 the Creative Life, a collaborative production between Think Tech Hawaii and the American Creativity Association. I'm Darlene Boyd, your host for today. Our guest, Dr. Alyssa Gleacher, joins us from Chapaqua, New York. Dr. Gleacher is a prominent cognitive behavioral clinical psychologist. She has played a major therapist role with clinics at UCLA, Columbia University and New York University. Alyssa received her professional foundational strength and PhD from the University of Hawaii. Alyssa, let me welcome you back to Hawaii as we broadcast virtually of course from the Think Tech Hawaii Honolulu Studios. How does it feel to be back in Honolulu? Feels wonderful, Darlene. Too bad we're not outside, right? Right. Perhaps the best way to begin the show, since we're going to be talking quite a bit about cognitive behavioral therapy and you are a cognitive behavioral therapist, could you just help us out and give us a short sketch of just what cognitive behavioral therapy is? Sure. That's a great place to start, right? I always say you have to start at the beginning. Yes. So cognitive behavioral therapy is the most evidence-based intervention for a number of mental health disorders. I focus a lot with children, so I'll be kind of child focused today if that's okay, but we're going to conceptualize problems. So anxiety, for example, is having three parts to them. The thoughts that we have are cognitions, the feelings, emotion, and the physiological symptoms associated with the experience of emotion and what it does to us in terms of how it impacts our behaviors or what we do. So there we have the cognitive behavioral therapy. So if we're talking about intervention for anxiety, we would work on cognitions that promote anxious thinking or misinterpretation about the meaning of threat or about a stimuli. We would also work with that feelings portion of helping folks gain coping skills or tools to help relax or calm their body when they're physiologically aroused due to anxiety. And then we would work on the behavioral patterns that promote anxiety as well. So there we would work on all three of those aspects to gain tools to help you overcome that experience of anxiety and situations where you may not need it or you may not need as much of it as you're having. And is it your opinion perhaps that, and I know cognitive behavioral therapy is referred to as CBT, that CBT might be more effective than the traditional forms of psychological therapy or psychiatric medications? I'm going to take those separately. I'm going to take other forms of therapy or, you know, talk therapies and then I'll address medications separately. Okay. So with respect to the research that has been done, some of it at the University of Hawaii, and I was a part of some of that way back when, but it has been shown to be more effective than a lot of other things that you would go out if you were just receiving mental health services. So that not all talk therapy is created equally. It's not the only intervention that has evidence behind it. There's other things like interpersonal therapy that have some success with different types of symptom consolation, depression, or things like that. So it's not the only one that has evidence behind it, but it definitely has the most research behind it. And then there's a lot of offshoots or kind of CBT and combinations of other things. So a good example of that would be dialectical behavior therapy is kind of a treatment for started out with borderline personality disorder or some of more severe emotional dysregulation and uses a lot of cognitive behavior therapy, but also borrows from other interventions as well. But definitely not all talk therapy is created equally. All right. And then medication is another question. So there are very often we see that for certain disorders that CBT has equal rates of helping with symptom reduction as medication alone. For others, for ADHD, for example, talk therapy does not do as good of a job at all as medical as medications would. So it really is disorder specific with respect to medications. And also I think there's a severity to that sometimes that psychosocial or CBT intervention is always warranted. But for things that are very severe and we need more symptom reduction as quickly as possible, we would definitely confer with a psychiatrist or a medical professional to help get someone treatment that helps to improve their symptom constellation as as quickly as possible. Melissa, I think that overview is that you provided for us is very helpful for us to set the stage for our topic at hand. And that is the effect that the pandemic is having on our youth. So the tools used to mitigate the threat of a pandemic, such as masks, social distancing, they may they may very well threaten child growth and development. How so? That's a great question. And I think it does it on a number of fronts. Now that being said, I think during the pandemic there have been times where those were absolutely warranted and we needed to isolate, we needed to go into lockdown, we needed to socially distance. I think though, if we think about the experience of childhood and the most basic thing, I like to say a child's job is school. So the first thing that happened to our kids is that stability that they have every day that regularity that no one quantity of going to school interacting with the teacher learning and also a huge part of school as a social aspect was taken away from them. And I know educators did a phenomenal job in trying