Archives: Mental Health

Throughout my career, I have worked in specialty and community mental health clinics where, to be frank, we see A LOT of stuff. One of the most frustrating parts of those roles was how deeply ingrained misconceptions around suicide are. Often, one of the biggest barriers to helping my clients was to refute the myths my clients and the people who loved them had about suicidality.  You might think that sounds silly, considering my job was kind of life or death in some situations, but tackling these myths is important, given how our belief systems drive our behaviors. Here are 5 of the most common myths I see in my clinical work.

Myth 1: People Who Talk About Suicide Won’t Actually Do It

One of the most dangerous misconceptions is that individuals who express suicidal thoughts are just seeking attention and won’t follow through. SO MANY PARENTS that I worked with felt like their kids just wanted attention, or to get out of their chores. But suicide was the second leading cause of death for people age 10-24 in 2021 and 2022 (CDC, 2023).  In reality, talking about suicide can be a significant cry for help. People may express their thoughts or plans as a way of reaching out because they feel overwhelmed by their emotions or circumstances. 

What exactly constitutes talking about it? When its via text? When it’s a joke? In Passing? When his mom asks if he wants to go to the store with her and he responds, “I’d rather die.”?? What about when your friend is complaining about work and says she wants to “Cha Cha real smooth off the side of a cliff”?? The short answer: Yes. If someone talks about suicide/ death/ dying unfazed, it is likely that the thought has crossed their mind. Just because someone makes a crude joke doesn’t mean they are in imminent danger, but they might be struggling more than we know. Additionally, when people talk about wanting to give up, feeling like they can’t carry on, or even saying they’d be better off dead: take them seriously! Best case- they tell you to chill. Worst- you give them a reason to stay another day.

Myth 2: Suicide Happens Without Warning

Another misconception is that suicide is impulsive and unpredictable. While there are instances where a suicide attempt may seem sudden, many individuals display warning signs, often for weeks or months beforehand. These can include changes in behavior, mood, or personality; withdrawal from friends or family; giving away personal belongings; and expressions of hopelessness. By understanding these signs and staying attentive to shifts in behavior, we can intervene before it’s too late. See my last post for more information on how to spot the signs. 

Myth 3: Asking Someone If They’re Suicidal Will Put the Idea in Their Head

Many people fear that asking someone about suicide will make them more likely to consider it. However, asking someone directly about suicidal thoughts does not increase the risk—it actually provides an opportunity for them to open up and share what they’re going through. Addressing the topic openly can help dispel the isolation they may feel and allows for supportive conversations that encourage them to seek help.

In contemporary society, we have access to ALL the information, ALL the time. If someone is thinking about killing themselves, you asking about it will not push them into it. If anything, it will show them that someone cares enough to check in. Additionally, if they are not considering it, asking about it won’t somehow make it seem like a good idea. Suicide is often the last-ditch option for someone who has been hurting for a while. 

Myth 4: All Suicidal People are Mentally Ill

While mental health disorders such as depression, bipolar disorder, and anxiety are risk factors, they are not the only reasons someone might consider suicide. Life stressors like financial difficulties, job loss, relationship problems, trauma, or chronic illness can also contribute to suicidal thoughts, even in individuals who don’t have a diagnosed mental illness. It’s important to recognize that anyone, regardless of their mental health history, can be vulnerable to suicidal thoughts during times of distress. 

Myth 5: Suicide Is a Selfish Choice

This myth stems from a lack of understanding about the overwhelming pain and hopelessness someone may feel leading up to a suicide attempt. Those who are suicidal often feel as though their loved ones would be better off without them, and they may believe that ending their life is the only way to stop their suffering. Viewing suicide through a lens of selfishness ignores the immense emotional turmoil that underlies it. Instead, it’s important to approach those who are struggling with empathy and compassion.

Most people have probably heard of the fight, flight, and freeze response system that our brains have developed to keep us alive. It’s that part of us that makes the hairs on our arms stand up when we are walking to our cars; the alarm system that forces us to sprint back through the door after we’ve taken the trash can to the curb after dark.  A gentle consideration to keep in mind is that suicidal people are in such spaces of turmoil that not only do their brains not recoil at the thought of death, but they often feel calm relief at the thought of not having to be in that pain anymore.  

So, what do we replace these myths with? Here are some key takeaways:

• If someone is talking about suicide: listen to them.
• Suicide is often a chronic issue that has risk factors and warning signs that we can pay attention to.
• Talking about suicide will NOT make someone kill themselves.
• You don’t have to be mentally ill (or have a DSM diagnosis) to be suicidal.
• People who are struggling with suicidal thoughts and behaviors are not selfish- they are hurting.

If you’re still here, thanks for sticking with me as we work through some of the myths and misconceptions around suicide. Next post, I will walk you through how this came to be my area of expertise, and how I handle the harder days. 

College students across the country face overwhelming stress, isolation, and mental health challenges. In fact, if you’re reading this at a college with 10,000 students, around 1300 of your peers have likely contemplated suicide in the past year alone. These are sobering statistics, but they underscore a critical point: suicide is a public health crisis that touches many lives, often more than we realize.  In fact, the CDC estimated that in the United States, over 13 million individuals contemplated suicide in 2022 with nearly 50,000 deaths by suicide. Globally, that number sits just under 800,000, suggesting that over 200 million people may have experienced suicidal thoughts. These numbers are more than just statistics—they represent real people with real stories,  whose lives are forever changed by this crisis.

There are different theories around why people experience suicidality, but the top two theories cite unmet psychological and interpersonal needs as the driving force behind suicidal thoughts and behaviors (Schneidman, 1998; Van Orden, et al., 2010). People may feel overwhelmed by intense emotional pain, hopelessness, or a sense of being a burden to others. Mental health disorders, such as depression, anxiety, and trauma often play a significant role. However, it’s important to recognize that these factors do not cause suicide in isolation; instead, they interact with one another and with an individual’s life circumstances, creating a scenario where suicide might seem like the only option a person has.

Preventing suicide requires addressing both the immediate risks and the underlying causes. One of the most effective strategies in suicide prevention early intervention, where mental health issues are identified and treated before they escalate (CDC, 2024). This can involve regular mental health screenings, but can also include opening up to friends and family about how we are feeling. When we talk about our own struggles, we create space for those around us to open up as well. Prevention starts with recognizing the signs that someone might be struggling and reaching out in whatever ways we can. For some, that may look like referring them to formal supports, like psychiatric care, therapy, etc. and sometimes, it might look like reminding those people that they are important to us, that they matter, or that there are better days coming. 

