The growing concern of Teenage Anxiety

WILD SESSIONS PODCAST

The Growing Concern of Teenage Anxiety

with Alicia Drummond

Henrietta: So we are in the car, on our way to meet Alicia Drummond. Alicia was one of the first people that I thought of to interview actually when we were setting up this podcast, because Alicia is a psychologist who specialises in adolescent mental wellbeing, and she is also the founder of Teen Tips, which is a fantastic resource for parents and schools, on how to support teenagers and adolescents. If anybody hasn’t heard of it, go check it out, it’s absolutely incredible; and a few weeks ago I was reading about a study that had come out that’s shown that anxiety in adolescents in teenage years had increased by 70% in the last 30 years, which I just found shocking, and I thought that that would be a great topic to unpick with Alicia, to understand exactly what’s happening with the body; why is this exponential growth occurring, and what we as parents can do about it. And the great thing about Alicia, is that not only is she clinically brilliant, she is also a parent herself, so I am really excited to hear about what she has got to share.

Henrietta: So, I am quite literally sitting around the kitchen table with lovely Alicia Drummond, who is a psychotherapist and founder of teen tips. Welcome Alicia

Alicia: Hello. It's very lovely to be with you.

Henrietta: Everything that I seem to be reading is pointing to the fact that there's this exponential rise in anxiety and most, especially in teenagers at a time when there's such rapid growth anyway, isn't there physically and physiologically, so for them to be navigating anxiety as well,

Alicia: It's a shocker.

Henrietta: Yeah. What was it about adolescent mental wellbeing that made you want to specialize in that area?

Alicia: Okay, so I qualified as a psychotherapist in 2009, and I did a lot of training in parenting and that kind of grew, so I ended up doing huge amounts of staff training in schools and by 2017, I think I was working about 160 schools. My car looked like some mobile cafe bin, we just thought we need to do this slightly differently. So we then worked, I worked with one of the schools that we worked with a lot, the King's school up in Chester to produce an online parenting course, which is based on a four hour course that I've been running for a long time.

Alicia: And then we did one for staff, and then of course COVID hits and, you know, you're not going into schools anymore, but we went online. So we had about four and a half thousand people on webinars between the end of March and the end of May last year.

Henrietta: Incredible, so that's actually perfectly illustrating demand for it, and the need for people to feel some sense of guidance around mental wellbeing and how to support their children. Issues that already, occurring with their children. Was there a specific theme around it? Was it around say anxiety, which I know we're going to talk about more today, but was there anything that was...

Alicia: It was really interesting, actually. I think when we started, we did various surveys as we went through the year last year, and at first, everybody was really worried about the online, you know, the online world, which wasn't surprising because suddenly they're all spending a lot more time online then really, by the time we got to September, October, and they were much more worried about mental health, um, by December it was anxiety. By February this year, it was motivation because a lot of the young ones had just kept going, kept going and then lost the will a bit. So, it was interesting how parental perspective changed, but always at the top of the list in the surveys, after that first one with the screens, from there on, in, it was all about mental health and wellbeing. A lot of people really worried about them.

Henrietta: So it's exaggerated what was really a growing concern, and then COVID accentuated that. And so for anybody that has been doing any reading about the increase in mental wellbeing, for anybody that's listening with children, are there any sort of signs of anxiety because anxiety is a kind of plethora of different disorders, isn't it? So, is there anything in particular that people should be looking out for in their children?

Alicia: I think mental health wise, there has been a massive increase. So we can't deny that, you know, if you look 2017, there were one in nine children and young people had a problem with mental health and that now as of 2020, is one in six,

Henrietta: One in nine children, and now it's one in six

Alicia: Children and adolescents, so young people. And it's...

Henrietta: That's shocking.

Alicia: Yeah, so it's really shocking.

Henrietta: So anxiety being a sort of presentation of, of fear then, and feeling threatened, whatever that might be in their environment,

Alicia: I mean, there are fears by age, it's normal for six-year-olds to be frightened of the dark. We all experience anxiety from time to time, it's a reaction to a perceived threat, and our brains have evolved over millennium to be on the scan for opportunity or for threat. So it's a normal human reaction. If your child was becoming overly anxious, sometimes it will manifest in anger because if you think about it, anxiety is part of the fight or flight response, so those who are fighters might come across as being overly aggressive. If they're the flighters, they'll be wanting to run away from whatever it is that's really frightening them. So you might see them, as I say, becoming more aggressive, becoming more withdrawn, avoiding certain situations and circumstances; they might become more clingy, trouble sleeping, there's lots and lots of things to look out for.

