sarah 00:03

Good afternoon dr hanan. , how are you?

Dr. Hanan 00:09

I'm good. Thank you. Can you hear me well?

sarah 00:11
yes i can hear you well. thank you so much for meeting me on such short
notice.

Dr. Hanan 00:18

It's my pleasure.

sarah 00:21
So for like, icebreakers, can you please state your name and your title?

Dr. Hanan 00:28

My name is Hanan Al Mala, and i am a clinical psychologist and Assistant
Professor of Psychology.

sarah 00:33
Okay, thank you so much.

Dr. Hanan 00:36

You're welcome.

sarah 00:37
Okay. Let's start right away. So I'm doing my my interview about anxiety
disorders among university students. And we'll kind of like, focus on the
anxiety levels are rising because of the current financial crisis that is
going on around the world because of, you know, the war in Ukraine and
the devaluation of the pound here, like how it is happening and how it's
causing stress among university or college students. Yeah. Okay. So let's
just start off with what is anxiety? And how can we differentiate between
the normal or normal anxiety and when we develop an actual disorder? How
can we differentiate?

Dr. Hanan 01:28

Okay, that's an excellent question. Usually, we talk about something
called a continuum, the continuum is like a line, you can see it, it has
its left and right side, and then in the middle, the middle is usually
then normal. So usually, people have a very low anxiety located in the
middle, they are experiencing average anxiety. And on the other side, on
the opposite side, the right hand side, which is the extreme, this is
where the person is experiencing really high anxiety. So anxiety is a
normal part of life, we all feel anxious. However, on the spectrum, if we
experience if we frequently have intensive and really persistent worry,
and a lot of fear, on everyday occasion, this is when when we're talking
that this is a disorder, so it should be affecting the person on a daily
basis. we can actually diagnose it as something as a disorder. And
anxiety disorders, as you know, there are many types of them and they
have different they have different criterias according to the DSM five,
the diagnostic criteria that we're we follow as clinicians. But in
general, it's we're saying that anxiety is something adaptive, we need
it, it's very important for our lives, and moderate in moderation, so to
say, it's when it becomes to the extreme this is when we call it as a
disorder.

sarah 03:13
Okay, thank you so much for the clarification. So do you feel like the
anxiety levels are increasing or rising, the percentage is reaching like
higher levels right now? due to the financial crisis, and people feeling
stressed cutting down on their budget, not having leisure time, as they
used to.

Dr. Hanan 03:37

What we know at this point for post COVID Is that anxiety is rising due
to the many, many different issues related to it. We know and that
financial constraints are contributing effect to anxieties, because when
we're saying here, anxiety, we're saying worrying, being worried being
being afraid of not being able to provide for yourself or to be able to
provide for your spouse or to have the necessities to have the car you
need to commute to work and so on. So, if financial burden is is a major
contributor to to excessive worry, and anxiety, of course, so, definitely
we can see we can see in the statistics and an increase in numbers,
because of the COVID-19 because of the consequences and effects of it.
And because of the the war going on in Ukraine as you mentioned that
clearly the crisis in the US at this point, which is also affecting the
entire world and of course, the devaluation here in Egypt. So there are
many contributing factors; global and local. Yeah.

sarah 05:06
And I have read in some articles, and based on some studies that there
has been a negative effect of this financial stress or the overall stress
in the world. It's affecting, like, the student's ability to perform in
universities like their, their ability to like focus and like have their
attention 100% on the material that they're studying is the qualities
that it's like lower because of what's happening. And some students are
actually seeking part time jobs are trying to help out their parents or
help out with their loans and stuff like that. How do you think like,
this stress is affecting them? Or do you agree with these studies?

Dr. Hanan 05:51

if we're talking about the global context, we know that college students
in the US and Europe, usually when they go to college, they usually
they're very independent, they move out from their parents houses, they
usually live in dorms, or they share rooms with partners, they usually
have the responsibility of budgeting, paying the rent and paying the
bills. I mean, they're very independent. It's a complete package. So to
say, of college students, and many college students take loans, they sign
up for military. So it's a very different. It's a very different context
than the Egyptian context. So to say, if we look at the Egyptian context,
how we can relate this to our Egyptian culture, we usually in the
Egyptian culture, it's either our students at universities, they have
scholarships, or they have financial aids. If we're talking about AUC,
usually, it's the parents who pay the tuition fees, because these are
very high tuition fees.
sarah 07:05
Yes, that's true.

