Holiday Pressures & Teen Stress: Real Talk with Dr. Ashley Zucker

Feeling overwhelmed by holiday stress? 🎄 Dr. Ashley Zucker shares tips for teens & families on managing pressure, emotions, and social media. Tune in for supportive advice and real talk on "The Hope Table"! #MentalHealth #Holidays #Podcast

Transcript

Erin Brinker: 0:00

Hey, welcome everyone to a brand new podcast called The Hope table. Our first guest I'm super excited about is Dr Ashley Zucker. You're going to hear another introduction that was recorded when we did this interview a couple of weeks ago, well before Thanksgiving, I think you're going to enjoy it. Let's get started. Welcome to the hope table. I'm Erin Brinker, and I'm thrilled to be sitting down again with Dr Ashley Zucker. She is a board certified psychiatrist focused on children, adults and adolescents, and today we're going to talk a lot about tweens and teens and the holidays and applying for college and all of those things that are stressors. She's worked with Kaiser Permanente here in Southern California. Dr Ashley Zucker, welcome back to the show.

Dr. Ashley Zucker: 1:20

Thank you so much for having me back.

Erin Brinker: 1:22

So so let's talk about this. It's November and the holidays. It seems like we were just dealing with 105 degree weather, and now we're we're focused. Halloween is behind us. So let's talk about the life of a teen during this time, especially seniors in high school, kind of what is their life like, and how do they keep everything straight?

Dr. Ashley Zucker: 1:47

Yeah, you know, you got to feel for those teens, especially in high school, it's just such a challenging time. And I think whether you're a senior or a freshman, you know, it's a really difficult time of year, because it's really when your classes have ramped up. So things are a little bit more intense. You know, heading into the holiday seasons. You might be heading into midterms or final exams even kind of, depending on what you know the status of your classes is. And then, of course, for you know, our seniors who are applying to colleges or considering what they're going to do after graduation, that just adds, you know, an additional layer of stress. And I know for myself, I have a sophomore, and so she's worrying about prepping for driver's ed, for having a child that drives. But yeah, so there's a lot of things coming at everybody

Erin Brinker: 2:41

as soon as the time where you can toss with the keys and say, Can you run to the grocery store? I'm out of milk?

Dr. Ashley Zucker: 2:46

Yeah, I can't wait,

Erin Brinker: 2:49

you know. And I brought up seniors, just because I think about the senior year when all of the applications are due. And so for their colleges, and if they didn't take the SAT, or they need to retake the S, A, T. They do that in the fall, and their classes are still most of them are still taking the AP classes or the honors classes or the, you know, all of them that International Baccalaureate IB classes, trying to get everything in so they can get into that good college. And it's stressful all the different colleges, all the different applications, you got to write essays for all of them and still do well in your classes. They may be playing sports or in a play. You know, we put a lot on our kids. We really do.

Dr. Ashley Zucker: 3:33

We really do. And there's only so many hours in the day. So, you know, I think making sure that we help them with their time management is one kind of strategy, but I think it's also trying to take away as much of the pressure as possible, easier said than done. But you know, if they're, you know, mostly on top of their stuff, just kind of stepping back and letting them kind of guide themselves can be helpful. But of course, some kids are just going to need a more hands on approach and maybe some more, you know, specific help with that, that time management, but you got to also make sure they've got time to just be a teenager too. Yeah. So that's probably the most important part.

Erin Brinker: 4:12

You know, I think about my teen years, and it's a time when every emotion is felt. To use a very old reference at an 11 and go watch Spinal Tap if you've not seen it, but everything is feel like everything is turned up to 11 when the the it's supposed to stop at 10, and you feel everything so intensely. So how do you how do you help your teens? And that's not unique to seniors, that's starting at puberty. How do you help them navigate that?

Dr. Ashley Zucker: 4:39

Yeah, I mean, I think it's really important to recognize that, just like you said, you know, teenagers are naturally kind of more emotional. They feel things very acutely. You know, they don't know anything else, and so what's happening for them now is the biggest thing ever, and it's also a time in life where you're really in this kind of stage of moving away from. Family being sort of your primary connection to more of your peers and your social connections. And sometimes there's a big bit of a tug and pull between those two. And so that can also, you know, raise emotions as well. But I think the number one thing that I would say is that we have to recognize for ourselves and for our kids that emotions are okay. I think too often we're sort of afraid of them, or we sort of label emotions as bad. And I like to say there's no bad emotions. It's just what you do with your emotions. And so, you know, letting our kids sort of freely express that, but making sure they have, you know, positive outlets for it, and also just hearing them. You know, it's not that we have to say anything or give them any advice, because they don't want to hear it. They're not going to take it anyway, exactly, right, exactly. But just hearing them, hearing them out, or just recognizing, hey, it sounds like you're having a rough day. Can I do anything for you? You know, those types of just very general kind of soft approaches. I think can, can be really helpful. But again, number one thing, no emotion is bad. It's just what we do with them. You know, I, I,

Erin Brinker: 6:10

I love that the no emotions are bad because we, you know, especially at that age, don't have any control over how we feel. We have control over how we act, although teenagers don't, yet they haven't learned that skill. But what we as adults have control over, how we react, but not what we are feeling. And when you have really big feelings all the time, it's overwhelming. I mean, you really need time and space and a way to unplug that's constructive,

Dr. Ashley Zucker: 6:38

yeah, for sure. And I think just what you said in terms of, you know, teens don't always have that full control, so they may be trying to do the right thing with their emotions, but they just, you know, don't have the full frontal, low development, right? Exactly. And I think that's where our role as adults comes in to really role model for our kids, right? We have emotions too. It's not just when you're a teen, and I think it's good to show your kids that you do have emotions too, and kind of show them the best ways to handle them. And also know that, you know, as adults, we don't always handle them the right way either, and that's okay. So you know, showing your kids it's okay to mess up and say maybe, oh, I shouldn't have gotten so upset about that, or so angry about that, or I shouldn't have yelled about that. I wish I had done X, Y or Z. And so really showing them, you know, it's okay to have emotions, okay to react, it's okay to react wrong, but you got to catch it, recognize it. I think that's where we can do the most, you know, benefit for our kids.

