mental-health

Can Children Grow From Loss?

~ corinnemasur2331 ~ Leave a comment

In our 4 part series on loss, I talked about the little losses of everyday life, how children understand death, how to introduce the topic of death to children and what a child may feel when they lose a loved one. But something I did not talk about is the fact that, as hard as losing a loved one is for a child, they can also grow as a result of the experience.

This may come as a surprise.

But many people, including children and teens, not only manage to survive difficult losses, but they also grow as the result of their experience with loss.

Scientists who study trauma and loss have found that there can be a variety of positive psychological changes for some people following challenging life experiences.

Lawrence Calhoun and Richard Tedeschi called this “posttraumatic growth.” They mentioned the following positive changes as being prominent for many people:

·    Greater appreciation of life

·    Greater appreciation and strengthening of close relationships

·    Increased compassion and altruism

·    The identification of new possibilities or a purpose in life

·    Greater awareness and utilization of personal strengths

·    Enhanced spiritual development

·    Creative growth

And, as it turns out, one crucial factor that allows people to turn a difficult event into one that promotes growth is the extent to which they explore their thoughts and feelings around that event.

Many people prefer “to look on the bright side” and to not focus on the difficult things that happen to them. In fact, one young woman who sees me in therapy told me that when she hurt herself as a child, her mother used to say, “pretend that didn’t happen”.

However, Calhoun and Tedeschi found that the ability to acknowledge that the event has happened and to think about and process the painful feelings associated with the event are what allow some people to grow from their difficult experiences.[i]

Two other researchers, Todd Kashdan and Jennifer Kane, also studied this subject. Using a group of college students, they looked at how much people tend to avoid difficult and painful thoughts and feelings versus how much they are willing to allow them. In their study, the most frequently reported traumas amongst their subjects included the sudden death of a loved one, motor vehicle accidents, witnessing violence in the home, and natural disasters.

Kashdan and Kane found that the greater the distress the person experienced, the greater the posttraumatic growth that resulted from it—but only in those people who did not avoid their feelings, or who did so infrequently.

 These findings support the benefits of encouraging children to experience and talk about their feelings following loss. It also supports the importance of having children and teens who are having difficulty experiencing or expressing their feelings get involved in some form of expressive psychotherapy, whether that be individual, group, or family therapy.

Another researcher, Jessica Koblenz specifically studied children who had lost a parent to find out what helps and what hinders them in their grief process. And she also found that there is growth from loss. One child in her study said they had a heightened sense of life and didn’t want to waste time or have regrets. Another said he had become more independent. Some mentioned that they learned to seek help from those who were able to provide it. Some found that exercise was a good method for coping with painful feelings, and others found humor helpful.

Teigan, a young woman I met through Winston’s Wish, told me that what happened to her after she lost her mother shaped what she wanted to do with her life. She described how one of her teachers at school called her every week after her mother died and provided her with much needed attention, support, and guidance. This teacher was an inspiration for Teigan, and she decided to become a grief counselor for children and teens so that she could help other students, just as her teacher had helped her. In the meantime, she was training to lead grief groups just like the one she had participated in herself.

For years, Calhoun and Tedeschi, studied the positive effects of trauma—including loss. They also found that some individuals who had suffered significant trauma experienced positive changes. These changes include improved relationships, new possibilities for life, a greater appreciation for life, a greater sense of personal strength, and increased spiritual development.

They also found some interesting contradictions. People they interviewed said things like “I am more vulnerable, yet stronger.” Individuals who experienced traumatic events tended to talk about their increased sense of vulnerability; however, these same people also reported an increased sense of their own capacities to survive and prevail.

Another experience often reported by trauma survivors was a need to talk with other people about the traumatic events, which tended to deepen some of their personal relationships. Some also found themselves becoming more comfortable with intimacy and having a greater sense of compassion for others who experienced life difficulties.[i]

In my clinical practice, a teenager whose father had died at the beginning of Covid said to me, “My dad’s death gave me a different perspective. I used to think that if a friendship ended or someone died, all the time you put into that relationship was wasted. Now I think that it was valuable. I would rather have had my dad for the time I had him rather than some other dad who was around longer.”

