Sharon Lambert and Naoise Ó Caoilte—Mental Health Podcasts: A Force for Good in a Contested Field

According to Edison Research, there are more podcast listeners than ever, with 64% of the US 12+ population having ever listened to a podcast. With over half a million active podcasts available, more time is being devoted to mental health discussions. However, little is known about the motivation and experiences of people listening to mental health related material in podcasts.

Joining us today are Dr. Sharon Lambert and Naoise Ó Caoilte from University College Cork in Ireland, who have studied the motivations and experiences of mental health-related podcast listeners. Their recent paper is entitled “Podcasts as a Tool for Enhancing Mental Health Literacy: An Investigation of Mental Health-Related Podcasts,” and it appears in the journal Mental Health & Prevention.

In this interview, we discuss the importance of mental health literacy and ask if the need for honest mental health experiences is being met from the recording studio rather than the consulting room.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

 

James Moore: Sharon and Naoise, thank you so much for joining me today for the Mad in America podcast. Before we get to talk about your fascinating study, could I ask you both to introduce yourselves and say a little about what you do at University College Cork?

Dr. Sharon Lambert: I am a psychologist and academic researcher. I research and teach applied psychology at UCC and my areas of interest are the relationship between psychological trauma and traumatic experiences in a very broad sense. So, that includes things like poverty and social exclusion, and how that impacts thinking, learning, and behavior. I’m particularly interested in how people design and deliver services so that everybody can use them and that came from working in the community with socially-excluded groups.

Naoise Ó Caoilte: I am a recent graduate of the Master’s at University College Cork in applied psychology and mental health and it was there that we started this piece of research. Sharon and I became interested in exploring some of the podcast listeners’ experiences. At the moment, I work for the Health Service Executive here in Ireland, as part of the primary care psychology team.

Moore: Why were you interested in studying what podcast listening might be doing for people’s knowledge and beliefs about mental disorders?

Lambert: I suppose it came about as a conversation. I have appeared on mental health-related podcasts before and my experience of being a guest on those podcasts was that people would contact you afterwards and say “I heard you speaking on such and such podcast, I’ve been struggling a lot, and it was the first time that I’d ever connected my social context like poverty. I’d always thought that maybe it’s just something fundamentally not good enough about me.”

So, I suppose there was a bit of sadness around that that the most socially excluded people are the ones who don’t have access to that information.

Then I saw a newspaper article that was criticizing podcasts. It said, “Is this a good thing? You have all of these people online talking about mental health and people who have mental health issues listening, is that a good idea?” I thought, well, my experience of it is that it has been positive but I don’t know, because we don’t have the research. So Naoise and I were chatting and he listens to a lot of podcasts so, we came up with the idea and went with it.

Ó Caoilte: As a student at the time studying psychology, I was also on placement, working with families in the foster care system here, and what I took away from listening to podcasts during that time was hearing people’s lived experiences. People who may have experienced coming through the care system or people sharing their mental health stories. That gave me an insight into the therapeutic process and the psychological world that you maybe don’t necessarily get from books, for example.

So, from that sort of professional development point of view, I found podcasts to be really beneficial for me.

Moore: Could we talk a little bit about the approach you took for the paper and your results?

Lambert: As Naoise said, we had a great conversation about podcasts and what I was hearing about what people were getting from podcasts, and then Naoise brought this extra perspective, “Actually, it’s not just people who are struggling who are gaining from it. It’s also students, potentially, getting professional development.

So, we were thinking about all of the different groups that are listening to podcasts and what they might be getting from them. Naoise had a look at the literature and he found that there was almost nothing there. So, we created a survey; Naoise worked really hard in getting that survey out and over 722 responded.

What was interesting was that every time I do a survey for research, I always put in this box at the end that says, “Any other comments.” No one ever fills it out and if they do, they might say, “That was a stupid effing survey,” or something like that. It’s never really that meaningful, to be honest, but I was persistent and put in that little comment box, hoping that somebody would fill it in.

