[MUSIC PLAYING] We are the Association for Child and Adolescent Mental Health, or ACAMH for short. Hello. And welcome to the In Conversation series with the Association for Child and Adolescent Mental Health, or ACAMH for short. I'm Mark Tebbs. I've been working in the mental-health field for over 25 years, including 15 years as a commissioner. If you're a fan of our podcast series, please subscribe on your preferred streaming platform. Let us know how we did with a rating and review, and do share with friends and colleagues. Today I'm really pleased to be interviewing Dr. Nic Hooper, psychology lecturer at Cardiff University in Wales. He specializes in an approach to mental health named Acceptance and Commitment Therapy, or known as ACT. Nic is an author of several books, including The Unbreakable Student, The ACT Diary, The ACT Journal, and The Research Journal of ACT. Nic, thank you so much for joining me. Could you start by just introducing yourself and maybe saying a little bit about your career today. First of all, Thank you for having me. I really appreciate the opportunity to chat to you, especially about all things student mental health. With regards to my career, I am a lad from Wales. I'm a lad from a low socioeconomic background. But I managed to have supportive parents. I managed to have great teachers. And I managed to get lucky a lot of the time, including during my degree, where I was randomly appointed to a new lecturer in the Department of Swansea University, who taught me about ACT. And prior to that, I really wasn't that in love with psychology as a discipline. But upon meeting ACT, everything sort of changed for me. And that lecturer, a professor now at University College Dublin, she asked me if I would like to do a PhD. And to be quite frank, I had no other plans whatsoever. And so I said, yes, without really fully understanding what a PhD was. And my PhD ended up specializing in thought suppression. So like, how our attempts trying not to think certain things or feel certain things probably isn't the best strategy for managing unwanted thoughts and feelings. And if avoidance wasn't the answer, then what is the answer? So the second half of my PhD involved research in ACT as an alternative to avoidance in the management of unwanted thoughts and feelings. And post my PhD, I was lucky enough to get a research job with wonderful people at the University of Kent. After that, I went on an adventure to the north of Cyprus with my girlfriend at the time, who's now my wife. And I lectured in a University there for a couple of years. And since then, I've worked at Warwick University, University of West of England in Bristol. And now I'm at Cardiff University. And in each of those places, I lecture within the psychology department, and I run research evaluating ACT. And it's nice for me at the moment to be at Cardiff because I'm from Cardiff. And so in some ways, I left when I was 18 years old, and it's taken 20 years to come back home. And so I'm feeling very settled where I am at the moment. Apart from that, I've got two boys-- a seven-year-old and a six month-year-old who I love dearly. And now, a smelly old dog called Dora, who we adopted from Cyprus, though, she actually probably adopted us more than us adopting her. What was it about ACT that so captured you? Great question when people start learning about ACT, what they learn about is like the technique. They learn about the different processes of ACT that are used by a clinician when working with an individual. What they don't often get taught about ACT to begin with is where it came from, and what makes it fundamentally different as an approach to mental health problems than a lot of the stuff that's come before. And so I'm going to try and really briefly walk you through that. And actually this-- why don't we talk later on about student mental health? I think that all of that will make sense in the context of what I'm about to say. ACT comes from the perspective that mental health problems are not necessarily caused by abnormalities inside of people. We too easily as a society get caught into thinking that mental health problems happen as a result of chemical imbalances, or poor cognitive systems, or these things that place the blame for mental health problems within a person. ACT doesn't come from that perspective. And this was the first thing that made me really love ACT, was that ACT comes from the perspective that context-- historical and present moment context-- contribute to the development of mental health problems. So, for example, if you happen to have a wonderful relationship with a loving partner. And God forbid, that loving partner ends up passing away through some illness. That change in context is surely going to play some role in you feeling something different and thinking something different inside. So ACT comes from the perspective that context is the most important factor when it comes to the development of mental health problems. That's the first thing. And then the second thing that ACT says if you look at context, if you look at the context of human lives, lots of stuff happens within the course of a human life that isn't that great. We experience things like isolation or frustration or exhaustion or injustice. We might happen to find ourselves in the middle of a world changing pandemic. We might happen to live with a physical disability or chronic pain. We might have lost loved ones or lost our jobs. Like, lots of stuff that happens to human beings isn't that nice. Thus far, what ACT is saying is that context causes mental health problems, and that a lot of the context of human-- that human beings go through isn't particularly nice. And then what ACT says