to put together things. And I think that goes into the creativity part of the show as well. Educators were incredibly creative in how we tried to deliver education, but we can't take away the fact that that loss of normal for such a long extended period of time has an impact on children, right? And that when they, so they were out of school for months doing online learning. And then they returned to school very often in a hybrid model where they were out of school a couple days a week and in school a couple days a week. And they were in smaller pods and you have to eat lunch six, you know, six feet away from your nearest companion. So it definitely had an impact on that. But if we think about the things in particular with anxiety that would promote anxiety, I like to say just there's more to it than this. But one of the things that I say as a quick and dirty rule is anxiety is maintained by avoidance, right? If I'm scared of dogs, and I stay away from a dog, I'm never going to be unscared of dogs. And all of the things that keep us functioning socially that keep us unscared of social interactions were off limits in a large number of domains across a child's life. We lost school, we lost socializing, we lost extracurricular activities. And so I think that's one of the huge reasons why we're seeing so many mental health issues and children at this point. So you just closed by saying that we're seeing many more issues with children. I suspect you can say that with great authority. How has this affected your practice? The pandemic and the anxiety issues. Yeah. So I'll talk. For practice, I think it is busy. And people, I think anecdotally, and then I'll speak to what the Surgeon General released in December that kind of backs up what we're seeing anecdotally. I'm seeing that the number of weekly referrals is up 150%. So I'm getting multiple phone calls a week. And what we're seeing is a greater need, right? That kids are in a lot more distress than they previously were at baseline. There's a larger number of kids who are suffering and in greater distress are having more symptoms than maybe we were usual. There's no easy cases right now. What about the age groups? Are they differing? The younger or the older having more cases or is it not that representative? I think the effects of the pandemic were different across age groups. I think if we look at the Surgeon General's report, we're seeing that in particular adolescent girls were particularly hard hit with the statistic that they referred to most in that is the number of referrals to emergency room for suicide attempts. So we're seeing, I'm forgetting the exact number by a drastic increase in that. But if we look at that same age group with males, with boys, we're not seeing as drastic. So I think it was something around 4% as compared to above 20% increase in those referrals. So we are definitely seeing that. But I think that at this point, without a lot of research to back it, I think I'll just say I'm definitely seeing that group as being very hard hit. But what I'm also seeing is younger kids who are now entering the lower elementary school grades who lost some of this critical development time and socializing and had spent more time with parents that there is a lot of separation and social anxiety going on amongst younger kids. But I think the severity of it we're seeing in that older group. So sometimes older kids, bigger problems, right? So we're not seeing that. We're not seeing the number of suicide attempts in younger kids, because that's just not how younger kids express that. But with older kids, we are seeing an increase in those types of things. You quoted the Surgeon General's report as, if I hear you correctly, as referring to the differential between boys and girls adolescence this is. Can you speculate on why that differential between girls and boys? You know, I'm not sure that I have a great answer for that one. I think that that they're just somehow it's different. I'm not sure why. I think speaking to that age group in general, it could be that boys were more connected with video games and things like that. I maybe they found other social outlets. I think we're seeing the back to your original question, Darlene, when we talk about like why we're seeing different effects. I think when we think about kids who maybe started the pandemic with a baseline level of anxiety that might have been a little higher than normal, this kind of deprivation, the loss of normalcy, the loss of these normal social educational and life experiences led them to this increased fear. I think we're also seeing a lot of kids who are having issues in school, educational difficulties because they lost education and then that plays out in terms of anxiety as well with performance anxiety, fear around taking tests, fear around peers, knowing that you don't know these things. So I think we're seeing a lot of different anxiety and I think that that makes sense if we think about it in terms of kids who may have had baseline anxiety or may have had a more difficult time socially or a more difficult time educationally, we just lost time and they weren't able to keep pace with some of their same age peers. But I don't have a great answer for why we might be seeing that difference between males and females. I know we're talking about the pandemic and its effect of the quarantine effects and the masking. I find it rather interesting. I've heard recently just from people in the neighborhood or moms that have crossed paths