Depression, Adolescence, and Education

As part of my masters of mental health studies, I was required to write a newsletter-style report about a mental health issue directed at a specific group of professionals. I chose to write about depression, adolescence, and education for teachers:

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It is estimated that, on average, there are at least two students in every class who are suffering from depression at any given point. This often goes unrecognised due to sufferers concealment attempts and carers are not being aware of symptoms. The repercussions of this can be great, as left unattended it impacts learning and leads to lower school attendance. Further, it has been associated with self-harm, eating disorders, substance abuse, and suicide. By being aware of the signs of depression teachers can, potentially, interweave preventative and curative interventions into the classroom to help reduce the amount of suffering. This following aims to provide some basic information, generate awareness, and promote further discussion of a school’s role in students’ mental health.

Causes

Depression is a complex condition that can occur on its own or with other conditions. It can be sub-categorised in the following ways: physical (e.g. anaemia, thyroid dysfunction, candida), situational (e.g. bullying, family disharmony, relationship conflict), or as part of a broader mental health condition (e.g. post traumatic stress disorder, anxiety, grief, adjustment disorder, loss). Irrespective of the underlying cause, all forms of depression share some common symptoms.

Symptoms

Normal challenges in adolescent years, coupled with hormone changes and social pressures, can lead to a mild depression which teenagers drift in and out of as they develop their sense of identity and place in the world. Depression, however, as a serious mental health condition, goes beyond this. Official diagnosis dictates that at least five symptoms are present for at least two weeks, and that these interfere with student’s normal functioning.

According to an Australian Government report:

“Symptoms of major depressive disorder may include significant weight loss or weight gain, loss of appetite, insomnia or hypersomnia, restlessness, fatigue and loss of energy, feeling of worthlessness and inability to concentrate.”1

Practical examples of how this may present in the classroom include: students isolating themselves, disengagement, slow bodily movements, not submitting work, aggressive outbursts, teariness, and other challenging behaviour.

Obstacles in getting help

Ideally, once a student has been identified with depression, they would be to referred to a counsellor or psychologist for professional guidance and diagnosis. Unfortunately this is not always possible as students often do not feel that talking to anyone will help. To meet this, simple strategies from teachers and school administration can be useful.

Myth busting

There are many myths surrounding depression which can impede teenagers getting the support that they need. This includes some well meaning philosophies such as positive motivational strategies. Whilst reframing things in a positive light  may be useful in some circumstances, it is not an exclusive approach that cures all. In the case of someone who is depressed it can be counterproductive because they are not making a conscious choice to be depressed, hence, motivating them to be more positive can lead to worsening feelings, such as guilt and shame when they cannot achieve this. Emerging research suggests that students who are susceptible to mood and behavioural problems lack skills, not motivation, to cope with life challenges.

What teachers can do

It is unethical to expect teachers to diagnose students, however, as depression can have such a negative impact on learning and other areas, it is appropriate for them to have an awareness for what to look for and how best to approach it.

Individually, teachers can make a difference to a student’s mental state. Depression contains the element of low self-esteem, therefore, by giving encouragement for efforts, rather than final product, self-improvement is more effectively inspired. Self-esteem building in this way comes across as genuine care and builds confidence in abilities due to the praise being given for the process, not end product.

Primarily, students who are suffering depression need empathy and understanding. This can be a difficult ask when teachers are pressured to achieve target goals and a student presents as not putting in sufficient effort. It can create a difficult situation in which the teacher does not know if the student is being lazy, doesn’t not understand what was expected of them, (i.e. possible learning disorder), or is suffering depression. In one-off incidents this is made even more challenging. A possible solution is for teachers to develop culture where it is normal to check in on students when returning work, opposed to handing it back without saying anything. Conversations could look like this:

Teacher: “Jesse, you seemed to have struggled with this assignment. Is there a reason?”

Jesse’s reply could then be an indicator of either supporting or dismissing the probability of depression. For example Jesse replies: “I rushed it at the last minute,” then suspicions can be reduced. Whereas if there is no reply at all (depressed students often avoid answering questions) or gives a simple response such as: “I don’t care what mark I get,” then further investigation may be deemed necessary.

What schools can do

Preventive measures are best; supportive school communities which promote growth mindsets, mindfulness, and anti-bullying programs, are sound approaches.

Cultivating a professional culture in which staff confer and collaborate with each other if they suspect a student is at risk of depression is one such way in which this could occur. This could be viewed much the same as mandatory reporting of child abuse conversations are expected take place. This practice could be done informally or extended to a formal systematic checking on students demeanours through digital surveys. A Melbourne based school approaches this by requiring all staff to fill in an online questionnaire once a month for every student. Three identifiable markers; mood, social interactions, and workload accountability, are checked across the board. The simple tick-a-box processes ensures that all students are looked out for and no individual teacher is responsible for reporting a student who is struggling. A central coordinator compares the information and follows up as required. This approach, which only requires a few minutes per class, could easily be adapted to most schools without adding too much extra work onto teachers.