is that not only is context not particularly nice for human beings sometimes, but also, we've got this brilliant skill that has made us the dominant species on the planet, but also comes with some side effects. And that is human language. Like, we shouldn't be able to outmaneuver lions and other incredible creatures out there. They're faster than us. They're stronger than us. They're tougher than us. And yet, we manage to outwit them. And we do that because of our cognitive abilities and our language and our cooperative behavior. But, of course, those same skills also allow us to evaluate and reflect and compare and analyze-- those things that are likely to be at the heart of psychological troubles. So then what ACT says is brilliant, which is if context causes mental health problems, and if context is hard, and we've got these added language skills, do you know what that means? That means the mental health problems, even though they've been painted by the world as abnormalities, they're actually a normal part of being a human being. Unwanted thoughts and feelings, psychological discomfort inside us, rather than being something that's abnormal, something that we need to get rid of, all of a sudden, those things are less scary because they're a normal part of being a human being. And therefore, mental health stigma goes away. If someone is suffering from a mental health problem, from my perspective and ACT perspective, it's not their fault. They've emerged out of a certain context. And that just allows me to interact with people with connection and compassion and empathy, which I find a really functional way of being. And then you get to avoidance, which is even though suffering psychologically is a normal human experience because of context, because life is hard, because of our language skills, the world is painted it to be abnormal. The world has painted happiness to be the normal state of affairs. And so because of that, when inner discomfort comes along we're like, oh, dear. What do we do with abnormalities? We've got to get rid of them. And so then what we do is we devise all these proper unhelpful ways of trying to get rid of our inner discomfort, rather than acknowledging it as part and parcel of being a human being. And then what we do is we drink too much to control our feelings, to feel better. We eat too much. We isolate ourselves. There's lots of different ways that are essentially all functionally the same, which they're all avoidance efforts. And not only that-- and I know that I'm ranting now, but I'm going to keep going because I'm on a roll. Not only that, but what we start to do is we start to realize that if we avoid certain situations, we're likely to avoid our exposure to painful thoughts and feelings. An example I sometimes give is based on an experience I had when I was 15 years old, which is when I fell madly in love with a girl as a result of going on holidays. And we used to go to the cinema every Wednesday. And prior to meeting this girl cinema was something that I really loved to do. Now, we went out for a little while. And then this girl, she dumped me for a lad that had a car, which happens. And, of course, that left me feeling a load of pain. A few weeks after that, I remember a friend messaged me saying, hey, do you want to go to the cinema? I was like, no, I don't want to go to the cinema. That's going to remind me of the pain. And so all of a sudden, my life had constricted. It had narrowed. I was now not doing something that I liked to do in order to avoid pain. That's like another way in which avoidance can make things worse. It can exacerbate the suffering. So ACT comes from the perspective that sort of avoidance underpins all psychological suffering, all psychological disorders, irrespective of what you want to call them. And then that's the point that ACT steps in and says, right. What we're going to do as an approach is we're going to help people to not avoid. We're going to help people to look at their discomfort and their suffering in the eye, and to not react to it in really unhelpful ways like it's something that we need to change and get rid of in order to avoid being abnormal. And so it aims to develop what's called psychological flexibility-- the ability to sit with and have inner stuff that isn't particularly nice whilst controlling our behavior, whilst continuing to do the things that are important to us. And for me, that brought me liberty as a 19-year-old, 20-year-old. It allowed me to see that unwanted thoughts and feelings were not cues or signals or triggers to not do stuff, which is what they had been prior to that point. It allowed me to see that I could do things even when I felt uncomfortable, even when I felt down or felt anxious or any of those things. And so it's really ACT's conceptualization of mental health, a fundamentally different one that really drew me to the approach in the first place. Thank you. And I think it'd be really useful for us to spend a little bit of time thinking about why student mental health is such an important issue. I think it would also be then useful for us to think about what can be done to support students at university. And then I think our listeners will also be interested in that wider student network. I'm particularly thinking about parents and carers and what they can do to support their children at university. So the first one was really just related to the start of your book. So the book starts with a description of Sarah, who's kind of isolated and feeling suicidal. And it really brings home what a challenging time university can be. So in your experience, why is student life so difficult for so many students? The reason why that-- the reason it's there