Stress of a Generation

DC4 Report Publication: INTAKEEdition: 1ST Day: 5. THU (THU) Date: 20060223 Page: I24 Section: STARTAB2 Byline: BY KIMIKO MARTINEZ Copyright: Yes KIMIKO.MARTINEZ@INTAKEWEEKLY.COM

Stress of a generation Today's 20−somethings have more opportunities than ever before. So just why are they all so anxious? BY KIMIKO MARTINEZ KIMIKO.MARTINEZ@INTAKEWEEKLY.COM When you're in your 20s, life sucks. Sure, there are good times; but overall, life is stressful. Between graduating from high school or college, searching for a significant other, working your way up the corporate ladder or searching for a career that engages your passions −− all while attempting to maintain some semblance of a social life −− things get a little harried. Not to mention worrying about paying the credit card, car and student loans bills −− and if you're lucky enough to actually own a home −− a mortgage. And all that living it up −− bar hopping in Broad Ripple or indulging in the culinary delights Downtown −− is really just a temporary escape from some deep−seated discontent. No, the 20s are no longer that carefree time of self−discovery, but instead are more often a grueling transitional period rife with confusion and self−doubt. And the pressure to "do it all" is driving more and more to the edge −− where popping pills, seeking therapy and, ultimately, learning coping skills are today's hottest trends. Something is definitely wrong Chances are that someone you wouldn't necessarily expect −− your desk mate, your best friend's roommate, your boyfriend or girlfriend, even your boss −− is popping anti−depressants or anti−anxiety medicine. Millions of Americans are. Demand for IUPUI's Counseling and Psychological Services has been increasing more than 5 percent annually, resulting in a 25 percent increase in total services provided in 2005 compared to 2002, according to Dr. Julia M. Lash, the program's associate director. "Depression is the most common reason students seek our services," Lash said. "However, anxiety and relationship concerns are also prevalent. More than 40 percent of the individuals we work with are also taking psychotropic medications as part of their treatment; again, predominantly for depression and anxiety." And college students aren't the only ones. Take Jen Shelton.

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DC4 Report By all accounts this 31−year−old has her life on track. She's a sixth−grade teacher at an urban public school, she's completed a master's degree, has a good marriage and, just last month, officially became debt−free. So what, then, is wrong? "I constantly get intense, overwhelming sensations that are in some cases crippling," Shelton said. "My anxiety only goes away if I am sleeping . . . or if I am on high octane doing 20 things at once." As drug treatments have improved in the past couple of decades, physicians feel more comfortable prescribing medicines like Zoloft and Wellbutrin, and their patients are feeling more comfortable taking them. Shelton admits that she was, at one time, on anti−depressants. "But they only made things worse and (slowed) everything down," she said. "This meant that I had more time to dwell on how insufficient I felt in this large world." Despite Shelton's misgivings, many 20− and 30−somethings are popping pills to feel better, and the rise in prescriptions leads to a couple of big questions. Are people popping more pills because the drugs are better now? Or is there a bigger problem that's causing us to seek help? It's not just you "Anxiety. We've all got it bad," said Anne Snyder, 22. "The question is: What are the things we are dealing with that past generations didn't have to deal with? People have always had stressors in their lives. But I think one big thing may be family structure. With divorce almost being the norm now, kids are having to deal with their parents fighting and being put into grown−up situations. "Kids don't have a childhood half the time anymore. There is no balance and structure. And when you grow up your whole life without a firm foundation, never feeling sure of things, of being loved even . . . it's enough to make anyone struggle with important decisions." Snyder is on the right track, according to Jean M. Twenge, whose book "Generation Me: Why Today's Young Americans Are More Confident, Assertive, Entitled −− and More Miserable Than Ever Before" comes out in April. According to the book, divorce is among several reasons why children of the 1970s and '80s are battling anxiety. Children in these decades faced major social changes −− nuclear families dissolved as divorce rates rose, society became more mobile and job opportunities took parents and grandparents to different parts of the country and world. The fear of nuclear war, violent crime and diseases like AIDS became larger environmental and social threats, and received an increased amount of media coverage. Due to all these factors, according to Twenge, schoolchildren in the 1980s had higher anxiety levels than child psychiatric patients of the 1950s. What used to send kids to seek serious treatment has become the baseline for an entire generation. "You'd think we would be happier now," said Twenge, 34. "No World War, no Great Depression, we're healthier and living longer. But we're getting into the real world and it's not what we expected it to be. These self−esteem programs in schools are raising people's expectations, creating a sense of entitlement that you can be anything you want to be." Times they are a−changin' 2