We were blown away by the comments, the amount of them, the level of engagement with that particular section and the quality of the information that people gave about their experiences. I can talk about that in a minute if Naoise, perhaps, you might want to come in and talk about the survey findings and the statistical analysis that you did.

Ó Caoilte: So, we asked participants about their demographic profile: education, annual household income, et cetera, as well as their motivations for listening to mental health podcasts, and their personal experience with mental health. We asked whether they’ve accessed mental health services before, and then, finally, what their experiences of listening to mental health podcasts were.

The results are quite interesting when you look at why people listen to podcasts. We found that above all, it was out of a desire to learn about oneself and to learn about mental health more generally. When you do a piece of research like this, you’re always interested in what are the differences in people’s responses based on their demographic profile. One of the patterns that we began to identify was that for participants in lower educational brackets, i.e. those who also tend to have poor mental health literacy and knowledge of mental health, they reported using podcasts to learn about themselves and their mental health much more than their more educated counterparts. Whereas those in higher education brackets reported using podcasts for entertainment much more.

This was quite an interesting and promising result, I think because it maybe shows that those who need it most are taking the most away from listening to podcasts. That was a trend that followed throughout the whole paper, even down to when we asked people about their experiences. Those in the lower educational bracket, as well as I believe those with lower annual household income, reported that their experiences were more based around learning new information and skills.

When we asked them about their experiences, the most rated statement was that they learned new information and skills. After that, it was that podcasts help normalize problems and foster connections. What I see in that is that normalization of problems is really a destigmatization and creating connections is maybe creating a validation and a sense of community amongst listeners. There is so much rich data within that qualitative piece that really brings the statistics alive as well.

Lambert: As Naoise said, the highest-rated item in the survey was for new information. One of the criticisms of podcasts was, is there a danger that people who have mental health difficulties are sitting at home, listening to podcasts, doing some kind of therapy on themselves, and not seeking professional support. Is that dangerous?

So, one of the items asked was, do you use podcast listening to process difficult emotions? The results showed it was not an issue. So, that kind of ruled out that concern. As Naoise said, the statistics he outlined are super interesting because what it did show is that people who are from lives of lower socioeconomic status who do find it difficult to access services and who are often shut out from education as well, they are gaining a huge amount in terms of mental health literacy.

They were starting to realize that these struggles that they were having, lots of people have them too, and that it did make them feel more connected and especially in the data around COVID. Lots of people were very isolated and that they felt quite connected to particular podcasters or some of their guests.

What people liked actually was a mix of guests. They liked the mix of hearing a professional by education speak about a particular difficulty or challenge. Then somebody with lived experience might come on and say, “I experienced a traumatic event. This is the impact it had on my life and these are the different kinds of barriers that I had in terms of accessing support, and then this is how I did on my recovery journey.”

So, that real raw sense of reality because sometimes when we present lived experience in professional environments, we bring on people who are successful in their recovery and it’s often presented as “This is amazing and this is how easy it is, and everything is great.” What you don’t often hear in those contexts is the fact that it isn’t a linear journey, that there have been lots of setbacks and that there are lots of barriers. One of the things with independent podcasts is that people are, I guess, not restricted in terms of being really honest about what worked and what didn’t work.

So, when we looked at the qualitative data we came up with five overall themes and they were around accessibility (and accessibility means a couple of different things which I’ll come to in a minute), mental health literacy, some potential pitfalls, reassurance, and lived experiences.

So, in terms of accessibility, it meant two different things. There was the practical element. So, the podcast content is free and I can access it any time that I want without geographical, financial, or transport barriers. The second point around accessibility was actually the language being used. So, people are speaking to me in a way that I understand and if I don’t understand it, I can listen to that episode two or three times, until I do understand it.

Moore: That’s so important, isn’t it? It’s theoretical but the paper says that if people attend a service, they might get a crisis response and the medical professional might be just responding to their symptoms. There is no time to talk about social factors and all the other things that might have led them there, but podcasts allow people to absorb that information in their own space and time.