Erin Brinker: 7:39

So I'm thinking about, they say that depression is and I don't know this is true. So you're going to disabuse me of this if it's not that depression is anger turned inward, and that if that is compounded, then it becomes overwhelming. So we have situational depression, that something, maybe a friend moved away, or somebody passed away, God forbid, or something you broke broke up with a boyfriend, or whatever you know as a teenager. But then there's the more pervasive depression. Can you talk about depression, especially starting in in middle school, so puberty, through the teen years? Yeah.

Dr. Ashley Zucker: 8:11

I mean, I certainly think that the the anger, turn inward, can be a component of depression. I don't think it's the end all be all. But you know, depression can actually look a lot of different ways, and it can also look very differently for, you know, for kids and for teenagers. And so when we think of depression, often, we think of people who are sad down, sort of, you know, slow moving or and that can be the case for sure. But one thing that we actually see more frequently in in kids and teens is that they are way more irritable. And now I say that, and you probably laugh, because what teen isn't irritable, but it really gets to, you know, these sort of excessive levels where it's just like, you know, everything is bothering them, not just you, but everything. And you do start to see that maybe they're just changing their typical behaviors in a way that just doesn't seem like it's not just, oh, I don't want to hang out with mom and dad. It's more, I don't want to hang out with anybody. I don't want to engage in the world. So that kind of social withdrawal, right? Because we know for for teens, it's that key time in life to really be social, and so if there's a huge avoidance of that, or just not wanting to do it anymore, especially if they were social before. Those are some of the big things that that we want to kind of watch for. But I'd also say, you know, to your point, there can definitely be things that cause depression, so situational depression, like you mentioned, but sometimes there's no specific trigger. So I hear a lot in my office from parents like I don't know why they're depressed? There's nothing for them to be depressed about, and that's because depression is, you know, a chemical problem in your brain, and doesn't necessarily be caused by something that's happening outside or around us. And so sometimes that can be hard to fully understand, but I think it's important to recognize, especially in kids, in a.

Erin Brinker: 10:00

Adolescence, you know, I remember with my own children, who are now adults. I remember they had this, a life that was so separate from me and by design, because I would ask questions I'd want to get to know their friends. And there was a, you know, I mean, I certainly knew who their friends were, but I there was a wall that, that they had, that their life, their inner life, and also their their outer life that was focused on school and friends. And that's scary for a parent, because you know you you don't know exactly what's happening. You try to do your best and and so there's these things going on that you can't protect your child from, and there's also the other side that you don't want to protect them from everything, because they had to learn how to navigate. And so, you know, how do you help families through that?

Dr. Ashley Zucker: 10:47

Yeah, I mean, every family is different, too, so it's hard to say there's one right way to do all of it. You know, I think, like you said, you want to give your kids their space. You want to allow them to make mistakes. I think sometimes we're really bad at that, at letting our kids fail, yeah, we want to protect them from everything, right? So I would say that's one thing is, you know, this is a time in life where they can fail at something that's not going to have massive consequences. Obviously, some things they fail at could but where there's that space to, you know, if they don't do great on a test. It's not the end of the world. It's one test, right? And maybe they kind of need to experience that, or you just have to let them experience that. So I certainly think that's one piece of it. I also think when you reference, like, the social stuff, I think just, you know, staying engaged and staying interested, and that doesn't mean you have to know every single thing, or pry or kind of be like, tell me everything that anyone said today to you, but you know, like, I don't know, right? Fine, I don't know, right? Yeah, but you know, remembering their friends names, or just like, oh, you told me about so and so last week. Is everything okay? Or what's the latest, you know, and maybe they want to share, maybe they don't, but the fact that they know that you were listening the first time where they were talking about somebody, I think it means a lot to them that you care about who their friends are and kind of what they're up to. But it doesn't have to be like a gossipy kind of thing. It's just, you know, like, Oh, I remember your friend Sally. You haven't talked about her recently. How's she doing something like that?

Erin Brinker: 12:26

Oh, see, that's good. That's good. I remember, yeah. And for my son, it was easier because he would come home, and my son's on the spectrum, and he would come home and sit down and do a brain dump, everything that he would want to start the beginning of the day and tell me everything, and my daughter was the opposite. So it's kind of, how do you how do you navigate that, right? And, you know, everybody does the best they can and try to keep that communication open, and a lot of it. So I know that with little kids, it's when you're when you're talking about how their world is shaped. You're really talking about the parents more than the kids. And as they get older, they become much more separate as the supposed as they're supposed to. But I suspect that when you're when you're dealing with teens, you're also really have to deal with their parents. Is that true? Yeah.