A person who is considering suicide might express their despair in different ways. Sometimes, they may speak directly about their intentions, saying things like “I want to die” or “I’m going to kill myself.” Other times, their words might be more indirect, with statements like “I can’t do this anymore ” or “Nothing matters anymore.” These expressions of hopelessness can be a cry for help. Behavioral changes are also common in someone who is contemplating suicide. They might start withdrawing from friends and family, isolating themselves from social interactions that they once enjoyed. Another concerning behavior is giving away prized possessions, a sign that they might be preparing for the end. You may notice them engaging in risky or reckless activities, almost as if they no longer care about their own safety. Paradoxically, some individuals might seem suddenly calm or show an unexpected improvement in mood, which can be a sign that they have made a decision to end their life.

Life events can sometimes push someone closer to the edge. Major losses, such as the death of a loved one, a divorce, or losing a job, can be incredibly destabilizing. Financial troubles or legal issues can add to the feeling of hopelessness. A history of trauma or abuse may also contribute to their emotional burden, making it harder for them to cope with life’s challenges. If you notice these signs in someone, it’s crucial to take them seriously. Offering a listening ear and encouraging them to seek professional help can make all the difference in saving a life.

Key Takeaways:

• You are Not Alone: Suicidal thoughts and behaviors impact hundreds of millions of people every year.

• Recognize the Signs: Be aware of direct and indirect expressions of hopelessness, behavioral changes, and life events that might trigger suicidal thoughts.
• Reach Out: Start conversations, offer support, and encourage professional help.
• Take Action: If you or someone you know is in struggling, contact a crisis hotline like 988 for help.

This is just the beginning of an important conversation. In the next post, we’ll talk about common myths and misconceptions around suicide and how to clap back against the stigma. 

In the journey towards emotional well-being, traditional talk therapy has long been viewed as the go-to method for healing. Over the years of being a clinician, I have thoroughly enjoyed this type of one-on-one conversation with my clients. However, I have also found that thinking outside the box is necessary to help a variety of people with a variety of issues presented in therapy. Having done everything from sand play to art therapy, EMDR, Bio and Neuro feedback, one of my all-time favorites is Equine Therapy!

Equine therapies stand apart from conventional therapy due to the presence of horses themselves. These magnificent creatures possess the remarkable ability to sense and reflect human emotions, creating a safe and accepting environment devoid of judgment. Whether the struggle is anxiety, depression, trauma, or any other emotional challenge, the horse provides an invaluable source of non-verbal support, building a connection that transcends the limitations of verbal communication (Johnson & Gee, 2018).

People ask me all the time, “What do you actually do with the horse?”  Well, the answer is simple: the horse becomes a therapeutic partner. Unlike humans, horses lack the inclination to mask or hide their own emotions. Their genuine expressions of joy, fear, trust, or discomfort encourage exploration of emotions without fear of judgment. By interacting with these majestic animals, individuals gain a deeper understanding of their own emotional states and learn to express themselves genuinely and without reservation. Research supports the notion that animal-assisted therapy, particularly involving horses, significantly reduces the symptoms of anxiety and depression in participants (Johnson & Gee, 2018). I have seen countless people almost immediately start to cry in their presence. The tears well up and cannot be suppressed. It’s almost as if the horse draws out these hidden emotions and won’t allow the suppression. That, in and of itself, can be important in the healing process.

Trust is fundamental to building meaningful connections in life and working with horses offers a safe space to explore trust issues (Wells, D. L. 2019). One of my clients, who struggled with disclosure, found comfort in sharing her entire adoption story with Lilli-Mae Goldstein, a Shetland pony with epilepsy, and seemed to draw considerable strength from knowing that Lilli-Mae held onto her story. 

The beauty of the horse is its astute ability to perceive subtle changes in human behavior and emotional states. In equine therapy, participants are guided to increase self-awareness and mindfulness, paying close attention to their thoughts, feelings, and physical sensations. This connection to the present moment can be a powerful tool in managing stress and anxiety. (Behan C. 2020). Many clients who visit the ranch realize they have not been attentive to their inner states until they spent time with the horses.

Another essential aspect of equine therapy is developing healthy boundaries and improving interpersonal communication. The Bible teaches us that God created animals. This includes horses. We are to serve a stewardship role toward creation not an ownership (Gen 2:15; Num 35:3-5). This stewardship is intended to include an attitude of respect (Lev 25:3-5; Num 35:33). Working with horses requires clear communication, emphasizing the importance of clear cues, body language, and observing the horse’s response. As individuals practice setting boundaries, asking for what they need, and assertively responding to cues, they cultivate healthier and more balanced interpersonal relationships. (Meyer, JF. 2023) They become aware of what the horse needs and what they need. These newfound skills can be truly transformative outside the therapy context as well helping both young and old alike to communicate more clearly.

With the sense of empowerment and confidence gained from successfully interacting with the horse, people find it translates into other areas of their lives. Children and adults leave sessions that include equine therapy with a stronger sense of self, or a clearer understanding of what they need to do. Constructive feedback and support from experienced professionals can provide tremendous help to individuals, fostering a sense of achievement and self-worth and ultimately boosting their overall emotional well-being.

Seeing firsthand the transformative impact that horses can have on individuals struggling with mental health challenges is truly awe-inspiring. The connection and trust that develop between the horses and the individual in therapy are powerful reminders of the healing power of animals and nature. And by virtue of our creation in the image of God, while working with horses, we can discover that we are uniquely special in comparison to them and to all of creation. The very size of the horse can drive home that difference. 

Equine therapy is not just a treatment method; it can be a pathway to self-discovery, growth, and hope. As we continue to explore and expand our understanding of equine therapy, I have no doubt that it will continue to be an extremely valuable and effective tool in helping individuals on their journey towards wholeness.

References

Behan C. (2020). The benefits of meditation and mindfulness practices during times of crisis such as COVID-19.

Johnson, K. R., & Gee, N. R. (2018). The influence of equine-assisted interventions on psychological outcomes: A systematic review and meta-analysis. Social Animals, 22(3), 145-162.

Meyer, JF. (2023) The 14 *essential* safety rules to follow around horses. Horse & Rider. Available at: https://horseandrider.com/western-horse-life/essential-safety-rules-to-follow.

Wells, D. L. (2019). Associations between pet ownership and self-reported health status in people suffering from chronic fatigue syndrome. Journal of Alternative and Complementary Medicine, 25(5), 520-528.

Happy April to the CBU community and beyond!  April is a month resplendent with spring colors, cheery weather, and new life.  April is also Autism Awareness Month!  It is at this time of the year that we can pause and reflect, not just on the symptoms of autism, as outlined in the Diagnostic and Statistical Manual, but also on what it means to live in a way that is accepting of our family members, friends, and neighbors, who live daily with a diagnosis of autism spectrum disorder (ASD).  This three-part series will explore ASD as a diagnosis as well as how we can all live alongside our neurodivergent neighbors in a way that is honoring and accepting of who they are and how they may interact with us. You can read part two here.

