Teen Mental Health During the Pandemic: Interview with Licensed Therapist, Erik Luna

For teens in particular, the Coronavirus pandemic is adding new stress, fear and uncertainty to their worlds.  Many are having a tough time coping emotionally with the disrupted routines and are feeling more depressed, anxious, and angry. Some of these elevated emotions may be signs they need more support during this difficult time.  We spoke to Erik Luna, a Park Slope father of two and a Licensed Clinical Social Worker, who speaks more about these challenges teenagers are facing, and what we can do as parents to best support and seek help if needed.
 
 
SSP: Can you please tell us about yourself and what therapy you provide?  Do you have a certain approach to therapy that you follow?
 
I was born and raised in San Francisco, and came to NY for graduate school in the late 1990’s.  I’m a Licensed Clinical Social Worker, I graduated from NYU in 1999.  For eleven years I provided therapy in public elementary, middle and high schools.  I started a private practice part time in 2005, and since 2010 I have been doing full time private practice in Brooklyn Heights.  
 
It’s a blended approach of psychodynamic and CBT (Cognitive Behavioral Therapy) principles. CBT is very much about the here and now and being able to realize how your perspectives affect your feelings.  CBT also involves monitoring and assessing your feelings/moods and provides tools and techniques for better management.  There is not much of an emphasis on the past.  A psychodynamic approach on the other hand is more about exploring the past to better understand the reasons for how we currently feel and behave.  I always say if your house is on fire, you call the fire department to put out the fire (CBT). Then you need to call in the arson investigator to figure out what caused the fire in the first place to prevent the fire from reoccurring (Psychodynamic). This allows you to go back and look at the genesis and root causes for your feelings and behaviors.
 
 
 
SSP: As we all know, the reality of COVID-19 is deeply affecting teens’ mental health.  What kind of challenges are you seeing more of during this pandemic?
 
First of all, I think everything is exasperated.  If you had anxiety or depression before, that will be increased.  For some adolescents that previously had these conditions well managed, it has now reached a point where it’s become a struggle again. For the general public, I think more people are feeling depressed and anxious since COVID started.
 
I think much of it, in particular with adolescents, is that they are struggling with the notion of uncertainty.  These are uncertain times. There is a natural rhythm to their year - school starts, and there are breaks, and then summer.  Back in March that abruptly stopped.  The normal rhythm has been thrown into chaos.  Everything has a beginning, middle and an ending.   We just don’t know where we are at right now.  In the spring, many teens were counting on summer camps to open as an indication that we were returning to normal.  For the most part, that didn’t happen.  Now there is a lot of emphasis on returning to normal with the resumption of the school year.  However, if you are in a blended model, there is a high level of uncertainty about what the school day will look like.  Many teens think that it will look like it did before COVID.  There will be a lot of shock when they realize they now need to wear masks and will be limited interacting with other peers.  In many cases, they will no longer be able to move from class to class.  I am worried that many teenagers will be disappointed when they realize this is the new normal for in-person education.  Some private schools are even doing a tent system.  The students are in tents set up outside with classes conducted under the tents.  The more flexible teens are to the new normal, the less stressed they will be.
 
Teens naturally have FOMO (the fear of missing out). FOMO is now less about feeling left out of activities with peers and more about missing out on where they feel they should be.  I was talking to a college freshman and there is this notion of not getting the true college experience.  Currently freshmen are often not able to eat in the dining hall.  There are limits as to how many people can be in a dorm room and many classes are virtual.  Normal ice breakers are not happening which makes meeting others hard.  This is a very different experience than what they signed up for (and paid for).  High school seniors are frustrated over missing prom and graduation – thinking this is not how senior year should be.
 
I almost feel like adolescents are less worried about being sick and more worried about getting family members sick and really worried about the stigma of being sick. There is less worry about not being able to recover from the disease and more worry about passing COVID to family members. They are also concerned that they will be labeled as the “COVID kid.” They are terrified to think they could be the individual responsible for shutting down a school.  
 
SSP: What do you think are the main contributing factors most impacting this age set?
 
Definitely the isolation.  Developmentally teenagers are supposed to be socializing with their peers.  They are at an age where they should be relying less on parents and more on their friends for emotional support.  Now this is much less of an option.  Not only are kids missing hanging out with friends in an unstructured way, they also have less structured activities with peers.  Sports have significantly been hampered, there are not many camps, and not a lot of extracurricular activities are happening.  There is also a narrowing of friends groups. Teenagers are mostly interacting with their core group and less with acquaintances.  Their socializing options have greatly narrowed.
 
Although Zoom and Facetime are helpful, it’s not a complete substitute for hanging out with friends in-person.  I do think that kids are relying more on video platforms, which is understandable with less options, but it’s not the same as hanging out with your friends after school and on weekends.
 
 
SSP: As parents, how do we best balance wanting to have our children reconnect with their peers socially and emotionally when they are feeling so very isolated, while deterring reckless behavior during COVID.  What is the best approach?
 
Kids cringe when I say this but I think partially supervised interactions is the answer.  What that means is that if you have a yard, which many of us in NY don’t, inviting small groups of teenagers to hangout in the yard but in a manner that can be supervised from a distance.  It doesn’t mean having the parents hang around with the group of teenagers, but rather having the parent be present in the background so the teens are gently reminded to follow safer guidelines.  Some of the biggest concerns when teens hang out by themselves are they are naturally impulsive, more susceptible to peer pressure, and they just get so excited.  They live in the moment!  This makes socially distancing, wearing masks, and engaging in safer behaviors more difficult for them.  Even if there is a prearranged social safety contract about how to be safe with their friends and they genuinely want to follow these rules, it’s so hard in the moment when they are with their friends.
 
