Solutions for Higher Education

Episode 34: Mental Health on Campus


This week's episode continues our focus on mental health with a conversation with Dr. Michelle Vo, a psychiatrist employed as the Director of the Student Wellness program at the University of Utah medical school.



Full Transcript

Steve Meredith: Hi again everyone, and welcome to Solutions for Higher Education, a podcast featuring Scott L Wyatt, the president of Southern Utah University in Cedar City, Utah. I'm your host, Steve Meredith, and joining me again in-studio today is President Wyatt. Hi, Scott.

Scott Wyatt: Hello, Steve. It's nice to be with you this afternoon.

Meredith: It's a beautiful fall afternoon in Cedar City and this is maybe my favorite time of year here. We have been sort of having an ongoing series of conversations related to mental health, and we have another guest with us here joining us by phone from Salt Lake City, and we're excited to have her join us. Will you introduce her?

Wyatt:  Yeah. Dr. Michelle Vo, thank you for joining us this afternoon.

Michelle Vo: Thank you for having me, I'm so excited to have this conversation.

Wyatt: So, you are a psychiatrist?

Vo: Yes.

Wyatt: And employed at the University of Utah in the medical school?

Vo: I am, yes. In the medical school I am the director of the Student Wellness Program. So, we've really modeled the program after, I think, many programs that exist at multiple levels of higher education where it's a multidisciplinary program. WE have therapists, I direct the medication management and kind of overall team and we're charged with the mental health of medical students and family at the University of Utah.

Wyatt: And you're certified in three different areas.

Vo: Yes. I'm what's called a triple board position, and that means that I have a board certification in the specialties of general pediatrics, general psychiatry and child and adolescent psychiatry.

Wyatt: OK. I think you're the perfect person for us to be talking about this.

Meredith: Yes, not only because of your academic training, but also because, clearly, with all that work you know all about stress and anxiety.

Vo: [Laughs] Certainly true from a personal standpoint. And I think one thing that I think I consider the program at the University of Utah a very successful program, and I think one of the reasons why we are successful is we kind of take this developmental approach that I think child psychiatrists and people who see families and children do particularly well where you see a person in terms of not necessarily numbers but where they are in their life and what sorts of challenges they might be dealing with.

Wyatt: Well, let's jump into this topic. It seems to us as we work in higher education and each of the three of those kinds of different roles, but all of them put us with students who are suffering from anxiety or depression and all three of us worry about suicides and the wellness of our students. And it feels like this is becoming a bigger problem than it used to be. Does it seem that way to you?

Vo: It certainly does. I think when we look at the utilization and engagement of just the medical students at the University of Utah…you know, people who make it to medical school are generally resilient people with grit and a lot of resources both intellectually and just as human beings and individuals. These are not weak people. But what we're seeing at the University of Utah is that we're seeing increasing numbers of students seeking services. We currently have seen over half the student body in just individual services alone which is kind of striking…

Wyatt: Yeah, that's a surprise.

Vo: You just imagine how many…how much suffering that probably represents. We don't have any illusion that we see everybody that's suffering. So, we are seeing very high numbers—unexpectedly high numbers—of people coming with not just little problems. Very, very real suffering, human suffering…depression, anxiety, things that are clinical but also really difficult situations. So, I really, I think you're right. We're seeing something that's unprecedented and it's probably reaching what I think many people would call an epidemic-type proportion. And so, I think there are lots of different things we could talk about. Why is that happening? Why are these students in so much distress? And I think it's hard as somebody that care a lot about young people to see this much suffering and wonder, "What is going on and how can we help?"

Wyatt: Yeah. And you're dealing with high-performing, very successful students that have been admitted to medical school…

Vo: Yes.

Wyatt: And are working through it and we're seeing…we have some graduate programs at Southern Utah University, but mostly we're working with undergraduate students and they're in the whole range of students that are getting ready to apply to your medical school…

Vo: Right.

Wyatt: Or don't know what they're going to do with their lives, they're still trying to figure it out. And we're seeing the same thing here, that it's just a continually growing problem. We keep adding additional mental health professionals and the lines don't seem to be getting shorter.

Vo: Mhmm.

Wyatt: There's a waiting list all the time.