We can begin living alongside our neighbors with ASD by first understanding the diagnostic criteria an individual must meet to be diagnosed with ASD and how those criteria may manifest.  It is crucial to understand that, as it is currently understood and diagnosed, ASD is a disorder that primarily impacts social interactions.  Diagnostic criteria are broken into two categories, with associated subsections.

The first category notes that “persistent deficits in social communication and social interactions” must be evident across a variety of settings and the three subsequent subsections detail how these deficits must present for an individual to qualify for a diagnosis of ASD.  The first subsection specifies that these deficits must include difficulty in what is referred to as socio-emotional reciprocity; that is, the individual must struggle with the back-and-forth interactions that are typical in social relationships.  Those deficits might look like complete disengagement from others; i.e., the stereotypical child with ASD who is “in his (or her) own world,” ignoring others and unresponsive to conversational prompts.  These difficulties, however, can also look like a child who wants to play with others but struggles to engage in developmentally-appropriate play such as imaginative play or games that involve taking turns.  This can also manifest as an adolescent who wants to have friends and/or engage in age-appropriate activities but struggles to understand the difference between a friend and an acquaintance or a friend and someone they are dating.  Individuals who meet this criteria may be unresponsive to conversational prompts or respond in ways that seem odd to others or off-topic.  They may also appear to ignore typical social niceties, such as not interrupting when another person is speaking.  

The second subsection notes that individuals who meet criteria for a diagnosis of ASD demonstrate deficits in nonverbal communication skills.  When thinking of this criteria, individuals often assume it means that a person with ASD will not make eye contact or will struggle to make eye contact.  These struggles can, however, manifest in a variety of ways.  It is true that some individuals who meet criteria for an ASD diagnosis struggle with making eye contact.  Others, however, engage in eye contact that is poorly modulated – that means that their eye contact lacks nuance and therefore might present as intense staring.  These deficits can also manifest as a lack of using socially and/or culturally appropriate hand gestures when speaking.  They can also extend to facial expressions – often, individuals who meet the criteria for a diagnosis of ASD present with flat or blunted affect, which means their thoughts and feelings are not evident on their faces or that the expression on their faces does not match the feeling they are sharing.

Lastly, the third subsection specifies that individuals who meet the criteria for ASD struggle to develop, maintain, and understand typical social relationships.  This can look like being uninterested in typical social relationships such as friendship and marriage but can also manifest as desiring these relationships and not understanding how to generate and maintain them.  For example, a person who meets the criteria for a diagnosis of ASD may report wanting to get married but may also not understand how to date, how to determine whether the person they are dating may make a good long-term partner, the role he or she should have in the relationship, etc.

While it can be frustrating at times for an individual who is neurotypical (i.e., a person who does not meet diagnostic criteria for neurodevelopmental disorders such as ASD, ADHD, intellectual disability, etc.) to interact with an individual who meets criteria for a diagnosis of ASD, it is important to remember that the person with ASD is not “being difficult” on purpose.  An individual who meets criteria for a diagnosis of ASD simply has a different way of engaging with the world around them, and that different approach is generated by the way their brain perceives and responds to their environment.  While many behavioral therapies for individuals who meet diagnostic criteria for ASD target what society considered problematic behaviors, April is a good time for us to consider whether or not all aspects of behavior exhibited by an individual with ASD need to be addressed.  For example, if making eye contact feels deeply uncomfortable to an individual with a diagnosis of ASD, is that something that needs to be changed?  Or can that difference be understood and accommodated?  If a child who meets the criteria for ASD would prefer to play alone instead of with others, does interactive play need to be forced on them?  Or can there be space for some private playtime? Can we, as a society and as a community, tolerate individual differences even when those differences may make us uncomfortable or seem atypical?  

The invitation to you this April is to learn about ASD but also to consider the ways in which individuals with ASD suffer, not just because of their symptoms, but because of how often they are excluded from society or forced into activities or ways of being that, in and of themselves, might be upsetting or distressing.  We will explore the second category of ASD symptoms in our next installment, but until then, we encourage you to intentionally practice the fruits of the spirit with the members of your community who seem to engage socially in ways that are atypical or maybe even odd.  Love, joy, peace, patience, kindness, goodness, gentleness, faithfulness, and self-control can create spaces in which every person can be celebrated for being exactly who they are.

“Mom, Mom, something is wrong with Cookie,” my daughter yelled from downstairs. On November 10, 2023, Cookie was found unresponsive and was rushed to the veterinarian hospital. They performed CPR and intubated her in attempts to stabilize to no avail. The doctor recommended euthanasia due to the poor prognosis. Cookie was our 15-year-old Terrier mix/ Chihuahua who we had since she was born. Just a few months earlier, we celebrated her Quinceañera (15th birthday celebration), where 99% of the attendees were humans. As we continue to grieve the loss of our furry friend, it is a reminder of how complex the topic of grief is. In our household alone, three of us are grieving entirely differently. It is essential to understand that this is not a “one size fits all” process. 

Understanding Grief and Loss

The grief process is unique. Everyone experiences some loss in a lifetime. Even “Jesus wept,” as noted in John 11:35, where he mourns the death of his friend, Lazarus. To better understand grief, there is some terminology I would like to share. Anticipatory grief is expected loss, which can stem from terminal illness or job loss due to the agency closing. There is prolonged grief, now recognized in the DSM-5 TR as an illness. Prolonged grief occurs when a griever’s daily function is impaired long-term, and there is difficulty adjusting to life without the person or thing (usually six months after the loss). There is also disenfranchised grief that is invalidated by culture or society (i.e., suicide, miscarriage, pet, overdose). 

Further, there are various levels of grief: primary, secondary, and multiple. Primary is a death or a significant life-changing event (i.e., death of a loved one, losing a limb, or a job). Secondary grief refers to the consequences of primary events, for example, a change in a family role, companionship, or freedom. Lastly, multiple losses are several primary losses, such as the loss of a loved one, the loss of a job, and the loss of a relationship (Cleiren, 2015; Haley, 2013; Zhai & Du, 2020). A recent example that affected millions was the multiple primary losses witnessed during the COVID-19 pandemic. Some clients experienced the loss of loved ones, housing, employment, and health.

These layers of different kinds of grief are further compounded by cultural influences on grief. From a clinical perspective, understanding the grief someone is experiencing will be incomplete without sufficient cultural humility. 

The Cultural Aspect

Trying to unpack the cultural influence on grief is as complicated as culture itself. Consider Latino culture as an example. The Latino culture is not homogenous in the way they go through the grieving process. Some are heavily rooted in religion and spirituality. For example, Dia de los Muertos (Day of the Dead) originally stems from an indigenous custom. However, I have noticed that family and friends who practice Catholicism tend to celebrate it more. Dia de los Muertos takes place annually on November 1 and 2, and surviving relatives commemorate the loved ones that have passed by creating ofrendas (altars) with their loved one’s pictures, favorite foods, and marigold flowers (think of the Pixar/ Disney movie Coco). During this time, it is believed that the spirits of those who have passed come to visit, thus being celebrated by the surviving family. Others tend to honor their loved ones by praying a Novenario (rosary for nine days) upon their passing and on the anniversary of their death and hosting a misa (mass). During this time, it is a remembrance and honoring their loved ones. 

