Pressure cooker

Patricia Deldin struggled with performance anxiety throughout her high school and college athletic career.

During a 1981 high school state track meet in Illinois, she choked under pressure while competing in the half-mile run.

“Halfway through the race, I felt I couldn’t move, and I slowed way down because my fear of performing in front of people was so strong,” says Deldin, a U-M professor of psychology and psychiatry and former deputy director of the Eisenberg Family Depression Center.

Anxiety continued to hamper her athletic performance into adulthood.

In her mid-50s, Deldin tested for a black belt in taekwondo, following years of training. Midway through judging, she forgot some of her moves. Performance anxiety also impacted her academic career when she developed a crippling phobia of public speaking. Still, she taught at Harvard University for eight years before joining the U-M faculty in 2003.

Not alone

As a researcher, Deldin became increasingly aware of the magnitude of the mental health crisis in America. An estimated 86 percent of the general population will experience mental health challenges over the course of their lifetime, according to a 2020 study on mental health disorders that appeared in JAMA Network Open. Even so, the resources to help these patients are inadequate, at best.

“We’re seeing rising rates of depression, anxiety, and suicide, especially in younger people,” Deldin says. “Whatever we’re doing to address this problem isn’t working at a population level, because things are getting worse in my field.”

In the first year of the COVID-19 pandemic, global prevalence of anxiety and depression increased by 25 percent, according to a scientific brief released by the World Health Organization in 2022. The pandemic has affected the mental health of young people, who are disproportionally at risk of suicidal and self-harming behaviors.

Nearly 50,000 Americans died by suicide last year, a 2.6 percent annual increase according to data compiled by the Centers for Disease Control and Prevention.

Drawing on her training as a neuroscientist and clinical psychologist, Deldin began searching for a solution that would simultaneously address four barriers to mental health care:

• the shortage of care providers
• the expense of traditional therapy sessions
• the lack of evidence-based treatment
• the stigma associated with mental health problems and care

The spark of an idea came from an unexpected source: a Weight Watchers meeting.

Adaptation is the key to success

On the journey to shed excess weight following the birth of her second child, Deldin had a revelation during a meeting of the popular weight-watching program.

“I thought: Why can’t we do this in mental health?” she says. “We can create a similar program that is science-based, highly effective, low cost, run by peers, and widely available.”

So, in 2014 Deldin and her lab, in collaboration with U-M colleagues, developed Mood Lifters. This mental wellness program enables people who shun — or can’t afford — traditional therapy to gain access to a mental health care program.

“I took everything I knew from the biological sciences, clinical psychology, and social psychology and created a program that anyone can access immediately,” Deldin says. “I wanted Mood Lifters to be cheap and led by trained leaders from the community to destigmatize it, so everyone can enjoy better mental health.”

With Depression Center funding, Deldin began testing the Mood Lifters program on adults in 2016. She was encouraged by the positive results.

To date, some 1,500 individuals have completed the 15-week program, reporting a dramatic reduction in their anxiety and depression symptoms, ranging from an average of 25-50 percent. Mood Lifters programs are tailored to meet the specific needs of college students, athletes, children and teens, senior citizens, and parents with chronically ill children.

Deldin, herself, benefited from Mood Lifters. In 2018, she delivered the presidential address at a Society for Research in Psychopathology conference.

“Mood Lifters helped me take control of my own fears and to overcome my public-speaking phobia,” she says. “My speech was well-received, and I now do a lot of public speaking.”

A life changer

Ann Arbor resident Teresa Kruse had no expectations when she volunteered six years ago to participate in a research trial for the 15-week mental health course. She had been laid off in late 2017 from her job as a customer success manager for an Ann Arbor technology company. She started the Mood Lifters class in January 2018.

“I came in as a healthy volunteer, but test data showed I improved in the areas of anxiety and depression,” she says. “I knew there was something special about the program.”

Mood Lifters delivered the tools and strategies Kruse needed to challenge negative thoughts, regulate her emotions, improve her mood, and solve everyday problems. It stressed the importance of sufficient sleep, sleep hygiene, and regular exercise. She embraced the program curriculum as “vitamins” for her mental health, and started leading Mood Lifters groups for the general public, members of the Ann Arbor YMCA, and parents with critically ill children.

Mood Lifters provided a lifeline to Kruse and her daughter, Miranda, after Miranda was diagnosed with stage three cancer in December 2021 and underwent surgery, several rounds of chemotherapy, and radiation. Miranda also had gone through the Mood Lifters program and become a group leader.

“Miranda and I felt the strategies we learned in Mood Lifters were critically important to this cancer journey and the way we both handled it,” Kruse says. “It was a life-changing experience, and we will be forever grateful.”

Back from the brink

Mood Lifters pulled Martin, currently a project manager at U-M Hospital, back from the brink of self-destruction in 2016. He asked that his full identity not be revealed in this article due to the stigma he feels around mental health treatment.