Taken to another level, schools can adopt global approaches to intervention by being  trauma-informed, and cultivating connection, and a community atmosphere. These provide excellent prospects for recovery and prevention. Included into such models are skilled based lessons on emotional regulation, relationships and conflict resolution skills, and self-identification and labelling of feelings.  In such environments students are better situated to work through personal issues, like depression, or ask for help, if needed.

Social researcher, Brene Brown, encapsulates this beautifully in her quote:

“A deep sense of love and belonging is an irreducible need of all women, men, and children. We are biologically, cognitively, physically, and spiritually wired to love, to be loved, and to belong. When those needs are not met, we don’t function as we were meant to. We break. We fall apart. We numb. We ache. We hurt others. We get sick.”2

Happy, healthy school communities, create happy, healthy students.

Further support

Teachers and schools wanting to seek further information can do so here:

Student Mental Health and Wellbeing. (2017). Education.qld.gov.au. http://education.qld.gov.au/studentservices/protection/mentalhealth/index.html

Lawrence, D., Johnston, S., Hafekost, J., Boterhoven de Haan, K., Sawyer, M., Ainley, J., & Zubrick, S. (2015). The Mental Health of Children and Adolescents: Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Published By The Australian Government. https://www.health.gov.au/internet/main/publishing.nsf/Content/9DA8CA21306FE6EDCA257E2700016945/%24File/child2.pdf

Fallot, Ph.D., R., & Harris, Ph.D., M. (2009). Creating Cultures of Trauma-Informed Care (CCTIC):A Self-Assessment and Planning Protocol. https://www.healthcare.uiowa.edu/icmh/documents/CCTICSelf-AssessmentandPlanningProtocol0709.pdf

Footnotes

1. Pg.35 Lawrence, D., Johnston, S., Hafekost, J., Boterhoven de Haan, K., Sawyer, M., Ainley, J., & Zubrick, S. (2015). The Mental Health of Children and Adolescents: Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Published By The Australian Government. https://www.health.gov.au/internet/main/publishing.nsf/Content/9DA8CA21306FE6EDCA257E2700016945/%24File/child2.pdf

2. Brown, B. (2016). The Gifts of Imperfection. [United States]: Joosr Ltd.

Bibliography

Bennett, M. (2017). Episode 1: Our Trauma-Informed Journeys. [podcast] http://connectingparadigms.org/podcast/episode-1/

Brown, B. (2016). The Gifts of Imperfection. [United States]: Joosr Ltd.

Fallot, Ph.D., R., & Harris, Ph.D., M. (2009). Creating Cultures of Trauma-Informed Care (CCTIC):A Self-Assessment and Planning Protocol. https://www.healthcare.uiowa.edu/icmh/documents/CCTICSelf-AssessmentandPlanningProtocol0709.pdf

Kidsmatter.edu.au. (2017). Cognitive Behavioural Intervention for Trauma in Schools (CBITS) | kidsmatter.edu.au. [online] https://www.kidsmatter.edu.au/primary/programs/cognitive-behavioural-intervention-trauma-schools-cbits

Lawrence, D., Johnston, S., Hafekost, J., Boterhoven de Haan, K., Sawyer, M., Ainley, J., & Zubrick, S. (2015). The Mental Health of Children and Adolescents: Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Published By The Australian Government. https://www.health.gov.au/internet/main/publishing.nsf/Content/9DA8CA21306FE6EDCA257E2700016945/%24File/child2.pdf

Making SPACE for Learning Australian Childhood Foundation Trauma Informed Practice in Schools. (2010). [ebook] Ringwood VIC: Australian Childhood Foundation. https://www.theactgroup.com.au/documents/makingspaceforlearning-traumainschools.pdf

Moss, R. (2013). A Clinical Biopsychological Theory of Loss-Related Depression. [online] The Neuropsychotherapist. http://www.neuropsychotherapist.com/loss-related-depression/.

Schwartz PhD, A. (2016). The complex PTSD workbook. Berkeley, California: Althea Press.

Student Mental Health and Wellbeing. (2017). Education.qld.gov.au. http://education.qld.gov.au/studentservices/protection/mentalhealth/index.html




Art and Trauma

What is Art Therapy?