As I began to write this blog, it became challenging because it forced me to stop and think about my feelings regarding the loss of my four-legged companion. The day Cookie passed, I cried and then “got it together.” Being “strong” (for others) became an expectation growing up in my Mexican family, which has followed through adulthood. 

As a social worker, I learned about the five stages of grief from Dr. Elisabeth Kübler-Ross: denial, anger, bargaining, depression, and acceptance. However, there is still that disconnect between knowing and doing, also known as the action paradox, further highlighting the importance of cultural pressure. As I examined examples of lived experience, I thought back to when my older brother passed away. At 18 years old, I was in charge of helping my mother with the burial process for my older brother, hence the “keep it moving” attitude. Further, in the burial process in Mexico, there seems to be no time to process the passing of the loved one. The burial process in Mexico happens so quickly compared to my experience in the United States. When someone passes in Mexico, they are buried within 48 hours, which is broken down by having a vigil for 24 hours followed by the immediate burial. Lastly, the Latino culture has a machismo foundation, and it is less accepting of males crying than females. These are a few examples of what I’ve experienced that show how the grieving process may be interrupted due to a lack of time or cultural acceptance. If grief is not processed, it can lead to prolonged or complicated grief. 

We have delved into grief and loss, but let’s address some common misconceptions and myths along with some coping skills and tips to support others experiencing grief.

Misconceptions and Myths

• Stages of grief happen in order from denial to acceptance.
• Grief has a timeframe.
• The stages of grief only take place once.
• If you don’t cry, then you’re not experiencing grief.
• The first year is the hardest.
• “If you keep crying for them, their soul will never rest.”

Coping Skills

• Seek support or counseling.
• Acknowledge your feelings and emotions (all are normal).
• Find ways to express yourself. These can be done in various ways, such as journaling, writing poetry, or drawing.
• Engage in mindfulness/ grounding techniques – breathing exercises, walking, meditation.
• Celebrate their birthdays, visit their favorite restaurant, or make their favorite dish. 
• Pray and press into God.

Tips to support someone experiencing grief – Do’s and Don’ts 

• Don’t say things like, “I understand what you are going through.” Although there may be similarities in grief, every experience is unique.
• Do engage in increasing cultural humility. It is essential as you begin to support others experiencing grief. Others include clients, students, friends, family members, anyone going through grief and loss.
• Don’t tell the person grieving to let you know if there is anything you can do for them. During this time, they may not have the mental capacity or energy to think of ways you can help. Instead, drop off a care package, send a card or a heartfelt text, invite them for coffee or a walk.
• Do let them know you are there (they may or may not reach out soon).
• Don’t encourage people to ignore their grief during this time. 

In closing, grief is a complex process and different for everyone. As we interact with others inside and outside of CBU, we can increase the level of openness to understand other’s grieving process. I encourage you to be empathetic to any loss a person is experiencing, whether it is a loved one, the loss of health, a limb, a job, home, marriage, or even the death of a pet – like our experience with Cookie.

Support and Resources

Websites/ Articles
CBU Counseling Center: https://calbaptist.edu/counseling-center/

• Mon – Fri 8am-5pm; call (951) 689-1120

Dial 988 Suicide and Crisis Lifeline

Dial 211 local resources in your area

Grief.com website is created by, David Kessler, grief expert – https://grief.com/

El duelo: Cómo sobrellevar la muerte de un ser querido – APA https://www.apa.org/topics/families/duelo

Books/ Podcast

Notes on Grief – by Chimamanda Ngozi Adichie

Finding Meaning by David Kessler and On Grief & Grieving Dr. Kübler-Ross and D. Kessler

The Grief Recovery Handbook – by John W. James and Russell Friedman

El camino de las lágrimas – Jorge Bucay

Déjalos ir con amor: La aceptación del duelo – Nancy O’connor

The Invisible String – Patrice Karst (Children’s Book)

You’ll Always Have My Love – Jennifer Lim Chobar (Children’s Book)

Te Extrañaré: Un libro ilustrado para niños para ayudar a los pequeños a lidiar con la Muerte de un Ser Querido – Ben King (Children’s Book)

Podcast: Terrible, Thanks For Asking by Nora McInerny

African American History or Black History is American History as evidenced by the advances in science, sports, art, culture, and the adversities Black people continue to overcome.  This statement does not come without contest, as seen with the influx of legislation from both sides of the divide, with one side hotly contesting Black history education and the other seeking legislation that would recognize the significance of ensuring that Black history integration into education (Black History is American History Act, 2023).  Yet, even as I write this blog, I begin to think of the implications in higher education for Black College students entering college this upcoming fall and all that goes into it.  For this blog, African American and Black are used interchangeably. 

Black History Month intends to celebrate and acknowledge the contributions of African Americans in shaping our nation.  Perhaps without this month, this conversation would not exist.  Even as we celebrate, one would be remiss in not acknowledging the emotional well-being struggles that Black students encounter when pursuing higher education.  Structural racism, finances, and the internalized pressure to excel in academic performance impact Black students’ outcomes and graduation rates, thus having more significant societal implications for life satisfaction trajectory (Thyden et al., 2023; Rice, 2021; Helling & Chandler, 2021).  According to the National Center for Education Statistics (2023), there are significant gaps in postsecondary degree attainment, with 36% of Black students graduating in comparison to 56% of white students.  

I am acutely aware of the current impact of black student health and wellness, not only as an educator and professional but as a parent, for my youngest child will join the fray this fall.  For the past few weeks, my family has come home to find ubiquitous boxes and large envelopes from various universities posted to my high school senior daughter.  Even before opening them, the boxes and packages proclaimed her acceptance to the colleges/universities of her choice.  She was/is excited to receive the offers and scholarships (a leap of joy for mom and dad) but also bittersweet as she made her final decision.  One of the determining factors for her final choice was proximity to home and the support on campus, as she indicated that she prioritized her mental health.  She recalled a recent conversation with her friends (also young Black college students) who graduated the year prior, identifying struggling with stress, anxiety, and depression while on campus. 