Vo: Right. And I think as somebody that is in administration that phenomenon can be very distressing and confusing. And I was just reflecting as you were describing the situation that you have down in Southern Utah University. I think…so I've been in this role for the last three years…they've significantly increased the resources available for the wellness of our students as I was being appointed. Previously, it was just one psychiatrist with a few PhD psychology students helping him with therapy and they didn't see quite as many students. I don't know because I wasn't involved with the program before my appointment, but what the Dean of Admissions told our Dean of Students when they hired me and the LCSW who is my coordinator and my right-hand person—basically helps me with all aspects of running this program and my life—what he said was, because we were both coming from the division of child psychiatry where he was also an appointed professor, so he said, "So, when I went on my mission in France, we drove these Peugeots" or like one of those French lemon cars. I don't mean to be pejorative, but he drove these terrible cars, and everybody kept getting in these accidents, and so the mission president decided to invest in these BMWs because he thought maybe that would make it safer. He was like, "Well, that didn't end up decreasing the prevalence of accidents actually" [All laugh] because people felt more confident in driving and they were taking more risks. So, he was like, "I have a fear that when we increase the resources that it's going to be like investing in these BMWs. That actually, students are going to feel more like they can let it all hang out, so to speak. [Laughs] So I don't know how much validity there was to that hypothesis—it's hard to test that—but I think it's something that I do sometimes wonder about. So, are we so successful of decreasing the stigma? Are we maybe calling more attention to something that in previous years people might have just powered through? And then what's the utility of that? The coping strategy of powering through and just "sucking it up"? I think those are all interesting questions that I sometimes struggle with.

Wyatt: What do you think are the causes? When Steve and I, we're quite a bit older than you I think, Michelle, but when Steve and I were in college, there were…my recollection as an undergraduate student at Utah State was there was one faculty member who taught psychology who also ran the wellness center (whatever they called it). And there may have been a couple more than him…

Vo: Right.

Wyatt: But clearly, it was small.

Vo: Right.

Wyatt: Really small. And what's happened in the last 20, 30, 40 years where we now find ourselves in Utah with the highest adolescent suicide rate? And working at universities where the demand for services just keeps growing and our students are continually in need of more help with mental illness or whatever their challenges are, anxiety, depression, and so forth. What do you think has changed?

Vo: I think reflecting on potential changes and I think there are probably a lot of nebulous changes that we can't…they probably all coalesce together in some kind of interesting and difficult to discern way. But I think that there are a couple things that are different for our students right now that were different then. And you may be right that we are of different generations, but I think about my own medical school experience, and it was very similar to what you're describing where there was one person that was sort of in charge of an issue if you had an issue, but the issue that you were supposed to go to this person for, it had better be a terrible issue. It never really occurred to us to reach out for some of the issues that I think are valid issues and useful issues to work through, it just never would have occurred to us to do it because you sort of just coped in other ways. The one thing that I think about when I think about changes in generations is I think that the current generation of higher education students, these are potentially more isolated than previous generations. I think about just changes in medical practice and teams in the hospital, so, not just for medical students but the residents, but the post-graduate MDs that are also getting some specialty training. When I was a medical student, we didn't have the electronic medical record. We wrote all our notes on paper, and so, you would stay as a team and then you would come back to the team room and all be together, and you would write your notes and there would be a lot more dialogue. And when I went to residency, the medical record had become a thing, and so, rather than having everybody facing each other at the table all sharing ideas and engaging, everybody had their backs to each other typing on their computers and putting in orders, so there was less interaction, even on the team. And so, I think that potentially, the students are more isolated than ever before. I think that community is very important, and I think the effect of social media can't be understated. There's a lot that we know about social media, how it affects mental health. It can be another stressor in the way that it's an opportunity for people to engage in what we might call negative self-talk or negative cognitive distortions. For example, comparing yourself to other people or perfectionism or sort of distorted thinking.

Wyatt: It's interesting that you'd talk about social media. I have a couple kids who decided to turn off all their social media, and they've told me that they actually feel better having done that.

