Nursing, 29(1), 21-32.

16 Saisunantararom, W., Cheawchanwattana, A., Kanjanabuch, T., Buranapatana, M., & Chanthapasa, K. (2015). Associations among spirituality, health-related quality of life, and depression in pre-dialysis chronic kidney disease patients: An exploratory analysis in thai buddhist patients. Religions, 6(4), 1249-1262.

17 Bamonti, P., Lombardi, S., Duberstein, P. R., King, D. A., & Van Orden, K. A. (2016). Spirituality attenuates the association between depression symptom severity and meaning in life. Aging & mental health, 20(5), 494-499.

18 Pečečnik, T. M., & Gostečnik, C. (2022). Use of Spirituality in the Treatment of Depression: Systematic Literature Review. Psychiatric Quarterly, 1-15.

Imprisioned Youth: Mental Health Impacts of the Juvenile Justice System

The Goal & The Current Reality

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

Violence and abuse

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

• physical violence amid detainees

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

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

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

• suicides, attempts and other self-harm.

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

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

 

Mental Health in the Juvenile Justice System

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

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

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

Methods of Reform

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

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

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

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

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

Contributed by: Ariana McGeary

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

REFERENCES

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

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

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

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

5 Ibid.

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

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

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

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

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

11 Modvig, J. (n.d.). 

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

13 Repka, M. (2014)

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

15 Ibid.

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

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

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

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

20 Ibid.

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

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

23 Ibid.

24 National Conference of State Legislatures. (2012)

25 Ibid.

26 Ibid.

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

28 National Conference of State Legislatures. (2012)

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

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

31 Ibid.

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

33 Ibid.

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

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

36 Healthy Returns Initiative.

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

38 Ibid.

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

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