It turns out the conversations between her peers were accurate.  A recent Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (2023) indicated, “Suicide rates among persons aged 10–24 years increased significantly during 2018–2021 among Black persons (from 8.2 to 11.2; a 36.6% increase)…amongst those aged 25–44 years (22.9%)”, which” is the most significant increase in suicide by racial group after a reported decline from in the preceding two years.  This surge in Black youth suicide was the impetus for the Johns Hopkins Center for Gun Violence Solutions (2023) Call to Action for Black Youth Suicide Preventionreport, which highlighted the impact of a post-Covid era on Black youth mental health exacerbated by discrimination, bias, limited safe spaces, financial problems, stigma, and social isolation that further increase suicide risk.  The African American community has strong feelings of distrust related to physical and mental health providers due to numerous instances of over/underdiagnosis, medical apartheid, and exploitation.  Several examples of medical malfeasance include Dr. Marion J Sims, also known as the Father of Gynecology, experimenting on enslaved Black women to the Tuskegee Syphilis experiments, Cincinnati Radiation Experiments, Ferguson v. City of Charleston for involuntary testing and targeting of pregnant Black women and the mistreatment of Henrietta Lacks, to bias and discrimination in current medical to name a few (Gamble, 2016; Martin & Johnson, 2023; Krill Williston et. al, 2019).  Another barrier was the stigma of seeking care due to previous perceptions that admitting depression was a weakness.  Still, this trend is transitioning positively with increased mental health providers’ engagement within the Black Church, social support, emotional support, and connectivity with individuals, family, community, and social institutions, and with religiosity identified as a protective factor within the Black community (Fanegan et al., 2022; Wang et al., 2013; Avent Harris & Wong, 2018; Suicide Prevention Resource Center & Rodgers, 2020).   

To promote meaningful support, faculty must adopt holistic strategies and solutions to support Black students who are struggling with mental health concerns.  Given that research has suggested that spirituality is a critical component in the improvement of mental health, Christian faculty are in a unique position to encourage students to lean into having an open dialogue about seeking available mental health support when they are distressed.  The integration of a biblical perspective focuses on love and how our relationships (e.g., with GOD, one another, and the environment) can help us remain connected when we feel isolated.  With faculty as the primary point of contact in most instances within universities, we must recognize the signs of distress and create open pathways to encourage professional support if needed.  An example of distress would be missing class frequently when this was not originally a problem, inattentiveness in class, and change in mannerisms, to name a few.  Another strategy is to adapt support for struggling students and be person-centered, as no student challenges are identical.  That said, support should not be “one size fits all.”  Finally, promoting the atmosphere of connectivity by increasing social support such as peer mentorship, clubs, and activities can improve overall feelings of isolation.

Let’s have Black History Month also serve as a way for educators to be good stewards to Black college students.

Dr. Erica McIntosh is a licensed clinical social work supervisor, Disabled US Air Force veteran, private practice owner, and assistant professor in the Department of Social Work with a focus on research, practice, and the promotion of mental and physical health equity.  Dr. McIntosh has extensive experience training healthcare professionals and speaking at conferences with organizations (hospital, community-based care, county social services events, and VA healthcare system settings) about substance use disorders, dual diagnosis, veteran health, cultural humility, and maternal health.  Dr. McIntosh formerly led the VA Loma Linda Riverside County team for HUD/VASH, a federal veteran homeless program, where she coordinated a social work team, employment coordinator, peer specialists and housing navigators in addition to collaborating support with community stakeholders and the Riverside County HUD program.  Dr. McIntosh’s is the executive director of Unapologetic Therapy and Consulting, which specializes in individual therapy focusing on mood and trauma related disorders with an intersectional lens, substance use disorders, and consultation.  Dr. McIntosh is also a past Vice commander of AMVETS post 77.  Dr. McIntosh currently has an article in review and has authored two chapters in a healthcare textbook pending publishing spring 2024.  Dr. McIntosh’s current research areas include the NAEBOR Clinic with Mommy and Me that focuses on Black Maternal Health in Rialto, CA , substance use disorders, health equity, cultural trauma, and veteran mental health.

References

Avent Harris, J. R., & Wong, C. D. (2018).  African American college students, the Black 

Church, and counseling.  Journal of College Counseling, 21(1), 15–28.       https://doi.org/10.1002/jocc.12084

Black History is American History Act.  HR 1394, 117^th Cong. (2023).  

https://www.congress.gov/bill/117th-congress/house-bill/1394/text?r=17&s=1

Fanegan, B., Berry, A. M., Combs, J., Osborn, A., Decker, R., Hemphill, R., & Barzman, 

D. (2022).  Systematic review of religiosity’s relationship with suicidality, suicide related stigma, and formal mental health service utilization among Black Americans.  Psychiatric quarterly, 93(3), 775-782.  https://link.springer.com/article/10.1007/s11126-022-09985-4

Gamble, V. N. (2016).  Under the shadow of Tuskegee: African Americans and health 

care.  Health Psychology, 434-441.

Helling, J., & Chandler, G. E. (2021). Meeting the psychological health & growth needs 

Of Black college students: Culture, resonance, and resilience.  Journal of college 

student psychotherapy, 35(2), 152-180.

John Hopkins Center for Gun Violence Solutions and John Hopkins Bloomberg School 

            of Public Health, Department of Mental Health.  (2023).  Still ringing the alarm: 

An enduring call to action for Black youth suicide prevention.  

https://publichealth.jhu.edu/sites/default/files/2023-08/2023-august-still-ringing-alarm.pdf

Krill Williston, S., Martinez, J. H., & Abdullah, T. (2019).  Mental health stigma among 

people of color: An examination of the impact of racial discrimination. 

International journal of social psychiatry, 65(6), 458-467.

Martin, K. J., & Johnson, K. L. (2023).  You can’t dismantle what you don’t recognize:

The effect of learning critical Black history in healthcare on perspective-taking. 

Journal of experimental psychology: General.  Advance online publication. 

https://doi.org/10.1037/xge0001482

Meza, J. I., Patel, K., & Bath, E. (2022). Black youth suicide crisis: prevalence rates, 

review of risk and protective factors, and current evidence-based practices. 

Focus, 20(2), 197-203.

National Center for Education Statistics.  (2023).  Educational attainment of young 

adults. Condition of education. U.S. Department of Education, Institute of Education Sciences.  https://nces.ed.gov/programs/coe/indicator/caa.

Rice, R. (2021).  Mental Health and Well-Being of College Students of Color.

Stone, D. M., Mack, K. A., & Qualters, J. (2023).  Notes from the field: Recent changes 

in suicide rates, by race and ethnicity and age group—United States, 2021.  Morbidity and mortality weekly report, 72(6), 160.  http://dx.doi.org/10.15585/mmwr.mm7206a4

Suicide Prevention Resource Center and Rodgers (2020).  Risk and protective factors: 

Black populations.  Newton, MA: Education Development Center, Inc.   https://sprc.org/wp-content/uploads/2023/01/Risk-and-Protective-Factors-Black_0.pdf

Thyden, N. H., McGuire, C., Slaughter-Acey, J., Widome, R., Warren, J. R., & Osypuk, 

T. L. (2023).  Estimating the Long-Term Causal Effects of Attending Historically    Black  Colleges or Universities on Depressive Symptoms. American journal of       epidemiology, 192(3), 356–366. https://doi.org/10.1093/aje/kwac199

Wang, M. C., Lightsey, O. R., Jr, Tran, K. K., & Bonaparte, T. S. (2013).  Examining        suicide protective factors among black college students.  Death studies, 37(3),  228–247. https://doi.org/10.1080/07481187.2011.623215

A Blog Series by Dr. Philip Breitenbucher.

