Learning to Say No

No Signs

The holidays are in full swing and brings with it wish lists, and often the desire for more screen time spent on newly received devices. Why are we as parents and educators afraid to tell kids “no” about this, and many other issues? This week Screenagers explored this very topic and how we can make setting a boundary a more effective, and positive situation.

How to Say No Effectively

There are so many reasons why for many youth screen time has crowded out activities and interactions that would benefit them—in other words, why they are experiencing excessive screen time.

One of the reasons is the inner discomfort that many parents (and teachers) feel from saying “no” to their children and teens. Saying no and being able to tolerate the myriad of emotions that result, such as guilt, self-doubt, and sadness is challenging for many people. On top of that, the child may add on their own negative emotions to the “no,” such as anger and disgust. Having to tolerate any one of these emotions, let alone several of them at one time, is a major undertaking.

Perhaps you have been wanting to set new limits, such as saying “no” to screen time in the car, “no” to screens in the bedroom at bedtime, “no” to screens at the dinner table. I will give some tips below but first these insights.

I have thought long and hard about how challenging it is to tolerate the discomfort of setting boundaries and saying no, not only from my viewpoint as a researcher and speaker on tech and parenting but also from my 25 years of practicing medicine. The hardest “no” that health providers are confronted with over and over is a person requesting opioids when the provider does not think the opioids are in the best interest of the patient.

What has frankly shocked me over the past couple of years with the discussions on the causes of the opioid crisis is that I never hear anyone (reporters, authors, policy makers, etc.) bring up the fact that a contributing cause to this crisis is the fact that health care providers often prescribe these medicines because they can’t tolerate the backlash from saying “no.” We hear reasons about how the drug companies told providers that the long-acting opioids were not addicting, about broken health systems, and others, but the human interactions in the providers’ offices are ignored.

In medical school, students learn next to nothing about addiction medicine. This amazed me since so many of the patients I was seeing in the hospital were there due to addictions (lung disease and tobacco, liver disease and alcohol, and so on). I decided to do an elective in addiction medicine and had the good fortune of having an incredible mentor, Dr. Barry Rosen. He would always tell me that, “The surgeon has her tool, a scalpel…my tool is my words.” Watching Barry lead complex dialogues, laden with intense emotions from his patients such as shame, denial, and hope, was true mastery in action.

I went on to do research and short films on doctor-patient communication, opioid requests, and recovery.  In the films I talk about one way to stay compassionate when setting boundaries is to remind oneself that it is the addiction talking (or crying or yelling), and not the person. That person at say 15, or pick any pre-addiction age, would never have thought to themselves “I would love to be a slave to heroin, wouldn’t that be great and how cool to know that I could die each time I use it.”

The real skill of a health provider is in their effective communication to be able to maintain a connection with the person so that along with a “no,” come discussions about why the “no,” collaborative decision making for alternatives and at times conversations about recovery treatment. Daily my heart hurts when I think of all the people and families dealing with an addiction of any type. If you are interested to hear about the many solutions happening around the opioid epidemic, my dear friend Ann Boiko just launched a wonderful podcast series on iTunes called Finding Fixes. I recommend listening to an episode with your teens.

Back to our topic of saying “no” to prevent excessive screen time. Here are some tips.

Prepping to say the “no”

  1. Spend time writing out why you want to set this screen limit so you feel confident that it is an overall positive thing for your child—such as providing undistracted time for better sleep or for them to build in-person relationships.
  2. Remind yourself that there are hundreds of studies that show parenting with love, but with boundaries, leads to the best outcomes (vs. command and control type parenting or a passive parenting style.)
  3. Baby steps are key. Just pick one thing you have wanted to say “no” to and work on that single challenge. Start with the easiest one.
  4. Know that you are modeling to your children, students, girl scouts, etc. the deeply important skill of “acting with integrity.” If you really believe, as I do, that having times undistracted by devices is good for youth (and all of us), then you are showing them that you are willing to act in line with your beliefs even though it means stepping into discomfort.

Fostering autonomy

Achieving greater autonomy as one enters adulthood is a primary human need. Whenever possible give your child some agency around the “no.” For example, you realize that you think that it is more beneficial to your 13-year old that devices, including the phone, no longer be in her room at bedtime. You do the steps above and now want to appeal to her need for some control. Ask something like, “What time are you thinking the phone should be put away? Should I come and get it or should you give to me at that time?”

Holding person accountable

One of the biggest gifts we give is holding people we care about accountable for their actions. It takes energy to do this and yet payoffs are well worth it. So know as you do the work to enforce the “no” that you are giving a gift, one of energy and dedication.

Here are some questions to open a conversation around “no.”