DC4 Report So not only is our base anxiety level higher, but there's a host of other things against us. Ours is a generation that has been coddled by Baby Boomers, moving from As, Bs and Cs in school to checks, check−pluses and check−minuses to improve self−esteem with positive reinforcement. "(Our generation) expects so much praise and has a hard time dealing with criticism," Twenge said. "But to cut us some slack, it wasn't our idea. It was the Baby Boomers who decided to raise us this way." Ours is also a generation stuck in the middle of a technologically transitional society. "Our coping mechanisms aren't as good, our support systems are down and we're in an age of information that is overwhelming us," said James P. Nicolai, medical director of the Franciscan Center for Integrated Health. "Cell phones are 20−years−old; the Internet is 15−years−old. Pagers, voicemail, Blackberries . . . we're in an age of information where you can be gotten ahold of 24/7. "And in this age of information, one of the things that has happened is that now we're forced to filter that information," he said. "Not only are we the transition generation in how to use this technology, but now we're trying to figure out which one is better than the other, which can be used instead of another and so on." Instead of carrying a Sidekick, Palm and cell phone, people are trying to consolidate and carry just one device. And even more often now, people are beginning to rebel against the constant connectivity. There's a reason why people call them Crackberries. While many thought Blackberries and such would allow for greater productivity and more freedom, they're now realizing how addicting the connection has become. Some decide to completely unplug, while others just can't do it. "It takes anywhere between one and two hours to go through phone mail, e−mail, memos, phone calls and people knocking on my door before I even get to my workload," Nicolai said. "That's pretty consistent. One of my best friends doesn't answer e−mail except on his Blackberry. We're being introduced to (new technology) at an incredible, accelerated rate and need to be re−educated on different things coming out. It may be making our lives easier, but it's also increasing accessibility. And one of our major challenges is when do we turn it off? At expense of slowing down or being left behind?" Oh, and then there are the big ones There's also love and money to think about. "Older folks don't seem to understand how hard it is to get by these days," Twenge said. "When you do the math of college student loans, grad school loans, housing, health care, daycare . . . the numbers don't add up. People can't afford to settle down." That is, if they have someone to settle down with. Increasing numbers of adults are not only living alone, but remaining that way until much later in life. The drive to succeed, whether personal or financial, often puts pursuit of relationships on the backburner. "I think another really big part of it is loneliness and uncertainty in romantic relationships," said Twenge, an associate professor of psychology at San Diego State University. "It's not just that we're more likely to live alone and have more choices. Think of the times when you're more likely to be depressed −− after a 3

DC4 Report breakup. And we do go through more breakups than previous generations." Snyder wonders what effects divorce has on the current generation. "I think it definitely takes a heavy toll on how we deal with relationships these days," she said. "Half the time I think people go into them assuming they won't last." Does it get any better? Coping skills are what we lack, so until we learn those, many doctors agree that while you're treating the symptoms with medication, you're not fixing the problem. "We don't have the teaching skills of handling anxiety or the opportunity to observe people who handle themselves well in those situations," said Jerry Fletcher of the St. Vincent Stress Center. "It's because of that that there is the sense that medications can fill that gap. They improve your mood, can improve your sleep/wake cycle, etc. But they don't make choices for you, and they don't give you the skills to cope." But since this generation is one that wants quick fixes −− drive−thru Starbucks, instant messaging, high−speed Internet −− taking the time to learn new skills isn't exactly on the top of our list of priorities. "All the problems in a sitcom are fixed in 30 minutes with four commercials," Fletcher said. "People want something that will happen now and that they don't have to put a lot of energy into. Therapy sounds laborious and self−help books take too long." Which is why so many people choose to self−medicate −− drinking too much, eating too much, shopping too much or experimenting with drugs −− all which provide a temporary escape, but only make problems worse in the long run. "The big stuff that most people worry about −− money, love and staying fit −− were not really things that got me worked up," Jen Shelton said. "Just the opposite. Spending, eating and dating lots are what used to keep me sane. Nowadays I find I have become obsessive, finding projects in my life or other things around me, to refocus my anxiety." Things may be looking up for the generations following us −− the economy is better, crime is down, teenage suicide and pregnancy have also decreased. "There are a lot of good indicators that for younger generations, maybe it's going to swing back," Twenge said. "But even though things look better for teenagers, it's looking increasingly negative for young adults. Once people hit their 20s, I think that you're still going to see the increased anxiety and depression." So when does it ever end? Shay Daily has been battling anxiety and panic attacks since his teens. But after more than 10 years of living with an anxiety disorder, the 23−year−old has learned to recognize the onset of an attack. He found a medication that works for him and slowly acquired the coping skills needed to deal with his day−to−day battles. "On a scale of one to 10, when I was 13 or 14 I was easily a 10−plus," Daily said of his anxiety problem. "Now it's about a four. A six or seven at its worst." 4