Vo: Yeah. I often recommend that students turn off social media when they are suffering. I often recommend it when…so, the medical students have to take these licensing examinations, they're quite a big deal, and so, I often recommend to them, "This is another stressor, and this is the time where you want to minimize your stressors. And if social media is a stressor, then probably it's time to delete that app temporarily at least from your phone." And so, I often will do that in a prescriptive type way and I rarely hear that it was a detrimental thing. Most people sort of needed that permission. And so, that's the other thing that I wanted to talk about that's maybe different for the students is I think they're used to having a lot more guidance and help along the way than previous generations, and so there's a lot more self-doubt than I think may of us dealt with when we were young people. And I think are a few cultural factors for that. Potentially parenting has shifted, parenting practices have shifted to be more child-centered and that's, in many ways, a good thing but sometimes it can reinforce this idea of self-doubt that contributes to anxiety and depression and fear. And then I think there are some other factors. Like economically, you may have heard, this generation of young people are not set up to do economically better than their parent's generation, and I think that weighs on the students in a way that I think many of us can't really understand. And then I think, related to the social media, there are just more influences. The world is larger and it's…you have more access to information, and when you have more access to information, you have more access to potentially fearful type intervention…and so, I think there are lots of interesting cultural factors that are different between this current generation that might contribute to some of the distress that we're seeing.

Meredith: So, is part of it that we're just less culturally sensitive to whatever stigma might have been attached to reporting a struggle with mental illness? Is that part of it, Dr. Vo? We…in previous generations, there might have been a stigma to visiting a psychiatrist or a counselor or some kind.

Vo: Right.

Meredith: Or in your estimation, is it more that young people simply don't have the wherewithal to power through because they've been, as you suggest, guided so much that we…when they got dropped off at college, they feel a little bit lost?

Vo: Right. I think that probably…I think it probably has been complicated and multifactorial. I think there are probably influence both at kind of a more micro level, so the family and how does the family interact and how does this person function? And then I think you're right that there is a shift towards the decrease in stigma of seeking help. That potentially they just…I don't necessarily think for example that the rate of autism has increased over the last several years, I just think that we as medical and mental health professionals have gotten better at identifying it earlier and there are better interventions, and so people are looking. And so, I think that there's a little bit of that happening with depression and anxiety in young people too where Id o think that it's less shameful to admit that you're struggling with fear or self-doubt or sadness. And so, that, I think, certainly plays a role in some of the phenomenon that we're seeing.

Wyatt: Is it possible that…this is such an interesting area to talk about. And as you've been going through some of these factors that maybe be contributing—I'm looking at isolation, social media, seeking more guidance, economic challenges, all of those kinds of things—sometimes I wonder if it's not limited to a generational issue but everyone.

Vo: Mhmm. I do wonder that too.

Wyatt: We've got so many people that, I'm nearing 60, and I've got 1,000 friends on Facebook that are my age, and some of them are on Facebook all the time.

Meredith: Yeah.

Vo: Mhmm.

Wyatt: So, and isolation…when I went to law school, as an example, at the U—that's your place.

Vo: Mhmm.

Wyatt: When I was in law school, we were doing research in the library with books. We had to go to a communal place to do our research.

Vo: Mhmm.

Wyatt: And now, all of the research for lawyers is done pretty much online by themselves staring at a computer screen.

Vo: Right.

Wyatt: So, the isolation issues that perhaps the adolescents are seeing might be similar to what those in my current generation see, along with social media and everything else. And so, I'm wondering if the same issues that the adolescents are seeing are being exhibited in the generation older than them, but the fact that the older generation has more experience behind them or more perspective so maybe it's not affecting them quite as much. Or maybe it is, I don't know.

Vo: Yeah. I think that's really interesting, and I think you bring up an excellent point. You know, I often wonder about technology and its influence on…it's unintended influence on our experience as human beings, our communities, because I think people's lives just in general across the generations have become fuller over the years, and so I think that some of the things that help keep us well sometimes fall by the wayside. We sometimes take the need for community for granted with the day-to-day. And you can sort of see how you might feel like you can connect with somebody on Facebook, but it doesn't really take the place of having a face-to-face, meaningful conversation.

Wyatt: I look at my life and the amount of time I spend starting at a screen answering emails, and it's me alone in a room banging away at the keys, very impersonal, efficient responses.

Vo: Right.

Wyatt: But, if I stop and say, "This…I can answer this question more quickly with a phone call or by walking over to somebody's office, I always feel better."

Meredith: Yep.

Vo: Yes.

Wyatt: Because I've had that face-to-face conversation. I feel like the issue is resolved better and that our relationship is better than just a quick email.

Meredith: Yeah, I…

Vo: I agree with you.

Meredith: I talk with young people about this fairly regularly because I actually teach in a Music Technology Master's Degree and it's delivered entirely online. We go way out of our way to engage the students in Skype conversations and other things where they know what our faces look like and we know what their faces look like, and it's not quite the same as being in the same place, but we try really hard for that very same reason. Anecdotally, last Valentine's day, my wife and I went out to eat and we just happened to be surrounded by young couples on dates for Valentine's day, and it was astonishing to us that both of the parties in those dates seemed to look more at their phone than they did at each other.