If you don’t have a yard, have a parent go to the park with the teens and stay an appropriate distance away.  This way the teens are with their friends but there is also a quiet reminder that they do need to follow these socially distanced guidelines.  It’s a fine line, it’s a dance – you don’t want to be in their face, they need their privacy, but usually it is not realistic to put forward these COVID safety guidelines and expect them to always follow it on their own.
 
Some parents are doing socializing pods where they are able to contact other parents, get tested, and limit socializing with other people.  Kids are able to be safer knowing these pods lower the risk of transmitting COVID.  It’s all about finding lower risk versus higher risk activities.
 
 
SSP: What warning signs should we be looking out for in our teens when they are feeling depressed? What should trigger us to seek professional help?
 
I think when people think of depression they think of an individual being sad or melancholy.  This is more true for adults.  Depression in teens can manifest in different ways. They can be that way, sad and melancholic, however, there are many other emotional and behavioral changes associated with teen depression.  Some of the emotional changes can be having diminished interest or a loss of interest in activities that they used to enjoy.  Depressed teens can also have a difficult time motivating to participate in activities that used to be natural or easy for them to engage in, including academics, hanging out with friends and hobbies.  Emotional outbursts can also be a sign of adolescent depression.  Depressed teens can have big mood swings, increased tantrums, and increased outbursts of anger or sadness.  Many people reach out to me saying “My teen is so angry”, but it ends up being a depressive component.  I think if you asked the parent if their kid is depressed, they’d say oh no…but when you ask the parents if their teens are happy, they start to realize it may be more than just teen angst and a depressive component may be present.
 
There are also behavioral concerns associated with depression.  A big one is self harm, which can include cutting.  Depressed teens can also have significant weight or sleep changes.  They frequently isolate themselves, even if they want to see friends.  They may want to reach out to a friend but lack the drive to do so.  Their social motivation is gone.  Other depressive behavioral concerns include alcohol and drug use and certainly suicidal ideation and suicide attempts. 
 
As far as when to seek professional help, kids are actually very willing and often recognize they want/need help. Sometimes just asking is a good first step.  Often they say, “Yeah, I could use someone to talk to.”  Recognizing the need for emergency help is critical for every parent to know.  If you suspect that they are a danger to themselves or someone else, it can’t wait and needs to be addressed immediately.  This includes immediately calling 911, contacting a physician, or going to the ER.  If there is a previous relationship with a psychiatrist or therapist, reach out to them immediately.  While seeking professional help may be able to wait a week or two, emergency help needs to be instant.  It’s important to distinguish between the two.
 
Depression and anxiety are treatable, and kids get better.  I always feel that when someone seeks treatment, it’s the low point, but they are now seeking help to improve themselves.  It’s amazing how much easier it can be tackling life’s obstacles without being clinically depressed or anxious.
 
 
SSP: What can we do as parents to best help and support them during this time?
 
One major way to help support children during this time is for parents to manage their own anxiety.  Sometimes parents are struggling more than teens or struggling just as much.  So it’s also important for parents to seek help and support for their own anxiety/depression.  Parents are worried about getting sick themselves and worried about the health of their extended family.  Parents are also worried about money and the uncertainty of their job.  By getting the support for themselves, they are better prepared to be able to focus on their childrens’ needs.
 
I also think it’s important to remind teenagers that they are not in this alone. I talk to teens who are caught up in missing their friends and missing other opportunities. I remind them that everyone is going through this to some extent.  Most people are feeling the way they do to some degree.  If there was ever a shared experience among us, this pandemic is truly it.
 
What goes along with the uncertainty is the need to be flexible.  I know I sound like a broken record but If teenagers can’t adjust to the reality of the new world, this experience is going to be very hard on them.  If they can accept that maybe some activities will need to be modified due to COVID, it will be less stressful for them.  If they can accept that having a parent 20 yards away as they socialize with their friends in the park is tolerable, they will feel better.  As I said earlier, maybe they can switch to a lower risk sport like tennis, where you can socially distance, instead of a canceled higher risk sport like football.  Less flexible teens sabotage themselves if they continue to insist activities must continue as they used to or they won’t participate at all. To summarize, being more flexible and less rigid is going to make this process easier.
 
At some point the world we know will be much improved.  Everything has a beginning, middle and an end.  We just are not sure where we are at now.  Sometimes that statement is helpful.  Many kids just want to hear that it will go away by 2021.  If they imagine a definitive date when COVID has disappeared, they feel they can get through a few more months until that date.  Unfortunately, nobody can guarantee when the pandemic will end.  The idea that experts are uncertain how long this will last is terrifying for them.  When teens realize and accept that everything eventually has an ending, they understand our current scenario (and struggles) will also eventually end.
 
The question is whether it will end quickly or slowly.  I don’t think we are going to wake up one day and it will instantly be over.  I think change is going to be more of a slow growth toward improvement.  It’s less like turning on a light and more like the sun slowly rising.  The sun slowly starts to rise and things start to brighten.  However, it takes awhile for the sun to fully come out and be overhead.
 
Erik Luna can be reached on his Psychology Today profile.
 
 
 

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