Tag Archives: wellness

The Future of Mental Health Awareness (Month)

I wrote my reflections on mental health awareness and prevention as an Op-Ed piece and pasted it below.

The Future of Mental Health Awareness

As we exit Mental Health Awareness Month version 2026, I’m already anticipating May 2027. It’s time to rethink, rebrand, and reboot mental health awareness and prevention.

Think about it. Can you name a single mental disorder that, in your lifetime, has decreased in significance?

Depression? Anxiety? ADHD? Bipolar? As a mental health professional for the past 45 years, I’ve watched mental disorders in America stubbornly increase, despite more national, state, and local mental health awareness and prevention programs than ever before.

Mental health awareness and prevention are failing for multiple reasons, none of which are the fault of all the compassionate, hard-working, and well-intended people involved with mental health prevention. More likely, our collective failure begins with confusion over how to define mental health. Most Americans use “mental health” to describe mental health problems, mental disorders, or mental illness. Mental health is supposed to be positive and include joy, happiness, meaning, and mutually supportive relationships.

Instead, even the term “mental health prevention” is awkwardly phrased. Wait. Does mental health prevention mean we’re preventing mental health? Ironically, that might be exactly what we’re doing.

Without a positive vision of mental health, we’re left trying to manage, eliminate, or run from negative symptoms. Mental health should be something positive to strive toward. How about we start with the World Health Organization’s (WHO) definition of mental health? “A state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn and work well, and contribute to their community.”

Pretend for a moment that you’re a young person. You have two options. You can enroll in a program designed to reduce your anxiety and depression. Or you can enroll in a program designed to help you strive toward happiness, meaning, and realizing your abilities. Of course, this is a false dichotomy, but which direction do you find more hopeful and inspiring?

We also need to stop using unidimensional slogans to bludgeon community mental health from bad to better. Mental health awareness is a great example. Too much awareness of negative symptoms is not a good thing. More on this soon.

Research indicates that school-based mental health programs can adversely affect students. Providing prevention programming that simultaneously helps all students is a worthy, but unrealistic goal. Because preference is a powerful determinant of effective therapy, students might be better served by choosing from a menu of indirect mental health education activities.

Contemporary prevention programs also ignore several basic psychological principles.

When young people begin learning about mental disorders, a natural and powerful process begins. First, they learn about psychiatric symptoms. Then, they’re told these symptoms represent mental illnesses. Inevitably, they see these symptoms in themselves (or their friends) and begin self-diagnosing. Sometimes, the labels help explain their experiences and youth experience temporary relief. Who’s not reassured to learn that social anxiety is a thing? But, when the label gets too closely linked to identity, diagnosis becomes self-limiting. Students think: “I can’t pay attention because I have ADHD” or “My anxiety stops me from having fun and being around people.” And, because labels are sticky, it becomes difficult for young people (and adults) to shake the label and pursue their potential.

As you read these words, thousands of American youth are learning about their so-called mental disorders in at least two ways: on social media (via Tik-Tok, in particular) and through school-based mental health literacy/awareness workshops. More awareness and more information can make mental health worse—especially if the information is inaccurate or not applied with sensitivity and nuance.

Another psychological principle operates to sustain and deepen negative labeling. Like everyone, young people are inclined toward “confirmation bias.” They easily find evidence for their pre-existing beliefs while discarding evidence inconsistent with their pre-existing beliefs. If I believe I have anxiety and my anxiety limits my ability to participate in social activities, I will become skilled at noticing when my anxiety is adversely affecting me, while dismissing evidence that I’m strong and resilient enough to socialize with my peers.

What we pay attention to grows. Although my teenage clients would respond to this statement with “duh,” prevention programs ignore this concept by paying far too much attention to what’s wrong. We will not shrink problems by paying more attention to them. This is fundamental brain science. The more we focus on and talk about our problems, the better we become at focusing on and talking about our problems. The famous neuroscientist Donald Hebb put it this way: “Neurons that fire together, wire together.” The more we think about our problems, the more we’re teaching our brain to think about our problems. Soon, it becomes automatic, and you’ll be thinking about your problems all day long.

For 2027, let’s reboot mental health. Let’s redefine mental health as a positive emotional, psychological, and relational state. Then, let’s help young (and older) people develop strengths, skills, empathic relationships, positive experiences, and resources to successfully pursue positive mental health.