Vo: Right.

Meredith: And I was just…you know, my wife accuses me—rightly so—of being too attached to my phone, but I am able to put it down and have a conversation and I agree that maybe one of the greatest causes of anxiety in young people would be to take their phone away, but it might be the best vacation from technology they could have.

Wyatt: Short from anxiety.

Meredith: That's right. It would be a…

Vo: Right. Yeah, I often recommend that the students unplug for many reasons. You know, when you describe sitting along in your office staring at a screen typing emails, I admit, freely admit, my bias of somebody that really enjoys working with people. [Laughs] It does sound lonely and potentially depressing to be starting at a screen all day. And not to mention the potential ramifications of the blue light in the screen…I'm just going to put my science hat on [Laughs] and say that might affect your circadian rhythms and your ability to sleep, which would affect your mental health anyways. But, I often have that conversation with students, too. Because, it can't be…the importance of taking care of our bodies can't be understated, and I think that sometimes because of the technology that we have in medicine and in all areas of our life, we forget the simple things. Which is that our bodies were built to be active, our bodies were built to sleep, we need to restore ourselves, and staying up all night watching YouTube is not a sustainable lifestyle. [Laughs] So I often will recommend unplugging from social media, but also just putting the phone down when it's dark outside and our bodies were meant to be getting used to going to sleep. Those are interventions that I think sometimes people take that for granted, and then they don't realize how these little interventions—paying attention to the way our bodies were meant to work—can make a difference. 

Wyatt: The problem seems to be getting worse, probably documentable worse, right?

Vo: Mhmm.

Wyatt: We know that suicide rates have gone up.

Vo: Mhmm.

Wyatt: And we understand that Utah, where we all live, has the highest adolescent suicide rate. How does that relate to college students> Because college students are chronologically beyond adolescent, aren't they? [Laughs]

Vo: Chronologically, yes. I mean, I don't know. I have a lot of questions about that. I think chronologically, they students that I see, we would expect them to be doing young adult type developmental things. And many of them are. Many of them are married and are starting families, but emotionally and socially, the students sometimes are dealing with more issues that we would classically think of as adolescent issues. Like, "Who am I?" My identity formation. Sometimes they're experimenting in ways that you would expect an adolescent to do, and so bringing it back to the general higher education population, we do know that in higher education, there are greater risks for things like depression and anxiety. I looked it up, it's…depending on what data you look at, it's about a two to three-fold increase in comparison to other young adults that are over age 18 that are not in college for anxiety and depression risk has increased. And then the suicide rate is increased as well. Also, the rate of alcohol abuse is a factor here that we can't really ignore. I think substance use and abuse in the higher education population is a big problem and predisposes people to anxiety, depression.

Wyatt: Sometimes alcohol and drug abuse is a cause, but sometimes, it's a symptom, isn't it?

Vo: Yes.

Wyatt: Self-medication.

Vo: Mhmm.

Wyatt: Are you suggesting that adolescence has been extended?

Vo: I think it's certainly possible. When I think about some of the things that the students come to us for, they do feel familiar to me as somebody who has subspecialized in child and adolescent psychiatry and pediatrics. That's a comfortable area for me, and I feel like I can understand that in a way that feels familiar. And when I think about that, these are young people in their mid-20s. So, there's certainly something about that. I'm seeing young people in their mid-20s dealing with some things that I often talk about with people who are more adolescent age. And so, I would speculate that there is a subset of students that are very high achieving that have focused very much on achievements and academic achievement and other things they maybe have been guided in certain ways, and so their emotional and social development sometimes needs to catch up. So, that is something that I do see happening in my work, that sometimes we are helping students form their identities in ways that I don't necessarily think that previous generations had to deal with this late in their life.

Wyatt: I'm thinking back at the time when I was in elementary school at in this discussion about adolescence and when does it end and has it actually sort of been extended or is kids' social development a little bit slower maybe because they're spending so much time of social media or some of these other things you talked about, but I remember, this is probably one of those classic, "I had to walk uphill both ways in the snow" sort of stories, [All laugh] but literally, when I was a first grader, I walked a mile to school every day and back.

Vo: Right.

Wyatt: Everyone in my neighborhood did. There wasn't anybody that got a ride to school. We all got out on the street, we walked together as friends…

Vo: Yeah.