This young woman gained a new perspective and came to a new appreciation of the relationships in her life. She came to understand the importance of the person that her father was despite her lifelong frustration with having had an older dad. And she also recognized that relationships are important in their own right, even if they end prematurely.

Calhoun and Tedeschi also found that some people who faced trauma were more likely to become engaged with fundamental existential questions about death and the purpose of life. A commonly reported change was for the individual to value the smaller things in life more and to also consider the religious, spiritual, and existential components of life. A common theme for many people in this study was that after a traumatic event, philosophies of life can became more fully developed, satisfying, and meaningful.[ii]

Researchers such as Calhoun and Tedeschi have found that growth can occur not despite adversity but because of it.

It is true that they looked predominantly at adults, but interestingly, very similar findings have been found in research on bereaved children.

In a study of what helps and hinders children and adolescents who lose a parent, Jessica Koblenz found multiple areas of growth in many of the children she interviewed.[iii]

Seventy-three percent of the participants in her study felt that navigating and understanding death at an early age made them grow up faster.

And it is interesting to think about whether “growing up faster” is a form of growth or a toll that is paid by children who have experienced early loss. I suspect that some children might consider it a form or growth, some might feel it was a toll they paid, and some might feel that it is both. 

Some children in Koblenz’s study said they responded to loss by embracing life. One said, “I have a heightened sense of life, not wasting time, and not having regrets.” According to some grief theorists, this renewed sense of life is an adaptive form of meaning-making following loss.[iv]

Many of the children Koblenz interviewed said that support helped them to get through their loss. This finding is important because traditional psychological and psychiatric views of bereavement have minimized the role of relationships and support from others in coping with loss. However, more recently, evidence has shown that relational support plays a crucial role in a child’s ability to cope after a loss and may actually improve and intensify some existing relationships.

Interestingly, participants in Koblenz’s study stated that their most helpful source of support were other mourning children who could relate with their exact position.

Koblenz also found that becoming self-reliant was a coping strategy that some of the participants in her study utilized. In her study, kids said that they began to rely more on themselves once they decided that they could no longer depend on others. For some, it was easier to express they “were strong” and “could handle it alone” than to acknowledge their loneliness.[v]

Koblenz says that the sentiment of “needing to be strong” was expressed by many participants and reflected their inability to convey vulnerability. As one participant said of her childhood loss, “Everyone always said, ‘You’re so strong.’ No one ever said, ‘It’s okay if you’re not.’” From this Koblenz concluded that applauding children’s ability to handle their grief alone may make it difficult for them to feel they can be completely open and show their vulnerable selves. But some participants were able to find a balance of healthy independence while still reaching out to others in times when they needed help.[vi]

[i] Lawrence G. Calhoun and Richard G. Tedeschi, “The Foundations of Posttraumatic Growth: An Expanded Framework,” in Handbook of Posttraumatic Growth: Research and Practice, ed. Calhoun and Tedeschi (New Jersey: Lawrence Erlbaum, 2006), 3–23.

[ii] Richard G. Tedeschi and Lawrence G. Calhoun, “Posttraumatic Growth: A New Perspective on Psychotraumatology,” Psychiatric Times 21, no. 4 (April 1, 2004).

[iii] Jessica Koblenz, “Growing from Grief: Qualitative Experiences of Parental Loss,” Omega 73, no. 3 (March 2015): 203–230.

Resilience

~ corinnemasur2331 ~ Leave a comment

George Bonanno, one of the leading researchers on resilience, defines resilience as the ability to maintain relatively stable and healthy levels of psychological and physical functioning in the face of adversity. He says that resilient individuals may still be upset and disturbed by a loss or a very difficult event but that their upset is short lived and that after a few days or weeks they are able to go back to functioning in their usual way.

And he states that this is not as rare as we once thought.

He says, “many people are exposed to loss or potentially traumatic events at some point in their lives, and yet they continue to have positive emotional experiences and show only minor and transient disruptions in their ability to function. 

Unfortunately, because much of psychology’s knowledge about how people cope with loss or trauma has come from people who sought treatment, theorists have often viewed resilience as either rare or pathological.