Together, we can turn Mental Health Awareness Month into a collective experience of joy and wellbeing for everyone.

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John Sommers-Flanagan, Ph.D. is a clinical psychologist and founding director of the Phyllis J. Washington Center for the Advancement of Positive Education at the University of Montana. He is coauthor of 10 books and many professional articles. The opinion expressed here is solely that of John Sommers-Flanagan and does not represent his current or former employers. You can email your thoughts to: john.sf@mso.umt.edu. For more information, go to https://johnsommersflanagan.com/ or https://www.umt.edu/education/cape

Neuroscience and Counseling and Psychotherapy Theories: John’s Historical Reflections

Everyone agrees: Neuroscience is cool. [See above for the cover of our forthcoming text, which everyone also thinks is cool.]

Neuroscience is also complex. Most of it goes completely over my head. My guess is that I’m not alone in having neuro-limitations in my understanding of all things neuroscience.

I do know enough to know when neuroscience is being oversimplified in ways that are misleading or problematically reductionistic. For example, as many of you know, I’m not a fan of the “amygdala hijack” or “fight or flight.” I’m also not a fan of polyvagal theory–which has gotten it’s share of comeuppance in recent weeks. (see: https://www.clinicalneuropsychiatry.org/download/why-the-polyvagal-theory-is-untenable-an-international-expert-evaluation-of-the-polyvagal-theory-and-commentary-upon-porges-s-w-2025-polyvagal-theory-current-status-clinical-applications-and/)

In our theories text, we try to straddle the “Wow, neuroscience is cool” enthusiasm along with holding a “Wow, that explanation of neuroscience seems oversimplistic” attitude. Below, is my biased personal reflection (over a 45 year period) which made the cut in the latest edition of our counseling and psychotherapy theories text. Enjoy!

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Historical Reflections

In 1980, I (John) began my career in mental health as a recreation therapist in a 22-bed psychiatric hospital. Many patients were actively experiencing severe depression, mania, auditory hallucinations, delusions, and aggressive behaviors.

An intimidating biological psychiatrist (Dr. M) roamed the unit. He would smile dismissively as I engaged patients in the “Newlyfriend Game” (like the old television-based Newlywed Game, only better), relaxation groups, bowling nights, and ice cream socials. Occasionally Dr. M cornered me, explaining how recreational programs had no influence on patients’ mental health. He waxed eloquent about brain chemistry. He acknowledged that the Thorazine and Haldol he prescribed had nasty side effects, but he claimed that eventually designer drugs that restored neurochemical balance and cured mental disorders would make everything else irrelevant.

The chemical imbalance theory of mental disorders dominated mental health etiology through the 1980s and 1990s. Etiological explanations focused on too much dopamine (causing schizophrenia) and not enough norepinephrine or serotonin (causing depression). No one knew what caused these so-called imbalances, but biogenetic factors were prime suspects. Although I kept silent with Dr. M, I held tight to my beliefs that social, psychological, and physical experiences could be therapeutic.

As I pursued graduate studies and accumulated post-graduate knowledge, I found evidence to support my beliefs about the two-way relationship between experiences and bio-physiological changes. One study showed that testosterone levels vary as a function of winning or losing tennis matches (Booth et al., 1989). If testosterone levels changed based on competitive tennis, what other ways might human experiences influence the brain? Another study showed that treadmill running increased serotonin availability in rats (Chaouloff, 1997). It seemed likely that acute physical exercise might also increase serotonin in human brains, possibly reducing depressive symptoms.

Then, along came two bombshells: epigenetics and neurogenesis. Epigenetics is an evolving term that refers to how behavioral experiences influence cellular activity, which, in turn, activates or deactivates genes, without altering underlying DNA (Ospelt, 2022). Environmental toxins, stress, smoking, and diet are experiences that can affect gene expression; these experiences may lead to physical changes and increased or decreased disease risk. One common implication involves how conditions of poverty predict adverse epigenetic changes—potentially increasing risk for negative physical and mental health outcomes (Assari & Zare, 2024).