DC4 Report While Daily's anxiety disorder wasn't one developed after years of battling workplace stress, he does feel the pressure to have his life planned out already. "Right now, at 23, I'm supposed to know everything, have it all planned out for the rest of my life," he said. "But a lot of the time, I don't even know what I'm doing tomorrow." Like Daily, though, finding ways to cope −− whether it's seeking out talk therapies or support groups, taking advantage of employee assistance programs or an insurance company's mental health services or incorporating endorphin−inducing exercise and natural stress−busters into his routine −− is necessary to make it through. "For myself and a lot of my friends, it gets better by the mid−30s," Twenge said. "You've found the person you're going to marry and a job that's a reasonably good fit. For many, the 20s were just a time of turmoil." DO YOU HAVE STRESS−PRONE HABITS? Rate yourself as to how you typically react in each of the situations 4 − Always, 3 − Frequently, 2 − Sometimes, 1 − Never. _____Do you try to do as much as possible in the least amount of time? _____Do you become impatient with delays or interruptions? _____Do you always have to win at games to enjoy yourself? _____Do you find yourself speeding up the car to beat the red light? _____Are you unlikely to ask for or indicate you need help with a problem? _____Do you constantly seek the respect and admiration of others? _____Are you overly critical of the way others do their work? _____Do you look at the clock often? _____Do you constantly strive to better your position and achievements? _____Do you spread yourself "too thin?" _____Do you do more than one thing at a time? _____Do you frequently get angry or irritable? _____Do you have little time for hobbies or time by yourself? _____Do you talk quickly or hasten conversations? _____Do you consider yourself hard−driving? _____Do your friends or relatives consider you hard−driving? 5

DC4 Report _____Do you have a tendency to get involved in multiple projects? _____Do you have lots of deadlines in your work? _____Do you feel vaguely guilty if you relax and do nothing during leisure? _____Do you take on too much responsibility? TOTAL ____________ Stress check 20−26: Low stress. Check your pulse . . . are you alive? 27−33: Average stress. Some stress in life is normal and can even be healthy! 34−39: Above−average stress. Start thinking about making some changes . . . NOW! 40+: Change your habits immediately . . . there's no doubt, you are stressed. ?CP,6.5p? Source: Mental Health Association in Marion County Stress Too much stress can cause illnesses, such as insomnia, backaches or headaches, as well as high blood pressure and heart disease. Reducing or controlling stress Remember: Success will not come from a half−hearted effort, nor will it come overnight; relieving stress takes determination, persistence and time. * Be realistic . If you feel overwhelmed by some activities (yours and/or your family's), learn to say no. Eliminate taking on more responsibility that you can or should handle. * Shed the "superman/superwoman" urge. No one is perfect, so don't expect perfection from yourself or others. Ask yourself, "What really needs to be done? How much can I do? Is the deadline realistic?" Don't hesitate to ask for help if you need it. * Meditate. Just 10 to 20 minutes of quiet reflection may bring relief from chronic stress. Use the time to listen to music, relax and try to think of pleasant things. * Visualize. Use your imagination to picture how you can manage a stressful situation successfully. Whether it's a business presentation or moving to a new place, many people feel visual rehearsals boost self−confidence. * Take one thing at a time. For people under tension or stress, an ordinary workload can seem unbearable. The best way to cope: Take one task at a time. Once you accomplish that task, choose the next one. The positive feeling of "checking off" tasks motivates you to keep going.

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DC4 Report * Hobbies. Take a break from your worries by doing something you enjoy. Whether you garden or paint, schedule time to indulge your interest. * Healthy lifestyle. Good nutrition makes a difference. Limit intake of caffeine and alcohol, get adequate rest, exercise 20 to 30 minutes daily and balance work and play. * Share your feelings. A conversation with a friend lets you know that you are not the only one having a bad day, caring for a sick child or working in a busy office. Stay in touch with friends and family. Let them provide love, support and guidance. Don't try to cope alone. * Give in occasionally. Be flexible! If you find you're meeting constant opposition in either your personal or professional life, rethink your position or strategy. Arguing only intensifies stressful feelings. * Go easy on criticism. You may expect too much of yourself and others. Try not to feel frustrated, let down, disappointed or even "trapped" when another person does not measure up. Remember, everyone is unique. ?CP,6.5p? Source: Mental Health Association in Marion County Where to go for help To know whether to seek help, ask yourself: Is anxiety or depression affecting your daily life? Has it shifted from occasional stress or blues to something that bothers you more often than not? If so, you may want to look at your options. * Your family doctor. Make an appointment to talk about your situation and symptoms. If you have an established relationship with your primary care physician and he or she knows your history, they may discuss options for treatment. For many, though, it may be better to ask for a referral to a psychiatrist, since they're trained to deal with this on a regular basis. * Your employee assistance program. If your work offers a program, take advantage of the free counseling sessions. Since many mental health disorders are highly treatable, the sooner you catch it, the better off you'll likely be. If you've hit a rough patch, maybe a couple of sessions are all you need to get you back on track. * Community resources. Especially if you don't have insurance, you'll want to check with places like the Mental Health Association or community mental health centers to see what resources they offer. About Anxiety Disorders Most people experience feelings of anxiety before an important event, such as a big exam, business presentation or first date. Anxiety disorders, however, are illnesses that cause people to feel frightened, distressed and uneasy for no apparent reason. Left untreated, these disorders can dramatically reduce productivity and significantly diminish an individual's quality of life. * Generalized Anxiety Disorder −− Chronic: Exaggerated worry about everyday life events and activities, lasting at least six months. Accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache or nausea. * Panic Disorder: Characterized by panic attacks, sudden feelings of terror. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness and more. 7