Dr. Ashley Zucker: 13:14

I mean, it's definitely true of all, all ages, but yeah, it's this, you know, in in my office, certainly, it's about really making sure that I'm understanding where the the teen is out at, sorry, but also getting their parents kind of on the same page. So it, you know, it depends on the situation, but often it's just kind of helping their parents sort of understand where their kid is struggling, or potentially why they're struggling, or just being that sort of safe space where, you know, I've definitely been in my office and had, you know, mom and teen yelling at each other, and I just have to guide them through that conversation. That's a fun part of my job. Oh, my goodness.

Erin Brinker: 13:59

And you know, your hope is that they get all of that out, they kind of clean out all the noise, and they they vomit their emotions all over everywhere, and then they clean themselves up and they go home and they're fine, or they're better, maybe not fun, but they're better. Yeah.

Dr. Ashley Zucker: 14:14

So I would say, I think the more positive experiences when you can kind of put something kind of on their minds, or sort of plant the seed, so to speak, and then sort of leave that for them to go home and talk about. And so a lot of that is usually around, kind of like what the treatment plan might be. But I really love kind of giving that ownership back to them as a team, to really decide what they feel is is best, unless, you know, there's certain circumstances where you may have to be a little bit more kind of directive of that guidance. But I love the idea of just having them leave the room with a conversation that I've asked them to have

Erin Brinker: 14:51

something to think about, something to chew on, so how much of what you see is. Maybe mom or dad had significant trauma in their life. They're trying to break those chains, those cycles, those negative patterns, and I just don't know how. And they, they're they, they visit that on their children, because that's how they're wired, because that's what they grew up with. And then how do you overcome that, that trauma, while trying to prevent the trauma, trauma in the daughter or the son. You know what I'm trying to ask? It's like, the intergenerational stuff,

Dr. Ashley Zucker: 15:28

yeah, well, there's a saying in child psychiatry that 90% of the time, if you treat the parent, you don't need to treat the child. And what that really means is that we have to make sure that parents are also getting the help that that they need. And so sometimes that is really advocating for the parent to also get their own therapy, or, you know, see their own psychiatrist, and because it's much easier to identify that somebody else needs help, or what I can do for somebody else, right? Everything that's wrong with them, exactly, exactly. Yeah, so. And I mean, therapy can help everybody, right? There's no one that therapy couldn't help. But I think sometimes when you're really seeing some of those patterns play out, or just not necessarily even a pattern. But you know, if I see parents that are just really struggling with how to navigate their you know, through life with their child, then that's often where I'm like, You really need to make sure you have your own support and your own help. It's not just about getting your child the help, but it's also making sure you've got a safe place, a safe person to talk to that's not a friend, not a family member, that you can really process this with. So, you know, I think that's a huge part of it is just making sure that parents also have the supports in place for themselves, and that we're not just solely focused on the child. Because sometimes that can make all the difference.

Erin Brinker: 16:56

I have to think, yeah, I'm sure it does. I mean, you can't give what you don't have, and you can't pour from an empty cup. And so if there's nothing filling up, mom and dad or primary caregiver, whomever it is or whoever it is, how can they give what they what they but they've never seen, or what they don't have, or what they've never dealt with and and, yeah, that's important. So it's really about treating the whole family. And maybe you're seeing the child. Are you seeing the child and the parent together? And then the parent getting support elsewhere is also important too. So that's a good point. So let's talk about expectations. So unmet expectations in any family dynamic is a lot, is a lot of where the friction points are, where you expect somebody to behave a certain way or do a certain thing, or get the certain grades or get the certain promotions, or, you know, this is not only with kids, but with adults, and they don't, and that's where things start to rub right? So what kind of expectation setting and do you have those conversations when you when you're treating your patients?

Dr. Ashley Zucker: 17:58

Yeah, I think it's, I mean, it's a really tricky one, because especially with our kids, right, we put a lot of expectations on the do. So that one's really challenging, but we also have to understand what's possible, and maybe some things are not. And so in a certain space, some of that is about like us as parents or as adults, kind of addressing, or sometimes even grieving the loss of what our expectations were for our children. And that sounds really negative, and it sounds really hard, and it is, but sometimes it's their reality, right? You know your your kid doesn't and it can be something like your kid doesn't love the sport you wanted them to excel at. It doesn't have to be something huge and tragic, but sometimes that's still a loss for you as a parent. And so I think it's one, understanding that parents may be grieving something through the process, but two, also helping them to recognize the things that are the strengths of their child, what their child is good at, but also just being realistic too, right? So maybe, if it's about grades, right, maybe your kids are performing as well in school as you'd like them to, you know, kind of trying to figure out, Is there anything that I could be helping with? Are there any additional supports they could do? Are you connecting with the school, with their teachers, to see if their teachers are recognizing something in particular. And so just kind of, again, it's that check in with your kids, and it's not the like helicopter have to know everything about you, but just like, Hey, I saw you. Know you didn't do so great on that last math test. Was there anything in particular, that made that one harder than usual, or, you know, things like that, where you're just sort of showing that you're concerned and you care and not that you're, you know, punishing them. Or like, Well, that was terrible. Why didn't you do better at that? You know, that doesn't feel very good.