Lambert: A big feature of that accessibility was the language being used because you often had lay people, people with lived experience who would say, “I have experienced this and what that means is that,” so there wasn’t that assumed knowledge that perhaps sometimes happens in other consultations. When people do go to appointments, they can be embarrassed to say, “I don’t understand what you’re saying and I’ve never heard what that word is,” so they can just sometimes nod and agree and then leave, and particularly people in addiction services feel a lot of shame and stigma. So, if you’re there and somebody says something and you don’t know this, it’s another thing to feel ashamed about. So, being able to access that information was important.

So, one of the themes was potential pitfalls. Now if you were being academically rigorous, you wouldn’t have included this theme at all. There were five criticisms out of 722, where somebody said a potential negative. Naoise said, “Look, it has been said. It’s important to these people so let’s report those potential pitfalls.”

So, one person said that they had obsessive-compulsive disorder and what had happened for them was a podcast had become part of a compulsion and they had to listen a lot and that person was a professional. They said that they were concerned about non-professionals being involved in podcasting, but of course, that’s their bias there in terms of their professional training. Can you remember the others, Naoise?

Ó Caoilte: It was one or two around what you mentioned there about podcast hosts and guests not having professional expertise and then, potentially the issues with podcasts not being regulated, and the concerns of, I guess, individuals who worried about misinformation, particularly in the context of mental health where it’s important not to spread misinformation.

So, they were valid concerns and while there were few, they were worth looking at and worth reporting because even though in our sample there were only five or six people, I’m sure that out there, there are more who are concerned.

Lambert: I think it was three people that said they were concerned about professionals not doing this stuff, and that it might be a non-professional, whatever that is. One of the quotes was, “I do think with a lot of access to professional services and increased availability of podcasts, there is a risk that people can take a podcast host’s advice as seriously as they would take a health care professional’s advice.” So, I suppose the problem there is assuming that the health care professional’s advice is always right, all the time, and sometimes it’s not, but actually, the data did not indicate that that’s what was happening.

What it did indicate was that listening to podcasts wasn’t making people not look for help in different places and spaces. It actually was increasing help-seeking behavior. The other quote here is, “I am less hard on myself. Podcasts have encouraged me to open up and speak about my issues.”

Moore: In the paper, it says that research indicated that mental health literacy is positively associated with help-seeking behaviors and negatively associated with stigma, shame and negative attitudes towards mental health. That’s so important, isn’t it, because podcasts, I guess, give a non-medical space for people to discuss really uncomfortable and difficult thoughts or feelings, without necessarily feeling that things have to be labeled from a medical standpoint. They can talk in purely human terms, can’t they? So, I can see how mental health literacy might seem like it’s a medicalized thing, but it isn’t, it is reducing stigma, making people more likely to seek help if they need it.

Lambert: Yes, there is a lovely quote here from one of the participants, and it says, “While I’ve suffered from depression for 10 years now, I sometimes still struggle to describe it to family and friends. Listening to peers sharing their journeys has helped me gain both the language and confidence to speak more about my lived experience.” I mean, we could be here for hours, James, reading out some of the quotes because they were just so powerful.

Ó Caoilte: What you mentioned there, Sharon, about the lived experiences, it ties into people questioning the expertise of podcast guests. I think the addiction services know this and have known this for a long time, which is that even though they might not have professional qualifications, people with lived experiences or peer support workers can be just as valuable to the therapeutic and the recovery process as professionals, and in addiction recovery programs, peer support is a huge part of it.

What we’ve found was that our participants who were listening to lived experiences were getting a sense sometimes of hope, sometimes of connection, and sometimes of community when they hear somebody. A really important aspect of that as well is that they hear somebody who looks like them or who sounds like them, and maybe is from the same socioeconomic background as them. When they hear that person share a story that resonates with them, that has a therapeutic power in and of itself.