“Social norms make it difficult to express emotions and demonstrate vulnerabilities,” he says. “There are so many social pressures to just get through it. Expressions like ‘man up,’ and ‘take it like a man,’ make it unnatural to express these emotions in public. Because of this, many men suffer alone.”

He discovered the program at a point when he was struggling to balance work, career, relationships, and family.

“I was contemplating suicide,” he says. “I joined Mood Lifters to ‘check off the box’ that I was doing something to help myself.”

He participated in Deldin’s first pre-clinical study sessions, but sat in the back of the room, arms crossed and unresponsive. Even so, Deldin shared empirical proof through diagnostic evaluations that he had made progress after 15 weeks.

“I knew I had improved based on how I was feeling and what I was thinking, but to have this confirmed by test results was astonishing to me,” Martin says.

He returned to the program, this time with the commitment to complete the exercises and activities. This “homework,” coupled with in-person or online meetings, constitutes an important aspect of the curriculum by establishing a toolkit for continued growth and improvements.

“It helped me to see some of the thought traps I was falling into, to better regulate my emotions, and to examine my character strengths and values,” Martin says. “It also gave me a vision for the future in terms of where I want to go and what’s important to me.”

Martin landed a new position at U-M Hospital and improved communications at home with his wife and children. He also became a peer leader for Mood Lifters.

Yet, the stigma of mental health treatment still casts a long shadow.

A new Cleveland Clinic national survey of men’s health in America revealed 83 percent of men have experienced stress in the last six months, but 65 percent said they are hesitant to seek professional help for such mental health concerns as stress, anxiety, and depression.

“Mood Lifters helps break that stigma and provides tools to work through this,” Martin says. “I look forward to a day when mental wellness consulting can be discussed in the same way as physical fitness training, financial assistance, or getting advice on your car.”

Fostering mental wellness in students

Research shows college students, particularly grad students, are at greater risk of developing mental health concerns than other young adults. Frequently reported issues include “imposter syndrome” (self-doubt of intellect, skills, and accomplishments), strained relationships with faculty advisers, isolation within their wider social networks, and stress from a highly competitive academic environment.

A 2023 U-M study, published in the Journal of Consulting and Clinical Psychology, suggests that Mood Lifters for Graduate Students (ML-GS) is effective in fostering mental health awareness in this population.

The 131 college-age participants in the study were divided into two groups, one that took part in the curriculum and the other that was waitlisted.

Neema Prakash, BS ’21/PhD ’27, a research assistant in Deldin’s lab and co-author of the study, reports participants enrolled in ML-GS experienced significant, clinically meaningful reductions in depression, anxiety, stress, and other symptoms when compared to their waitlist counterparts. The changes made during the ML-GS program were also maintained at the one-month follow-up.

In contrast, students who were on the waitlist became significantly more anxious in the same time frame.

“I went through Mood Lifters in my sophomore year when I had relatives who passed away,” Prakash says. “The program helped me go through my grieving and work toward mental wellness without worrying about the cost.”

Elena Pokowitz, PhD ’28, who also is a lab assistant and peer leader, says Mood Lifters provided her with a wide variety of mental wellness skills and fostered connections with other people who had similar experiences.

“Financial and time constraints as well as knowing where to seek care can be huge barriers for graduate students,” Pokowitz says. ML-GS groups are low cost, offered online at a variety of times, provide care without the need for health insurance, and are advertised through departments on campus, she says.

Reducing feelings of isolation

During the height of the COVID-19 pandemic, mental health practitioners sought solutions for isolated and older populations, especially in rural areas, who were struggling to access mental health services.

Chelsea Hospital in Chelsea, Mich., responded by using private funds to offer Mood Lifters to senior citizens through its Outpatient Behavioral Health Clinic. The in-person program launched in May 2022 in partnership with the Chelsea Senior Center and debuted in September in collaboration with the Dexter Senior Center.

Among other benefits, the program provides early intervention and reduces social stigma to help individuals manage their mental health earlier in life, seek services when needed, and avoid downward spirals that may end in a crisis, says Ellen Fabes, manager of the outpatient clinic. “People loved it, and some Dexter participants have continued to meet with each other after the program ended,” she says

Thus far, 30 people have completed the program, and the outpatient clinic plans to offer the curriculum in nearby Manchester and Stockbridge through a research collaboration with Deldin and her team.

“One of the biggest benefits people derived was a reduction in feelings of isolation,” says Kathryn Walz, a behavioral health navigator at Chelsea Hospital, a joint venture between Michigan Medicine and Trinity Health.

Commercializing and scaling up

In October 2022, population health technology company Color Health announced its acquisition of Mood Lifters, the company Deldin founded and led from 2018-22.

The Silicon Valley startup plans to help public health departments, school districts, and other organizations provide behavioral and mental health care services at scale and for those in need.

Deldin and her lab will continue to conduct research, education, and training at U-M.

*The University had a financial interest in Mood Lifters, LLC. Deldin holds equity in Color Health.

(Lead image comes from iStock.)