DC4 Report * Obsessive−Compulsive Disorder (OCD): Repeated, intrusive and unwanted thoughts that seem impossible to control. * Post−Traumatic Stress Disorder: Persistent symptoms that occur after experiencing a traumatic event, such as war, rape, child abuse, natural disasters or being taken hostage. Nightmares, flashbacks, numbing of emotions, depression and feeling angry are common. * Social Phobia−Extreme: Disabling and irrational fear of something that poses little or no actual danger; leads to avoidance of situations and can cause people to limit their lives. Treatments Treatments have been largely developed through research conducted by National Institute of Mental Health. They often combine medication or specific types of psychotherapy. More medications than ever, including antidepressants and benzodiazepines, are available to effectively treat anxiety disorders. The two most effective forms of psychotherapy used to treat anxiety disorders are behavioral therapy and cognitive−behavioral therapy. Behavioral therapy tries to change actions through techniques, such as diaphragmatic breathing or through gradual exposure to what is frightening. In addition to these techniques, cognitive−behavioral therapy teaches patients to understand their thinking patterns so they can react differently to the situations that cause them anxiety. ?CP,6.5p??CL,7.5p? This content was adapted from material published by the National Institute of Mental Health. Source: Mental Health Association in Marion County. Non−drug alternatives * Exercise. Physical activity relieves muscle tension and forces built−up stress to go elsewhere, instead of being stored in the shoulders or back; the stomach, causing acid reflux and ulcers; or neck and skull, causing headaches. * Omega−3 fatty acid supplements. Herbs like passion flower and Holy Basil have also been shown to calm and improve mood. * Light exposure. Works cumulatively, so be sure to get outside for at least 30 minutes each day, or consider investing in a light box with at least 10,000 lux. * Sleep. Many experts recommend a full eight hours of sleep each night. Sleep deprivation is one of the biggest risk factors for depression. * Social support. Spending time with others is a great way to distract yourself and seek the support you need. It's also a great time to get hugs and other types of physical touch, which are good for the soul. ?CP,6.5p? Source: Dr. James P. Nicolai of The Franciscan Center for Integrated Health, Dr. Young K. Park of the Westview Center for Integrated Medicine and University of Kansas research. By the numbers 22.1 8

DC4 Report percent of American adults who experience some type of emotional or mental problem in a given year 1.8 million people being treated with anti−anxiety or anti−depression medications in 1987 6.3 million people being treated with anti−anxiety or anti−depression medications in 1997 19 million people affected by anxiety disorders each year 46.6 billion dollars that anxiety disorders cost the U.S. in 1990, nearly one third of the nation's total mental health bill of $148 billion ?CP,6.5p? Sources: IUPUI's CAPS associate director Dr. Julia M. Lash, Mental Health Association in Marion County, Dr. Jean M. Twenge of San Diego State University, Dr. James P. Nicolai of The Franciscan Center for Integrated Health, Dr. Jerry Fletcher of St. Vincent Stress Center. _____________________________________________ "More than 40 percent of the individuals we work with are also taking psychotropic medications as part of their treatment; again, predominantly for depression and anxiety." −− Dr. Julia M. Lash, associate director of IUPUI's Counseling and Psychological Services "Right now, at 23, I'm supposed to know everything, have it all planned out for the rest of my life. But a lot of the time, I don't even know what I'm doing tomorrow." −− Shay Daily "[Medications] improve your mood, can improve your sleep/wake cycle, etc. But they don't make choices for you, and they don't give you the skills to cope." −− Dr. Jerry Fletcher TEXT NAME: SLUG: TOPIC: SUBJECT: KEYS: TYPE: GEOGRAPHIC: ART TYPE: ART CAPTION: PROC:

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Photos by Michelle Pemberton and Arnel Reynon ; photo illustration by Arnel Reynon H 9

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