Moore: That’s so important, and as you mentioned earlier that there are virtually no barriers to accessing these podcasts. They are easy to get hold of and easy to consume in a time that matters for them and they can listen multiple times. Or, if they are struggling in the middle of the night, there is somebody comforting there that they could listen to.

The point about misinformation, I find really interesting, because, as we know at Mad in America, there are examples out there of professionally-produced podcasts where there is misinformation being given. Maybe they are talking about chemical imbalances or maybe they are talking about areas of mental health as if it’s settled science, when it isn’t really. Equally on the other side, we are aware that there are paid influencers out there that might be covertly funded by pharmaceutical companies.

So, I guess misinformation is a concern but part of me also thinks that talking about the full range of experiences and possibly considering what might or might not be misinformation, and the freedom of podcasts as a platform to do that is probably quite a healthy thing too, isn’t it?

Lambert: Yes, because if we think about humans as biopsychosocial beings as we are, we exist within a social context. I do believe that it’s shifting and changing in psychology, not as fast as probably some people would like, but there is more of an increasing understanding of social context. For example, how poverty is a driver for mental distress and how that should be responded to. That’s not a psychological disorder, it is somebody who is deeply distressed because they are living in a really difficult situation and maybe at risk of homelessness or in homelessness. So, their distress is appropriate for the situation that they are in. That conversation is happening. It’s shifting, it’s changing, and I know folks in Mad in America have been talking about it for a very long time and would prefer those conversations happened faster.

What brings it back to the podcast is that people are perhaps interfacing with different disciplines and models of understanding mental health. I know that you would say within Mad in America, there are particular diagnoses that are not helpful, and I would agree with you on lots of that. Then sometimes I worry about that because there are people who receive a diagnosis and for them, it’s a relief. Then I think for me as a psychologist, I have to be really careful that you don’t come along and say, “That thing that you have, there is this big group of people who don’t believe that that exists,” and that can be quite devastating.

So, how you can manage that in a way that is helpful is through conversations around different perspectives. So, some people would have a very biological understanding of mental health, some people would have a very psychological understanding of mental health. I’d probably fall more on a social understanding of mental health, but I need to understand all of them. I think for people who might be having difficulty, once they start to improve their own mental health literacy by access to this information then what they do is they start to say I’m learning a lot and I want to learn more. So then, they will start to listen to different perspectives and they will learn about things they might not have learned about before, like the social determinants of health and how poverty is one of the biggest predictors of addiction and poor mental health.

So, I think that podcasts do create that space. I do think that what they are doing is saying here are a host of multiple different perspectives. Then sometimes we underestimate people’s ability to be able to sit back and say, that’s really interesting, I haven’t thought about it like that. Where does that fit with me? For me, what matters is what you need in order to go on your recovery journey, what works for you.

Moore: People can find experiences that resonate with their own experience, can’t they, which is so important to not feel isolated and to feel connected. There are people out there who’ve had broadly similar experiences and it was interesting to learn how they thought about it or dealt with it, or haven’t dealt with it, or whatever else. So, that kind of menu approach of having a range of views to choose from is so important, I feel.

Ó Caoilte: On that piece about feeling isolated, like you mentioned James, I did a quick search on the qualitative data earlier today and the words “not alone” together come up over 120 times. That was one of the major takeaways under the qualitative theme of reassurance and validation, was that sense of feeling not alone and not isolated in your mental health issues. People kept saying things like, “I’ve realized that everybody struggles,” or “I’ve developed compassion for myself and others because I’ve been able to understand my struggles in the context of maybe my past experiences.”

Moore: I couldn’t help but identify myself with so much written in the paper, firstly as someone who runs a podcast, but secondly as someone who has had mental health struggles and got into podcasting precisely because I felt alone and disconnected, and couldn’t easily leave the house. So, I really do value the space that podcasts can fill that professionals couldn’t do even if they wanted to. They wouldn’t have the time or resources available to do that.