Henrietta: And actually you said something about adolescents can start much earlier now. Isn't it being defined as starting at something like eight years old?

Alicia: Yeah, we always used to think adolescents, you know, 12 to 20. And that was it. But actually we know now that there are lots of girls, for example, getting their periods around eight, a lot of the hormonal changes, which you'll know more about than I will, are occurring younger. And I don't know whether that is about changing our diet or what it is, but it is happening. So we know it can start anywhere from eight and all the latest research from the world of neuroscience tells us that you don't have the brain of an adult til your mid twenties. So it’s a lot longer than we ever thought.

Henrietta: Yeah!

Alicia: So, yes, the number of children seeking help has gone through the roof. As a therapist, it's kind of like watching a tsunami coming at you across the hill, we just get so many inquiries. And the problem is that the system is not there to pick up the pieces. So CAMHS, which is your child and adolescent mental health service. At the moment, only a third of those who were referred to CAMHS end up getting treatment. And if it's a real emergency, it might be four weeks, but it could be anything between four, twelve and even longer for your first assessment. Well, that's a very long time

Henrietta: when you were experiencing anxiety and you're a parent to a child who's experiencing anxiety.

Alicia: So it's a fantastic service. There's amazing people in it, but it is simply not up to the job of coping with what we're dealing with at the moment.

Henrietta: And if you were to put your stake in the ground of what you think might be contributing to this?

Alicia: I think, the whole of last year in terms of the isolation and loneliness. The developmental drive of adolescence is to start to separate from your family and attach to your friends, and of course, lockdown just drove everybody in the opposite direction. And that was okay for most, and for some, it was fantastic; particularly those on the autistic spectrum found it really actually very calm being able to learn at home rather than perhaps being in school; for many, I'm generalising, but for many of them.

Alicia: So I don't think that's helped at all. I think the concerns about the future, you know, and things like eco anxiety. Why wouldn't you be anxious? About the future of the planet, when you hear endless statistics on the news about, you know, global warming

Henrietta: Absolutely.

Henrietta: And it's, it's interesting where information can become power, but it can also be debilitating if you know too much of it at a time when perhaps you don't have the developed capacity yet to rationalise it or process it, it can feel overwhelming. And you know, even as an adult, particularly if you're on social media, you know, you're bombarded with information and things to think about and process and question yourself about...

Alicia: Well I think the other thing that we have to think about is that the safeguarding systems within schools are much much more robust than they ever were, which is fantastic, but it also means that teachers are signposting children towards the safeguarding leads. And sometimes it's a medicalisation of a normal response; so if a child is anxious about exams, well actually they need to understand that it can be quite useful to be a little bit anxious going into an exam because situational stress makes us perform better. We have to be careful that we're not just panicking and sending them towards help left right and centre, when actually. It would be better for them if we were really, really calm, because anxiety is a bit like I've got this ball of anxiety and I chuck it at you and now you've got it. And if the adults are chucking it down the generation, then it's really not helpful.

Henrietta: That's a really interesting conversation that could be a whole podcast in itself.

Henrietta: I would love to understand a little bit more about what is going on underneath the skin of a teenager. We now understand science is showing us that the mind controls the body, but the body also, and I think the teenage years are a really good illustration of this, where the, the body actually does also control the mind. So the physiological, biochemical changes; so that's all the chemicals that are naturally produced in your body, start changing the amounts that are produced during your teenage years. That influences how teenagers can feel as well. So what exactly is happening underneath the surface in the teenage brain and body?