is because it was such an impactful experience in my life. Because prior to that, the words "student suicide" was something I saw in newspapers or magazine articles. Or even now these days, there will be people out there listening that will scroll through their phones. And that experience-- and I was young when I went through that. It was during my PhD at Swansea University. It really opened my eyes to the human beings that are underneath those words-- such an important experience of mine. And this was a student who was struggling-- who was struggling with university life. Now, this particular student was also struggling with other stuff outside university life. There are students out there who leave their homes where they have loving parents, where they have stable friendship networks, where they're in education that is supportive and offers good pastoral care because that's what tends to happen when you do your A-levels in the UK. And then that student who is thriving in that context changes city. They now are living away from that context. And they're thrown into an entirely different context, one in which they've now got to manage their own finances. And if they don't do that properly, they are going to find themselves with limited opportunities to do stuff. They need to be able to cook for themselves. They need to be able to look after sleep without someone saying to them, by the way, you need to go to bed. They need to be able to exercise. And then they get-- they're living with brand new housemates. And then you've got the fact that they've got to throw themselves into social situations with society. And then you get essays. And you get exams. And you get presentations. And you get a whole new level of complexity with regards to academic work that makes you think, am I good enough? That makes it hard. And so those transitional students, those year one students, that first semester is hard for a lot of students because of that change in context. Outside of that, students are probably having to deal with stuff that I myself wasn't having to deal with, which is climate change and the lack of response. It costs a lot more money to go to university these days. There doesn't seem to be a whole load of jobs for students afterwards. So students will be constantly worried about, am I wasting my money? And that's without COVID. If I was to put my money somewhere as to why some students-- by the way, not all students. Some students are just perfectly fine-- but why some students struggle at university, I would put it down to that change in context. That's a lot to deal with when you describe it in that way-- the rapid change and dealing with both the long-term debt issue, but also struggling with the cost of living crisis and the bills, et cetera. It's a lot for people to be coping with. You mentioned the impacts that COVID has had on this generation. What's your sense of the impact of that on the cohort of students? Before I answer that question, I feel as though in the last answer that I gave I failed to do justice to the people that do come to university and thrive. Students can come and have the time of their life at university. And I wouldn't want people out there in the world to be really worried for their kids and stuff because plenty if students do absolutely fine. But some students do struggle, which is why it's so important to figure out how to support those students. With regards to COVID, our current year 3s-- man, I feel sorry for them. Because year one was no lectures. So they're in their rooms a lot of the time and not leaving their room. So they're isolated whilst watching online lectures. When they're doing their assessment then, even their exams, they're doing them at home. And now that same cohort are now missing valuable lectures as a result of the strikes. And so I feel really sorry for this particular cohort. But what we've seen from that cohort as a result of COVID-- elevated levels of anxiety with regards to face-to-face exams. They have not been trained for face-to-face exams to be able to go into a hall with a pen and paper in front of them, and no books, and no sort of materials whatsoever to help them, and remember stuff off the top of their head to put down on paper. And that's such a shame. Because what you get is the people that are particularly anxious tend to be the people that perform not so well unless they've got real good strategies for managing their anxiety. COVID functioned to isolate people and to stop them from doing things that might ordinarily push them out of their comfort zone. I think being able to step out of a comfort zone is a generalized skill, and you get it from stepping out of your comfort zone relatively consistently across the course of our life. And I think that as a result of that, there's more of a fragility among our students than I've seen in the past. And so COVID, no doubt, functions to make things worse for students. And Student Mental Health Day is trying to make student mental health more of a priority for the whole university community. And I think you've answered some of this. But why should we be focusing and prioritizing on student mental health? There's a way to answer to this question that isn't cold and analytical, and there's a way to answer it that's cold and analytical, so I'll do that first. Why should we be focusing on prioritizing student mental health? The easy answer to that is because there's demand. Student counseling services seem to be [? overfun ?] just in this particular population of people seem to be suffering, and we need to do something to help. The less cold reason why we should be doing something to prioritize student mental health is because those kids are our