Bonanno says that among adults, only 10 – 15% of bereaved individuals experience chronic distress or prolonged grief after a loss. This is a much lower number than we might expect!

He talks about some people as “hardy”, that is, they are able to withstand difficult events and move on. 

While he has mainly studied adults, perhaps we can also think about this in terms of teens and children. 

Bonanno says that people who seem to be hardy are usually committed to finding meaningful purpose in life, they possess the belief that one can influence one’s surroundings and the outcome of events and also the belief that one can learn and grow from both positive and negative events in life. He also says that people who are hardy are likely to be more confident and able to use active coping strategies as well as social support from the people around them.

Another attribute which has been found amongst people who prove to be resilient is the trait of self enhancement. Interestingly, people who think well of themselves, and perhaps even exaggerate their positive attributes, often do better under difficult circumstances. This  has been found to be particularly true following severe loss.

Research has been done on people who were near the World Trade Center on 9/11 in New York City as well as on Bosnian civilians who lived in Sarajevo after the Balkan civil war. In both cases, people who were high on the self enhancement scale were rated by mental health professionals as being better adjusted than those who were not as likely to engage in self enhancement. 

People who are full of themselves, people who are what some of us might consider over confident may sometimes be annoying to be around – but it turns out that this trait can have benefits when it comes to weathering adversity!

 Other researchers have found that certain pre-existing characteristics help people to weather adversity. For example, one study done during the pandemic found that people who have a sense of being able to affect others and their environment (called self-efficacy) are more likely to return to normal functioning after a significant loss. The team summarized the findings of their study saying that a high degree of self-efficacy served as a protective factor against depression and grief among the bereaved individuals who lost their loved ones due to Covid.[i]

In his review of the professional literature on this subject, another researcher found that individuals who were characterized as having what is called openness, who have a tendency to accept new experiences, who feel less nervous through disappointments, and who believe in themselves, also fare far better following loss. 

Similarly, individuals who are agreeable, those with conscientiousness traits, those who exercise their abilities and recognize their limitations, and those who set realistic goals all tend to have increased ability to persevere and persist in challenging situations.

In an interesting study on children and teens, it was found that those who have a tendency to ruminate and reflect on their experiences are both negatively and positively affected by this tendency when they are faced with an adverse event. As it turns out, while rumination on negative events can lead to depression, it can also facilitate processing, integration and making meaning out of the negative things that happen to us.

 And one last way that people who seem to be resilient are observed to cope with adversity is through the use of positive emotion and laughter. Often the use of positive emotions after loss and other difficult experiences has been seen as a sign of an unhealthy level of denial. However, in recent years, research has shown that positive emotions can reduce levels of distress following difficult events and it is thought that their use need not necessarily be seen as unhealthy. 

It seems that those cultures which have a tradition of telling jokes and funny stories about the deceased at a wake or funeral were on to something important years before the social scientists!

So loss and exposure to difficult events may be very painful, they may be difficult and recovery may be lengthy – but there ARE ways to cope, and many, in fact most people are resilient in the face of loss and adverse events.

References:

Bonanno, George.  Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? The American Psychologist, Jan. 2004. P. 20.

Bonanno, George. The Other Side of Sadness.

Lawrence G. Calhoun and Richard G. Tedeschi, Handbook of Posttraumatic Growth: Research and Practice (London: Routledge, 2014).

Todd B. Kashdan and Jennifer Q. Kane, “Post-Traumatic Distress and the Presence of Post-Traumatic Growth and Meaning in Life: Experiential Avoidance as a Moderator,” Personality and Individual Differences 50, no. 1 (January 2011): 84–89, https://doi.org/10.1016/j.paid.2010.08.028.

Jessica Koblenz, “Growing from Grief: Qualitative Experiences of Parental Loss,” Omega 73, no. 3 (2016): 203–230.

On July 3rd, my new book called How Children Grieve will come out – and in honor of the occasion, I am starting a 4 part series on loss.