Wyatt: I'd sit there and wait for the kids up the street to come by and then I'd go out and walk with them, and I don't know anybody that is sending a five-year-old to school to walk a mile today. They get taken, dropped off at the front door…

Vo: Right. I can certainly reflect that. My son is a second grader, and speaking of anxiety and parental anxiety, there was one evening where one of his friends came and he left to go play at his friend's house—something that I think many people would recognize from previous…but I remember saying to myself, "Is he old enough?" And thinking to myself, "Wait a second…" [Laughs] "Once upon a time when you were also in first or second grade, you hardly ever wore a seatbelt. You were in the front seat with your mom."

Wyatt: What is a seatbelt?

Meredith: Right, we didn't even…

Vo: So…

Wyatt: My mother grew up on a farm. She had her own horse at five years of age. When she was five, she had her own horse.

Meredith: Yeah.

Vo: That's amazing.

Wyatt: And she'd go anywhere she wanted to go. It feels like we're not growing up as fast.

Meredith: Well, yeah. That people have become bubble-wrapped, and because of that, when they're actually confronted with adult issues and anxieties, they may be a little less adept at dealing with them or less prepared to deal with them.  

Vo: Yeah. I think it comes back to this idea of being privy to so much more information than maybe our parents or our generations were. I think, as a pediatrician, my son will stay in his car seat, in the five-point car seat, until he outgrows that car seat because of the risk-benefit ratio is favorable. But if you take that line of thinking too far that, "I have to protect my child and do everything possible to minimize any sort of risk" the implicit message sometimes becomes, "The world is not a safe place for you" and "Independence is scary." And so that's something that I think is a really interesting concept and a fine line to walk. How do you protect your child from risk, but also help them self-actualize and develop into a functioning grown-up person? It's an interesting idea.

Wyatt: Yeah. So, what do you think…there's two worlds here. The one world is families…what can parents, guardians, do to help children as they grow up and prepare to go away to college to help them be more resilient or whatever it is that's causing greater anxieties today than it used to. And then on the other hand, what can we do at universities to help the students that we feel so much obligation for to help them succeed in life?

Vo: I think, to speak generally to both a first and then maybe I can dial down and speak to both populations, I think recognizing that as human beings, everybody has different needs. But ultimately, we all have the need to become functioning adults and to function in our independence. So, what I would say to parents and what I would say to people in administration in higher education, we do kind of have to accept where our young people are. So, some of these young people might not have the skills, for example, to deal with conflict face-to-face because they may have never had to do that in play or as young adolescents or as people living at home.

Wyatt: They can break up a relationship with a text message.

Vo: Right. And, I think to many of us, that seems kind of bonkers and inappropriate and rude. But, I think to many young people, it's sort of become something that's socially acceptable. And so, I think leaving them where they are and recognizing when some of these phenomenons may be creating issues and negative thinking or negative patterns of behavior and gently redirecting it. So, first, meeting people where they are and recognizing and helping build skills that they need to manifest their independence. And I think the second think when we think about, "Is there a role for prevention of mental health problems, both in the family and in education?" I think there is. I think it's a little bit trickier, but I think sometimes in mental health, we become so focused on treatment that we begin to see everything as a problem rather than, "This is just where this person his in their development." So, what I often find myself pondering is, "Is there a way that we can pay more attention to community building so that people feel less isolated and so that they can build some of the skills that they may not have built yet?" So, one of the things that we're looking at at the University of Utah in the Wellness Program is that yes, we have to provide services individually. I think there's still…even though we've talked about how the stigma of mental health has decreased, we have, I think, evidence that that is happening, there's still a tendency for the students to not want to engage in groups. So, for example, our group therapy type interventions, they're sort of hit or miss. Everybody thinks that they're struggling and they're the only one that struggles, when literally, we know that more than half the student body is struggling enough to come see us. And so, how do we shift the community and the culture so that people can join in these experiences, learn from each other, and build their skills? That is something that I think our program, that's sort of our charge over the next few years and I'm fairly excited about that it is sort of an intellectual and programmatic challenge. How do you shift a culture?

Wyatt: There seems to be a lot of evidence that is the science of wellness and happiness, there's a lot of research going on, and it seems that one of the real key components to living a happy life is to have good relationships.