Erin Brinker: 19:57

What's wrong with you idiot? Right? Oh, probably not the most constructive way to approach it, exactly. So there was a movie that came out late summer, early fall, actually, not that long ago, called the senior. And it's about this, this guy, this football player. He was, he's in his late 50s at the in the movie, but when he was in college, he was a football player. And through that, you're getting flashback. Flashbacks of how he was parented very, very harshly. And he he had gotten into fights, which his father encouraged. He had gotten into fights when he was a senior in college and gotten himself bounced out of school, kicked out of school, and kicked out of the football team, off the football team in West Texas. And he's going back to a reunion. He hasn't seen everybody in 30 years, or 40 years, whatever it was, and they all joked that he had another year of eligibility, and he thought, Well, I wonder if I could go play. And he did. He went and tried out for his team, and he ended up playing as a 57 year old on a college football team in Texas. It's a true story, and through that, you saw this dynamic, both with his father and not meeting his father's expectations. His father's very, like I said, very harsh. But also, his son wasn't a football player at all. He was this creative guy, and how they kind of are starting to figure it out. I don't want to give too much, but if you haven't seen the senior. It's an excellent movie and and does expectations colliding? Every family deals with that at some level. I know our family, did you know? Because you think your kid, I'm going to do these things with my kid. I'm going to have a boy, I'm going to we're going to do these things together. I'm going to have a girl. She's going to like the things I like. Well, not necessarily. She's a wholly different person.

Dr. Ashley Zucker: 21:42

Yeah, yeah. Sometimes it's also I recognize this with my own kids. I'm like, I want them to like something I didn't like and they don't like it either.

Erin Brinker: 21:51

I want you to be able to paint because I can't draw a straight line.

Dr. Ashley Zucker: 21:57

I'm like, Well, I guess you are my kid. So

Erin Brinker: 22:02

that's funny, yeah, my daughter, when she was really little, she really wanted to play the violin. I'm like, Okay, you have to commit to it for one year. One year she was six, we bought her a little violin. She hated it. She hated everything about it. We made her stick to it, because that was the deal. And, you know, she had lessons once a week. It wasn't that bad, but, but then she, after that year, she's like, I'm done, I'm out, you know? And was on to the other thing. And I so, I love stringed instruments. I can listen to string instruments all day long. And I thought that would be so exciting. But no, that was not for her, exactly. So let's talk about, you know, the holidays and and expectations of the holidays and all the different family dynamics and family stresses and kind of how to take care of everybody during that window of time.

Dr. Ashley Zucker: 22:54

Yeah, I mean, I think that last part that you said is probably the first thing I would pick up on, which is, how do we take care of everybody at that time? It's not our job to take care of everybody at that time. Okay, well, I would say that great. I you know, I think it's understanding where, where you're at, what you have to give, what you need, right? Because everybody around you trying to give to but also recognizing that we have to be realistic, right? You're not going to be able to do everything for everybody, and you may have to pick and choose. You know, what you can and can't do. You know, be realistic about the amount of time you have what you can offer. Yes, right, exactly, right. But know that it's, you know what? I'm just so busy right now, I just don't have time to help out with X event. But you know, I'd love to be first on the list for next year, something like that, right? So I guess that would be my number one advice for the holidays, is just recognize your own limits. And yeah, that it's not your responsibility to take care of everybody. You have to take care of yourself first, and then what you have, you give, you know, and what you don't have you don't have, you don't that's okay,

Erin Brinker: 24:19

yeah, you know it reminds me of I know women, many women like this have been some in my family where they putting on the perfect spread with the Perfectly Decorated home, and everything has to be perfect, and the food is delicious and the home is beautiful, but But the person who wants that perfection is exhausted and cranky and yelling at everybody and nobody wants to be around them, right? So maybe, maybe put on a few fewer decorations and get takeout, and everybody will enjoy themselves

Dr. Ashley Zucker: 24:49

exactly. There you go. Or if you you're not that person, right? That's setting everything up and making everything perfect. It's saying, What can I do for you? Right? Can I do the dishes? Can I clean up for you? Or maybe, can I bring X dish so you don't have to worry about all of it, right? Because, you know, whatever your role is, where can you kind of lean in in a realistic way and maybe take some pressure off of somebody else too? But again, we've all got our own pressure, so we've got to find that

Erin Brinker: 25:19

balance we do, we do and give each other space to be human, yep. So, so what are some trends that you're seeing in in your office, with people coming in, or that you've read about, things that are happening in the interpersonal space and the mental health space? Because I know it's been, it's been changing a lot over the years.

Dr. Ashley Zucker: 25:43

Oh, that's hard to say. I mean, some of it doesn't change at all, right? It's just the social dynamics of being a teenager. It might play out a little bit differently, but I think those things are still there, certainly, you know, things like people being challenged with bullying. That's still a very common I think what that looks like might be a little bit different with, you know, like social media and stuff like that, but the the impact that it has has always been there. So I think some of those patterns are very much the same. I think about, you know, for teens, and this is part of why I really love working with teens, is, is that time of life where you're just trying to figure out who you are, and that's really challenging to navigate, and you're trying to figure out who you are for yourself, but also trying to manage, I guess, those expectations of your parent and that maybe you're not who they think you are, who they think you should be, those are Definitely some, some challenges. I think, you know, school performance, that's a big one that we see for sure. You know, I think the world is a very, very stressful place. So certainly you see some of that, you know, play out and in what I see in in my office. But, you know, I think also, it's not like there was ever a time where life or the world wasn't stressful. It's just what it looks like changes. So I try to keep that perspective as as well.

Erin Brinker: 27:08

You know, it used to be that all of the scary stuff would be on the nightly news from at six and 10. Now it's in the palm of your hand, 24/7 and so, you know, and and the rage bait. It's really something because I, you know, will be on x, and I don't really post very much, but you know, the stuff that people post, you know, this horrible thing has happened, but you don't care, nobody's going to comment. I mean, so everything is manipulated to make people feel bad, and that is a really twisted way of existing. But it seems to be how, how some marketing is done in this era. It seems to be how news is told in this era. And that has to have an impact on teenagers. I'm an I'm a full grown adult, and it bothers me. And so for them, I have to imagine, it's overwhelming.

