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- 09/24/18--03:00: College Students at Risk for Mental Health Challenges
The books are still fresh, the first exams not yet printed, but college students may have more on their mind than you think. A new study finds one in five students reported thoughts of suicide in the last year, and three out of four reported at least one stressful life event.
The study published in the journal Depression & Anxiety surveyed 67,000 college students across more than 100 institutions, finding high rates for stress events, mental health diagnoses, and the risk of suicide or suicidal thoughts. Minorities were found to be especially vulnerable.
Lead author Cindy Liu, PhD, says the findings are important for both families and colleges. In a news release from Brigham and Women's hospital she notes: “Some stressful events cannot be prevented and, in some cases, are completely normal. But for others, a plan should be in place for family, friends, and colleges to provide support. Our study highlights an urgent need to help students reduce their experience of overwhelming levels of stress during college.”
Liu works in the departments of psychiatry and pediatric newborn medicine at Brigham and Women's Hospital in Boston. Hospital officials say she and her colleagues analyzed results from a survey asking students a variety of questions related to depression and anxiety. That includes whether they had been diagnosed or treated for a mental health issue, if they had engaged in self harm, and considered or attempted suicide. The authors note that college years represent a time of increased vulnerability for a wide range of mental health issues, with many common psychiatric conditions beginning during this period of a person's life.
The survey also asked how many stressful life events students had experienced in the past year. Stressful life events are defined as exposures the student felt were traumatic or difficult to handle. They cover a lot of territory, including academics, career-related issues, the death of a family member or friend, family problems, intimate relationships, other social relationships, finances, a health problem of family member or partner. They may even include the student's personal appearance, personal health issues and sleep difficulties.
Some key findings: rates of stressful life events were high, and associated with mental health issues. Three out of four students reported having at least one stressful life event in the past year. And for more than 20 percent of students, there were quite a few events, reporting six or more in the past year. The stress events appeared to take a toll, with stress exposure found to be strongly associated with mental health diagnoses, self-harm, and suicidal thoughts.
Mental health issues and thoughts of suicide were common in the study. One in four students reported they were diagnosed or treated for a mental health disorder in the past year. One in five had thought about suicide, nearly 20 percent had harmed themselves, and nine percent reported attempting suicide.
Sexual minorities showed high rates of mental health disorders, thoughts of suicide, and self-injury, particularly transgender students. They showed elevated rates of all outcomes, with about two-thirds reporting self injury and more than one-third attempting suicide. More than half of bisexual students reported thoughts of suicide, with more than a quarter reporting a suicide attempt.
Racial and ethnic minorities were found to under-report mental health issues. The study found Asian students had a higher likelihood of suicidal thoughts and suicide attempts, but reported a lower rate of mental health diagnoses compared to white students. African American students showed a lower likelihood of reporting all outcomes compared to white students.
The survey results were all based on self-reporting, which the authors say needs to be taken into consideration. But they provide an eye-opening glimpse into obstacles college students may be up against.
“Colleges and family members who are sending students off to college need to remember that this is a phase of life where young people are confronted with expectations from new relationships and living situations and other encounters that are stressful,” said Liu.
She and her colleagues say their study's findings point to an urgent need for strategies on campus to help mitigate stress, given its relationship to mental health issues and suicidal thoughts, and get students the help they need during this key developmental period.
Over the years Eye Movement Desensitization and Reprocessing (EMDR) therapy has become increasingly popular, evidence-based, therapy approach to resolving psychological distress. Initially used to relieve psychological distress related to clinical symptoms caused by traumatic experiences, its use has now spread to relieving psychological distress related to a number of different clinical symptoms that cause psychological distress and not only to clinical symptoms caused by traumatic experiences.
History of EMDR
According to Francine Shapiro (1989), sometime in 1987, she was walking in the park when she realized that eye movements appeared to decrease the negative emotion associated with her own distressing memories. Francine assumed that eye movements had a desensitizing effect, and when she experimented with this she found that others also had the same response to eye movements. It became apparent however that eye movements by themselves did not create comprehensive therapeutic effects and so she added other treatment elements, including a cognitive component, and developed a standard procedure that she called Eye Movement Desensitization (EMD). Over the following years, Francine continued to develop this treatment approach, incorporating feedback from clients and other clinicians who were using EMD. Consequently, sometime in 1991, she changed the name to Eye Movement Desensitization and Reprocessing (EMDR) to reflect the insights and cognitive changes that occurred during treatment, and to identify the information processing theory that she developed to explain the treatment effects (Shapiro, 1991).
