by Tina Tormey
Even before the pandemic impacted their mental health, college students struggled with stress, anxiety, and depression. Since then, parents have taken a bigger role in advocating for their students. Increasingly, higher education professionals receive first outreach from parents – and not students – about problems experienced in the residence halls. Carol Landau has seen these experiences firsthand in her private practice and as a clinical professor at Brown University.
Based on her research and experience, she has written a book – Mood Prep 101: A Parent’s Guide to Preventing Depression and Anxiety in College-Bound Teens (Oxford University Press) – that serves as a primer for parents of future college-bound students. In addition to providing a clear and comprehensive explanation of the developmental and social milestones and challenges that older teens experience, she offers easy-to-implement recommendations about how to talk to kids and navigate these transitions in a way that affirms their experiences, empowers them to make good decisions, and develops their skills and confidence. The book can also outline how to partner with parents and coach them in pre-entry programs such as accepted students’ days, open houses, and orientation.
The book is divided into four sections. The first provides an overview of depression and anxiety and adolescent development, and the second discusses skill building, growing resilience in teens, and effective skills for communication between parents and teens. Part three covers risk factors (like perfectionism, students who are part of the LGBTQ community, and those who are overweight) and strategies like Cognitive Behavior Therapy and help-seeking. The final section covers the transition to college and how parents who no longer have daily visual check-ins with their student can learn to support their need for independence and their ability to self-advocate.
Recognizing that a fair number of parents have kids who have been already diagnosed with a depressive or anxiety disorder, Landau addresses both clinical and non-clinical emotional health issues, providing a nice balance for the work parents can do to identify normal developmental shifts and to teach their kids strategies for overall health and wellness. The strategies are simple and actionable; they do not require advanced mental health knowledge or skill. Landau also addresses how to identify when smaller issues escalate and how to appropriately scaffold an approach if a situation becomes either more pervasive or more serious. While books of this nature can be overwhelming, the personal stories, simple strategies, and a tone that illustrates warmth and trust in the parents enhance its approachability.
Landau’s audience is very much parents of teens headed off to college, but she also provides a roadmap for how we can explain these transitions to parents and presents information and situations that may seem quite familiar to housing and residence life professionals who work with students and their parents, navigating mental health concerns on a daily basis.
The Talking Stick emailed Landau questions which she responded to via email, as documented below.
I spent a good part of my career doing psychotherapy with college students and younger adults. At a certain point I wished I could reverse engineer some of the psychological necessities for success in college, and even graduate school and medical residency, where I have also worked. At that time it seemed that many parents felt so much pressure to have high school students prepare academically for college that they neglected the psychological development. In addition to working more with high schoolers and their parents to develop self-efficacy, self-advocacy, and distress tolerance, I wrote Mood Prep 101 in order to provide this information to a wider audience.
When I have spoken with college and university professionals, they say that several parts of the book are helpful. First, everyone can benefit from increased knowledge about the symptoms of psychological disorders like depression and anxiety. At the same time, understanding how to self-regulate one’s tolerance for stress and distress is helpful in working with new college students in particular. One chapter that addresses “College as a land of opportunity” helps them understand in some detail what students need psychologically. Even if students can find only one individual on campus that they can confide in and that can make them feel safe and validated can make an enormous difference in their lives. That person may or may not be a counselor or a faculty member; they might be a resident assistant, a dean or professional in the housing office, or an adviser to a student-led group.
I think the first step is to identify these students who are struggling. Even though they may not show signs of depression or anxiety, they may have trouble regulating sleep or studying. There are many segments of the college and university communities that can respond. Some campus counseling centers have outreach programs for psychological education, and resident assistants are often able to see the problems firsthand or hear from one student about how another student struggles. Some counseling centers offer training to RAs, and I think this is extremely valuable. Many psychology departments have had courses on self-understanding as an introduction to clinical psychology for some time. Now other campuses, like the University of Maryland, are offering courses on well-being that are available to undergraduates in general, not just those concentrating in psychology.
For some reason, this question and the parental dilemma remind me of a scene from one of my favorite movies, “Almost Famous,” directed by Cameron Crowe more than 20 years ago. In one scene, Frances McDormand is saying goodbye to her teenage son, who is going off to work with a band, and she yells out “Don’t do drugs!” as he gets on the bus. I think this represents the struggles of most parents who want to give their children important messages, but maybe waited too long.
It’s very hard for parents to first monitor and provide structure to their children during high school but then begin to let go if they are going to college or move away from home. We hope that our children will internalize the structure and concerns that their parents showed them for well-being. But I also think that (perhaps in their junior year and certainly by their senior year) some basic tools should be emphasized. One of the most important is sleep regulation. If you’re still having to get your child out of bed when they are a second semester senior, a lot of work needs to be done before fall comes. There are similar self-regulation patterns for exercise and food. Many teens involved in sports will have learned how to self-regulate their physical activity, so that’s a real plus.
I know that at Brown and some other universities, staff from health services, psychological services or counseling centers, and the dean’s offices have sessions for parents during freshman orientation that emphasize the importance of allowing students to solve some of their own problems before making that phone call. I know that many students feel supported just by being able to dump their concerns and problems onto their parents during a phone call or on FaceTime or Zoom. Parents need to know that it’s the process of sharing these problems rather than the resolution that is often most important. Of course, we want to help their children, but the immediate impulse to do it for them is something we should try to check. In the book, I do follow one student and the various paths she could take to get help. This can show parents that their students are not alone on campus. Similarly, there could be a parallel process where sometimes parents just want to share their concerns with university professionals, rather than have them take action. So it’s very important to clarify this before responding in any way.