~ corinnemasur2331 ~ Leave a comment

https://www.penguinrandomhouse.com/books/738355/how-children-grieve-by-corinne-masur

Part 1

The Losses of Everyday Life

Everywhere you look, someone is either writing or podcasting about how you should be raising your children. You should be more gentle; you should be less gentle. Your children need to develop an understanding of feelings; your children are overprotected and unprepared. Whether you are reading Sarah Ockwell-Smith or Johthan Haidt, you will find that you are doing it all wrong.

What’s a parent to do?

Well, if you ask me, it’s not one or the other. Sometimes children need limits and sometimes they need help understanding their own feelings and the feelings of others.

We don’t want to over protect our children so they are unprepared for what life is really like nor do we want to overexpose them to disappointment and difficulty.

So, again, what’s a parent to do?

Well, I would like to start with just one subject. And that is the subject of loss. 

Children – all children – experience losses and disappointments in their lives and we do not need to protect them from these or from the feelings that result from these. 

But we do need to prepare them and to help them when these losses happen.

We need to prepare them for both the little losses and the big losses so that as they mature, they will be able to handle what comes their way.

We don’t like to think about it, but children suffer losses all the time. And they need to be able to manage when these losses occur.

A friend doesn’t show up at school because she’s sick. Another friend moves away over the summer. A beloved stuffed animal is left behind on a trip. A promised adventure to the amusement park is cancelled due to rain.

These are small losses, but losses all the same.

So, do we go out and buy a new stuffed animal right away? Do we call the teacher and tell her how sad our child is that her friend is out sick? Do we try to introduce our sad child to other kids as soon as we find out her friend is moving? Do we substitute a trip to an indoor trampoline park instead of the amusement park?

You might be tempted to do one of these things.

But how about holding off?

Our job, as parents, is not to protect our children from experiencing loss, nor from the feelings accompanying loss.

What we need to do is to help our children with their losses, whether big or small, and we need to start early.

We need to convey that yes, it is sad to lose a stuffed animal or to miss a friend or to lose a much hoped for day at the amusement park – but we also need to convey that these losses can be survived.

Little losses are the best place to begin – because they lay the groundwork for dealing with bigger losses which will certainly come along at some point.

We should try to avoid giving our children the impression that life is always good.

Because it isn’t.

And we want our children to be able to feel what they feel when life isn’t good, and to be able to talk about it (if they want), and eventually to be able to move on.

The problem is that often these small losses are not spoken about. 

For the obvious ones like the loss of the stuffed animal, parents are often tempted to make the sadness go away by replacing the lost toy.

But why not let your child feel sad for a while?

Part of the problem with this is that for parents, it can be hard to tolerate a child’s sad feelings. It is painful for us.

But try to take a moment.  This is our job – we just have to try to allow the sadness and to show that WE can survive it ourselves. 

If we can tolerate our child’s sadness, this will help them to tolerate their own sadness.

And a missed friend or a missed day of fun?

Let’s also let them be sad.  Let’s try not to “make it all better”. Let’s talk about how sad and hard these things are. Let’s share times when we suffered in the same way. And let’s tolerate our children’s sadness and disappointment – and let them know that these things will happen from time to time in their lives.

And what about less obvious losses? The ones that we might not notice but which children are suffering with? 

They are what Pauline Boss calls “ambiguous losses” and I will talk about these in Part 2 of this series.

SCREEN TIME – AGAIN!!!

~ corinnemasur2331 ~ Leave a comment

Dr. Corinne Masur (Be sure to leave a comment below if you have something to say about screen time!)

In our parenting group on Friday one mother said, “at our house it’s always a battle about electronics”.

I think she speaks for 98% of all parents in the US. 

Once kids get on Youtube or once they are playing a game, they don’t want to stop. And in fact, it’s really hard to stop. 

So there’s either a battle – or there are frustrated parents shying away from a battle.

Parents are genuinely afraid to say no. Parents want to avoid a meltdown.

And this is doubly true in public. In our group, parents admitted to being afraid that if they say no when they are outside of the house, there will be a scene, a tantrum, yelling and screaming – and everyone will see it.

And then they will feel ashamed. 

The parents talked all about this. They admitted that sometimes they don’t set limits because they are afraid the ensuing battle will take away everyone else’s good time.

