An American College Health Association survey in 2011 found 30 percent of students reported feeling so depressed that it was difficult to function and 49 percent felt overwhelming anxiety. The National Alliance on Mental Illness reported in 2012 that 64 percent of college student dropouts were due to a mental health-related reason. College counseling centers are struggling to keep up with the demand for services as more students seek help.
At the University of Pennsylvania, a leading mental health center in the nation, students have issued a “Green Ribbon Manifesto,” demanding shorter waiting times. Part of the problem is that Penn, along with college counseling centers across the country, is diagnosing and treating depression from a mental illness model dating from the 1960’s.
In spite of fairly high rates of treatment failure and relapse, the current model of depression is embedded in the minds of clinical psychologists and clinical counselors. If 60 percent of clients report a reduction in depressive symptoms, the therapy is considered effective, without mention of the other 40 percent.
The National Institute of Mental Health (NIMH) in 2012, noting the significant lack of progress in treating mental illnesses, abandoned the symptomatic model of mental disorders. NIMH is looking to understand mental illness from basic biological mechanisms, such as genes, cells, and brain circuits. It also supports transdiagnostic psychotherapies, which target common factors that lead to related diagnoses.
The American Psychological Association has discouraged implementation of the NIMH approach by continuing to focus on symptoms with its Diagnostic Statistical Manual-5. Since many DSM symptoms overlap, the diagnoses are not always valid. The diagnoses also are not reliable, as evidenced by poor interrater consensus.
The students at Penn have yet to learn that reducing waiting times simply by increasing the availability of counseling clinicians, who will continue to treat symptoms without any thought toward the contributing factors leading to one’s anxiety and depression, can produce only temporary relief.
Rather than demanding that clinical counseling services reduce waiting times or change their modus operandi, students at Penn, as well as those discontented students from other universities, can take charge of their situation by implementing a peer-to-peer approach based upon a new model of problem formation and change.
This model proposes a two-step process: 1) Young people are socialized to adopt values and norms that are dysfunctional for them as adults, which lead to unresolved intrapersonal conflict; and 2) unresolved intrapersonal conflict gives rise to anxiety, depression and a multitude of self-defeating behaviors.
Behavioral change is brought about by recognizing and strengthening one’s own values and norms, as well as owning-up to and dealing with one’s unresolved anger from the past, whether justified or not.
A New Paradigm
PsychResilience Training (PRT) can be defined as a short-term trans-diagnostic approach for prevention and treatment of depression and anxiety. It is based upon psychological resilience as a self-referential process that can be learned to maintain a positive sense of self under prolonged stress. It is effective because an individual with a positive sense of self cannot simultaneously experience high levels of anxiety or depression.
Step1- PRT Postulates:
We are generally attributed with two minds—the emotional and the rational. Our rational mind has two voices—our own voice and the voice of authority figures embedded in our heads from childhood. “You must look before crossing the street,” “You need to follow directions,” and “You have to do your homework.” This embedded voice is often mistaken for our own voice, but is recognizable when we tell ourselves “I have to do this,” “I need to do that,” or “I must do the other.” These have tos are always mandatory, without choice.
These early have tos soon become habit of mind, controlling our emotional life with “either-or” value judgments—good or bad, right or wrong, moral or immoral. We begin to screen out our honest emotions—not just to hide them from others, but even from ourselves. We become anxious about inadvertently revealing our true feelings. Suppressing this anxiety, however, leads to dysphoria and depression.
We can recognize our own voice with its use of want tos, like tos, and wish tos. Want tos provide freedom of changing our minds. Want tos don’t necessarily dispel all have tos as without merit, since the merit can be independently determined by our own voice, based on our own self-interest. Want tos place us in charge of our lives.
Those who refuse to let-go of have tos must default to embedded authority or outside authority to make decisions for them. Submitting to authority, however, can lead to powerlessness, anxiety, and depression. It is difficult to feel good about yourself when someone else is pulling the strings and you are only reacting.
Listen to the number of “I have tos” and “I need tos” you hear while talking to yourself. Compare this to the number of "I want tos" and "I'd like tos" you hear. As a result, you may wish to strengthen your own voice.
But how do we change have tos to want tos? Who wants to study? We want to study to get good grades, but we don’t have to. We don’t have to exercise to stay healthy, but we may want to. We always have a choice—as long as we are willing to accept the consequences.
__Step 2 will be the subject of the upcoming blog: Dealing with Unresolved Anger.