I think you are right here that many of the parents who are calling are struggling with their own mental health problems – a longstanding depression, an anxiety disorder, or separation anxiety – as they try to adjust to their child no longer being at home. Basic reassurance and validation of someone’s concern is a positive step to working with all parents. If it is clear that a parent is depressed or overly anxious, then it's also clear that students’ mental health is directly related to that of their parents and therefore it is important for everyone to get treatment and support.
I think that colleges becoming less selective is one factor, but other factors will also have an impact. The lessened emphasis on or elimination of standardized testing will lower the stress. I hope that this will also reduce the pressure, and I have a whole chapter in the book showing how it is incumbent upon us as parents and educators to lessen the stress on young people. But I fear that many families will continue to feel the stress of the college application process, in part because there has been so much emphasis on how college is the road to financial success. I was pleased to see that the governor of Pennsylvania and several others, for example, have eliminated the requirement for a college degree for many of the state jobs. This will allow a focus on skills and experience rather than college courses per se.
We also must remember that teens who are not from privileged backgrounds still feel the pressure to compete for scholarships and financial aid, and so the stress on them is a bit different. Teens are also the ones who lost the most time during the pandemic, and so they may well have academic issues.
As time goes on, the issue of social media becomes more complicated. We know how much of a negative impact social media have on women, especially with respect to body image, and how that negatively impacts their self-esteem. It is true that social media is just that, one medium, and the content is key. But the well-known images of women who are too thin – and at the same time too large breasted for the average body – are magnified by the video exposure that so many teenage girls experience.
The impact on depression itself, however, is less clear. One study of young adolescents found that teens who already had depressive symptoms logically had more frequent negative reactions to social media. However, positive emotional responses to social media were later associated with depressive symptoms, suggesting that some were turning to social media as a vehicle to avoid loneliness. As predicted, overall, girls had greater emotional responses to social media in general. Psychotherapists can certainly guide students toward viewing empowering and psychologically meaningful content. Nonetheless, there is still the draw of peer pressure to see specific TikToks, etc.
I have noticed this trend. It’s unfortunate because I believe that activism and leadership are extremely important in adult development, just as important as the academic side of college. There’s evidence that some students do not see leadership as being directly relevant to their professional success. This troubles me because the college or university experience is a greater gift for development than it is for specific career success. In addition, we know that administrative skills and emotional intelligence can be developed in college leadership, sometimes more than an academic course or grade. And, finally, leadership and activism can provide networking opportunities beyond campus. Students who don’t see them as related to professional success are missing out.
I think that most of what I wrote is even more relevant today. If I were to write an addendum, it would really be about accessing help and not giving up because that is becoming increasingly difficult for everyone, not just on college campuses. We also certainly need to address the negative impact of the COVID-19 pandemic, overall, on mental health. Among other factors, the uncertainty of life now has become prominent. The financial uncertainty of families directly impacts students on every level. I think I might also pay more attention to psychological help beyond psychotherapy, especially mindfulness and meditation, which is discussed in the book and is increasingly showing evidence of having a positive impact.
Also, although I still see the need for individual development away from the family, the pandemic has emphasized even more than ever the need for strong family support. And I think if a student needs that, it should not be minimized. You have to remember that ideas about individualism are culture bound and that in some cultures connection to family remains the most important factor. The pandemic has also made us aware of the close interconnection we have globally, and this makes me think much more about the existential issue of climate change.
This is such an important point! We know that an increasing number of students come to campus with a diagnosis, and that number has skyrocketed since the pandemic. I believe that psychological education is a start: that is, letting students know that, although college is a wonderful opportunity, it is also stressful just because of the large number of changes involved. We know that stress can negatively impact mental health in general, and particularly so for students who have already experienced a psychological disorder or any students who feel ashamed of their diagnosis, so it is important to destigmatize. The overall message that psychological issues are very prominent in college students and that treatment is effective cannot be overemphasized.
As I mentioned earlier, having sessions with parents both during freshman orientation and then perhaps again during family weekend can be extremely beneficial to parents. The sessions should include not only counseling center professionals, but also general healthcare professionals, deans, RAs, and faculty. This would show that psychological development is important to everyone on campus. In addition, having a reading list that would include books like Mood Prep 101 and others can be a great resource for parents, as can relevant TED Talks and YouTube videos.
I think the broader awareness of mental health issues in colleges and universities is a tremendous step forward. The shame that I saw for many years in students and their parents is now almost nonexistent, in general. If we view mental health issues as acceptable, then students can get help. Integrating the issue of mental health in coursework and in student life offices – not exclusively in counseling centers – can normalize psychological issues as part of the human condition. The only downside I see here is that very few counseling centers have been expanded to respond to this demand.
Tina Tormey is the director of residential education & housing and an adjunct instructor at The College of New Jersey in Ewing. Carol Landau, Ph.D., is a clinical professor in the Department of Psychiatry and Human Behavior and the Department of Medicine at The Warren Alpert Medical School of Brown University in Providence, Rhode Island. Additionally, she maintains a private practice and serves as a consultant to a number of academic, corporate, and healthcare clients.