What if they are at a restaurant? Out with friends? Or on a trip with other families?

No one wants to be the parent who caused the meltdown that makes everyone else uncomfortable.

One mom said “I don’t think it’s healthy but that’s the way it is”.

Another parent said, “but if you let things go, it’s hard to make a change.”

This IS hard. 

If you don’t set limits early and often, kids are used to getting 10 more minutes…or an extra half hour. They persist at asking for more because they know sometimes they get it.

Parents are confused about what to do. Set a limit? Don’t set a limit? Give in to your child’s desire to stay on screen and give yourself another half an hour to look at your own phone? Or do the laundry? 

This is a conflict. Parents want and need more time for themselves. At the same time they want their kids to listen when they say, “It’s time to get off your screen”. 

Is it better to make a few rules? Ones that are just for your family – which don’t have to be like anyone else’s rules?

Or is it better to keep the peace?

Giving in sometimes and having established rules are not necessarily compatible. As we all learned in Intro to Psychology, the most reinforcing thing in the world is intermittent reinforcement. It’s better than all positive reinforcement and it’s better than all negative reinforcement – that is, if you want that behavior to persist, whatever that behavior is, rewarding it SOME of the time is the thing that will make it persist. In other words, if you give in sometimes, your child is even more likely to ask for more time on screen than if you say yes every time. Hard to believe – but true.

So what is a parent to do? You have a rule: 2 hours of screen time on Saturdays. But this particular Saturday you are sick and need a nap or you’ve been busy and you need time to catch up on work.  

It’s easier to give some extra screen time than to insist that your child find other things to do; it’s easier to give some extra screen time than to set up a playdate; it’s easier to give extra screen time than doing almost anything else!

We discussed all this in the group and in the end, the consensus seemed to be that it was important – to these particular parents – to figure out what worked for each of their own families. And then to try to be consistent. Some of them wanted to have no screens at meals at all. One mother wanted her kids to have no phones at all until age 13. But she was willing to let her 9 year old have an iwatch that couldn’t make calls. Two parents said phones at meals were OK as long as the kids ate their food before looking at the phone.

They all said they struggle with these questions – but they all also want more of a feeling of control in their homes.

Of course, you can’t entirely control your children. They are going to do some things and spend their time in some ways that aren’t your preference. But for their sake, and for your own, do you want to decide whether you WANT phones at meals or how many hours a day YOU want your children on devices?

You might find it worthwhile.

And you might want to stick by what you decide.

It’s hard to set limits, it’s hard to make rules and stick to them, it’s hard to say no and suffer the resulting melt downs – especially in public. But it is also important to think about whether it’s worth it. For you. And especially, in the long term, for your children.

All children have meltdowns sometimes. If you can tolerate your child’s meltdowns, and if you can allow them to happen because you’ve said no – you might actually find out that there will be fewer of them – and your child might – just might – get off her screen when it’s time. It’s not a guarantee. But there’s a chance.

Teens and Social Media – AGAIN!

~ corinnemasur2331 ~ Leave a comment

This post is by Ana Hagstrand

Ana is a psychologist in private practice in Philadelphia. She is the mother of three children and she enjoys outdoor adventures.

At what age should we let kids use social media?

As a clinical psychologist and mother of three, I’ve been grappling with this question. My oldest child is 13 and he claims that everyone has Snapchat except him. 

Looking at the scientific research, the wider mental health trends, and what I know about adolescent development, I’ve decided he will have to wait until he’s at least 15.

Here’s why: 

First, there are concerning trends in adolescent mental health. The rates of teen anxiety, depression, and suicide have risen significantly over the last decade. Numerous studies show that teens report persistent feelings of sadness and hopelessness at significantly higher rates and that mental health professionals are diagnosing higher rates of depression. Most alarming is that the suicide rate for 10-14 year olds increased 139% for girls and 70% for boys over the last decade. And what does this have to do with social media?

Adolescent mental health started to decline sharply in 2012, which is the year that we started using the word “selfie” and the year that Facebook acquired Instagram. 

Is there evidence that social media has played a role in these worrisome mental health trends?