Read Part 2 here!

Recently, the news has been abuzz with discussions on artificial intelligence (AI) technologies and their potential dangers and opportunities (Agomuho & Larsen, 2023). Many in higher education have scrambled to understand the powers of AI technologies, such as ChatGPT, and how to respond responsibly. Faculty and administrators have begun asking questions like: should we ban AI, mandate its use, or allow it with guidelines and instructions? 

Here at CBU, Artificial Intelligence Guidelines were issued at the start of the 23/24 academic year. The university’s Teaching and Learning Center has created a learning community called Artificial Intelligence in the Classroom. The learning community meets monthly and explores options for developing policies, grading rubrics, and sharing teaching tips on using AI. In the College of Behavioral Social Sciences, the Division of Psychology has assembled a research team to understand the benefits of ChatGPT in clinical practice, and the Division of Social Work has deployed a brand new AI policy for all courses, providing students with clear directions on how to use AI in academia ethically. Meanwhile, for the past two years, a partnership has existed between the College of Engineering and the College of Behavioral and Social Sciences focused on using natural language processing (NLP) to analyze big data sets to better understand and respond to the nation’s opioid and fentanyl crisis (Corso & Breitenbucher, 2023).

While AI and ChatGPT have grabbed the public’s attention recently, the historical relationship between social work and technology dates back over 100 years. Historically, technological revolutions, like the one we are experiencing now, have accelerated social issues and the need for social services. Baker et al. (2018) link the expansion of social work practice to the Industrial Revolution, arguing that as technology improved, social issues grew. Researchers have discussed the interconnectedness of social media technologies and social issues such as mental health, anxiety, depression, and suicide. Moreover, just recently, the Surgeon General described the effects of social media platforms as a “driver” for America’s mental health crisis (Abbasi, 2023). 

In addition to the interconnectedness of social issues and technology, social workers’ interaction with technology is well documented. Early social workers embraced technology, such as the invention of the automobile, because it made home visits easier, and the facsimile machine because it made it easier to share information. A recent study found that 98% of social workers used technology in their professional capacity. Still, they described the use of technology in social work as a requirement of the funders and as a reporting requirement, not a tool that benefits their work (Harris, 2022). Contradictorily, social workers described technology as imperative to connecting with clients and getting things done. However, they often use their own devices because their agencies do not provide access to technologies or forbid specific uses (Harris, 2022; Mishna et al., 2021). Finally, a very recent and significant (N=1,144) study found that social workers reported technology as highly useful and beneficial in their practice (Barrera-Algarín et al., 2021).

In 2016, a collaboration of major social work associations set out a bold agenda to transform social work practice and education for the next decade by identifying and analyzing a series of grand challenges that would focus resources to positively transform the field (American Academy of Social Work & Social Welfare [AASWSW], n.d.). One of the grand challenges is to use technology for good. Coulton et al. (2015) stated, “The digital revolution is producing vast quantities of social, psychological, and organizational data that social workers can harness to address society’s most difficult problems” (p. 3). In 2017, the National Association of Social Workers (NASW), in partnership with the Association of Social Work Boards (ASWB), Council on Social Work Education (CSWE), and the Clinical Social Work Association (CSWA), developed Technology Standards in Social Work Practice (NASW et al., 2017). The standards are designed to educate the public, guide social work education, and bring awareness to social workers about their ethical responsibilities for using technology. In 2023, NASW published a series of articles on the use of AI in social work practice (NASW, n.d.). 

As social workers, we are committed to eradicating society’s grand challenges and positively focusing resources to transform the field (AASWSW, n.d.). To successfully harness technology for good, social work must move beyond merely accepting technology to fully embracing and leading technology development. The latest AI Digital Revolution presents an apex for social workers to lead in adopting and creating technology to support best practices in alignment with our values and beliefs.

 For this blog series, I have collaborated with several colleagues, alums, and students to unpack their experiences and understanding of technology use in social work practice. A CBU MSW Alumni, James Armour, wrote the first blog. In his article, The ChatGPT Chronicles: Tackling Community Needs Assessments, James discusses his experience using ChatGPT to assist in analyzing qualitative data collected for a community needs assessment.

The following articles will focus on the drivers that influence the use of technology in social work, the role of leadership in the development and deployment of technology, using NLP to analyze big data to address big social issues and the development of AI policies, practices, and assignments in the classroom. 

References

Abbasi, J. (2023). Surgeon General Sounds the Alarm on Social Media Use and Youth Mental Health Crisis. JAMA, 330(1), 11–12. https://doi-org.libproxy.calbaptist.edu/10.1001/jama.2023.10262

Agomuah F., & Larsen, L. (2023, September 15). ChatGPT: The latest news, controversies, and tips you need to know. DigitalTrends. Retrieved from: https://www.digitaltrends.com/computing/how-to-use-openai-chatgpt-text-generation-chatbot/

American Academy of Social Work & Social Welfare. (2021). Retrieved from https://grandchallengesforsocialwork.org/about/ 

Baker, S., Warburton, J., Hodgkin, S., & Pascal, J. (2018). The New Informational Paradigm: Developing Practice-Led Approaches to the Use of Mobile ICT in Social Work. British Journal of Social Work, 48(6), 1791–1809. https://doi.org/10.1093/bjsw/bcx124

Barrera-Algarín, E., Sarasola-Sánchez-Serrano, J. L., & Sarasola-Fernández, A. (2021). Social work in the face of emerging technologies: A technological acceptance study in 13 countries. International Social Work, 00208728211041672. https://doi.org/10.1177/00208728211041672

Corso, A., & Breitenbucher, P. (2023). Using location analytics and social media to address the opioid overdose crisis in America. CalGIS Annual Conference, Monterey, CA.

Coulton, C. J., Goerge, R., & Putnam-Hornstein, E. (n.d.). Harnessing Big Data for Social Good: A Grand Challenge for Social Work. 21.

Harris, S. (2022). Australian Social Workers’ Understandings of Technology in Practice. Australian Social Work, 75(4), 420–432. https://doi.org/10.1080/0312407X.2021.1949025

Mishna, F., Sanders, J., Fantus, S., Fang, L., Greenblatt, A., Bogo, M., & Milne, B. (2021). #socialwork: Informal use of information and communication technology in social work. Clinical Social Work Journal, 49(1), 85–99. https://doi.org/10.1007/s10615-019-00729-9

National Association of Social Workers, Association of Social Work Boards, Council on Social Work Education, & Clinical Social Work Association. (2017). Technology standards in social work practice. National Association of Social Workers. https://www.socialworkers.org/Practice/NASW-Practice-Standards-Guidelines/Standards-for-Technology-in-Social-Work-Practice

NASW (n.d.). AI in Social Work. National Association of Social Workers. Retrieved from: https://www.socialworkers.org/About/Ethics/AI-and-Social-Work

We’ve all been there. You step into an airplane, gaze down the aisle, and see two gleaming armrests flanking an unfortunately placed seat—yes, the dreaded middle seat. If you’ve ever had to sit here, especially for a long-haul flight, you’re familiar with what I refer to as the Middle Seat Syndrome (MSS). It’s the sensation of feeling trapped, hemmed in, and, to a certain extent, overlooked.

