Follow-up on the effectiveness of mental health apps



For the last month, I have been trying out apps that aim to improve mental health of users. I installed the following apps: Headspace, Calm, Whats Up and Dailyo and aimed to use at least one of these every day for the month of January. Below, I will give my impression and opinions on these apps and whether I believe I learnt anything from using them.


Headspace:

When I installed Headspace, it asks me what my reason is for using the app, so it can be targeted at a specific area. It adds a disclaimed straight away that Headspace has not been proven nor is intended to diagnose, treat or cure disorders. So at least it’s being honest!



Aside from a basic introduction course, short animations and advice sound pieces, there is not much available that you don’t have to pay for first. What I found interesting is that there are meditation exercises for children under 5 as well as students, therefore it can be targeted for most ages. I enjoyed watching the short animations to help explain thought processes, these were very cute and good to reflect on.

Screenshot from a short animation on ‘noting’


Overall, Headspace offers primarily guided meditation and short courses on help with how to meditate, with focus on certain areas such as Stress, anxiety, personal growth and life challenges. Without paying £74.99 a year or £9.99 a month, I cannot say upfront whether these courses are beneficial. And I think for something which claims itself to have not been scientifically proven for its effectiveness, it’s debatable as to whether it is worth spending this amount of money when there is probably a wide range of targeted guided meditation videos on YouTube for free.

Calm:

I liked the feel of the Calm app. You can select a relaxing scene and sounds to play while on or away from the app in the background, which are very aesthetically pleasing. These is a Breathe section where you follow a dot around a circle and the circle expands and contracts as it tells you when to breathe in and out. This can potentially be very useful in times of sudden panic or stress. Calm also focuses on guided meditation as well as incorporating relaxing music, sleep stories (although there is only 1 for free) and short programmes e.g. 7 days of focus and Mindfulness at Work. These are focused on meditation and mindfulness techniques, and learning to change your core beliefs and negative thinking patterns (although only the first session is available on a select few programmes.)









There was a programme called 7 days of Calm which was entirely available for free so I listened to I completed this programme in the evenings for 7 days. This programme was focused on learning to meditate, focusing on the breaths and trying not to let the mind wander or get distracted. After completing this, I do feel like I can ‘master’ meditation a lot better than previous attempts, and I use the techniques in the programme to help ‘clear my mind’. I actually used what I learnt from the programme last week when I was feeling quite stressed. I sat in a dark room and focused on my breaths for just a few minutes to allow myself time to ‘recharge’ before continuing my busy schedule.

‘7 days of calm’ programme

Similarly to Headspace, most of the content can only be unlocked when paid for. Calm is £37.99 per year so relatively cheaper than Headspace. The introductory content is probably good enough on its own but I would be more inclined to pay this amount if I were interested in completing more 7 day programmes in the future.


Whats up?:

Honestly, I used this app the least, mainly because it is not as interactive as the other ones I tried. Whats Up? feels very reminiscent of Cognitive Behavioural Therapy (CBT) techniques. There is a section on Coping Strategies – including: unhelpful thinking patterns, metaphors, managing worries and positive steps. The Help Right Now includes a Get Grounded activity where it gets you to name 5 different ice cream flavours for instance to help distract.

There’s also lots of useful information regarding different mental health issues, uplifiting quotes, positive affirmations and breathing techniques. There is also a diary section where you can enter whatever you want and then rate your day as well as adding any positive or negative habits you would like to work on.

Overall, there is a lot of reading information on this app. I think this would be beneficial for those who are wanting to get into CBT but are maybe on a long waiting list to be seen or fear actually attending therapy sessions and talking in-depth about difficult subjects.

Dailyo:

Dailyo is what I have been using the most in January since it only takes a minute out of my day- it’s all about speed and efficiency with me!

Dailyo involves keeping a mood diary, whereby you can rate how you feel at any precise moment using a scale (the labels on the scale can be edited by yourself to keep it personalised). You can then add any activities you have been up to such as work, sport, good meal etc. I really like the simplicity of this app and how you can add your own activities onto the list (I added university, dogs, organised and yoga).





Once you have collected enough entries, you can look at your stats. This is where I get excited because I love a good graph! You can view your daily average mood, which activities were most popular (mine was overwhelmingly and unsurprisingly work), and see a chart of your mood and notice any peaks or dips. I think this is a good app for monitoring your mood changes and being able to reflect on how your day is going so far.