Dr. Hanan 07:06

yeah, so what we can see here is that the the effect of the financial
burden on the parents definitely will bring about a lot of effects on on,
on the students, directly and indirectly, some parents may might be
forced to take a second job, or they might be forced to work even more
than they used to be cut off on things they they like, if they need to
get a new car, they won't do that, let's say for the coming two years
till the students leave or um finish university, the students might want
to take one or two or three extra credits for a specific course they wish
to take. Probably they won't do that anymore. So definitely, the the
financial burden has a direct and indirect effect on the students, on
the students well being and students. Let's say overall psychological and
emotional, well being, we're very affected by our family. We live in a
context where family is very important, it's part of life, we don't have
this independency like the West. So we're more like a family construct
than the individual construct in the in the West, which means that we are
affected very much to a very high degree by our close family and extended
family as well. The financial burden is actually let's say it's, it's
affecting the entire society on many levels. It's, it's reality at this
point, we're living in a very difficult financial situation. And the
uncertainty, just like the COVID, we're talking about, it's very
uncertain. We have we have no clue. If the vaccine will work. We have no
clue if if we get COVID If we will stop breathing, or if we can make it
there were a lot of uncertainty and anxiety.

sarah 09:24
Uncertainty is what causes anxiety as we feel out of control. We can't
really control what's going on. So that's what causes more stress
levels, right?

Dr. Hanan 09:34

Usually, when we talk anxieties, we say that we exaggerate, we
catastrophize the event, we overestimate the situation or the event, and
we underestimate our ability to cope. Yes. So that's what usually
happens. At this point. We really, even if we overestimate The situation
the situation is really a big thing. It's a reality. It's not a
hypothetical issue, it's a big thing. We have students who cannot pay
their tuition fees at this point, and we have students who are, might be
actually forced to leave university because of that. So it is a real,
huge issue. And the ability to cope, the ability to control is very
minimal. Yeah, so it's a really major contributing factor, definitely to,
to what's actually going on here. But although we might, we don't know
the statistics, we don't have any statistics here in Egypt, relating to
the college students at this point, as far as I remember, as as far as I
know. Yes. But we can see that definitely, the anxiety is much higher
among our students at this point. And I think it's contributing a lot to
the COVID. And this point to the financial crisis.

sarah 11:02
So when should like a student consider receiving therapy for their
anxiety? Like when should they be like, Yeah, I need help, I'm reaching
out and I actually need professional help. Because this anxiety, I can't
deal with it alone, like, when can we differentiate between; yes, this is
normal, and it's gonna pass, or it's no, it is just continuous.

Dr. Hanan 11:24

that is a really good point, I think at this point, that students should
be going to, I mean, student well being are offering a lot of webinars,
and those webinars are addressing anxiety, procrastination, self image,
all of these things that usually college college students are suffering
from. And we know that college students are suffering from FOMO fear of
missing out, they're suffering from the excessive use of social media and
the bomb that bombarded by a great deal of external pressure of looking
in a certain way behaving and having something in a certain way. I mean,
it's a lot of pressure that these students are going through. So I think
prevention is key, not waiting till the fact that you are not feeling
well. So you can actually seek support. No, I would rather say let's go
for prevention management, rather than seeking support when I'm actually
I'm not able to cope anymore. So my advice would definitely be would
definitely be that attending those webinars trying to find what does
anxiety do to me? How can I cope with it? How can I stop procrastinate?
My Tasks? How can I work on time? How can I be efficient? I mean, one of
the webinars, I'm not making any any ads here, I'm not affiliated to the
Center for wellbeing, but they're doing an amazing job. And they had once
a webinar about sleep, sleep is a devastating effect. I mean, people who
don't sleep well, sleep hygiene is very important. And not sleeping, not
getting enough sleep can actually cause you many mental disorders. So
it's really serious issue. And I know many of my students have a hard
time with this, they they're not sleeping well, they're sleeping very
late. And even though they're not eating well, they're not eating healthy
enough. It's not about not having money, it's about that they don't have
the knowledge of the effects of not eating well, we eat a lot of junk
food or a lot of snacking and so on. So educating our students in an
unhealthy diet, diet habit and healthy sleep and sell good, good self
image, how to control the use of social media, how to have a balance in
order to avoid hitting the rock and getting into anxiety. But if someone
is is actually experiencing a lot of anxiety on daily basis, they're
having a lot of thoughts, they can't control. They have a hard time
sleeping, they have a hard time concentrating. they procrastinate a lot,
I would definitely say that they need to seek therapy.

sarah 14:29
Thank you so much. And also last question, you mentioned like the
webinars and the activites at the center of well being doing at AUC and
also obviously in many other places. I feel like mental health is
becoming... it has more awareness than it used to like it's not
embarrassing to seek out therapy. It's okay. And I think,like around
campus, I feel like it's a safe place to like if I'm struggling with an
anxiety disorder, even with financial burdens or whatever that's causing
the anxiety, feel like it's becoming better like the awareness is. This
point is better than before.