Alicia: Well, the teenage brain is a truly fascinating place to have a rummage, because it is completely different to any other point in your life. So it all kind of really starts around about 11 for the girls, 12 for the boys. So the boys are about a year behind most of the way through, and it's a time of cognitive restructuring. So we're getting rid of lots and lots of the neurons, brain cells that we're not using and we're making super highway connections between the different parts of the brain. So for example, the prefrontal cortex, which is your higher thinking frontal lobes. That's what we use to read other people's facial expressions, to assess risk and outcome, to control our impulsive behavior, to control emotion and outburst, but it's the last part of the brain to get its adult brain wiring. So for a 14, 15 year old, actually, being able to interpret your facial expressions and tone of voice is really quite difficult. So the peer group's really, really important because it's where they feel safe. But if you're not very good at reading social cues, it's easy to misinterpret how other people are responding to you, which is why there's often a lot of social drama because they want to attach to the peer group, but there's that fear? Am I going to be criticised? Am I going to be rejected? Am I going to be judged? And so it's a sort of toxic combination. They're hypersensitive and they're not very good at reading them either, so difficult for them to see perspective.

Alicia: So from a brain perspective, there's a huge amount going on. They are wired for novelty and excitement and they get a bigger buzz out of anything than we would do so that is also unhelpful.

Henrietta: That's quite an unnerving space for them to be in as well, isn't it, to feel slightly out of control of their own feelings and their own reactions; and so the more that we can say it's okay. Eventually it's like that sort of pendulum, isn't it as eventually it will start coming back into the middle again and finding some balance

Alicia: But I think also we're, as parents, quite often alarmed when they're having really strong emotions; so we try very hard to bump them out of it or stop it. And actually for them to learn that the quickest way out of any feeling is straight through the middle of it, is really important; but we don't allow them often to feel their feelings, because we feel uncomfortable.

Henrietta: Can we talk more about the environment around them? So at the beginning you said that they can be triggered or calmed by their environment. And actually you said about tweaking the environment around can actually shift a lot of things. You're talking holistically I assume, about what they're exposed to and sort of parenting family, schools, peers, but also would you build diet and sleep into that as well?

Alicia: Absolutely, I'm permanently banging on to them about the need to get really good sleep. Because if you have poor sleep, you have higher cortisol levels the following night, which means you get a worse night's sleep then the following night, and it kind of is that spiral and, you know, sleep deprivation, I mean, it's a form of torture in some....it's not good for us.

Henrietta: We know that one really well..

Alicia: ...as anyone who's had a child will know.... yeah So sleep is massively important. Diet, I mean, I know that's your area, so I wouldn't deign to tip toe on there, but, if you've got a poor gut microbium, you've got higher levels of cortisol in the brain. So, absolutely...

Henrietta: And the irony of whatever game nature was playing, because at that stage in their life, all they want to do is eat sugar and salt and processed foods because it's that part of the brain that wants the instant reward.

Henrietta: Gut health is so important. What's one of the biggest threats to gut health is processed foods, salts, sugars, and actually it's also stimulating that stress response. That change in blood sugar levels means that you can't concentrate as well. They get moody, it affects their skin, digestion, and it means that the body is always working in a slight state of recovery, recovering that balance, that equilibrium, which triggers the release of their stress hormone. So it becomes this kind of self perpetuating cycle and sleep, I think is a really interesting one because even though my area is in diet, one of the first things that I'd say with everybody is are you getting enough sleep? Because if you don't get enough sleep, then you have more tendency to reach towards stimulants the next day and sugary foods.

Henrietta: I was reading a study recently that looks at blue light. So we are going to talk about social media and digital connection because obviously that's the thing that cops the blame for everything that's going wrong with the world. But, one of the things that it was looking at was whether or not exposure to blue light from screens like tablets or phones, impacts on sleep. So if they're looking at a blue light device before they go to sleep, is it affecting how well the body produces melatonin, which is a hormone that has a really, really important role in regulating all sorts of things, including, energy, mood, the immune system. It works in over 700 different functions in the body. So it's incredibly important. And this study showed that when you have just 45 minutes of exposure to a blue light device, that it reduced your melatonin production by 80%, which is huge, huge. You know, I read that and thought, in the summer holiday, my eldest fell asleep with his phone nearly every night and I swore that would never be the case. I saw that every day for like a big, slightly weathered down worn down by the last year and a half. I'm going to use that as an excuse COVID is going to get the cop, the blame for a lot of things for a long time.