Out of all of the 4 apps I have tried, I think I will continue using Dailyo, but at the end of the day, you use whatever suits your needs!

Again, I have measured my social anxiety using the Liebowitz Scale. 

My previous rating on 30th December was 45 (for fear), 41 (for avoidance), which is a total of 86 overall, and labelled as ‘severe social phobia’.

After completing the scale again on 1st February, my rating is now 38 (for fear), 36 (for avoidance), which is a total of 74 overall, and labelled as ‘marked social phobia’.

I’m very surprised that the rating is significantly lower than that just over a month ago! However, it is of course hard to say whether these mental health apps have lowered my anxiety, or if other variables in my life have contributed to feelings less anxious. I have since started university again and earned a promotion at work, so perhaps these have contributed to improving my mental health.. who knows?!

Do apps for mental health actually work?

There is a frightening and persistent statistic that 1 in 5 people have a diagnosable mental health condition, the prevalence being greater among young people aged between 16-24 years old, with most conditions presenting themselves by the age of 18. Of course it is important to treat these conditions so they do not worsen into adulthood or lead to people developing other conditions which will be trickier to treat.

However, according to many studies, only around 25% of young people under the age of 18 with a diagnosable mental health condition will actually access professional help. There are many barriers to seeking help such as financial constraints, fear of being stigmatised, feeling uncomfortable or vulnerable discussing mental health problems and long waiting lists to be seen by a professional. Similarly, although evidence-based interventions such as cognitive behavioural therapy (CBT) are available, services which provide these treatments are limited. Because of all these barriers, it could be that other forms of receiving treatment can help more young people in desperate need of support. 

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CBT aims to challenge negative thoughts, behaviours and emotions

Studies have found that computer-based CBT and acceptance and commitment therapy (ACT) provides a way of increasing access to evidence-based interventions for children and young people and has shown to be effective in promoting mental health (e.g. Pennant and colleagues, 2015; Viskovich & Pakenham, 2018). 

However, with the increasing number of young people who now have mobile phones, it is suggested that mental health applications can provide a platform to delivering quick access to interventions. Using mobile apps may reduce the barriers to accessing mental health treatment, and potentially be more effective than face-to-face therapy since there is more anonymity,  can be accessed anywhere and provides immediate support (Gulliver, Griffiths & Christensen, 2010).

There have been countless apps designed in recent years, with an aim to target a spectrum of mental health conditions, e.g. depression, anxiety, OCD, addictions, insomnia etc. 

On the Mind charity website and Psycom there is a list of many apps. While taking a look through them, there are many that claim to incorporate CBT techniques such as ‘What’s Up?’, ‘Rise up’ and ‘Catch it’. Other apps such as ‘Dailyo’ and ‘Worry Watch’ use diary approaches to keep track of thought processes. There are also apps which primarily use guided meditation and breathing exercises such as ‘Headspace’ and ‘Calm’. 

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Screenshot from ‘Calm’
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Screenshot from ‘Worry Watch’

Also, there are apps which give the opportunity to speak to a trained therapist (with a charge). This could provide an alternative to those who need therapy but who fear leaving the house due to their mental health. 

Despite so many mental health apps being readily available to install, the majority of them do not have any evidence-based support for their effectiveness. On Mind, they even put a disclaimer that they are not able to recommend any particular apps and that the apps should not be used as a replacement for seeking medical help.

There is little information regarding how valid the symptom assessments are, which apps are effective or how well the apps compare to face-to-face interventions (Olff, 2015). A systematic review in 2017 investigated publications between 2008 and 2016 on the efficacy of mobile apps for mental health in young people. They found that usage of the apps had little effect on mental health outcomes and found that very few had undergone any research evaluation. Given that the number and pace of mental health apps which are produced, it is important to evaluate their effectiveness, otherwise individuals will be trying to cure their conditions with something that potentially does nothing. It could be that anxiety is increased due to the self-diagnosing tools of these apps and there could be an over-reliance on the effectiveness of the apps whereby people avoid seeking professional help as they believe the apps will fix everything.

While the majority of apps are not supported by evidence, health experts believe mobile mental health treatment will play an important role in the future of health care and gives more people the treatment they need that is not readily available in face-to-face form. 