Dr. Ashley Zucker: 27:57

Yeah, no, absolutely, you're absolutely right. I think what's so, you know, difficult with, I guess I would say social media in particular. Are these like algorithms that, you know, get get created that we don't necessarily have control over, and so we get fed stuff that we weren't necessarily looking for, that they think will grab our attention and keep us kind of wrapped in and unfortunately, there's a lot of stuff that's very negative that is utilized in that kind of manner. But that's also not to say that, like all social media is bad, or, you know, all you know, news or entertainment is bad, I think it's about one moderation. But to, you know, really trying to find the things that actually bring you joy. There's a lot of really great stuff on the internet and on social media, and so if you can really try to manipulate your own algorithm

Erin Brinker: 28:49

exactly, be intentional about it, yeah, because one one afternoon of doom, scrolling could wreck your whole algorithm.

Dr. Ashley Zucker: 28:59

Absolutely, absolutely, yeah, it's also, you know, like, I think of don't follow things that don't make you feel good, right? Or maybe you follow like, one, I don't know, I don't want to say one media source, because then you're only getting one media source. But maybe only follow one negative thing and the rest are positive. Or for every like, one media outlet you follow, you follow 10 funny dog video people you know exactly.

Erin Brinker: 29:28

If you're if your feet is full of baby goats and cats and dogs, you're probably going to be just fine, right? Exactly. So I did see, there's a new trend that I saw yesterday on Tiktok that that what they call raw dogging life, or raw dogging boredom. And so they'll just sit there with nothing, and they'll time themselves just kind of sitting there. And I thought, you know, it was those in between spaces where real creativity happens, right? So that's where, you know, it's out of boredom that great. And. Novels are written. It is out of boredom that beautiful music is written, because people are left to just think. And I think that if, if that trend really catches on, what a beautiful thing. If we're if we're consuming 24/7, then we don't have any time to create, and we don't have any capacity to create. And I worry that our brains will lose the ability to create. I don't know what your what your opinion is about that, but that's my theory.

Dr. Ashley Zucker: 30:26

Well, I think the the irony of social media trending, not doing anything is great. Yeah, I think, I mean, if you think even about yourself, right? If you're kind of sitting there for even a second. Well, one you've got like, your to do list going through your head, right? But what's like? The first thing you do like, you pick up your phone, you scroll through social media, or you do something or right? You're like, you don't even let yourself be bored. So how are our kids supposed to know how to navigate that, you know? So I do think it's important that we all kind of, you know, have those moments where we really turn things off, put them away, put them aside, and really try to engage in the non electronic world around us, so to speak, and go for a long and, yeah, exactly, go for A walk, do some coloring, you know, I don't know, dig in your backyard Exactly.

Erin Brinker: 31:26

Pick up, pick up that guitar that's been collecting dust

Dr. Ashley Zucker: 31:29

in the corner. Yep, yep, exactly. So let's

Erin Brinker: 31:33

talk about the, you know, what? What the How bright, how people's brains are are have changed with the advent of social media. And so, you know, I know that all of this impacts how brain wiring, right? And I'm not a neuroscientist. Don't pretend to be, don't even play one on TV. But I, I know that it has an impact, especially for young people. And are you seeing that, that how people think is different, how how they approach life is different, how, you know, they're just all of it is different because of the advent of of this ubiquitous device that we've been holding in our hands since 2007

Dr. Ashley Zucker: 32:13

I think the the most common thing that I see is that it's really impacted our attention span. And I see that even my myself, you know, it's like you're just sort of constantly seeing something different or right? It's all these, like, short, you know, 32nd videos, or whatever it might be. And so it's just a lot of information always coming at us in short bursts. And so I feel like our brains just sort of get used to that pattern, as opposed to more extended periods of, you know, focus and attention. And so there's definitely a trend, not just with with kids, but certainly with adults, of, you know, complaining about concentration and focus issues. And I have to think that some of it is just also that the way we're working with the world right now is not helping us, you know, build no sustained attention. It's not, yeah, I think that's probably, I mean, I can't say like that. We're definitely seeing this through X, Y and Z, you know, study or things like that, but I know that there is some evidence that does suggest that there is some change in just duration of attention span over the last several years to decades, where we're seeing that people are just sort of, I don't know that. It's not the ability to focus, but that's just not our pattern, or we're sort of craving that, like constant flow of change and information, because that's what we're used to.

Erin Brinker: 33:45

I wonder what that does to our capacity to do hard things. And I think about, you know, people to get and I'll use doctors as an example. Obviously, you know this example, well, the classes that you have to take to get into the undergraduate program are all the hardest classes. And then you get into the undergraduate program, you're taking organic chemistry and chemistry and biology, etc, etc, etc, and that's hard. And then you go into medical school, and then you have an internship, and et cetera, and on and on. All of that takes concentration. It takes discipline, and it takes the ability to work through something that's really hard, and are we? Are we hijacking or our kids? Are maybe not we, but yeah, we, as a culture, hijacking our kids brains so that they don't have the capacity to do that.