  1. As always start a conversation about the positives of tech such as what cool tech activity grabs everyone’s attention the strongest these days.
  2. If your child currently has any devices with them in the bedroom at bedtime, ask the reasons they like having your devices in their room with them.
  3. What time do they think is a reasonable time to put devices away, out of their room?
  4. Discuss other possible “no” situations related to screens that you may wish to create.

If you, or a loved one is struggling with an addiction to technology call Tamara Ancona, MA, LPC at (678) 297-0708 for an evaluation, and to discuss the best treatment options available.

7 Scientifically Proven Benefits of Gratitude


With Thanksgiving upon us it’s a great time to reflect on gratitude. Psychology Today recently published an article on seven benefits of gratitude, below. As you go throughout this week of giving thanks we wish you a most blessed and Happy Thanksgiving from TAG Counseling.

“Stop feeling sorry for yourself,” we are often told. And while it can be hard to avoid self-pity entirely, mentally strong people choose to exchange self-pity for gratitude. Whether you choose to write a few sentences in a gratitude journal, or simply take a moment to silently acknowledge all that you have, giving thanks can transform your life.

Here are 7 scientifically proven benefits:

  1. Gratitude opens the door to more relationships. Not only does saying “thank you” constitute good manners, but showing appreciation can help you win new friends, according to a 2014 study published in Emotion. The study found that thanking a new acquaintance makes them more likely to seek an ongoing relationship. So whether you thank a stranger for holding the door or send a thank-you note to that colleague who helped you with a project, acknowledging other people’s contributions can lead to new opportunities.
  2. Gratitude improves physical health. Grateful people experience fewer aches and pains and report feeling healthier than other people, according to a 2012 study published in Personality and Individual Differences. Not surprisingly, grateful people are also more likely to take care of their health. They exercise more often and are more likely to attend regular check-ups, which is likely to contribute to further longevity.
  3. Gratitude improves psychological health. Gratitude reduces a multitude of toxic emotions, from envy and resentment to frustration and regret. Robert Emmons, a leading gratitude researcher, has conducted multiple studies on the link between gratitude and well-being. His research confirms that gratitude effectively increases happiness and reduces depression.
  4. Gratitude enhances empathy and reduces aggression. Grateful people are more likely to behave in a prosocial manner, even when others behave less kindly, according to a 2012 study by the University of Kentucky. Study participants who ranked higher on gratitude scales were less likely to retaliate against others, even when given negative feedback. They experienced more sensitivity and empathy toward other people and a decreased desire to seek revenge.
  5. Grateful people sleep better. Writing in a gratitude journal improves sleep, according to a 2011 study published in Applied Psychology: Health and Well-Being. Spend just 15 minutes jotting down a few grateful sentiments before bed, and you may sleep better and longer.
  6. Gratitude improves self-esteem. A 2014 study published in the Journal of Applied Sport Psychology found that gratitude increased athletes’ self-esteem, an essential component to optimal performance. Other studies have shown that gratitude reduces social comparisons. Rather than becoming resentful toward people who have more money or better jobs—a major factor in reduced self-esteem—grateful people are able to appreciate other people’s accomplishments.
  7. Gratitude increases mental strength. For years, research has shown gratitude not only reduces stress, but it may also play a major role in overcoming trauma. A 2006 study published in Behavior Research and Therapy found that Vietnam War veterans with higher levels of gratitude experienced lower rates of post-traumatic stress disorder. A 2003 study published in the Journal of Personality and Social Psychology found that gratitude was a major contributor to resilience following the terrorist attacks on September 11. Recognizing all that you have to be thankful for —even during the worst times—fosters resilience.

Can Teens get Addicted to Fortnite?


Can teens get addicted to Fortnite? Fortnite is an online video game, released in 2017 by Epic Games, that has multiple playing modes. The most popular mode is the Fortnite Battle Royale, a game where up to 100 players battle to the death. After jumping out of a plane onto an island, a Fortnite player fights against 99 other players. The gruesome mission is to kill everyone until one winner remains.

Although the cartoon-style gameplay is not realistic, the game’s violent nature is apparent. Newport Academy recently published this article to discuss the ramifications of Fortnite and it’s effects on youth today.

Fortnite Success and Video Game Addiction 

More than 125 million players have participated in Fortnite Battle Royale. Since players can improve their weaponry by buying upgrades, Fortnite’s success has led to a dual economic and cultural phenomenon. Children addicted to Fortnite have created a huge revenue generator for Epic Games.

Indeed, Forbes recently reported that Fortnite brought in $126 million in February of 2018, $223 million in March, and $296 million in April. Given the tremendous cash flow, Epic Games is forming a $100 million prize fund. In the future, the fund will feed Fortnite competitions, giving financial prizes upwards of $25,000 to competition winners.

