It has been reported that 11 per cent of children aged five to 16 had probable mental disorders in 2017, a figure that has risen to nearly 17 per cent during the pandemic (ONS, 2020).
As worrying as these figures are, they very likely underestimate levels of emotional distress in the young: they focus on mental health problems meeting the criteria for diagnosable disorders. This is quite a strict definition, which excludes many levels of real distress. Asking 11 to 16-year-olds about their experience through the pandemic suggests 40 per cent experienced some dysphoria (ONS, 2020).
Something must be done to address the negative emotional consequences of pandemic and lockdowns in the young. Earlier articles in this series have looked at the challenge of identifying the dangerous form of depression that is hopeless despair, at ways of rebuilding hope, and at helping the young to develop balanced perceptions and reactions to risk.
This article asks how best we can address the emotional problems that many of the young have experienced, and are likely to go on experiencing, as many aspects of life are permanently changed or thrown into uncertainty by the continuing issues posed by Covid.
REBUILDING HOPE POST-COVID: To read other articles in this series, visit
- The signs of depression and despair
- Helping students to overcome despair
- Understanding risk
- Fostering hope and positivity
Emotional problems
Our society has a highly medicalised approach to emotional problems, typically treating them as requiring drugs or psychotherapy. In some cases, of course, that is appropriate. Certain mental disorders do need medical intervention, and the pandemic may have exacerbated some of these: not just the obvious things such as severe depression or anxiety disorders, but also specific problems likely to resonate with the pandemic, such as paranoia or OCD.
There is evidence, for example, that the pandemic has exacerbated OCD in sufferers with contamination fears and washing rituals (Prestia et al, 2020) – hardly surprising in a world where hand-washing has become crucial.
Where medical intervention is really needed, fair enough. But many experts suspect that we over-medicalise mental problems, treating what are really the ordinary ups and downs of emotional life as disease (Pilgrim et al, 2010). This over-medicalisation not only adds to the pressure on mental health services, but misses the point for many: they are not ill, but failing to maintain mental wellbeing in the face of setbacks, and the help they need is not medical, but lessons in managing life differently.
A large proportion of the emotional distress generated by the pandemic is probably better viewed as life stress rather than illness. It is not “disorder” to react adversely to the extraordinary circumstances of the past 18 months. In many ways, that reaction is natural and normal.
Flourishing
One alternative to the medical model of such stress is the distinction between “flourishing” and “languishing” (Keyes, 2002). Flourishing is a state of positive mental wellbeing, active engagement and motivation. Languishing, by contrast, is an absence of mental wellbeing characterised by apathy, losing motivation, fatigue – everything seems to take so much effort. It includes feelings of emptiness, stagnation, monotony, and lost “joie de vivre”.
The suggestion is that for many, the emotional problems of the pandemic were not illness, but languishing (Fielding, 2021). Languishing is an interesting concept. The idea is explored more in sociology than psychology, where there is as yet little research. However, the idea that our young – and us – have been languishing in the past year underlines the need to find non-medical ways of helping the young recover wellbeing.
A focus on attitudes and values
Many commentators writing about restoring wellbeing focus on the practical actions, such as connecting to others, getting out and doing something life enhancing, exercising and so forth. All good ideas, when those things are possible – but those things are not always possible, even in normal times.
An alternative is to focus on our internal response to the ups and downs of life: on the attitudes and values that shape our way of relating to ourselves, to others, to the world and our experience in it.
A founding father of psychology, William James, called these our spiritual values (James, 1892). Many in our secular society shy away from any mention of spirituality, confusing it with religion or new-age mysticism and the like. But spirituality is not inherently religious or mystical. Everyone has spiritual values as defined by James, consciously or not, religious believer or not. Spiritual values are about ways of being, and apply whatever the circumstances, whatever practical things we can or can’t do. And some ways of being are more resilient to life’s vicissitudes than others (Hauser et al, 2006).
Can our fundamental ways of being be changed? The answer is yes. For example, experts argue that the policy, launched in the 1980s, of working to raise the self-esteem of all even though that decoupled praise from achievement and effort has led to a marked change (rise) in narcissistic entitlement in our young (Lessard et al, 2016; Twenge & Campbell, 2009).