Vo: Yes. That cannot…I think that can't be over stated. I really do think that having a community and paying attention to what values are manifested in your community can go a long way. And when I say community, I mean both the higher education community, so our campuses, but I think that for the parents that are listening, there are these little communities within our families that we can pay more attention. And this is the kind of area where you don't have to completely shift everything that you're doing. Sometimes, a small intervention can go a long way. Like plugging in the phones at the end of the day so that they phones aren't present at the dinner table and everybody joins together in some type of gratitude exercise like sharing the best part of their day and really making eye contact and being present with each other can go a long way to helping people feel less isolated and alone.

Wyatt: You know, I wonder if that's something that has changed, because I remember when I was a kid, we all had dinner together and we all had breakfast together, and today, it's far less common.

Vo: Yes, I think…

Wyatt: That's an interesting suggestion.  So, what you're suggesting is for families to create times when everybody's together.

Vo: Yes.

Wyatt: On a more frequent basis interacting with each other, caring about each other, listening to each other' stories, get rid of the phones during those times. Dinner. Having dinner together.

Vo: Yes. It sounds so basic, but I think that sometimes if we don't pay attention to some of the other influences in our lives, we live such full, busy, modern lives that are sometimes over-programmed, something as basic as putting the phone away and having dinner as a family, sometimes you think about it and you're like, "I don't even remember" because you've been so busy. It's hard to prioritize that unless you willfully and set an intention to do so. And I think that is one thing…no one could argue that that's not helpful for a family or a community to connect periodically. I think there's a certain mystique or kind of fairytale thinking that positive things are fun or enjoyment of each other or joy needs to be spontaneous. I don't think it necessarily needs to be that way. Often, it's very, very helpful to structure that and to plan it into your busy life. And so, if there's anything that they I think anybody can do on any level to really take a look at the structure of how our lives are being lived and how our professions are going about our work and are there ways that we can get up from the computer, have the conversation in person. Or have that meeting in person or have that dinner in person with the phone plugged in and charging. I think that can go a very, very long way.

Wyatt: Yeah. My wife listens to these and she's going to tell me about this. 

Meredith: Laughs.

Wyatt: She's going to say, "Remember when you were talking about having dinner as a family? Get home in time for dinner." [All laugh]

Vo: She sounds like she has very good ideas. I'm fully supportive of that. I think that's really, really important. [Laughs]

Wyatt: So, that's one of the really big things that we can be doing in our families and in our small relationships is increasing the social time when we visit, talk, celebrate little things, express gratitude.

Vo: Right. I agree. I think that's very important. It can, like I said, go a long way even though it sounds so basic and trivial.

Wyatt: Well, sometimes getting back to the basics is the best answer to a lot of questions.

Vo: Sometimes it's elegant.

Wyatt: Yeah, that's right. What other things would you have as suggestions for us?

Vo: So, we talked about sort of these micro-cultures and families and smaller interactions which I think are really important. I think it's important as people who are leaders to build on that when we are building systems. We can't take the importance of community for granted. So, I think that we can leverage technology to work for us in that way. There was maybe a period of time like I described earlier where people took the importance of being face-to-face for granted. I think that now, we're starting to reach an inflection point where people are starting to realize, "That's not a joyful way to live or to work." And so, when we think about building systems or building programs or growing our institutions, I really think people who are leaders, I really encourage people to think about the importance of relationships and communities and what are we doing in our institutions that helps support the growth of that? It's sometimes very difficult to advocate for that because I think everybody on some level recognizes that that's important, but I think it we often take it for granted. For example, are we building new systems where people have opportunities to interact with each other in meaningful ways? Or are we building institutions where people are more likely to be isolated from each other?

Wyatt: You know, this is so interesting. I recently completed a multi-stage marathon race.

Vo: Congratulations.

Wyatt: Yeah, it was a lot of fun.

Meredith: 175 miles.

Vo: Wow.

Meredith: Or some crazy thing. [All laugh]

Wyatt: So, it's called the Grand to Grand Ultra. But one of the things that I dreaded was that it's a self-support race where we had to take everything with us—our food, and it went for seven days—but one of the things that I dreaded was the team and the organizers of the event provided tents and assigned us to tents and that meant that I had to share a tent with four people that I didn't know.

Vo: Mhmm.