Efficacy of EMDR
Even though criticized at first, over the years EMDR has got a broad base of published case reports and controlled research that supports it as an empirically validated treatment of trauma and other adverse life experiences.
According to the American Psychologist’s Association (APA), with a number of controlled studies of EMDR, EMDR is currently one of the most researched methods of psychotherapy used in the treatment of trauma. Its efficacy has been supported by a number of studies.
The Form of EMDR
At the moment EMDR is best described as a complex therapy approach that combines salient elements of the major therapeutic schools (e.g., cognitive, behavioral, psychodynamic, physiological, and interactional). Although the eye movement stimulation (and other forms of dual stimulation used in the approach) have garnered the most attention professionally and publicly, EMDR actually involves a much broader spectrum of interventions, which are organized into eight phases of therapy (Shapiro, 2001).
In the eight phases of EMDR therapy approach, attention is given to three time periods – the past, present, and future. During this, the attention is given to past disturbing memories and related events. And, also, to current situations that cause distress, and to developing the skills and attitudes needed for positive future actions.
The following is a more detailed overview of the eight phases of EMDR therapy, according to Shapiro (2001).
Phase 1: The first phase is a history-taking session(s), where assessment of the a client’s readiness is performed, after which a treatment plan is starting to be developed. Within this phase, possible targets for EMDR processing are identified. These may include distressing memories and current situations that cause emotional distress. Other targets may include related incidents in the past. Emphasis is placed on the development of specific skills and behaviors that will be needed by the client in future situations.
Initial EMDR processing may be directed to childhood events rather than to adult-onset stressors or the identified critical incident if the client had a problematic childhood. By doing this, it is possible to generally gain insight into situations, which resolves emotional distress and starts to change the problematic behaviors. The length of treatment depends upon the number of traumas and the age of onset of clinical symptoms. Generally, those with single event adult onset trauma can be successfully treated in under 5 hours. In this regard, multiple trauma victims may require a longer treatment time.
Phase 2: During the second phase of treatment, the knowledge about different ways of handling emotional distress in raised. In this regard, the client may learn a variety of imagery and stress reduction techniques that can be used during and between sessions.
In general, the goal of EMDR therapy is to produce rapid and effective change while the client maintains equilibrium during and between sessions.
Phases 3-6: In phases three to six, a target is identified and processed using EMDR therapy procedures. These involve the client identifying three things:
1. The vivid visual image related to the memory
2. A negative belief about self
3. Related emotions and body sensations.
In addition, during this stage, the client identifies a positive belief. The therapist helps the client rate the positive belief as well as the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation. These sets may include eye movements, taps, or tones. The type and length of these sets are different for each client. At this point, the EMDR client is instructed to just notice whatever spontaneously happens.
After each set of stimulation, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending on the client’s report, the clinician will choose the next focus of attention. These repeated sets with directed focused attention occur numerous times throughout the session. If the client becomes distressed or has difficulty in progressing, the therapist follows established procedures to help the client get back on track.
When the client reports no distress related to the targeted memory, (s)he is asked to think of the preferred positive belief that was identified at the beginning of the session. At this time, the client may adjust the positive belief if necessary and then focus on it during the next set of distressing events.
Phase 7: In phase seven, closure, the therapist asks the client to keep a log during the week. The log should document any related material that may arise. It serves to remind the client of the self-calming activities that were mastered in phase two.
Phase 8: The next session begins with phase eight. Phase eight consists of examining the progress made thus far. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses
When it comes to different stages of EMDR therapy described above, it should be noted that currently EMDR is often used as a part of integrative therapy approach. Hence, at times, the form of EMDR therapy may deviate from the one described by Shapiro (2001).
As it was previously noted, the EMDR integrates many psychological theories including psychodynamic, behavioral approaches, and cognitive behavioral theory. This makes EMDR possible to use as a part of integrative therapy approach. This type of approach is, therefore, possible to use with a wide variety of client and in a wide variety of situations.
In addition, numerous studies have shown the effectiveness of EMDR. Much of the EMDR research has studied clients suffering from PTSD, particularly veterans. However, studies proving the efficacy of EMDR have been conducted on clients struggling with addictions, excessive grief, developmental traumas, sexual dysfunction, and dissociative disorders, to name a few.
Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2, 199-223.
Shapiro, F., (1991). Eye movement desensitization & reprocessing procedure: From EMD to EMD/R-a new treatment model for anxiety and related traumata. Behavior Therapist, 14, 133-135.