Recently, on a trip to Atlanta (ATL) from Los Angeles (LAX), my husband and I found ourselves experiencing the nuances of MSS. While on the journey there, we were fortunate enough to snag a window seat, allowing for a slightly more comfortable experience, with my husband in the middle seat. As a gesture of love and understanding, I lifted the armrest to give him some semblance of space. And even though it was a tight fit, we managed. He leaned towards me, I leaned towards the window, and we found a balance.

However, the return trip to LAX was another story. Our seats were reassigned, and we found ourselves separated, each confined to a middle seat. This amplified MSS and the physical discomforts it brings. While the passengers by the window have the freedom to rest their heads and those in the aisle can stretch their legs, the middle seaters are left with limited options. Most tragically, the unspoken code of airplane ethics doesn’t always acknowledge that the middle passenger should, by all rights, have access to both armrests.

This experience of feeling “boxed in” in the middle seat is evocative of a broader societal concern: the experience of marginalized individuals. Just as the middle seater grapples with spatial restrictions and a lack of consideration from those on either side, marginalized groups often face systemic barriers, lack of representation, and limited access to resources.

Here’s where the nursing and social work perspective comes in. In both fields, we consistently encounter individuals who feel “stuck in the middle.” They are the unseen, unheard, and often underserved populations who, like the middle seat passenger, don’t always have the space or voice they deserve.

The person experiencing teen pregnancy, homelessness, the senior citizen battling loneliness, or the individual with a disability fighting for accessibility—all can feel like they’re boxed in, surrounded by a society that often doesn’t seem to care about their comfort or needs.

But, as professionals, we have the power to change this. Just as I lifted the armrest for my husband, we can make small but impactful gestures to improve the experiences of the marginalized. By advocating for their rights, ensuring their stories are heard, and working to dismantle systemic barriers, we can help create a society where everyone, regardless of their position or background, feels valued and seen.

In closing, the next time you find yourself or someone else in that middle airplane seat, remember the unspoken rule: the middle seat gets both armrests. Extend that courtesy. In the grander scheme, let’s all strive to be more cognizant of those who feel boxed in and offer them the space, respect, and resources they rightfully deserve. Because everyone, whether on a plane or in life, deserves to journey comfortably.

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A note from Dr. Erin Smith, the CSHB Director: At the time I hit “publish” on this blog, Israel and Hamas have been at war for 5 days. This blog engages with Elul, a month with significant symbolism in the Jewish calendar, a calendar that Jesus was raised under. Christians and mental health professionals can learn a lot from the wisdom offered in the framing of Elul. Thus, the goal of engaging the Jewish calendar is not meant to be political, but reflective. I would encourage all readers to evaluate the content and reflect on what that means for them as individuals, including what a proper response to the sudden outbreak of violence in Southern Israel and Gaza entails.

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It’s that time of year again: Schools are starting up, we are anticipating cooler weather, and perhaps looking forward to the various holiday celebrations this season holds. Some of us are well rested, having enjoyed summer vacations and are full of expectations for the coming year. Others may be filled with dread at the thought of a fast-approaching end of year, the hustle and bustle of holidays, etc,.

Whatever side of the scale that you are on, have you ever found yourself needing a reset? A time where you can make everything, I mean everything, stop so you can catch your breath, look around, and start over? 

The noise of constant stimulation has become so much a part of our lives, we don’t even realize how internally diffused and depleted we may have become, how even the good things have sapped our energies and stolen our attention, together with more easily recognized trivial and worthless things. And more importantly how hard we work to break any silence we may encounter.

Even though my work in counseling involves helping people reset, I think GD, in HIS great wisdom, has included in the yearly calendar a natural space for us to formally reset on an annual basis, to enter that silent and holy place that we sometimes work so hard to avoid and to come before HIM again. That time of year is called Elul.

Elul is the 12th and final month in the Jewish calendar. It usually falls right around September. But even though this time of year has just passed, we still have much to learn from it. The month of Elul is a month that connects the past year with the coming year. And though each month of the Jewish calendar radiates with a distinct quality, Elul is a time when we are to reflect on where we stand and where we should be going. It is a season in which to reflect, repent, repair, but most of all deepen our relationship with GD. 

One central focus during Elul is Teshuvah or repentance. Jews are encouraged to reflect on their actions over the past year, both towards oneself and others, and ultimately toward GD. The practice of Teshuva involves first knowing before WHOM we stand. The 14th chapter of Hosea, read at this time of year, challenges us to return to the LORD our GOD Himself as not simply the center, but the entire horizon of our attention. (Rabbi Stuart Dauermann). Through Hosea, our GOD challenges us to be “those who live in his shadow” (v. 7). And realizing that we stand before a HOLY GD the need for forgiveness is very real. 

But authentic repentance is more than a one-time event. It is a way of life. Teshuvah is one of the great gifts GD gives each of us, the ability to turn back to HIM and seek healing for our brokenness. (Proverbs 28:13) We are used to imagining repentance as a form of surrender, a confession of weakness. And it is. But we also need to see it as a source of empowerment, a return to our only true and sufficient center––the luxuriant juniper, the fruitful vine––the LORD our God. 

“I am like a luxuriant juniper; From Me comes your fruit” 

(Hosea 14. v. 8)

Jesus said it this way:

“I am the vine, you are the branches; the one who remains 

in Me, and I in him bears much fruit, for apart from Me 

you can do nothing” (John 15:5) 

The result of living this way is incredible empowerment and fruitfulness!

Another significant aspect of Elul is preparing oneself for seeking forgiveness from others. It is customary to engage in acts of kindness or tzedakah, expressing a desire to make amends and demonstrate genuine change. Jewish tradition teaches that true repentance can only be achieved when one actively works towards rectifying past actions.

As both seekers and givers of pardon, we are to turn to those we have wronged, acknowledge our sins and the pain we have caused. We are to search our memories, our souls, to find what we did wrong during the past year, and to make them right. And in one sense, this is the first step as we are instructed to “be reconciled (first) to (y)our brother, making good on things that were done badly” (Matthew 5:23-24)

We are commanded to be willing to let go of any resentment we feel towards those who have committed offenses against us. Only then can we turn to GD and ask for forgiveness. I think those two steps: being forgiven and forgiving, are simultaneous. This is even found in Yom Kippur liturgy: 

“And for all these, GD of forgiveness, forgive us, pardon us, and grant us atonement.”