Wyatt: But, but the end of the week, that was the highlight of my trip. My natural tendency was to want to be alone in my thoughts and to not have the complication of figuring out how to change my clothes in my tent when there's all these other people in the tent and all the other kind of things and listening to snoring and making sure I've got my earplugs and so forth, but at the end of the week, it ended up being the highlight of the whole thing was the time that I spent with all of these new people. So, we have also found this true with student housing. That students tend to want a condominium style housing unit where they have their own bedroom and their own bathroom. But students that end up being, for whatever reason, in an apartment where they have to share a room or share a bathroom or share a kitchen or go to the cafeteria to eat their food, they actually tend to be happier. They didn't want that, but that makes them happier because it forces them out of their cocoon into a more social environment.

Vo: Right. I don't think…yeah, that doesn't surprise me at all. It's funny, because I think that there are certain things that we tell ourselves that we think we want. We don't want to deal with the possibility that somebody might be snoring or that I might hate my roommate, or they might, I don't know…

Wyatt: Yeah.

Vo: All those college dramas. [All laugh] Probably the path of least resistance is to avoid it all.

Wyatt: yeah.

Vo: But I don't think that that is a helpful or healthy way to go about living. And sometimes we have to take risks, and so yeah. I think that's super interesting and I could talk all day about, "How to we build systems in institutions so that we support healthy interactions and health behaviors?"

Wyatt: Yeah. We've talked about some of the causes of the increase in anxieties and depression, all of these factors, including isolation, social media, needing too much guidance, other kinds of things, and we've talked quite a bit about the need to reduce isolation and perhaps the need to reduce some of the social media, get people engaged more. With respect to guidance, how do we help our young people, whether it's our children or our students, take more ownership in their decisions? That seems to be one of those factors.

Vo: I think that's a mystery for those of us in higher education. Because when you think about learning any skill…for example, you have a child that's learning how to walk. I often say to parents, "You don't…" when we're learning skills or dealing with depression and anxiety, "You don't walk outside on the twelve concrete steps where they could fall and really injure themselves. You want them practicing walking in the carpeted living room."

Wyatt: Yeah.

Vo: You know, where the risks are lower. And so, I think when it comes to helping people build either independence, I think it of sometimes in terms of skill building in a similar way, where ideally, people would be testing their independence at earlier ages in the bosom of their family with safety. Sometimes we deal with young people, as you do, that haven't had those experiences. And so, we have to think about, "Are there ways that we can help support them in higher education to test their independence and get exposure?" Really, when you think about treatment for anxiety, the best non-pharmacological treatment is exposure. Just being exposed to the thing that makes you anxious, because almost always, it's the anticipation and the fear associated with it that's worse than actually going about…

Wyatt: It's never as bad as you think.

Vo: It's never as bad as we think.

Wyatt: Yeah.

Vo: There's always so much more heartache and fear leading up to it. And so, the best treatment for anxiety is exposure, and so, notice that I said "exposure" and not "flooding." In psychology, colleagues would say, "It's not flooding" which is that if you're scared of spiders that you immerse yourself in them. It's that if being alone or being on your own makes you anxious—if independence itself makes you anxious—then probably it's important to test that out and maybe not put yourself in a situation where you're living in a condo on campus with no roommate and not a lot of skill to interact and make friends and build these relationships on your own. Or maybe it's important to find a safe group of people that share interests with you so that you can start building your social network that's protective. So, I think it's important to think about this kind of graded exposure and exposure to things that make us anxious and building skills. So, that's what I would maybe say in terms of guidance. And like we said, I think we're all acknowledging here that in many ways, the three of us are sort of thinking outside our box. It's unusual for us to conceive of an idea that somebody could be in college or in medical school and very anxious about what we would think of as normative, developmental experiences of adulthood.

Wyatt: Yeah. Well, this has been such a fascinating discussion. It's the core of what all three of us are doing is trying to help our students be successful. And some of these mental health challenges are making it difficult for them to be successful.

Vo: Yeah.

Wyatt: And moving to full adulthood. But I know a lot of adults that are trying to figure out how to be adults. [Laughs]

Vo: Right. It's sort of a human condition. I think we just happen to have a very intimate view of what our students struggle with and I think it's very clear you both care so much bout these young people and yeah…I think it's just really encouraging to have this conversation and very interesting, so I really appreciate it.

Meredith: You've been listening to Solutions for Higher Education, a podcast featuring Scott L Wyatt, the president of Southern Utah University in Cedar City, Utah. We've been joined on the phone today by our guest, Dr. Michelle Vo, she's the director of student wellness for the University of Utah medical school. Thanks to Dr. Vo, and thanks to all of you for listening. We'll be back again soon, bye bye.