kids. I look at my seven-year-old, and I think one day he's going to be an 18-year-old, and for the first time in his life he's probably going to be at university, and he's probably going to be fending for himself. It's a hard thing for a person to have to do that. And when they do get to that stage and they're on their own, I think they need more from the University community to help them with what is essentially the transition from dependence to independence, or from being a child to being an adult. That, for me, is why we should be focusing on [? prioritize-- ?] when I look at my students, I see my son. Sometimes I think that when I'm going above and beyond for students, I'm doing so because in my mind, I'm making a deal with the gods of karma that one day, when my son is them, someone like me will step in and just help just that little bit, just offer that ear, just do something to change how they view things, to change how they act in a way that will be functional for them in their lives. Yeah. I like both approaches to your answer there. Undoubtedly, there is kind of increased demand. But it's such an important period of time, that kind of transition into adulthood, and all of the kind of issues of identity that kind of go with that transition. Could you tell us a little bit more about whether there are particular groups of students who are more vulnerable to mental health issues at university? And is there kind of any evidence around the best way to identify those most at risk? At Cardiff University, I oversee a peer support initiative that has been created to try to help students from particular populations that are at greater risk of suffering from poor mental health. The reason why the peer group thing happened was, first of all, it came from the students-- the students that had noticed that certain groups of students could just do with a little bit of an extra help up. And then I came across a report that was written by the Center for Transforming Access and Student Outcomes, or TASO. It's an independent charity that's funded by the Office for Students. And it produced a report about mental health inequalities. And it suggested that the following groups were at risk of suffering from poor mental health-- so students from low socioeconomic status backgrounds; students from Black, Asian, and minority ethnic backgrounds; mature students; LGBTQ+ students and care experienced students. And I think there's also something to be said from students that identify as neurodiverse. And then the second half of the report detailed, OK, so what can be done to help these particular subgroups of students? And what came out of that was the importance of peer support. And so what we've done at Cardiff University is tried to put in place peer support groups that are student-led, supported by the school and me, in particular, to try and provide some sort of mechanism to help those students with regards to their mental health. And, of course, what happens with a students' mental health directly impacts how well they do academically. And so that is obviously the hope is that students' mental health in these subgroups improves. And therefore, their academic performance improves as well. We mentioned your book The Unbreakable Students is based on ACT principles. How can students best look after themselves? But you know what? I'll tell you a secret. I hate self-help books. I do. I hate them. Because I think that they provide simple answers to complexity. Human suffering is complex, and I don't think that there are simple answers. Now, the best way to answer your question is to go, they should read my book. It'll give them all the answers. And all of a sudden, they're going to be zen and happy human beings as soon as they've read it. But that would be so inauthentic because it would give a simple answer to what is really, really complex. And like when I wrote the book I wanted it to have depth and nuance and almost a sense of these are some things that I think I know, and you may or may not find them helpful. I hope that you do find them helpful because I understand how complex like human suffering is. My book in some ways, it does provide an easy solution or an easy answer for students that will help them to look after themselves when they're at University. And that simple solution are basically the chapter titles. So the chapter titles, they map onto the six ways to well-being. Now, a lot of people listening will probably have heard of the five ways to well-being, which was put forward by the New Economic Foundation. But the six ways to well-being was created by a researcher called Dr. Geentanjali Basarkod, who was an ex-student of mine at Warwick University, actually. But she's working in Australia at the moment. And she ran huge research studies essentially to figure out the answer to this question. Happy people-- what do they do a lot of? What are the behaviors of happy people? Because if we know the behaviors of happy people, then people that are unhappy, we can say to them, do more of these behaviors. This is what happy people do. And so some of those behaviors, the six ways to well-being, would be to exercise, to challenge yourself, to connect with people, to give to people, to embrace the moment, and to self care. And so in some ways, an easy answer to your question is if students want to look after themselves when they're at universities they need to do more of those things. It's as simple as that. And so if I was a student listening to this, or if I worked with students and I had someone that was struggling, that's exactly where I'd start. I'd start with let's figure out how you can do more of these six things. The complexity comes from the fact that as we