Art therapy, also sometimes referred to as art psychotherapy, is a counselling approach that incorporates the creating of artwork into the therapeutic process. Creating art provides a means of directly tapping into the subconscious mind and in doing so provides insights and directions for conversations that could be otherwise missed. Art therapy also enables traumatic experiences and associated thoughts and feelings to be processed in a safe and efficient manner which talking alone cannot achieve.

What does trauma-informed mean?

A lot of mental health issues, such as depression and anxiety, stem from traumatic experiences in one’s personal past or their family system. By acknowledging this, core issues can be address as well as the symptoms that they create. In a trauma-informed space, safety, collaboration, and awareness of triggers are of the utmost importance; hence, these are respected and incorporated into the therapy process.

Benefits of trauma-informed art therapy

Art therapy and healing trauma go hand in hand. This relates back to neuroscience principles; for a general overview of this read the article Art Psychotherapy and Neuroscience. More specifically, when someone experiences trauma, the brain that controls cognitive functions (ie. reasoning, memory, attention, and language) doesn’t work as efficiently as it could. The brain can switch to automatic and fight, flight, fawn, or freeze responses dominate. Basically, the nervous system’s takes over and either pumps adrenal so as quick movements to escape real or perceived dangers can be made, or the body becomes rigid and cannot move as an alternative means of protection. Simply “moving on” or “letting go” of traumatic experiences solemn works. Such approaches are often glorified repression tactics which result in trauma symptoms still being present days, weeks, months, or years later. Bessel van der Kolk, an expert in trauma describes phenomena in detail in his book The Body Keeps the Score. Further, he stipulates that reminders of traumatic events have a way of interfering with one’s life until that are suitably addressed. Van der Kolk (and other researchers) suggests that simply talking about traumas is often ineffective. On a physiological level, this is due to a break in the connection between the thinking and feeling parts of the brain. Art therapy bypasses this problem by not relying on cognitive functions. By mark making, hand modelling (clay, wax, or plasticine), and being creative in other ways, trauma can be expressed and released in an effective manner, thus improving mental health and wellbeing. While participating in any artistic activity can be beneficial, doing so with the support and guidance of a professional therapist, means a greater level of healing can be achieved.

When discussing trauma it is useful to keep in mind that there are two main types. There are big “T” trauma events which are life-threatening occurrences and there are small “t” events that impact one’s confidence and self-agency. Below is a table that provides examples of each. While most people automatically think of big T trauma events as being of significance, little t traumas that remain unaddressed can have drastic long term effects on mental health. Once trauma has been processed via the emotional part of the brain – which it does so when someone is being creative in art therapy – then cognitive functions begin to improve.

Examples of big “T” trauma

  • Physical, sexual, verbal assault
  • Vehicle accidents
  • Natural disasters
  • Difficult divorce or death situations
  • War-related experiences
  • Child abuse; neglect and other intrusions on safety

Examples of little “t” trauma

  • Being bullied
  • Passive-aggressive treatment from family, friends, work, etc
  • Rejection
  • Ridicule
  • Invalidation

Both forms of trauma can have serious impacts on a person’s mental health and lead to PTSD symptoms such as: nightmares, insomnia, intrusive memories, flashbacks, lack of concentration, feelings of helplessness and hopelessness, irritability, rage, anger, dissociation, self-destructive tendencies, avoidance, mistrust, poor memory, negative self-image, guilt, shame, and hyper-vigilance.

BIBLIOGRAPHY

Kolk, B. van der. (2015). The Body Keeps the Score. Penguin.

How to Zentangle: Art therapy style

When people first try art therapy there is often some level of self-consciousness. Thoughts and comments along the lines of  “will my drawing be ‘good’ enough?” or “I haven’t been creative since I was a kid!” or “I can’t even draw a straight line!” often come up. Such things often arise as a result of what Julia Cameron terms “art wounds”. That is situations from our past in which our attempts at being artistic were laughed at or somehow made to feel they did not measure up to what our society deems to be “good” or “real” art. Zentangling is a great way to overcome these “art wounds”. It is my firm belief – based on personal observations and research – that EVERYONE has the capacity to be creative and artistic. Giving oneself the permission to do so, without judging oneself against others, is the first step towards this.

Zentangling is basically a form of doodling that has a wonderful structure to it and the story of how it begun is also quiet special.

HOW ZENTANGLING BEGUN

Zentangling is a relatively new art form created by a couple called Maria and Rick; she was a graphic designer and he was an experienced mediator. One day when Maria was working on a detailed drawing Rick came into her studio and tried to get her attention. “Maria” he called gently at first, however, she was so absorbed with what she was doing that she did not respond. “Maria!” Rick called out a little more louder and assertively. He repeated this again and again until he had Maria’s attention. When Maria’s concentration was broken and she looked up and realised that Rick had been calling to her for several minutes it promoted some self reflection. Together, Rick and Maria established an understanding that what had happened was identifiable as Maria being in a “flow” state while she was drawing. In positive psychology, this is a state in which a person is fully living in the moment, concentrating, absorbed, yet relaxed and at peace. It also resembles the state in which many meditators try to achieve with their practice. So it was that Maria and Rick then went on to formulate a way in which they could share this practice with others.