Fortnite Addiction a New Mental Health Disorder 

In response to the growing number of teenagers addicted to Fortnite and other video games, the World Health Organization (WHO) recently classified gaming disorder as a mental health condition. Released in June 2018, the WHO’s International Classification of Diseases revision included gaming disorder for the first time.

According to the classification, gaming disorder is defined as “a pattern of gaming behavior (‘digital-gaming’ or ‘video-gaming’) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.”

Although the video gaming addiction classification is not exclusive to Fortnite, concern over Fortnite use may well have been a driving force behind the decision. The problem of teenagers addicted to Fortnite is at the forefront of the issue.

Therefore, parents need to learn more about why and how kids become obsessed with Fortnite. Moreover, as with all substance use disorders, Fortnite addiction is the result of underlying mental health challenges and the impact of the substance on the brain.

Hence, treatment for video gaming disorder needs to address the root causes, rather than simply addressing the symptoms of addicted teens. And these are both individual and societal.

Why Kids Get Addicted to Fortnite

Playing video games like Fortnite directly impacts a teen’s developing brain. According to the American Psychiatric Association, “Studies suggest that when these individuals are engrossed in Internet games, certain pathways in their brains are triggered in the same direct and intense way that a drug addict’s brain is affected by a substance. The gaming prompts a neurological response that influences feelings of pleasure and reward, and the result, in the extreme, is manifested as addictive behavior.”

Moreover, there is a connection between excessive video gaming and mental health conditions. Research shows a correlation between addiction to video games and the prevalence of depression and anxiety. Thus, an outer behavior, such as Fortnite addiction, is a sign of inner discontent. Such discontent may result from trauma, depression, anxiety, or other conditions.

As Louise Theodosiou of the Royal College of Psychiatrists explained in a televised interview, “There’s a growing body of evidence that shows that there’s very specific mental health needs that can be associated with gaming disorder—for example increased rates of depression, increased rates of social anxiety, and ADHD.”

Know the Symptoms of Fortnite Addiction 

By knowing the signs of video game addiction, adults can help prevent teens from becoming addicted to Fortnite.

Fortnite addiction symptoms include the following:

  1. A teenager plays Fortnite all the time, quickly going from one or two hours a day to spending every free moment playing.
  2. A teenager neglects school to play the game—pretending to be sick, ignoring homework, and abandoning extracurricular activities.
  3. A teen ignores family responsibilities and consistently chooses the game over family obligations.
  4. Kids let their appearance go. Personal hygiene becomes unimportant.
  5. Teens have health issues that arise from aberrant behaviors. Staying awake all night playing the game leads to mood swings.
  6. Teenagers may steal money to pay for upgrades. They’ll charge the costs on a credit card online without parents’ knowledge.

Fortnite Addiction and the Competitive Instincts of Parents 

Rather than recognizing and addressing video game dependancy, some parents encourage their teenagers to play. The recent announcement of the Fortnite World Cup, with $100 million in prize money, has provoked the competitive instincts of both teens and parents. As a result, awareness of Fortnite addiction problems goes down.

However, the problem of teenagers addicted to Fortnite is becoming recognized around the world. In the United Kingdom, a well-publicized story of a nine-year-old girl sent to rehab by her parents after choosing to wet herself in order to keep playing characterizes the challenge.

In addition, a recent study in England and Wales showed that Fortnite addiction and video game dependency contributed to 5 percent of all divorces in the United Kingdom, roughly about 4,000 divorces in 2018. Therefore, the impact of Fortnite addiction extends beyond teens.

Fortnite Use Fueled by Social Pressures 

For teenagers addicted to Fortnite, the game has become a way to build false self-esteem. And, since winning gives kids bragging rights, like hitting a home run in a baseball game, some parents want their kids to win. Indeed, “soccer moms” and “dugout parents” fervently rooting for their kids have morphed into video game parents.

For example, when discussing why he hired a Fortnite coach for his kids, a sales executive from Georgia explains to the Wall Street Journal, “Our skills were nowhere near where we needed them to be.” Thus, Fortnite dependence becomes not only acceptable, but also rewarded.

Help for Video Game Addiction Is Available 

Should parents worry about kids becoming addicted to Fortnite? The evidence shows that it’s a real possibility.

Consequently, taking away the video game is only the first step in recovery. In addition, parents need to make sure that teenagers addicted to playing video games also address the root causes of the addiction. Therefore, experts recommend teen mental health treatment that encompasses clinical and behavioral approaches.

If you, or a loved one is struggling with an addiction to Fortnite call Tamara Ancona, MA, LPC at (678) 297-0708 for an evaluation, and to discuss the best treatment options available.