Dr. Hanan 15:10

Yeah, definitely, the stigma around mental illnesses is so much lower.
It's getting better. We were more open about it, we're fine with it, we
talk a lot about going to therapy, and we're proud of it, and which is
something really good. But we're not there yet. There is some stigma
around yet. Still. And also, I don't think many students are proud to
say, I'm very anxious, my parents can pay the tuition fee.

sarah 15:39
yeah

Dr. Hanan 15:40

Right,I'm soon it's I mean, when we're talking about financial issues,
we're talking here about classes, which is not the best thing to say, or
to feel. So someone might say I'm depressed from the exams, or this is
too much overload. That's very normal. But it's not as normal to say that
I'm financially burden. I can't have that lunch today, because I don't
have enough money. It's very shameful still in our society. And
definitely, it's not uncommon, but it's not usually the common so to say.
So I think it's very important to raise the fact that financial
difficulties can bring about anxieties, and we need to talk about it, we
need to address it, and we need to raise the voices. So the student can
realize and feel that I'm not alone. This is burdening me I'm not I'm not
happy about it. And I need to raise my voice to, to express it.

sarah 16:46
I completely agree. And also, there's was an article about having an app
for like therapy, and so that it's easier and maybe free or easier to
communicate with, with professionals on like the apps, because it's like,
you don't have to pay for example, is pay less if your students their
vouchers when you're when your student. So what do you think the apps
about from from the point of view of like authenticity and from like,
connection, does it have to be, like face to face so that I can feel like
I'm receiving the right therapy? Or do you think apps are could could
like help us in the future?

Dr. Hanan 17:24

Now, I think it's very individual.And some studies have shown that being
physically in the session is more effective on the treatment. But it's
really related to the to the person, How comfortable is person, some
people are more comfortable being sitting behind the screen and meeting
someone and disclosing their problems. And some people are not some
people need that human interaction, they need to be in the room, they
need to see the the, the, the environment, they need that in order to
feel some sort of progression. So it's very individualistic. But we know
that the human interaction is the more effective way to receive therapy.
But again, we're talking about generations that grew up with the mobiles
and iPads since birth. So they're more comfortable than the older
generation, so to say.

sarah 18:35
and being announymous is less embarrisng, as we mentioned, like having
this sense of embarrassment, embarrassment of like not being freely and
talking about things like financial issues or burdens, to be anonymous or
behind the screen with an app.

Dr. Hanan 18:52

Yes, definitely, definitely. And I know some students were embarrassed to
go to the student wellbeing or the psychological training center. So as
far as not to be labeled as seeking therapy, I mean, so those people who
do seek therapy, they are, they are those, they're actually they have
more, they have higher self esteem than those who were actually
embarrassed to do so. Because still is stigma around mental illnesses is
still still a fact. It's something we're living with. People are not
sensitive enough when addressing mental illnesses. So, so people can be
very embarrassed and feeling ashamed of it. But in general, I think there
are so many amazing therapists who can who can deliver amazing therapy
online through apps or through zoom or whatever. So I think we don't need
to limit it. We need we just need to find out what is the best way for me
to do so? What's the best way for me to receive therapy? Is it one on one
physical face to face? Or is it good enough? Through an app or, or
screen, we have many people who are suffering from social anxiety, for
instance, they prefer to do it at home, they prefer to have it in their
own comfort zone, I used to have students with a panic attack being in my
session was very, very anxiety provoking for but I think this kind of
client would probably much more, be much more comfortable staying at
home. But however, we know also that this can actually reinforce the
behavior, the destructive behavior, so we don't want that. Right. So at
the end of the day, it's it's I think it's very individual. And it's hard
to say, What's the best thing? Me personally, I am willing to face to
face definitely,but that's my personal preferences.

sarah 21:07
Okay, thank you so much for your time. This has been amazing.

Dr. Hanan 21:11

You're welcome. I love this topic. I think it's very important. I'm
really happy. Are you raising it? It's really essential.

sarah 21:20
thank you!

Dr. Hanan 21:22

Yeah, I mean, it's, it's it's so spot on, given the fact that we are
actually living in a time where financial burden has becoming very
hindering to many students, which, which is I don't remember. Remember us
going through this hardship in this region, as we do at this point. So I
think it's very important that we raise it and this is very, yeah, that
this is very essential. Definitely. And I like the fact that we should
normalize that I can be anxious because of my financial burdens, which is
very understandable. It's, I mean, it's the college, it's your future. So
you should be able to feel confident enough that you can pursue your
career at university or to be a university student without being hindered
or troubled by your finances. Definitely.

sarah 22:26
Thank you so much for your time. This has been amazing.

Dr. Hanan 22:30

You're welcome, sarah. Again. Yeah. Best of luck.
sarah 22:34
Thank you so much.

Transcribed by https://otter.ai