Without thorough investigation into these apps myself, I cannot give too much information on them. As someone who has undergone counselling and CBT for my anxiety, it would be interesting to see whether the quality of the apps is comparable to real-life therapies. Therefore, I will be installing a few of these apps to try them out for the whole of January and I will give my verdict on them at the end of the month! 

I will be installing ‘Calm’, ‘Headspace’, ‘What’s Up?’ and ‘Dailyo’ to test out apps which claim to offer something a bit different from each other. I will be mostly focusing on managing my anxiety and will target my use of these apps with this in mind. 

I’ve collected a score of my social anxiety using the Liebowitz Social Anxiety Scale and have got a score of 45 (for fear), 41 (for avoidance), which is a total of 86 overall, which apparently means I have ‘severe social phobia’ (oops!). I did the same scale approximately 6 weeks ago and got the same score (so I can kind of see that my degree of social phobia hasn’t changed much over that amount of time). I will collect my social anxiety score at the end of January and see if there is any marked difference, or if I have been cured completely! Obviously there are holes in my experiment and it’s hard to control for everything but it’s just a curiosity test for myself. 

As long as I don’t get distracted, I should post again at the end of January, so I’ll see you all then!


Picture credit: https://mrc.ukri.org/funding/science-areas/neurosciences-mental-health/

Living with an Autistic sibling

My sister is 2 years younger than myself and has been diagnosed with Autistic Spectrum Disorder, including repetitive and receptive language disorder with moderate learning disabilities. She was originally diagnosed with speech and language delay before the diagnosis of Autism. My mum received a folder telling her about the diagnosis and sent her on her way with no advice or guidance, so the majority of our family’s learning was ‘on the job’ so to speak.

As someone who has grown up with an Autistic sister, it has been a very interesting and often difficult experience (to say the least!). I wanted to share my experience of living with an Autistic sibling and the important life lessons I have picked up along the way. I will say that this will all be my own experience and most might only be applicable to myself. Of course it’s important to note that Autism runs on a spectrum so not all individuals on the spectrum act in the same way.

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1. Learning to put others first from a young age

Early childhood was absolutely the most challenging time. An abundance of screaming tantrums from my sister, biting other children, throwing and breaking stuff, put a strain on our parents as they did not know how to handle her behaviours. As a sibling of an Autistic child, you quickly learn to put their needs above yours and understanding they need the attention from parents more than you do. I did not understand why my sister would act out like this, but as a result I knew that I had to behave myself and limit the demands placed on my parents so they had less to deal with.

2. Being one of the only people to understand her

Since my sister’s condition gives her a speech and language delay, when she used to speak as a child, she often did not make much sense and found it difficult to be understood. However, I always remember being able to understand most of what she was saying and didn’t understand how other people didn’t get what she wanted. I’m not sure whether I just spent too much time with her or it was some weird sisterly bond but I became my sister’s translator. According to our mum, I would often say stuff like ‘She said she wants a biscuit’, so as helpful as I was, I feel I may have used my translator skills to my advantage when it suited me!

As well as being able to understand her speech, I can always know what will make her laugh. If I send her a funny video, I can always pinpoint the moment that she will find hysterical even though it might not necessarily be the part that was supposed to be funny in the video. The context of whatever I show her can be irrelevant but she might find the facial expression of the subject hilarious.

3. Learning to laugh at embarrassing times

I remember when we were both at primary school in assembly. My class had entered the hall first and sat down, then my sister’s class walked in and I spotted her straight away as the one kid that had ran into the hall in just her knickers. My class started giggling and pointing out to me that my sister was there in her knickers and I just wanted to die of embarrassment!

Looking back on the embarrassing moments my sister caused me as a child, I now find them hilarious. I have learnt that when moments like that come up again when we are in public, (thankfully she doesn’t go to such extremes nowadays!) I just have to embrace what’s going on and try not to feel that others are judging her.

4. Finding a common interest with her

In as many ways as my sister and I are different, we are also very similar. Once finding what we both enjoy, it’s easy to spend time together. I’ve found that my sister, as well as myself get very nostalgic and we enjoy reminiscing in board and video games we played as kids. I think because as much as we both frustrated each other as children, we would always get on better when playing games together. My sister was always a boss at video games so I would often just watch her play and I would be her cheerleader. I think we both like to capture these childhood moments as adults.