Henrietta: But, it just struck me that millions of teenagers around the world, and people actually humans, using their blue light device before they go to bed. So, leading on to the impact of social connection through a digital device of some sort. Some people say that it's the connection that you get online is as strong as the connection that you get in person, and then some people very much beg to differ. And I'd love to know what you think about social media, digital connection.

Alicia: I mean, over the last year, it would have been an utter disaster for teenagers without it because that disconnect was bad enough as it was and causing lots of problems now, but actually you have to remember, you get a different chemical release when you're face-to-face with somebody. So when you're with somebody, you get the touchy, feely, oxytocin, which you don't get online. So, yes, there's lots and lots of pros for it. And you know, there's evidence that some gaming will increase their fine motor skills and brain speed, all of that kind of stuff, but it's about everything and you've got to keep it in balance. They need to be having face-to-face communication amongst other people. If you look at what the job markets of the future predict our kids are going to need, top of the list is good social skills and social skills are something that you need to learn with people of different generations. It's not enough just to be communicating via gaming because actually when you hear them communicating by gaming, quite a lot of it, isn't stuff you would ever think you could translate into a boardroom frankly. So I think it's just about everything, you know, as parents you're up against it because the way that all of these games are made in Silicon valley, you know, they bring in the psychologist, they know exactly how to manipulate the dopamine cycles in the brain.

Henrietta: Well this is it, exactly, and the fact that it's built not to have any pause I think that's one of the things that I...I would love to say that we had a beautiful childhood skipping through fields and it was all very idyllic, and nowadays it's look at it, you know, I have to hold myself back from actually being that kind of parent because actually that's not helpful or true actually, but one of the things that we did have is we had a lot more social connection and less time on devices. And so when the children are saying yes, yes, yes, to gaming and being on screens, they’re also saying no to other things. So no to physical exercise, no to being outside, and I just wonder how important exercises for a teenager who might be experiencing anxiety or being in nature.

Alicia: It's hugely important. I mean, 20 minutes of exercise stabilizes your cortisol for about 24 hours. So,

Henrietta: So interesting. And does it matter where it is, what you're doing?

Alicia: No, ideally being outside, because the connection with nature is really important as well. You know, our brain loves that kind of soothing being in nature moment and again, there's a chemical release that goes on there. Cortisol is the main hormone that's involved with the anxiety response. I think one of the things we can do with young people is to help them to find their healthy coping strategies. For me I either swim every morning or I walk every morning, and then before I go to bed I'll always have a hot bath and read a book. And if I get those two things in, I know that that boosts the parasympathetic nervous system, which is the rest and digest system. And then the thing that happens between the two. You know, whatever your cortisol is doing during the day, because stress happens, then it goes down and then somebody else happens and then it stops. If you have a start and a finish. Actually you, you put your system back into balance.

Henrietta: That's such great advice for anybody. And I imagine with adolescents it's finding actually what works for them. It also builds in those daily pauses, which just seem to be lacking in our very busy frenetic, modern life that we have. I was talking about social media and the games are constant. There's never an end to them. It just keeps going and keeps going. There's no natural pause.

Alicia: That's why Tik Tok's so pernicious, it’s the short form video and very fast scrolling. And that's what makes it so addictive. So I think as parents, it's just about being aware of what they're doing, you know, and not stopping it because ultimately they need to learn to be responsible digital citizens, and you're not going to learn that if you don't use anything.

Henrietta: Is there any sort of ring fencing you would advise around it though, is there a sort of cutoff point that you would recommend?

Alicia: Not for an hour before bedtime, and I would say, you know, put in, you can't have it before X time in the morning because otherwise you get the younger ones thinking, well, I can just sneak downstairs before everybody's awake and they'll be up at five in the morning and they'll have done three hours gaming before you've even woken up. And then I think rather than saying, right, you can have it for an hour and 20 minutes, which is a nightmare because now you've got to police it, is actually just saying, right, we don't have it at this time. We don't have it this time. We don't have it at meal times. So you put in segments of the day where screens are just not an option, and I would say to them, look, provided, you're getting a decent amount of exercise provided, you're talking to people in real time, provided your engaging with the family in whatever format that might be, and doing hobbies and all the rest of it. Provided you can keep your life in balance, I really don't have a problem with your screen time, unless of course, you're kind of, busy off watching X-rated porn, at which point I might want to have another think about it, but on the whole, if you're managing it, you're keeping yourself safe and you're doing it as part of a balanced life. It's fine. I wouldn't give you a plate of chips for every meal. If you can show me, you can balance out the plate, then you don't need my intervention, unless it goes wrong. At which point I'm here. If you need me..