Neurogenesis is the creation of new brain cells. It has been long known that during fetal development, cells are created and migrate to specific places in the brain and body where they engage in specific roles and functions. Cells that become rods and cones end up in the eyes, while other cells become bone, and still others end up in the cerebral cortex. In the 1980s and 1990s, everyone agreed that neurogenesis continued during infancy, but most neuroscientists believed that after early childhood neurogenesis stopped. In other words, as adults, we only experienced neuronal pruning (cell death).

In the late 1980s, neuroscientists began conducting research that shook long-held assumptions about neurogenesis. One research team (Jenkins et al., 1990) housed adult monkeys in cages where the monkeys had to use their middle finger to rotate a disc to get banana pellets. Even after a short time (1 week), brain autopsies showed that the monkeys had an enlarged region in their motor cortex. The conclusion: in adult monkeys, repeated physical behaviors stimulated neurogenesis in the motor cortex. This seemed like common sense. Not only do our brains shape our experiences, but our experiences shape the brain (literally).

As it turns out, neurogenesis slows with age but doesn’t stop. It continues throughout the lifespan. New learning stimulates cell birth and growth in the hippocampus (and other areas involving memory processing and storage). This “new brain research” left open the possibility that counseling and psychotherapy might stimulate neurochemical changes and cell birth in the human brain.

As brain research accelerates, implications and applications of neuroscience to counseling and psychotherapy have flourished (Satel & Lilienfeld, 2013). Practitioners have created new marketing terminology like “brain-based therapy,” “neuropsychotherapy,” “neurocounseling,” and “interpersonal neurobiology,” despite the lack of clear scientific evidence to support these terms. In some cases, the birthing of this new terminology has caused lamentation within the neuroscience, genetics, and academic communities (Bott et al., 2016; Horsthemke, 2022; Lilienfeld et al., 2015).

Appreciating Neuroscience and Epigenetic Complexities

Where does all this take us? As Dr. M would say, the brain and biogenetic predispositions are central to mood and behavior change. We now know that the reverse is also true: mood, behavior, and social interaction are central to brain development, gene expression, and change. The influences are bidirectional. More importantly, we need to acknowledge that relationships between and among brain structures, neurotransmitters, hormones, other chemicals, human behaviors, and gene expression are extremely complex and still largely unexplained. The whole brain is functioning, as well as regions, and inter- and intracellular processes, while doing all these activities both sequentially and simultaneously.

    Many students in psychology, counseling, and social work have strong interests in neuroscience. We think that’s great news. Neuroscience illuminates our understanding of psychological, emotional, social, spiritual, and other processes—and neuroscience will only grow in helping us understand what’s happening in the brain. That said, when we hear students say, “I love neuroscience!” we also feel concerned about where they’re getting their neuroscience knowledge. Too often, we hear students’ ideas about specific structures (e.g., amygdala, hippocampus, prefrontal cortex) or specific neurotransmitters (e.g., serotonin, norepinephrine, dopamine). Talking about the role of brain structures and neurotransmitters runs the risk of reductionism. Just as clients are much more than diagnostic labels, their aggression is much more than an “amygdala hijack.” Neuroscience is exceedingly complex. Most of us will learn just enough neuroscience from workshops and classes to practice simplistic reductionism. To emphasize neuroscience complexity, we would like to share a summary of a recently published neuroscience article. Here’s our selection for today (there will be more tomorrow). This is from an abstract of an article titled, “Mindfulness meditation and network neuroscience: Review, synthesis, and future directions,” published in the journal, Biological Psychiatry: Cognitive Neuroscience and Neuroimaging:

    In this review, we begin by defining network neuroscience and providing an overview of the common metrics that describe the topology of human structural and functional brain networks. Then, we present a detailed overview of a limited but growing body of literature that has leveraged network neuroscience metrics to demonstrate the impact of mindfulness meditation on modulating the fundamental structural and functional network properties of segregation, integration, and influence. Although preliminary, results across studies suggest that mindfulness meditation results in a shift in connector hubs, such as the anterior cingulate cortex, the thalamus, and the mid-insula. (Prakash et al., 2025, p. 350)

    Before reading this excerpt, you may have thought that the neuroscience on how mindfulness meditation affects the brain was straightforward. After reading this excerpt, please take a moment and bow in respect to the complexity of neuroscience and to the large brains of neuroscience researchers. In your spare time, you may want to similarly immerse yourself in deeper readings on epigenetics (Assari & Zare, 2024; Horsthemke, 2022; Ospelt, 2022).