Shapiro, F., (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd edition). New York: Guilford Press.
According to the United States’ Veterans Association, post-traumatic stress disorder (PTSD) can occur in individuals who have witnessed combat. Research shows that in excess of 20% of veterans who served in Afghanistan and Iraq suffer from PTSD.
Symptoms can include intrusive flashbacks and nightmares, emotional numbness, difficulty sleeping, feeling on edge, anxiety and panic attacks, and suicidal thoughts. If symptoms persist after a few weeks, an assessment is needed in order to determine whether a person is suffering from PTSD and if so, what kind of treatment is most appropriate.
For some, Accelerated Resolution Therapy (ART) may be the answer. ART is a four to five-session, evidence-based psychotherapy program that uses a combination of relaxation and memory visualization to resolve a traumatic memory. According to ART International, 70% of service members and veterans who completed treatment “substantially” reduced their symptoms of PTSD in an average of four treatment sessions and the U.S. Department of Defense is bringing ART to Ft. Hood, Ft. Stewart, Ft. Drum and Ft. Belvoir Community Hospital.
“ART is one of those therapies that was absolutely amazing for me and helped me walk this path that I’m on,” Brian Anderson, a veteran who struggled with PTSD told us.
Anderson joined the military after 9/11. He is a retired Army Green Beret with 14 years of service, 33 months in combat and three Bronze Stars. Anderson struggled with severe PTSD and had thoughts of suicide as he made the transition to civilian life.
“My third deployment was to Uruzgan Province Cobra Base (in Afghanistan),” Anderson told us. “Our very first firefight on Cobra Base was eight hours long and we killed 39 Taliban that day. This 12-man team went on to do a lot of fighting in that area and every single time we left the wire, we were in a heavy firefight. I was already angry and bitter with all the fighting and then September 29, 2010 came around, which was day two of Operation Sundown. My teammate, Calvin, wasn’t supposed to be on that operation but he went. We’re sitting there and watching a couple of helicopters fly into our base. We got a call on our radio that mail just came in. We were all excited and pumped for day two. We’re thinking that once we’re done this operation, we can open our mail.”
Calvin was killed that day along with Mark, Anderson’s combat controller. They were both killed by a high-ranking Taliban commander.
“I was right there when they were killed and took out the machine gun nest that was holding them next to the building,” Anderson told us. “They passed away and we took off the sensitive items from off their bodies, put them in body bags, put them on a plane and sent them out. We kept on with our operation for the next couple of weeks. We went through the rest of that deployment and there was still a lot of fighting. We had a couple more injuries and a couple more casualties. They were all difficult. Then we came home.”
Anderson wanted to leave the military. His team moved to Eglin Air Force Base and he stayed at Fort Bragg. That’s when he says he started feeling panic attacks.
“I started feeling symptoms of PTSD when I left active duty,” Anderson told us. “I was first diagnosed while I was still in service. I first went in because I thought I had blood pressure issues or diabetes. I was getting lightheaded and weak, and didn’t know what was causing this. When I got to the hospital they ran all the tests they needed to do. When I came back to the hospital for my follow-up visit, the doctors told me I was suffering from PTSD which was causing my panic/anxiety attacks.”
Anderson began a long road at trying to figure out what this meant and how he could recover.
“It got a lot worse before it got better,” says Anderson. “I started questioning my existence, whether I was alive, thinking I was in purgatory and thought I actually died in Afghanistan and had to right everything that went wrong. Then I started seeing Calvin and Mark. I started seeing Calvin driving the car next to me. I would see Mark walk past me. I would have images of bullets going through my head. I would imagine rage coming through the door.”
A friend pointed Anderson to ART.
“What was really interesting is after my session some of the scenery I would see on a regular basis - seeing Calvin driving the car next to me, Mark walking past me, images of bullets going through my head or rage coming through the door - all that stuff went away after one session,” Anderson told us. “I’ve really tried to push other warriors to see what this therapy – a therapy that I call brain fitness on steroids -- is really about. I didn’t go through another ART session for a year and a half. I did go through several more ART sessions after the year and a half for things like my time in war, people passing, survivor’s guilt and other stories. During these sessions, I would picture myself waking up in the morning and feeling this heavy guilt and shame, which expanded to the entire day. I would then envision what my perfect day was. That was about a year and a half ago and I haven’t had guilt and shame since then. I think ART absolutely is effective and it helped me out tremendously with overcoming some of these gaps that I’ve had. ART saved my life.”