Dr. Ashley Zucker: 34:35

I hope we're not but, I mean, I think it's yes and no, right? I think there are some things where it just sort of depends on the like amount of time that you're spending on social media or even on things like video games, and so it's sometimes about like quality, not quantity type of thing, right? So again, I don't like to say that all. Social media is bad, or all video gaming is bad. I think there's actually some skills that you can can build through utilizing those things that might actually help throughout, even if you're taking those hard classes or, you know, trying to really apply yourself. But it's also that ability to really know when you need to turn it off that I think, is, like that key piece that we have to hold on to, like, how do you really say I'm gonna go do this or play this game for an hour and then I'm gonna stop? I think that's the hard part. Yes, yeah, yeah. I think we have to focus on and that will help us to make sure that we can do hard things. But you know, it's also, I think, like we were talking about before, taking that time to maybe be bored have nothing to do, or maybe taking the time to make sure you do focus on something for a long period of time, and like reading a book, for example, right?

Erin Brinker: 35:58

You know, I think of there are, there are, there are faith communities. And specifically, I'm thinking about the Jewish community that they they turn off their devices. They turn off everything on Friday night to Saturday night. And it's just about family. It's about connection. It is about just getting back to what's important. And wow, what a great example I you know, creating that kind of a tradition in your family, whether you call it a Sabbath or not. I think is really wonderful, yeah?

Dr. Ashley Zucker: 36:25

And I think that that may sound like a really lofty goal for a lot of people, so I think of like, can you have, you know, one meal a day where there's no phones at the table? That might be where you start, right?

Erin Brinker: 36:38

That's true. That's true. Yeah? So, well, yeah, so, so what kind of, you know, we're talking about, about setting boundaries and, and, you know, we exist in this very connected world, so you have to be connected if you want to to exist and engage in this world. So how do you set those boundaries and, and if you didn't do it when they were four, can you still? Can you it? Has you? Have you lost the window at 11 or 14?

Dr. Ashley Zucker: 37:04

Well, no, you've never lost the window. But I think for many things, it's, I guess, well, what I will say also, and I say this to parents of like newborns too, especially when they asked about things like sleep training, just as an example, right? It's like you're going to have to put in the work at some point. Do you want to put in the work now? Or do you want to put in the work later? So I don't think you're ever like beyond the point of no return. I do think it happens a little bit faster the earlier you sort of set those boundaries, those expectations, but I can't say it's easy at any time, you know. So I think it is important.

Erin Brinker: 37:47

It's about doing it yourself, too. I mean, when they're really little, you're not really disciplining them, you're disciplining yourself, which is really so sorry.

Dr. Ashley Zucker: 37:56

I didn't mean to interrupt. No, no, no, that's so true, though. But yeah. I mean, I think, you know, you see it play out, like with teens and stuff around, like the cell phone, right? So they don't sleep because they're up all night on their phone. Okay, we'll take it away. But I can't, they get really upset. It's like, okay, well, you're gonna have to torture yourself and them. So, yes,

Erin Brinker: 38:19

yes, yeah, because you want them to grow up to be fully functional, fully developed adults. And sometimes that job is terrible. A lot of times when, especially when they're teens, and they're they're, you're, you're, you're embarrassing them by existing, and you're making rules that they don't like, but they secretly do like because they need the boundaries. It's just they're pushing back against them. You know, they get past 25 and they recognize that that, Oh, Mom and Dad weren't stupid. Oh, right for this, parents who don't know when your child hits about 11, they're gonna think you're an idiot, and it's okay. It's normal.

Dr. Ashley Zucker: 38:57

What do you know, Mom,

Erin Brinker: 39:00

what do you know exactly? Exactly? I actually have to tell you story. I was at a family event, and there was an uncle there, and we're standing around a a bonfire, or it was in a it was in a container. But my I said something to my daughter, I remember what we were talking about, and I gave her some advice, she goes, No, Mom, that's not right. And this uncle who was standing there gave her the same advice, like, not three minutes later, oh, that's really great. I think I'm going to do that really.

Dr. Ashley Zucker: 39:33

That's actually my role. A lot of the time, parents will come in and be like, can you talk to them about this, because they won't listen to me.

Erin Brinker: 39:44

Oh, that makes sense. That makes sense. So, so let's switch gears a little bit and talk about, you know, mental health is, is has been on the front of people's minds for the last few years. People are talking about it. They're being open about it. People make. Videos about their diagnoses, whatever those diagnoses are. And a lot of people think they want to go into the mental health field, whether as a psychologist or psychiatrist or some other kind of practitioner. What would you what advice would you give to a young person who's considering that?