Reminiscing in Kerplunk

My sister is also fascinated with dates, specifically in history. We spent a good couple of hours recently with our youngest sister discussing King Henry VIII’s life and she enjoyed researching how all his wives died and how old they were, and what year they died. It sounds morbid but it’s all out of her genuine interest.

5. Being extra protective and recognising vulnerability

Throughout her school life, my sister has faced bullies because of who she is. Because people may look at her and think she doesn’t look like she has a disability, this led some people to believe that she was just ‘weird’ and this warranted being picked on.

As I was very painfully shy at school, I feared, and still fear confrontation. However, I accepted that I needed to put my fears aside to stand up for my sister. I often messaged these kids and I had to point out to them that my sister has a condition and that how they were acting was unacceptable.

Even now as adults, I have had to have a word with crappy boyfriends of hers who were clearly taking advantage of her vulnerability and not treating her right. My sister finds it hard to recognise people’s intentions and can’t see through lies that seem obvious to ‘neurotypical’ people due to the social impairment that comes with Autism. Therefore, as family, we have to be protective over her and get to know people she spends time with as it’s terrifying to know that she will trust anyone who is nice to her.

6. Autistic people are empathetic too

It is a common misconception that people with Autism Spectrum Disorders lack empathy and are Sheldon from The Big Bang Theory type characters who show little to no emotion. I would say that my sister is the most emotionally expressive person I know. She shows pure joy and happiness, compassion, genuine concern and upset, and finds it hard to fake these emotions so you know it’s real.

For her 21st birthday, a load of us went out for a meal and surprised her with this amazingly hand-made Beauty and the Beast themed birthday cake, which was a big interest for her at the time. The look of absolute shock and joy on her face was beautiful to see. After I said my vows at my wedding this summer, I look over to my sister and she was crying with happiness for me. When I have been sad or felt ill, she has shown compassion and tried to help me. Similarly, when our dad decided to end a relationship with us due to his apparent lack of compassion, my sister was devastated, although she tries to hide it. Therefore I can say that my sister has a wide spectrum of emotions.

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At my wedding in July

7. Wanting to help people who are Autistic

After growing up with an Autistic sibling, I went on to study Psychology with a focus on education and Autism because I wanted to find out more about my sister’s condition. I then went on to be a support worker for adults with learning difficulties because I felt passionate about wanting to help people who have struggled like my sister.

I think that growing up in a household with learning difficulties and other conditions makes you empathetic since you have real-life experiences with the conditions and can use this experience to be effective in aiding others. In a world full of people who want to be rich and successful, a career dedicated to being kind to others makes you the richest person.

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8. Accepting that she might need support her entire life

Since Autism is by no means limited to childhood, it’s important to consider the next steps for an adult with Autism. Now my sister is in her twenties, I am learning to support her in making good decisions but to not pressure her too much since it’s important to remember she is still an adult.

I supported my sister with getting a full-time job. I assisted her with the application and prepped her for the interview process. She surprised us all with sticking with the job for over 2 years so far. The amount of independence she has gained over the last few years has been astonishing. She still needs support with other aspects of her life such as managing her finances and she might always need someone there to make sure she is safe. I don’t know how independent she will be in future years or whether she will be able to live on her own or with a partner. I jokingly told our 13 year old sister that she will be living with her when our parents are too old to look after her (which was met with a look of scepticism and annoyance!).

 

Whatever happens, she is very lucky to have a strong support system around her and many people who care about her. Without sounding soppy, she is the bravest and funniest person I know and I wouldn’t wish for her to be any other way than who she is.

Why I changed Hogwarts house

As someone who is a massive Potterhead, of course I feel the need to discuss Harry Potter frequently, so why not on my blog?

I wanted to talk about why I changed my Hogwarts house and what this might mean regarding the validity of categorising people into one house or another.

I would say that my peak obsession with the Harry Potter series was when I was 15/16 years old. I took all the sorting hat quizzes online, and when Pottermore came out a few years later while I was at university, I solidified myself as a true Ravenclaw, as I would get this result nearly every time I took these quizzes.