Although rooted in ancient Jewish tradition, the themes of Elul hold great relevance to us today. In our fast-paced world filled with distractions and constant busyness, taking dedicated time for self-reflection allows us to pause, reset, and reconnect with our values and priorities. It encourages us to evaluate our relationships, actions, and impact on the world around us. Elul can be a wonderful time of divine closeness, a time to do what our spirit yearns for: introspection, soul searching, personal stock-taking (known in Hebrew as cheshbon hanefesh — literally “an accounting of the soul” (Rav DovBer Pinson). 

With this focus, we should take this time to search our souls, to recall and find people we have wronged, family, friends, to give up the grudges, and to forgive people for their wrongdoing. And most of all to return to a place of shalom (peace). Elul serves as a powerful reminder that personal transformation requires conscious effort and commitment. 

As we navigate life’s challenges together, the significance of Elul remains as relevant today as it was centuries ago – urging us all towards introspection, repentance, forgiveness-seeking behavior – ultimately fostering personal growth and a deeper connection with GOD.

May your name be written in the Lambs Book of Life!

La Shana Tova!

Rabbi Stuart Dauermann: Shulchan Shelanu from Interfaithfulness

Rabbi DovBer Pinson: Sha’ar HaBitachon

John 15:5: I am the vine, you are the branches. The one who abides in Me, and I in him, bears much fruit; for apart from ME you can do nothing. Tree of Life Version

Isaiah 55:6: Seek Adonai while He may be found, call on Him while He is near. Tree of Life Version

Hosea 14:7: His tender shoots will spread out. His beauty will be like an olive tree and his fragrance will be like Lebanon. Tree of Life Version

Matthew 5:23-24: Therefore, if you are presenting your offering upon the altar, and there remember that our brother has something against you, leave your offering there before the altar and go. First be reconciled to your brother, and then come and present your offering.

For further reading: 60 Days: A Spiritual Guide to the High Holy Days. Shimon Jacobson (Kiyum Pr., First Edition (January 1, 2008)

Have you ever been so absorbed in an activity that time has flown by at a surprising rate?  Or had a game where your performance felt seamless, like your body knew just what to do at just the right time?  If so, it is likely that you have experienced “flow”.  In sport it is often called being “in the zone” or “in the clutch”.   While it is often discussed in relation to sport, it is experienced in multiple other domains as well such as business (Ie. “work flow”), performing arts, and writing.  Flow is an enjoyable state where one feels in control of their performance and is fully immersed in the activity.  

I first became interested in flow about 15 years ago when I started running.  Of course, I didn’t call it that back then, I called it a “runner’s high”.  Its that intense, euphoric feeling one gets for a short duration of time mid-run.  You only need to experience that runner’s high one time to get hooked.  When my running distances increased the amount of times I could experience a runner’s high during a run increased.  I found during a marathon I could experience three runner’s highs and I could approximate the mileage that these could occur at.  Like any good scientist, I couldn’t leave it well enough alone, I wanted to understand why I experienced these highs and how to induce them.  I began by talking to other runners about it.  I was surprised to find that some runners had never experienced it and, in fact, didn’t even believe in it (gasp!).  When I told this to some of my endurance runner friends, they laughed and said “Why else would we run so much?”.  Of course, running by itself is enjoyable.  Your brain clears, your mind lets go of the daily planning and worry, and several feel-good neurotransmitters lead to you experiencing an increase in your mood and energy.  That is enough to keep you running short distances, but running over 20 miles?  I, for one, need more than a little workout boost to motivate me to do that.  

In his pursuit to find the meaning of life and happiness, Csikszentmihalyi (1975) interviewed multiple people that were involved in many different types of activities and that had experienced this state.  He coined the term “flow” to describe this state as he equated it to flowing water, where the action is smooth and seems effortless. After analyzing and synthesizing the interviews, Csikszentmihalyi outlined nine dimensions associated with the flow experience (Csikszentmihalyi, 1988; Jackson & Csikszentmihalyi, 1999).  

1. Challenge-skills balance 
2. Merging of action and awareness 
3. Clear goals
4. Unambiguous feedback 
5. Concentration on the task at hand 
6. Sense of control 
7. Loss of self-consciousness
8. Transformation of time
9. Autotelic experience 

These dimensions were then used to create a measurable, testable definition of flow termed by some as the Jackson-Marsh model of flow (Jackson & Marsh, 1996).  It is this model of flow that has remained the primary model of flow since it was introduced.  A review of the research articles on flow revealed that there was disagreement on what neural areas were involved in flow (Alameda, et al., 2022).  Seemingly rigorous studies using similar methods were finding different results.  The problem was the way flow was being defined and, consequently, measured. 

In most of the research conducted on flow the level of flow the participant is experiencing is measured using scales that are based upon these nine dimensions (ie. Flow State Scale, Jackson & Marsh, 1996), self-report, or is simply assumed if the challenge of the task seems to match the skill of the participant (for review see, Alameda, et al., 2022).  Recent reviews of flow have called for a new definition of the flow construct, one where the challenge-skills balance, clear goals, and unambiguous feedback are considered antecedents to flow rather than part of the flow experience (Norsworthy, et al., 2021, Swann, et al., 2018) and two of the dimensions, that of time transformation and loss of self-consciousness, are not necessarily a part of the flow experience.  

Thus, out of these recent reviews a new definition of flow is emerging.  As defined in the beginning of this essay, flow is the feeling of being completely absorbed in an activity and in control of one’s own performance.  It is enjoyable and may lead to increased performance and, as such, is much sought after.  In order to enter into flow one must be focused on the task, have a clear understanding of the goal of the task, and receive ongoing unambiguous feedback. Transformation of time and loss of self-consciousness may be experienced, but only if these dimensions are not relevant to the task.  For example, basketball players will not lose track of time when the clock is ticking down and dancers will not lose their self-consciousness when performing for a crowd of spectators as these dimensions are relevant to their performance.

So why did I write this?  Why take an entire blog to write about how flow is being revised?  There are two take home messages here: 

1. Remember how in your research methods class you were taught what an operational definition is and what construct validity is?  How we drilled these terms into you early on as part of the base of understanding research?  The case of flow is a wonderful example of why this is important and what happens when construct validity is violated.  Having multiple researchers test the same construct and come to different conclusions is a big red flag that the definition of the construct needs to be reviewed and revised.
2. Now you are on the cutting edge of understanding what flow is!  There is a lot of misunderstanding on what flow is despite the fact that it has become a hot topic in a variety of performance domains.  You can now be that cool person that corrects the common misconception.

Perhaps even more exciting is this sets the stage for the next blog in this 3-part series: How can we increase the likelihood that we will experience flow?  I will tell all in the next blog post!