go to exercise or challenge ourself or connect with ourself-- with people, what we're going to find is that the human mind is going to get involved, and it's going to start putting barriers in the way. So like if you go to exercise, your mind is going to say, oh, it's raining outside. Don't go and exercise today. Imagine you want to ask someone out on a date. Your mind is not going to be your friend. It's going to say you're not worthy of this person. Or they're going to shoot you down, and everyone in the canteen is going to laugh at you. I mean, your mind is going to get in the way and stop you from moving towards these important well-being behaviors. And so the next question is, OK, so what do we do with our minds when they stop us from moving in personally important directions? And that's the [INAUDIBLE] ACT was included in the book because it provides a way of managing thoughts and feelings. Now ACT, as an approach, it aims to develop people's psychological flexibility. And what that means is it wants people to be able to be willing to have their unwanted thoughts and feelings, to take them with them as they do things that are important, and it gives six key skills or processes that help to develop psychological flexibility. And in the book I took talk through some of those processes. Thank you so much for today's podcast. It'd be great to know what you're planning next. Is there anything in the pipeline that you'd like to share with us? First of all, I'm the co-director of an organization called Connect PSHE. And we've been working for about six or seven years to create a well-being curriculum for primary schools that sits within the statutory requirements of PSHE. It's over 250 lesson plans that are delivered from reception to year six. So it's a-- it's the biggest ACT intervention there's ever been created sort of thing. Recently, we ran our first research study in collaboration with Bangor University with over 700 students. And the research study showed that just 18 lesson plans out of the 250 delivered to year five children significantly improved well-being. And also, the themes of Connect are the six ways to well-being that are in the book. And so it's basically, the whole point of the curriculum is, how do we get our kids to challenge themselves more, to exercise more, to embrace the moment more, to self-care more, to give to others more? So we're really proud of it. But I think maybe the more exciting thing for me in the short-term is-- in fact, someone is probably going to steal the title because I have not even written the book, but I'm going to say it anyway because I think it's cool. I want to write a book called How to Become a Dog. The beauty of The Unbreakable Student is it managed to weave messages of psychology and mental health and self-help into what's essentially a story. And I think that's the way to reach people with mental health messages, not through technique-driven self-help books. And so I want to tell the story of my dog Dora, who I met on the streets of Cyprus, and try and weave some psychology messages into that story. And so I think of it like this. Whereas, Marley and Me was a dog book written by a journalist, How to Become a Dog is going to be a dog book written by a psychologist. And so that is the thing that I really want to start thinking about. Although, if one of your listeners now steals that title, I'll be furious. [LAUGHS] It is a great title, I have to say, and great idea, too. Nic, is there a final take-home message for our listeners? I guess it depends on who the listeners are. Like, if the listeners are parents, or if the listeners are students themselves, maybe the message is similar across both those groups. Being a human being isn't straight forwards, and mental health isn't straightforward. If it was straightforward, if mental health was a straightforward problem to solve, then mental health wouldn't be such a big thing that we talk about in society today. And so I don't think that simple solutions exist to the mental health problem. I think it needs more thoughts and more depth. And whilst the awareness that's been created around mental health is brilliant, sometimes I worry that it's still being pathologized. It's still being painted as something that's very abnormal, and therefore, a problem to be solved. And that's why I love ACT because it doesn't paint mental health problems as a problem to be solved, but a normal part of being a human being. And as soon as I take that position, it allows me to relate to those inner experiences really, really functionally, and to continue to move my feet towards what's important. And so a take-home message for me I guess would be don't look for really simple solutions to psychological discomfort. But do know that it is possible to have our discomfort and still do things that we find personally meaningful. Your thoughts and your feelings-- they're going to change the clouds. They're going to come, and they're going to go, and they're going to come, and they're going to go. And the bad stuff is going to come, and it's going to go. And the good stuff is going to come, and it's going to go. And I think the most important thing that we can do when bad stuff comes along is just keep doing the things that make our life work rather than shut down, which is what a lot of us will do. Thank you so much, Nic. It's been a real pleasure talking to you today. For more details on Dr. Nic Hooper, please visit the ACAMH website at www.acamh.org, and Twitter @acamh. ACAMH is spelled A-C-A-M-H. Don't forget to follow us on your preferred streaming platform. Let us know if you enjoy the podcast with a rating or review, and do share it with friends and colleagues. [MUSIC PLAYING]