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However, more recently as a 25 year old, I have taken these quizzes again out of interest. My hypothesis was that the result we get has potential to change years between taking the quiz (of course you have to be answering truthfully each time). And sure enough, I was right! There has actually been an overwhelming lean towards me now being sorted into Hufflepuff house! I still have Ravenclaw as being ranked my secondary house, however I think I recall from years ago having Hufflepuff be very lowly ranked, therefore it is an interesting shift in results.

So the question now is why did my house change?

When I consider the typical traits of both houses, Ravenclaws are usually academically-motivated, witty and have a lot of wisdom. Hufflepuffs however are typically loyal, hard-working and fair.

Looking back at how I was as a person when I was a Ravenclaw, I completely agree that I considered being knowledgeable and intelligent as valuable traits. I was a full-time student back then and I was often seen visiting the library and getting my assignments done early and always aimed for the highest standard.

Nowadays, I am working in a role which requires me to be kind and supportive. While I still value intelligent people, I believe it is not as important as being loyal. In the last couple of years, I have also switched to veganism and developed a real love for all animals (being an animal-lover is often synonymous with Hufflepuff, so makes sense).

So it appears that my values have changed from what they were a few years ago. And if this happened for me, perhaps this happens with the majority of people. It is also possible that my values have not changed so much as I had all these Hufflepuff traits on my spectrum before, but now they are more prominent, and the Ravenclaw traits have moved lower down the spectrum. This would mean that values work in a similar way in which personality traits are theorised to work on a spectrum or scale.

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An example of personality traits working on a scale (The Big Five/OCEAN)

In contrast to personality traits, which are mostly known to be consistent throughout our lives, it can be agreed that our values can be changed.

A change or shift in our values could possibly just be a part of maturing. Therefore it seems reasonable to suggest that those 11 year old Hogwarts students being sorted into a house on their first day of school, may identify more with a different house by the end of their 7th year. Perhaps the whole house system is flawed if it is based on current values and interests.

It would be interesting to see whether a change in Hogwarts house is very common. Maybe if you’re reading this, take the sorting hat quiz again and let me know your result!

 

About sharing your child’s success on social media

It is not surprising to hear that social media use is massive right now, with more than 35 million people in the UK having a Facebook account alone.

Social media comes with many benefits such as being able to connect, stay in touch with people easily and many people being able to turn to online groups to help with issues they find hard to discuss outside of the internet (myself included).

However, it is worrying to hear that 1 in 5 children worldwide now experience mental health problems, with rates of depression, anxiety and suicidal tenancies increasing into the 21st Century (Bor and colleagues, 2014). One argument is that higher rates of anxiety in particular could be down to technology use. This post is a brief reflection on parent’s use of social media to share children’s success.

When I am scrolling idly through Facebook at around September time, my feed is often flooded with ‘First day back at school’ pictures of children in their brand new school uniforms, clutching their backpack, with an apprehensive grin on their little faces. These often being accompanied with captions from parents exclaiming how smart they look and that they grow up so fast! This is one example of how from a young age, even sometimes before birth, parents can document their child’s entire lives on social media.

Although it is understandable that we would want to show family and friends our children reaching big milestones and succeeding, perhaps it is important to consider the implications of doing this.

Firstly, if another parent is viewing the success of a child of a Facebook contact, it is natural to compare the success of that child to their own. For example, if a parent posts about how their baby has started to walk at the age of 10 months and your own child started walking at 13 months, it could make you believe that you could have done more to get your child walking earlier. Documenting success online could therefore become a bit of a competition between parents. This isn’t to say that we cannot be truly happy for the success of other children and their parents, but we also cannot help but to compare our lives to those we see online (Vogel and colleagues, 2014; 2015).

Parents can also post about how proud they are that their child achieved good grades or their end of year report was really good, followed by commenters congratulating them or saying how clever their child is. If their child is old enough to use social media themselves and reads these posts, they might feel proud of themselves, but they may also feel pressured to keep achieving (Luthar and colleagues, 2018). This added stress to their already stressful experience of school could be detrimental to their mental health, be a major cause of anxiety or feeling depressive symptoms if they do not live up to their parent’s standard. As stated in my previous post, Perceived parental pressures on girls from wealthy families and the effect this has on their mental health and wellbeing, parents can have a profound effect on their children’s mental health. Children can often perceive parents to be pressuring them to succeed. Whether this is true, intentional or not, if a child sees parents posting about their success online, it makes sense to believe that this can contribute towards this perceived parental pressure.