    Welcome to Grand Forks, North Dakota [or, “How to get a good night’s (almost) sleep”]

    Apparently, it’s winter in Grand Forks, North Dakota. Who knew? Clearly not me. Being from balmy Montana where we’ve barely experienced any winter in 2025-2026, I arrived here in Grand Forks to the -25 F degree windchill without a stocking cap or gloves. What was I thinking, you ask? Well, maybe I was just in a here-and-now mindfulness state where the future had not yet arrived. Yep. That’s it. I didn’t forget to plan. I was just in the moment.

    In this moment, I’m in my hotel room prepping for three things:

    1. My keynote presentation at Red River H.S.
    2. My hoped-for good night’s sleep, and
    3. How to get to the airport and make it to Boston before I get frostbite.

    While prepping for these first two things I had an incredible epiphany and discovered or recovered the simple solution to insomnia. Some of this is old, so bear with me:

    Sleep is a challenge for much of the U.S. population. If you struggle with sleep, join the club. It’s a big club. We welcome you, principally because misery loves miserable company.

    There are three main forms of insomnia: (a) initial insomnia (aka difficulty falling asleep); (b) terminal insomnia (aka early morning awakening); and (c) intermittent insomnia (aka choppy sleep).

    Several other factors also interfere with sleep including children, pets, light, your neighbors starting up their chainsaw, alcohol, caffeine, temperature, nightmares, and more.

    This means that many Americans are awake in the night at times when they would rather be asleep. I know you’ve been there, done that, and will likely do it again.

    But when you’re there in that “I wish I was sleeping” state, did you ever have the epiphany that you should stop trying to get back to sleep? Sure, you have. Maybe you’ve even gotten up. But that’s not what I’m about to suggest.

    Because sleep is elusive and difficult to directly achieve, if you awaken in the night—and you have a pattern of insomnia—you could (and maybe should)—immediately let go of sleep as your primary goal. This is because if you have a goal and you’re not achieving it, you’re going to feel frustration and other unpleasant emotions (anger, sadness, anxiety, etc.) that are directly contrary to sleep.

    Do you recall the main characteristic of a smart goal? A smart goal is within your control. If your goal is not within your control, then it’s a dumb goal. Make sense?

    So, if you’re awake and struggling to return to sleep, try shifting your goal away from sleep and toward something that is, literally, the next best thing. You should shift to a goal of relaxation, of soothing, of comfort, of emotional peace, and of getting yourself into a generally pleasant state of mind and body. You can accomplish this via several strategies. You can meditate. You can count your breaths. You can use the Seligman technique of three good things. You can do progressive muscle relaxation. You can use the cognitive shuffle. Essentially, you can use anything you want that helps you get to an emotionally calm and pleasant state (although I recommend avoiding drugs and alcohol to get there).

    Or, if you need more info on this stuff, plus sleep hygiene, you can watch the video linked below.  

    The point is that, over time and with practice, you will begin to be able to achieve your very pleasant, almost sleep state. And physically, physiologically, and emotionally, the benefits of almost sleep are very close to the benefits of sleep. But—on the other hand—if you directly keep pursuing sleep as your primary goal, you will feel frustrated and less restored that you would with almost sleep.

    Experiencing frustration through the night offers you zero benefits.

    I’ve thrown out several ideas here and this may not feel like the ultimate fix for your sleep issues, but then again, expecting to find an ultimate fix for your sleep problems will likely only magnify the problem. For most of us, there is no ultimate sleep fix. There is just time alone in bed with our own brain and our own thoughts, and so teaching ourselves to be as comfortable as possible with our brains and our thoughts is a fantastic goal.

    If you want more on this, I’ve stolen the Module 3, Part 2 Sleep video from our Happiness for Educators course and the link is here (Note: for some reason, maybe because I pretended I was asleep at the beginning of this video, I seem—at least to me—to have a very slow pace in this video; of course, this may be a good thing; it could make you very, very, sleepy): https://www.youtube.com/watch?v=qOXW_5Df3UE

    As for me, I’m looking forward to up to 850 Grand Fork educators tomorrow, so I’m stopping here, not in search of a good night’s sleep, but in search of experiencing a pleasant mental and emotional state, which just might translate to a more restorative nighttime experience. . . and maybe even more sleep.