with saying that their children, now that the masking is coming off for the schools and some of the schools, they're afraid to take off their masks, the younger ones, they fear. Is that coming up? That is actually, that was a hot topic in my office today with my clients before I got on with you guys. How do you feel about tomorrow when the masks come off? And I think that the answers run the gamut. Some kids feel, well, if the CDC says it, then it must be okay to kids who really want to throw a party tomorrow morning before school when they get on that bus with no mask on to others who are very fearful of taking it off, that it's almost become part of that and that their underlying fear around COVID and germs and catching stuff is still really high and their brains haven't kind of made that adjustment to the different level of threat that we're experiencing now. Do you think as we move along and as things open up that the pandemic has scarred our children? And I recognize that's not a universal question. I mean, certainly some children, but let's say children that have high anxiety, do you think this whole pandemic process could leave them with some scars? And is that why they would come to you to port that off or heal? I think yes, definitely. I think there's a higher number of kids who are seeking treatment because they are experiencing distress. Our parents want to give them the tools. So this is a bump in the road. It's a part of our history. It's this time that we've all lived through and we've coped with and we've come through and we overcame it versus that kind of scar or defining moment that kind of there was pre-pandemic, post-pandemic. So I think the hope is that, and I think the reality is that with treatment, this becomes something that you can overcome. But I do think there are a number of individuals out there, children and adults, probably, where this was and is something that will last a long time and that the fear could become more permanent without treatment. And I think that's the great thing about the resources that are out there with mental health treatment is that there is treatment available. There is help available to children, families, and adults that need intervention. What effects do you think our pandemic or a pandemic hopefully will not live through another one? But we know those have preceded us. What effect do you think it has had on parents and the family? I think the effects are intense. Especially when children are suffering, parents are suffering to an extent. And I think the demands on parents throughout the pandemic have been high from shifting to becoming working, stay-at-home parents who are also educators and the only companion of your children. The demands were really high for all of those things and still continue to be. So I think that parents have definitely suffered through this. And I think the effects with when you're having a child who is in distress, it does impact your ability to perform your role and it affects your happiness, it affects your level of anxiety. And there was just a survey study that came out, I believe last week, that says 30 to 40 percent of parents report that their job performance has been impacted by their children's mental health in this kind of pandemic slash emerging post-pandemic world. So I think this shows us that children and families are really struggling to deal with the effects of the pandemic and how it has impacted children's mental health. I think the hope is as we return to normal more and more that there is help with treatment and that the world becomes a shift back to normal more and that that then provides the foundation to go out and to live life more fully and more normally without as much fear. Not to put you on the spot, but what might be some measures that parents can take right now to protect their children and perhaps the adults in the family too, spouses or older siblings? Protect them from anxiety. From the anxiety issues that you say or projected or perhaps you could predict are going to still remain for a while, the scars so to speak. Well, so as we kind of go into treatment, I think what we want to do and I'll kind of put my mom hat on at the same time as well is we want to, one, if we're fearful of things, we don't want our fear to impact our children as well. So we always need to help ourselves. I always think of it as when you're on the airline and you read the safety card, you have to put on your mask before you put on someone else's so that if you're suffering, you need to help yourself as well. But I also think when we think about anxiety and that avoidance component to it, we want to provide our children with those normal childhood experiences and if they're experiencing a lot of fear, we want to try to come up with smaller chunks that they are able to manage successfully and build off success with that. And that would be a big part of if you were doing treatment, you would do exposure therapy for anxiety, gradual exposure where we start low, go slow, and we do little bits of the things that make us feel anxious and nervous. And we see that those negative things didn't happen and we build that back into our repertoire. So I think parents can do portions of that, but I also want to say if your child is really suffering and the things that you're doing at home don't seem to be helping, treatment is out there for folks. Do you, are you doing much family counseling and also small group, especially I would guess perhaps small group therapy might