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The Dark Side of the Internet’s Obsession With Anxiety

Clinical psychologist Darby Saxbe joins the show to dive into the way we talk about anxiety on the internet and what good mental health conversations might look like

Close up shot of the Rethink Mental Illness webpage - Photo by: Newscast/Universal Images Group via Getty Images

We’ve done several shows on America’s anxiety crisis. This one asks several questions that might get me in trouble. Have we overcorrected from an era when mental health was shameful to talk about to an era where people talk about anxiety so much online that it’s worsening our mental health crisis? Is the very design of algorithmic media engineered to increase rumination and mental distress? Is there a dark side to all this media about trauma, anxiety, and depression? (Yes, the irony of us asking this question is not lost on us.) Today’s guest is Darby Saxbe, a clinical psychologist and professor at the University of Southern California. We talk about anxiety as identity, why talking about anxiety on the internet is such a mess today, how the architecture of the internet unhelpfully shapes our discussions of mental health, and what a better conversation about mental health online might look like.

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In the following excerpt, Darby Saxbe and Derek talk through the rise in youth anxiety and a recent study on mental health in teenagers that produced counterintuitive results.

Derek Thompson: You are a professor of psychology at USC. What do you research and teach there?

Darby Saxbe: Yeah, so I run a lab at USC called the NeuroEndocrinology of Social Ties Lab, which stands for the NEST Lab. I study close relationships and health across the lifespan with an emphasis on the transition to parenthood. So I actually have a cohort of parents I recruited when they were pregnant with their first child, and I’ve been following them over the last seven years to look at how the brain and body are changed by parenting.

Thompson: And you and I have spoken a few times about youth anxiety and the CDC’s now quite famous reports showing skyrocketing rates of sadness among American high schoolers. As a clinical psychologist and as someone working at a big university and as someone working in the field that joins developmental psychology and the body and the way people feel about their relationships with each other, I’m just curious—before we get into the real meat of this conversation—what is your perception of the youth anxiety crisis? How do youth see things have changed in the last few years?

Saxbe: Yeah, and I should have mentioned also in addition to my lab and my research, I run our clinical psychology PhD program. So I’m the current director of clinical training. I teach in that program. I teach clinical interventions. I’m a clinical psychologist myself, as you mentioned, but honestly, most of my perspective on this comes from being a parent of a 12- and 14-year-old.

I think in the wake of the pandemic particularly, it seems like youth anxiety has become so commonplace that it’s actually hard for me to think of one of my kids’ friends or acquaintances who doesn’t have some kind of challenge related to mental health, and anxiety in particular. So just anecdotally, talking to other parents, being part of parenting Facebook groups, and then also with the clinical psych perspective, working with graduate students who are themselves doing a lot of clinical work, I feel like I have a pretty good ear to the ground. It feels like the tenor of the conversations has shifted around youth mental health [from] mild concern all the way to full-blown panic. It feels like we’re in a kind of unprecedented place right now.

Thompson: So obviously with this wave of youth anxiety in the U.S.—and it really is a wave around the world—there are all sorts of well-meaning schools and psychologists who are trying to fix it. There have been these efforts to test the effect of delivering therapy to teens en masse because, I guess as you just said, this is not a problem of a handful of kids. It is an en masse problem, and so it would be nice to have en masse solutions.

Recently, researchers in Australia did a study where they took 1,000 young teenagers and they assigned them to two different groups. There was a middle school health class that basically taught a mental health treatment called dialectical behavioral therapy, DBT, and then there was a control group of, I guess, the other 500 students. If you believe, as I do, in DBT or the more commonly practiced CBT, cognitive behavioral therapy, my hypothesis would’ve been that a program like this, delivering mental health help to hundreds of kids at a time, will succeed—if not thrillingly, then at least on the margins. At least giving people the tools of basic DBT and CBT is going to help young people. Is that what happened?

Saxbe: Unfortunately not, and I share your intuition. I mean, I’m a fan of DBT and CBT. I’ve taught it. I’ve trained in it. It’s effective. It’s known to be effective.

Thompson: Can we actually just stop here? We’ve talked about CBT and DBT in other episodes, but why don’t you give a 101 definition of what CBT is and then of what DBT is.

Saxbe: Definitely. Yeah. So cognitive behavioral therapy stems from the intuition that our thoughts, feelings, and behaviors are interconnected, and it’s very hard to change someone’s behaviors. It’s also very hard to change someone’s feelings or emotions, but it’s relatively easier to change how they think.

So CBT targets thinking patterns and identifies what are called cognitive errors, which are sort of misattributions that lead people to feel less empowered, more hopeless. By reframing or restructuring those cognitions, CBT helps to increase flexibility so that people can then behave in ways that are more adaptive and that help them to feel better. So that’s kind of CBT in a nutshell.

There’s a whole alphabet soup when it comes to psychotherapy. Lots of people have acronyms. DBT is dialectical behavior therapy, which kind of takes CBT and adds this sort of Zen, almost Buddhist perspective on it. So it’s focusing more on reconciling opposites. That’s where the dialectical piece comes in, so holding two conflicting thoughts at the same time. My life is intolerable as it is, and yet I don’t want to change, for example. Learning how to build in the ability to tolerate these conflicting or contradictory thoughts or feelings is a way that people can learn to regulate emotion more broadly.

So what that means in practice is a lot of focus on acceptance and a lot of focus on just sitting with difficult feelings and learning how to build tolerance for them. So if you asked me, “Let’s deliver CBT skills or DBT skills to 1,000 teenagers and see what happens,” I would’ve said, “Of course they’re going to benefit. These are incredibly valuable skills.” But they did not, and, in fact, the teens that were randomized to the DBT—the program was actually called Wise Teens; it was this sort of broadscale adaptation of DBT skills—the youth that were randomized to Wise Teens actually ended up doing worse.

So they had worse depression, worse anxiety, worse relationships with their parents. And it’s not just the case that they did worse and then over time as they kind of built in the skills they started to do better. … Those iatrogenic effects, what we call in psychotherapy “things that make you feel worse,” those effects persisted over time. So even at a six-month follow-up, they were still reporting worse functioning than people who were randomized to just sit in the regular old health class.

This excerpt was edited for clarity. Listen to the rest of the episode here and follow the Plain English feed on Spotify.

Host: Derek Thompson
Guest: Darby Saxbe
Producer: Devon Baroldi

Subscribe: Spotify