Dr. Ashley Zucker: 40:16

Ooh, well, I think the first thing I would like say is that there's just so many ways to get into it. It can look so many different ways to become somebody in mental health, right? So like you said, there's just a lot of options about what that could could look like. So I think it's about sort of exploring and even understanding all of the spaces in which, you know mental health things exist. So I think the things we think of the most are therapists, psychologists, psychiatrists. But there's a lot of other opportunities out there too. I think there are some people that really, really love the concept, but then when they kind of get that sort of actual involvement in mental health, it's something that they feel is too much for them. So that's always one thing that I think about, too, is it's good to, you know, try to get some experience wherever you can, although I will also say sometimes getting experience in mental health is really difficult because of the sensitivity of it. It's not like you can just go shadow or do these types of things. But if there's, you know, if you're in in high school and there's like a peer support club or something like that, I think those are the ways to, you know, kind of get involved and sort of see, do I like actually doing that? But I think, I guess, I think back to when I was in medical school, I had a really good friend who was incredibly caring, compassionate, very sensitive, and when she did her rotations in psychiatry, she just couldn't handle it. She was like, this is just so hard. I can't live like this, right? And so for her, it was recognizing that like, even though, in theory, that really sounds like it fits with her and her personality, it just wasn't something that she could really navigate through, and so recognizing that too. So that's where the experiences is helpful. Unfortunately, you do have to be able to separate a little bit some of the really difficult stuff you have to deal with in mental health, and make sure that you're not carrying the weight of all of that all of the time. And so that's just not for everybody. But again, that's why I think it's so important to recognize that there are other ways to be involved in mental health that might look a little different than just sort of those traditional, you know, methodologies. But I think the biggest thing I would say is that, you know, being in some type of peer support, type of program, no matter what age you are is probably the best thing that we can do, also not just for our own like experiences or interest, but to help one another, because we'll never have enough therapists. We'll never have enough psychiatrists for everything that everybody needs. And so where can we really fill in those gaps with just each one of us having a little bit of a better understanding of how to support one another. To me, that's like the best opportunity we have.

Erin Brinker: 43:05

So you might get in and I I'm one of those where I really wanted to be in mental health. I really did. And several times over the course of our marriage, I've been married for 31 years, my husband's like, Erin, you would take everything home. Every single patient would be on your mind all the time. It would eat you alive. It's like, okay, so what can I do? I can be a mentor. I can be a coach. I can be I can volunteer to work with youth, and all of those things I do, and I love them. And he was right. And you have to understand where your boundaries are and your capacity to create boundaries. And if you can't do that in a healthy way, then that that job will kill you.

Dr. Ashley Zucker: 43:45

Yeah, no, definitely. Opinion, yeah, no. And I think you know it's it goes each way, right? So I think about like, I love being a psychiatrist. I love working with kids. I love working with adolescents. But if you asked me to be a teacher in high school, elementary school, kindergarten, no way. I don't know how teachers do it. I give them so much credit, but you know, and so it's just finding your space, right? I love kids, but I cannot be their teacher,

Erin Brinker: 44:17

right, right? We all have our gifts, yes, yes, that's that's very, very true. So for those of the for those people thinking maybe they're they're heading into medical school, and they're considering psychiatry as a specialty, and I know that you kind of are asking yourself, what do I want to do all the way through? I would imagine, you know what? How would you tell them to? How would you have them order their their learning in a way that favors psychiatry?

Dr. Ashley Zucker: 44:49

Ooh, that's really difficult. I mean, when you're in medical school, certainly you're getting exposure to, like, all of the different specialties. And I think that's critical, no matter what you do, right part of the like. Joy of medicine, to me is that we know so many things about other things outside of our specialty, but then we do get to kind of focus in on something in particular. So I would say, first of all, don't overlook the other things that are outside of psychiatry, because they will make you a better psychiatrist in the long run. So that would definitely be one, next one piece of it. And then I think it's about the variety, like the, you know, especially, I always, one of the things I love about psychiatry is that it's one of the, you know, kind of under developed specialties. And so there's so many new things, like constantly coming out. And so there's so many ways to look at it. And you can say, you know, whether you're in the outpatient space or you're in the more acute space, inpatient, the emergency room. But there's also all of these emerging technologies within psychiatry which are really, really exciting to be involved in. And so again, there's just so much variety, and making sure you kind of get a little bit of all of that to sort of see, you know, what excites you or maybe you don't like it. That's okay too.

Erin Brinker: 46:05

Yeah, you know, yes, because you may get in there like, oh, I don't like this at all. I didn't think I'd be doing this much in statistics, yeah, if you will,

Dr. Ashley Zucker: 46:15

exactly, exactly, well. But I'm really grateful for a lot of the things that I learned and did outside of psychiatry, and I really still utilize those today. So that's why I always think it's, you know, you don't want to get so lost in the weeds of one thing that you forget to, you know, learn the other things around you.

Erin Brinker: 46:34

Well, that's excellent. That's excellent. So what are some things going on in Kaiser Permanente surrounding psychiatry, psychiatry and psychology and and what are, what? What's on the horizon for Kaiser?