Yes. 

You may recall that Facebook was initially only for college students and was rolled out at different colleges at different times over the course of two years before opening up to the general public. One study found that the rates of anxiety increased by 20% and the rates of depression increased by 7% at each college in the year following the introduction of FB. 

Several recent studies actually demonstrate causation, not just correlation between social media use and decreased mental health, and the apparent pathway is social comparison. In other words, use of social media causes people to engage in more social comparisons and fear of missing out (FOMO) and this in turn increases depressive symptoms and decreases self-esteem, body image, and self-perceived social acceptance. 

And it has been found that the harmful effects of social media are stronger (worse) for girls.

Some of the studies I just referenced were done on young adults, and it’s important to consider that there are several reasons why social media may affect adolescents even more than it affects adults. During adolescence, the brain regions associated with attention, feedback, and reinforcement from peers become more sensitive as teens navigate identity formation, acceptance, and social status. This is a normal part of adolescent development, but with so many peer interactions occurring online for all to see and possibly even enshrined forever on people’s social media feeds, the stakes seem higher than they were pre-social media. If adults feel pressure to curate a certain image on social media, of course it’s even more fraught for teens.

Teens have always had a tendency to think they have an audience that notices their every blemish, and we used to try to quell their anxieties by telling them that no one is paying nearly as much attention to them as they think. Now that argument doesn’t work. 

Social media, which started out as a vehicle for social connection seems to have turned into a way of quantifying social status.

So why do I recommend waiting until age 15? 

One large study in the U.K. found developmental windows of increased sensitivity to the harmful impact of social media. Apparently, the onset of puberty and the onset of adulthood are especially vulnerable times: age 11-13 for girls, age 14-15 for boys, and age 19 for all genders.

I’m under no illusion that we can control our children’s online activity at age 19, but let’s try and hold out until at least age 15. When many teens in a community are on social media, it impacts everyone negatively, even those who don’t use it, so I think it’s worth thinking through this together as a community of parents. Most of us have felt the dopamine-fueled pull of social media on our adult brains, and I doubt we will regret holding out a little longer before unleashing it onto our kids. 

Adolescence, with all its developmental tasks and hormones is certainly hard enough.

References:

https://www.nature.com/articles/s41467-022-29296-3(Developmental windows)

https://pubmed.ncbi.nlm.nih.gov/27940701

(national trends depression)

https://www.cdc.gov/childrensmentalhealth/data.html

(national trends anxiety)

https://stacks.cdc.gov/view/cdc/101761

(national trends suicide)

Makarin, Alexey. American Economic Review, Volume 112, No. 11, 2022

(Facebook rollout study)

Kleemans, Daalmans, Carbaat, & Anschütz (2018). Picture Perfect: The Direct Effect of Manipulated Instagram Photos on Body Image in Adolescent Girls. Media Psychology. 

(manipulated photos on IG lead to worse body image in girls)

González-Nuevo, C., Cuesta, M., Postigo, Á., Menéndez-Aller, Á., & Muñiz, J. (2021). Problematic Social Network Use: Structure and Assessment. International journal of mental health and addiction.

(social comparisons on SM and depression)

Samra, A., Warburton, W. A., & Collins, A. M. (2022). Social comparisons: A potential mechanism linking problematic social media use with depression. Journal of Behavioral Addictions.

(social comparisons on SM and self-esteem)

Lee (2022). The effects of social comparison orientation on psychological well-being in social networking sites: Serial mediation of perceived social support and self-esteem. Current Psychology. 

(social comparisons on SM and mental health)

Burnell, George, Vollet, Ehrenreich, & Underwood (2019). Passive social networking site use and well-being: The mediating roles of social comparison and the fear of missing out. Cyberpsychology: Journal of Psychosocial Research on Cyberspace.

(causal pathway: passively using SM🡪social comparisons and FOMO🡺worse mental health)

https://www.nature.com/articles/d41586-020-00296-x

(social media in a community hurts everyone)

https://docs.google.com/document/d/1w-HOfseF2wF9YIpXwUUtP65-olnkPyWcgF5BiAtBEy0/edit

(causation, girls)