Personally, I have always struggled with meditation and mindfulness activities; Zentangling, on the other hand, comes easily. Like Maria, I often find that when I am absorbed in the creative process I feel at peace, other worries in my life subside, and I’m able to feel a sense of perspective that I don’t ordinarily have. Through research, I have discovered that such an experience is linked to nervous system regulation. In short, by engaging in activities that encourage relaxation, like Zentangling, our minds and bodies have the opportunity to reset, so to speak. Simply deciding to be creative and make art work in order to achieve this stage when one is stress is not, however, always easy. It is for this reason I feel extremely grateful and indebted to Maria and Rick for putting together such a wonderful system like Zentangling which enables this to occur with ease.

I have used this approach as a therapeutic intervention with beginners who are nervous of their art abilities, right through experienced artists – every time it produces amazing results – both on paper and in client’s minds. I’ve seen clients who have an extensive art back grounds loosen up and gain new insights and bursts of creativity. I’ve also witnessed clients who swore they could not draw a thing be delighted in what they produced – so much so that their future attitudes and involvements with art therapy changed dramatically for the better.

While the aim of art therapy is not to make something beautiful, it is part of human nature to appreciate such, and in this regard, Zentangles have the added advantage of achieving this every time!

Maria and Rick claim the main benefits of Zentangling as being:

  • Relaxing
  • Incressing focus abilities
  • Expand your imagination
  • Learning to trust your creativity
  • Increasing awareness
  • Learning to respond confidently to the unexpected
  • Discover the fun and healing in creative expression
  • Feel gratitude and appreciation for this beautiful world and all that you can do.
  • And perhaps most importantly . . . Have fun!

Personally, I would add to this list an appreciation of the beauty of imperfection. Zentangling does not require rulers or definite rules. Rather, marks made with free hand guestures add uniqueness and beauty to the work.

So now that we know how great Zentangling is, let’s get started!

YOU WILL NEED

  • A small piece of paper – 10x10cm is fine. Or a sketchbook – I’m using my trusty A5 travel pad for this example.
  • A pencil, fineliner or pen. The traditional zentangle is done in black, however, as with most rules in art, these can be broken! Using a white pen on black paper creates some pretty groovy results!
  • Optional – reference pictures of patterns to get you started. Many can be found on Pinterest, such as these.
STEP 1: You need paper (sketch book as I have) and a pencil or pen. Traditionally, Zentangling is done in black and white, however, as with all art rules, these can be broken!

STEP 2: Make 4 marks on your page that roughly indicate a square, like above (this is rule that you can break later once you are more familiar with the process)

STEP 3a: Draw lines connecting these dots – these can be straight, curved, or whatever!
If you prefer, these step can be done with lead pencil so as there are no sharp edges when you finish

STEP 3b: Completed enclosed shape.

STEP 4a: Draw a few lines to divide the space. No limit or definite rules for this; just do it.
As above, this step can be done in lead pencil as well.

STEP 4b: Divided sections completed.

STEP 5: Fill in each section with a different pattern. This is where you may wish to use the reference pictures you found on the internet. I find that I often start with these as prompts then go off on my own creativity. It’s amazing what you can do with basic lines and shapes such as circles, squares, and triangles!

STEP 6a: Once you’ve completed one section with pattern, go on and fill in the other sections! It is that simple!

STEP 6b: It can be tempting to finish your Zentangle with line patterns, however, I’d encourage you to colour in some sections so as there is a definite contrast between light, dark, and other sections. To complete this one, I added a pole to make it look like the Zentangle is a flag – turning your Zentangle into a recognisable object is completely optional!


How did you go? I’d love to hear people’s experience and if possible it would be great if you could post a photo of your work down below so as we could build up a little Zentangle gallery. If you’re interested in doing so, fill out this form and up load a photo of your Zentangle/s. I can’t wait to see them!

If you’d like more guidance on zentangling you can book an individual session or you can sign up for a Mediation A group that incorporates some zentangling into the session.

Thanks for stopping by and I hope you enjoyed zentangling. For more tips on how art can support mental health click on the follow link at the bottom of the page.

BIBLIOGRAPHY

CAMERON, J. (2002). The artist’s way: a spiritual path to higher creativity. New York, J.P. Tarcher/Putnam.

Maria, & Rick. Zentangle. Retrieved March 20, 2019, from https://zentangle.com/