Dr. Ashley Zucker: 46:46

Oh, boy, that's like, where do you start? I mean, there's so many pieces again. I think one of the one, I guess, a place to start is where you start, right? So one thing that I, you know, truly believe in, and I know has always been a huge focus for Kaiser Permanente, is really in that preventative space, right? So how do we keep you healthy? How do we prevent you from, you know, actually needing more intensive care? That's our goal, right? We want to help you be, you know, be the best you can be early on. And so I think it's about that, like early identification, early intervention. So there's definitely been a large focus on on that. So the early identification and that you know is taking place when you see your primary care doctor or your pediatrician, right? They're Screening for Mental Health concerns. But there's also so many offerings that are available that you know, you don't have to come into psychiatry or addiction medicine to access a lot of those resources and services. So you know, whether it's the utilization of we have certain apps that we like to to offer to partner with, but one resource which is really great and actually available for non KP members too, is that we have a lot of mental health webinars that are available through the website that kind of go over a variety of topics. Some of them are actually teen specific, like, there's some parenting ones, so I'll plug those. There's some about like anxiety and work stress and and it, there's just a ton of them that are really there. So it's also a great place, or a great resource for people who are, one, just kind of looking for that sort of first step. But two, I've actually used those a lot with my own patients who are very hesitant about like, getting more into therapy. It's sort of dipping your toe in the water in a more safe series, because it's, yeah, it is. It's like, I don't know what that's going to be like, or that feels very personal or invasive. And so that's a very safe space to kind of enter and start to learn some of the you know, skills and strategies and ways of managing, you know, your mental health that I think are really, really important. So I think that upfront focus is huge, but we also have to have the full spectrum of care, right? So yes, we want to keep you healthy, but that doesn't work for everybody, right, right? And there are some things you just can't avoid. Your genetics are just going to take over. And so making sure that we have kind of all of those layers of care throughout and so again, having a, you know, robust psychiatry department where you can get the individual therapy, the group therapy, the medication management, kind of all of those components. And then if it escalates beyond that, like, how do we make sure that we connect our, you know, our patients, our members, to those services, and really try to track them throughout that, you know, kind of continuum of care is what we call it. So, you know, if, for, you know, whatever reason, unfortunately, one of our patients ends up in the hospital, making sure that we have them come, you know, directly back into the system, so that we can make sure that they have all the resources that we need. So I. Think that kind of care management throughout has been just a really, you know, strong component of what Kaiser is able to do with our integrated system. But I think also what people don't always think of is we kind of touched on it a tiny bit, is like all the kind of innovations that are happening within psychiatry and so really, you know, the focus on incorporating those and making sure we have those accessible to our patients, you know, has been something that's important to us. So it used to be, you basically had medications or ECT, right? And ECT is the stuff movies are made of, literally. And ECT is actually a wonderful treatment. I've seen some really amazing things happen with ect. So I don't want to give it a bad rap at all, but there are a lot of things that people, I think are more comfortable with, like TMS, which uses magnets instead of electricity, and so being able to offer those services. Yeah, yeah. So that's a relatively new one, I guess in the last, I don't know, decade or so, so not like yesterday, new but, but yeah, it's been kind of the the sort of replacement for ECT, or maybe the first step before, kind of getting to ect. So feels less kind of scary to people.

Erin Brinker: 51:15

So I know that, you know, if you if you grew up, and we'll just say lots of families have lots of trauma that's been around for a long time, and unpacking that in an hour, and then having to pack it all in and go on with your life for the week until you can come back, that's a little scary. And you know, people need to have ways to connect beyond that that that one appointment, because you need support. Once you start unpacking, maybe that wound, well, it's open now, and and how do you deal with that in a constructive way? And do you see that kind of happen in your in your treatment?

Dr. Ashley Zucker: 51:53

Yeah, I mean, I think that's part of the process of therapy too. Is like you don't want to make or you want to make sure that somebody doesn't leave your office like an open wound bleeding out into the universe. So you want to try to get them to a better place before they exit. But I think it's also about really, you know, empowering people with the skills and the strategies to manage how they're feeling. And so you know that that sort of old perspective of you go into the psychiatrist or the therapist, and you lie on the couch and you pour your heart out, and then you walk out the door, you can still do that, but you know, a lot of the focus over the years has really been on, how do we make sure that we're equipping you with how to navigate and manage what comes up next, right? Because we're not going to stop you from ever being sad or ever being anxious ever again, but really equipping people with the skills and the strategies to do that. So I think that's one big piece that I always like to think about, is like, what's something I can kind of give you to take home and use, and then it's also being able to utilize some of the great technologies that we have, like apps, right? So that, you know, maybe you don't have a therapy appointment, or you don't have access to somebody in the moment and you're having a panic attack, for example, can you pull up some resources on your phone that you can use? You know, are there other strategies? Or, you know, there's even, like, those apps that you can you can text with a robot or AI. And I know that's a whole nother Hot Topic typically designed for it. So I'll say that very adamantly, they are created to help and program to help with mental health, as opposed to some of the more generic ones, which we've heard some terrible, you know, news stories about, but also things where we like we have some programming or some apps that you can use, that you can actually do, like live texting with a like a coach, right? So they may not be a like a therapist level professional, but they have enough of that kind of education and training to kind of guide you through that moment until you can get to that next appointment, you know. So I think those are some of the great things that we can kind of incorporate into our practice. Well.

Erin Brinker: 54:02

Dr Ashley Zucker, as always, this has been a great conversation. This time has gone by so quickly. How can people learn more about Kaiser Permanente, the mental health services at Kaiser Permanente, and make an appointment with a clinician? Yeah.

Dr. Ashley Zucker: 54:16

I mean, the best place to go is kp.org, and you can see all of it there. A lot of our mental health resources are available right on that kind of home screen, but you can also search for, you know, just mental health, and you'll be able to find all of those resources, how to make an appointment, access to some of those webinars, like I was talking about. But another great thing that I always remind people of is you can always start with your primary care doctor, a lot of them, really, really can start you off in treatment, and if they need to, then they can, you know, send you on to psychiatry. But they often have access to a lot of resources, and you know, know how to start that treatment process and take care of you too. So it doesn't have to be in psychiatry. It can be with your primary. Care doctor as well, wonderful.

Erin Brinker: 55:02

Well. Thank you very, very much. Happy Holidays, and I hope to have you on again next year.

Dr. Ashley Zucker: 55:08

Yeah. Thank you so much for having me back.

Erin Brinker: 55:13

Thank you so much for joining us today. I'm Erin Brinker, this has been the hope table, and you can listen to this on terrestrial radio in Inland Southern California on X 95.7 Sunday mornings at 9am that's X 95.7 in Inland Southern California and wherever you download and listen to your favorite podcast, Apple Spotify, etc, again. Thank you so much for joining me. You've been listening to the hope table. Have a great week. You.