Such entitlement is the feeling that one intrinsically deserves or is owed certain things that others would see as privileges that have to be earned. If we can bring about that change in spiritual values in the young, we can bring about other change too.
The rise in narcissistic entitlement in our young is unfortunate. It is a poor spiritual value, not conducive to welfare or resilience. This orientation to life is associated with increased vulnerability to distress and maladaptive responses when entitlement expectations are not met (Grubbs & Exline, 2016).
It is easy to see how this might have fuelled the rise in emotional problems in the young both before, and more particularly in reaction to, the pandemic. Undoing the inappropriate self-esteem of narcissistic entitlement may be a painful and difficult project.
What better spiritual values should we try to foster in the young? One source of ideas lies in ancient wisdom, as expressed, for example, in Greek philosophies and in many religions from around the world. This ancient wisdom would have eschewed narcissistic entitlement, espousing a more realistic and humble view of self and a greater concern with others.
There is evidence that they were right: humility is a strong corrective to the pride of entitlement, and is associated with far better resilience and wellbeing (Everett et al, 2017). Ancient wisdom offers other suggestions as to the attitudes we should foster in the young as a foundation for a robust way of being, and research is beginning to explore and endorse these…
Living in the present moment
In his best-seller The Power of Now, Eckhart Tolle (1997) argued that the path to wellbeing, overcoming stress and living serenely is to focus entirely in the present: don’t ruminate on the past, don’t worry about the future, live now.
This idea picks up on the ancient wisdom of many religious traditions. It has had its greatest impact in our society through secular adaptations of the Buddhist practice of mindfulness, in which one focuses vividly on current experience without passing judgement.
Mindfulness has been hyped as a panacea for the stresses of life, adopted in many schools and workplaces. Is mindfulness as powerful a tool as the hype suggests? Research suggests a nuanced conclusion. On the one hand, there is evidence that practising mindfulness does indeed provide benefits in wellbeing (Hoffman et al, 2010); however, these benefits are relatively modest.
On the other, research suggests that mindfulness is not useful for everyone: some get nothing from it and some are damaged by the practice. For example, the effort to focus on the present can undermine strategies for distracting oneself from stress, in ways that exacerbate problems (Lustyk et al, 2009).
Perhaps these mixed results should not surprise us. Thoughts and experiences rooted in the present moment are not necessarily conducive to feelings of serenity and wellbeing, as many a sailor caught in a storm, and many languishing in lockdown would agree.
Furthermore, in its original Buddhist context, mindful practice was part of a more comprehensive spiritual orientation to life, not the entire package. Our secular version has decoupled mindful practice from Buddhist ideas on how one should relate to experience, and we offer the young little in its place. Ancient wisdom offers ways of filling this gap.
Practising acceptance
A second theme in many ancient philosophies and religions is the value of acceptance of what is in the present moment, whether that be good or bad, rather than railing against setbacks. The rational for this stance varies from one philosophy or religion to another. But whether or not one accepts any of those rationales, the wisdom of this approach is supported in secular research.
Accepting “what is” is a fundamental element in resilience: individuals who can accept that a negative situation or setback “is as it is” manage better both emotionally and practically than those who cannot, because they can more easily develop strategies for coping with the problem and moving forward (Hauser et al, 2006).
Accepting a negative situation can be hard to do: every therapist will have met individuals who simply cannot accept their situation, who live in misery, resentment and frustration, sometimes for many years. Helping others to accept things as they are is hard, as such recalcitrant cases suggest. But learning to accept reality and move on is a vital life lesson.
We already try, albeit informally, to teach this to the young, through the advice we give them. Some of this advice is more memorable, and more functional than other. My father had a useful comment: “Life is full of opportunities, heavily disguised as problems.”
This is a very constructive mindset, not only offering a philosophy for construing setbacks in a positive light, but through the word “opportunities”, implicitly motivating a resilient response. That attitude, and the self-confidence to seize the opportunity, is a powerful spiritual orientation for life.