Henrietta: And if somebody who has a child with anxiety who is using the phone or that kind of world to retreat to, is there any advice on that or awareness for that teenager to know that sometimes that can heighten anxiety rather than quell it?

Alicia: Yeah, I mean, I always say to them, what do you think the most common emotion felt by people using social media is? And the answer is envy. So, why would you put yourself into a position using a gadget that ultimately is probably going to make you feel inadequate compared to other people. So I think a lot of the studies will show that 20 minutes of social media scrolling is actually quite good in terms of happiness, but it goes down after that. So it's really short, sharp bursts rather than long scrolly, scrolly times is, is a good thing. And I think just rather than telling, asking them, you know, well, how do you find you feel after, what do you notice the difference between using it for 20 minutes and using it for an hour? So getting them thinking for themselves

Henrietta: Could that be applied to us? Yeah. Okay. And if you had to give your top three tips to a parent who might be listening, who's got a child who's experiencing anxiety, what would you say the three things that to look forward to do?

Alicia: I think the first one is for you to be very calm. When children are tiny, they can't do something called self-regulation. So they do co-regulation. So co-regulation is kind of, we lend them our prefrontal cortex, so that they can calm themselves down. And that's why we do with babies. You know, you touch them and you look them in the eye contact and you make little kind of cooey noises and they gradually develop the ability to self-regulate to calm themselves down. That does get a bit out of the window during adolescence, which we'll come on to, um, kind of towards five, six, but when the stress goes up. So when they become anxious, that becomes really difficult again. So you need to go back into that process. Try and get a little bit of contact. So even if they won't let you give them a hug, sometimes you can just get shoulder to shoulder. So contact is really soothing. I contact, all those, Oh I know, Oh, lots of empathy. When they're in the middle of the panic, because they're not in their thinking brain. They're in their in their emotional limbic brain. So they're not going to not to calm down.

Henrietta: So not giving them the, it will be okay. It's, you know, you shouldn't feel like this, although that sounds really hard.

Alicia: Do you know that I can see you're really, really struggling at the moment. What do you need from me? I don't know what I need from you? Okay. Well, sometimes I find that when I feel really, really stressed or anxious, just sitting outside or running my hands under warm water or having a cuddle really helps. But in the heat of the moment, don't try problem solving. It's completely pointless. They can't hear you literally. Uh, so you allow them to calm down. And that's actually also really important when it comes to anxiety, because anxiety comes in a big wave and you feel like you're going up and up and up and up, and I'm not going to be able to cope any longer. But actually, if you can just learn to sit with it, you will find that you start to come down the other side and anybody who's had a panic attack. It's so frightening that often they start to develop a fear of the fear. So they're frightened of having another panic attack. So you kind of lose sight of what you were originally scared of.

Alicia: So there's a really good app called Clear Fear, which I recommend because it's a very good way for helping them to learn to ride the waves.

Alicia: So I think that that not backing away from things as well, so not letting them constantly not do things that they're frightened of because actually when you do that, you reinforce the idea that there's something that they need to be frightened of. If your child says there's a monster under the bed, do not go looking for it, because if you go looking for it, you've reinforced the idea that it might be there in the first place. So we don't want to create monsters where there are no monsters, you know, actually the message we want to be giving them is, you know, no, there's nothing to fear here, but your brain seems to think there is. So how do you think we could work together to, kind of, get you out the other side of that.

Henrietta: And it's, it's their engagement and their sort of recovery, so that you're doing it together, that I can imagine is empowering them, increasing their awareness of themselves as well.

Alicia: Because when you go into that anxiety space, you feel that you don't have any control. So if we can gradually give them a sense that actually they can start to recognize their triggers, they can start to understand. And you, you talked about that mind, body connection, you know, I'll say to them, what's the first thing you feel in your body because I think, many of us have become kind of disconnected from the neck down. You know, we’re just not listening to the feedback and the feedback gives us massive clues. So, oh, I know if I start to get butterflies. Oh, okay. What's going on Alicia? Why am I feeling like this? And you can start to be more proactive in recognizing what your triggers are, and also getting in before the fight or flight kicks in big time, because once it's gone, you're, you know, you kind of out of action for probably 20 minutes.