work very nicely with adolescents? It does. There is and there's a lot of research on group therapy. I don't do as much group therapy and I think when you're working with children, you're working with families, right? So there's very often a family component to what I do in practice. So definitely when I'm working with kids, I'm working with families because very often, especially if you have a child who's been in a lot of distress, the family system has adjusted to limit that distress so that we're working to give parents tools to help them overcome that. So a good example is if I'm an anxious teen and I'm texting my mom all day from school, mom is probably has the inclination to respond to the text if their child is saying, this is so hard. So we would work with the family, we'd work with the child on having tools and coping skills so that they're not in that level of distress and feeling like they need to reach out to parents. But we'd work with the parents on strategies of how to deal with those things as they come in. So that's just like what small example of some of the things that we would work on and see. So I'm thinking of the examples you gave about we have to take care of ourselves first as parents before we can help the anxiety in our children. But I'm also thinking of those parents when you mentioned the texting, the parents that will constantly text the child during a situation to say, are you okay? How are you doing? Right. So I think we, especially during the pandemic, that everything we've said about kids, except for maybe the school component can be said about parents as well, except they, right? So we all as parents, we all as adults lost all of those things too. So I think anxiety across the board is high and we are probably had just kind of biologically primed since something bad did happen to all of us with the pandemic to see more threats. So absolutely, I think the inclination for parents to check in is a normal one, but we would definitely work on if we're providing cues or clues to the child that they might be in an unsafe situation. How about the effect on the really little ones, the toddlers, the toddlers that I don't, I know under two did not have to wear a mask. So they were pretty much exempt and were probably getting a lot of love. But do you see some effects on toddlers, those long lasting effects, because they're living with witnessing anxiety and can't express themselves? I'm thinking the very little ones. You know, I think the kind of juries out on what those effects are, right? So the hope is- Probably because they can't communicate, I would suspect. Right. So I don't think we exactly know. The hope is that we take off the masks and as quickly as they adjusted to having them on, they adjust to not and we kind of move past it. But I think for some kids who are just more genetically predisposed to anxiety, I imagine that there will be effects of those things or that we'll see more effects when they're separating from their parents more for the first time. I know a lot of people have delayed things like preschool or they've gone to shortened programs. So they're not getting as many of those social things. Although I do think it's easier to catch up to being three than it is to catch up to being five or 10. So I think that we have a lot of hope there that as things return to normal, that that group can return to normal as well. So we're about to wrap up our times about up. But I have one final question and nothing like getting some free advice here, right? So those of us that deal in creativity and those that watch us regularly know that we talk often about problem solving and recognize that the experts often recognize that sometimes the problem is that we don't identify the real problem that we're not there. So do you think cognitive behavioral therapy, even if we just do it very privately or attempt to do it ourselves, can help us to be better problem solvers? Absolutely. Problem solving is a huge part. Problem solving is a really if we look at the evidence base and we look at dismantling studies of CBTA problem solving shows up, you know, across most of the major disorder subtypes as one of the evidence based interventions that we'd be working on. And I think you nailed it, Darlene, is that part of what we're working on is to actually really define what the problem is accurately, right? To say what the big problem is and then think about it. What is, how does that break down? What's bad about that so that we actually are working on solving the right problem? Thank you, Alyssa. Thank you. It's been, it's been a pleasure as always. I'm so glad to have had this opportunity to chat with you. And as with all our guests, we just don't have enough time to discuss what we would like to. So you have been for our viewers, you have been watching the creative life on think tech Hawaii with our guest cognitive behavioral psychologist. Wow, Alyssa, that's a long time. Dr. Alyssa Glitcher, we hope your time spent with us has offered you a better understanding of today's youth mental health issues and the utilization of cognitive therapy as an effective treatment model. Join us in two weeks for the next edition of the creative life until then Aloha. Thank you so much for watching think tech Hawaii. If you like what we do, please like us and click the subscribe button on YouTube and the follow button on Vimeo. You can also follow us on Facebook, Instagram, Twitter, and LinkedIn, and donate to us at thinktechhawaii.com. Mahalo.