Living in gratitude
There is a long tradition in ancient wisdom of extoling the virtues of living in gratitude for what we have, and again, modern research is supporting the value of this spiritual orientation (Smith et al, 2020). Those who live in gratitude are more resilient, happier and more optimistic than those who don’t.
Gratitude has two core elements: an affirmation that there are good things in our lives whatever setbacks we might be experiencing, and that other people are a source of those blessings, large and small (Emmons & McCullough, 2004).
Such blessings may not always be instantly obvious: an important part of living in gratitude is the mindset which actively looks for the gifts and blessings in life. This is a “positive attention bias”, in contrast to a “negative attention bias”, which homes in on the downsides. The latter is associated with depression and anxiety (Duque & Vazquez, 2015; Waters et al, 2013).
There is some evidence suggesting that attention bias can be shifted from a negative focus to a positive focus more suited to gratitude, with general good effect (Waters et al, 2013; Wong et al, 2018).
A variety of interventions have been explored in this context, from the surprisingly simple, such as training children to spot the one smiling face in an array of frowning ones (Waters et al, 2013), to asking adolescents to repeatedly write letters of gratitude to someone, whether they post the letters or not (Wong et al, 2018). Both interventions shifted attention bias in a positive way, and the gains generalised beyond the tasks and were maintained for weeks after the intervention ended. As yet, these are small-scale studies needing replication, but the data is encouraging.
An everyday intervention to foster a positive attention bias is to ask the young to list, at the end of each day, five small blessings experienced that day (the taste of an apple at lunch; a smile from a friend; the pleasure of a game or activity).
Those with an initial negative attention bias find this task very hard at first, if not impossible. But the daily effort to find five things to list can lead to a shift in attention to look out for blessings, and hence a move toward living in gratitude.
Dr Stephanie Thornton is a chartered psychologist, author and lecturer in psychology and child development. She is the co-author of Understanding Developmental Psychology (Macmillan International/Red Globe, 2021). To read her previous articles, including in this series, go to http://bit.ly/seced-thornton
Further information & references
- Duque & Vazquez: Double attention bias for positive and negative emotional faces in clinical depression, Journal of Behaviour Therapy and Experimental Psychiatry (46), 2015.
- Emmons & McCullough: The Psychology of Gratitude, Oxford University Press, 2004.
- Everett et al: Handbook of Humility: Theory, research and applications, Routledge, 2017.
- Fielding: Languishing is the mood of 2021, how to identify it and how to cope, Mental Health News, April 2021: https://bit.ly/2RBfgIv
- Grubbs & Exline: Trait entitlement: Cognitive-personality source of vulnerability to psychological distress, Psychological Bulletin (142), 2016.
- Hauser et al: Out of the woods: Tales of teen resilience, Harvard University Press, 2006.
- Hofmann et al: The effect of mindfulness-based therapy on anxiety and depression, Journal of Consulting and Clinical Psychology (78), 2010.
- James: Psychology: The briefer course, Henry Holt, 1892.
- Keyes: The mental health continuum: From languishing to flourishing in life, Journal of Health and Social Research (43), 2002.
- Lessard et al: Sense of entitlement. In Encyclopaedia of Adolescence, Levensque (ed), Springer, 2016.
- Lustyk et al: Mindfulness meditation research: Issues of participant screening, safety procedures, and researcher training, Advances in Mind-Body Medicine (24), 2009.
- ONS: Mental health of children and young people in the pandemic, October 2020: https://bit.ly/3hImzbX
- Pilgrim et al: The SAGE Handbook of Mental Health and Illness, Sage, 2010.
- Prestia et al: The impact of the Covid-19 pandemic on patients with OCD, Psychiatry Research (291), 2020.
- Smith et al: The gratitude project: How the science of thankfulness can rewire our brains for resilience, optimism and the greater good, New Harbinger Publications, 2020.
- Tolle: The Power of Now, New World Library, 1997.
- Twenge & Campbell: The narcissism epidemic: Living in the age of entitlement, Simon Schuster, 2009.
- Waters et al: Attention training towards positive stimuli in clinically anxious children, Developmental Cognitive Neuroscience (4), 2013.
- Wong et al: Does gratitude writing improve the mental health of psychotherapy clients? Psychotherapy Research (28), 2018.