Henrietta: Is that how long it takes to come back down?

Alicia: Roughly. Yeah, usually it peaks around 11 to 13 minutes.

Henrietta: It's an amazing response, it’s a really clever, intelligent response of the body. Isn't it? I mean, it's just, it's when we stay in that heightened state, that that's when it becomes detrimental to the body. And if we don't have those pauses in our day, which, you know, you've already highlighted, we can't ever really come back down for not getting enough sleep. We're not eating well. If we're not finding those pauses in our day, then we constantly stay in this hyper aroused state.

Alicia: I think for them understanding that absolutely not one single one of the symptoms of fight or flight is going to ultimately cause you damage because you know, when you're hyperventilating and you feel like you can't breathe, you might think you're going to stop breathing, but you're not; when your heart is going, like the clappers you might think, oh my God, I'm going to have a heart attack, but you're not. So if you have one panic attack, it's always worth going to the GP and getting it checked out just to make sure there's nothing wrong with your heart or anything else. But beyond that, it's understanding this is all part of a normal response that is actually designed to protect me.

Henrietta: And your third tip.

Alicia: It's a protective response. Learn to ride the waves and expose, don't avoid wherever possible, would be my top three; but perhaps more important than all of that, if I'm a parental perspective is for you to stay really calm because they need to borrow your calm.

Henrietta: That's a really lovely way of putting it, borrow your calm. I love that, and that's a really important point because we're talking about what we can do for the child, but actually it's our self-care and what we're doing for ourselves to ensure that we can be there wholeheartedly in a grounded way for our children as well. And so I would imagine that some of the advice that you've given is also stuff that we could apply to ourselves?

Alicia: A hundred percent. Yeah. Yeah, really all of it.

Henrietta: And even though sometimes you may feel that it's you as a parent that needs to be there in their point of crisis, sometimes it's actually about you stepping away from it, so that you can come back into it. If you feel that you're beginning to ride it with them, for you to, at that point to take a pause and step away.

Alicia: And we, you know, as parents we're very over invested because we just love them so much that we can't bear them to feel any of those big, horrible emotions.

Henrietta: So one of the things that we'll do in this episode, in the footnotes, is also put some links in there on your recommendation of people that they might be able to reach out to. But obviously you've got your fantastic Teen Tips, which I have to say is an amazing resource. Can you explain a little bit more about how people can find that and what the process is?

Alicia: Okay. Absolutely. So Teen tips, T E E N T I P s.co.uk. And we have launched over the last year, a well-being hub for schools, but parents can join individually. So if your school's a member, then you can have free access to it. And it really does give you a just a huge, huge library of resources, whether that's parenting courses, staff, training courses. Live Q and As. They can find a specialist they can jump on for live Q and A every Tuesday evening. We just, you can just jump on and ask any question you want. Um, and we do a monthly webinar, so which for hub members is free. So the next one is going to be self-harm, and then the one after that is body image.

Henrietta: One of the things that I really like about this platform, as well as that, it gives that sense of community that you're not alone. And I think when things are really big and are happening, particularly again in the last year and a half, where we spent a lot of time with our family in the same four walls, you can feel like it's only you that's experiencing it. And also as a parent, if things are going wrong with our children, that kind of knee-jerk reaction is, it's all my fault, what have I done? And actually, it's really nice to go into a community where you can sort of be honest and share and hear other people's stories and know that you're not alone. And, and they're all surmountable because again, when we keep it in our minds and in the four walls, sometimes it becomes a monster that it actually isn't.

Alicia: Um, yeah, it's like anything. The more you talk, the more you can rationalise.

Henrietta: Absolutely. Oh, Alessia, it's been so lovely to speak to you. And, I was so busy listening to what you were saying as a parent, um, that I'm going to have to try and jot it down and make sure that I don't forget, but it's been so interesting and I really am sure that a lot of the information that you've shared will be really helpful for people listening as well.

Henrietta: So thank you so much for your time.

Alicia: It's a huge privilege to be invited. I thank you very much, for having me.