While it is good to celebrate successes of children and to be proud of them, it is important to think about how documenting parts of their life can affect them. There is a lot more research needed in this area to see how posting about the successes of a child can affect their mental health. It is possible that only children from high achieving families would be affected by parents documenting their success, or perhaps there are gender or age differences. All of which are something to look into in future research.

This post is not intended to criticise parents in the slightest, these are just topics that keep me up at night!

Have a good weekend, friends!


 

Perceived parental pressures on girls from wealthy families and the effect this has on their mental health and wellbeing.

As someone who is by no means from a wealthy background and whose mum provided little to no pressure to become a competitive high-achiever during my school years (her approach being along the lines of “You have a choice of whether to study or not, and if you get detention then it’s your own fault”), I have wondered whether if I were from the other end of the spectrum, receiving pressure to achieve from high-income parents would have raised my educational standards and given me a strong sense of wellbeing.

Educational attainment in females is currently at a record high, with more females going into higher education, university and beyond. While this is an all positive and empowering statement, adolescent girls often report higher levels of stress and dissatisfaction with school, especially those from wealthier backgrounds. I question why this is the case when these girls have access to high achieving schools and resources, and whether parental influences play a role.

A recent study by Spencer and colleagues, published in the Journal of Adolescent Research in 2018 conducted interviews on girls from wealthy single-sex schools (77% self-identified as white Caucasian), as well as interviewing their parents to investigate themes of stress and wellbeing.

Through analysis of these interviews, the researchers identified emergent themes surrounding the girl’s perceived cause of their stress. Many of the girls believed that their parents were the root cause of their stress, feeling as though their parent’s performance expectations were ‘out of sync’ with their own expectations they held for themselves. Some of the girls expressed how everyone wanted them to reach their full potential and how these high expectations interfered with the relationships they have with their parents. What was a cause for concern is how the girl’s stress was normalised and accepted to be a part of the school’s culture with one girl stating that she had occasional panic attacks but explained ‘it’s not that bad’.

The parents in this research were not naïve of their daughter’s stress and were indeed concerned. However, the parents would often contradict their own statements, perceiving themselves to be encouraging the girls to not be so harsh on themselves, at the same time expressing that the grades they achieve were ‘not good enough’. Some parents accepted that their daughters needed to perform at high levels to ‘make it’ in society but some would also say that they were open to a spectrum of grades so long as the girls tried their best.

The main conclusion to take away from these interviews is the general theme that the girls perceived their parents to be contributing to their stress, whereas the parents tended to not share this belief and viewed themselves as more laid back in comparison to their daughter’s description of them. This research provides an important contribution towards young people’s stress and perceived parental pressures. It is important to note that the sample size was relatively small and obtained from only 2 schools. To investigate the validity of this research, a larger sample is required. Likewise, a possible follow-up interview at the end of high school would be interesting to see whether the girls’ perceived source of stressed changed throughout their education.

From reading this research, I can infer that girls from wealthy backgrounds are stressed. My interpretation is that their parents are trying hard to encourage their daughters to be academically successful, which is not necessarily a bad thing, however, perhaps these parents tend to encourage goals more towards achievement and extrinsic success rather than intrinsic goals. Since it is assumed that parents can be influential towards their children’s self-esteem, they have a big role to play in their mental health and wellbeing.

Ciciolla and colleagues (2017) have suggested that to increase wellbeing in young people from wealthy schools, parents should focus on promoting prosocial values that encourage healthy relationships and community at least as much as promoting educational attainment. Similarly, a focus towards promoting young people’s intrinsic interests, whether educational or not, has been shown to increase motivation and developing a sense of wellbeing (See Ryan & Deci’s self-determination theory for more information).

After researching for this post, I believe that coming from a low-pressure, working class household was beneficial for me. I did not achieve the best grades at school that I probably would have achieved if my parents were high-achieving and wealthy, but as a consequence, I learnt to encourage myself to work hard and I am thankful that I was promoted to be independent.

There is a lot of pressure for young people to strive for educational and career progression in today’s society, therefore it is important for parents to be aware of how their approach can contribute towards the already apparent stress placed on their children.


 

 

 

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