It’s a brilliant and fascinating piece of work that you’ve both done together and with your co-authors. I wondered if you had any thoughts about whether there are further developments of this work. Is there more that could be done with looking at the role of podcasts in helping people come to terms with their thoughts, knowledge, and beliefs about mental disorders?

Lambert: Currently, I have a master’s student who is looking at the role of podcasts in probation clients. So, these are people who have experienced difficulty with the criminal justice system. Where that came from, actually, was an Irish-based podcast called The Two Norries. The hosts of the podcast were both in recovery from addiction, but have had significant experience with the criminal justice system, including periods of imprisonment.

Like you, James, their podcast emerged during the first lockdown, because the support structures that were available to them to maintain their recovery were gone. So, they were worried about themselves and they were worried about their community because they are from an area of socioeconomic deprivation. So they had this idea to set up a podcast, which they did in Timmy’s shed in his back garden.

What happened then was there were no visits allowed into the prisons. So the prison service started playing The Two Norries podcast into the cells. Then the psychology service in the Irish Prison Service started to notice that people were developing a language that they probably wouldn’t have gotten if you gave them something to read, a more formal produced document from a health service, for example. They were saying, “This is really interesting because people who are in custody now are coming, looking for the psychology service and they are using words like I experienced this difficulty and it was a trauma, and it might be linked to my addiction and other social problems that I’m having.”

So, Dr. Reagan from the Irish Prison Service liaised a lot and continues to liaise with The Two Norries podcast around the impact that it’s having in the prison service. So then, that led me to think about people when they’ve left custody and they are now linking with a probation officer. So, my current master’s student, Sally Condon, has interviewed probation officers about do they think podcasts are a useful tool for probation officers.

She’s just finished her analysis and she is writing up her dissertation. It’s not published yet but what was interesting was it is really similar to Naoise’s findings. She deliberately didn’t read Naoise’s paper in case it would impact how she might think about themes. So, when she came to me and said, “These are the themes that have come from the data,” it was so interesting because they are very similar to the themes that come from Naoise’s paper.

So, I suppose, primarily what they notice, probation officers, was that people who were struggling with mental health and addiction difficulties, and that was leading them to involvement with the criminal justice system, they were turning up to meetings and they were having entirely different conversations now. So, the chaos that they were experiencing in their personal lives was starting to make sense, and once they had access to the information, then it became this thing that was in their awareness and that they could do something with.

Ó Caoilte: Something that we saw reflected in the results was clinicians and healthcare professionals who were reporting using podcasts in whatever healthcare setting they are in or using them as resources for clients. So, that’s something that’s reflected in the literature as well, not to a large extent, but we discuss that and feel that there would be a lot of value in speaking to professionals, as well as speaking to people like yourself, podcast creators, to get their perspective and experience on that. I think that would give another side to this research as well, which I think would be really meaningful.

The other thing that we felt would be very valuable is in some way getting a quantitative measure of the impact of listening to mental health podcasts and maybe measuring mental health literacy using a scale. That would be an experimental design, I guess, something maybe at the end of the road.

Moore: Before we come to the end of this, Sharon, you mentioned the comment box that you put at the end of the survey. We need to do that on podcasts too. Was there anything else related to the paper that you think important to share with the listeners?

Lambert: I suppose the most important thing that we heard was for the vast majority podcasts are a positive thing. They are positive in terms of being available, the language that’s being used is understandable, the varying experiences and perspectives that people are exposed to. So it’s not just one particular perspective or one model or one life experience, that it’s a whole vast range of all of the different things that can go on in this space and then that is contributing to the development of mental health literacy.

Knowledge is power and people can make decisions for themselves when they have access to knowledge, and people are feeling less alone, they are feeling more connected. Their experiences are more normalized. It is decreasing stigma. It is increasing help-seeking behavior, and they are just an incredible resource for people.

Ninety-nine point nine per cent of the experiences are just incredibly positive and I see a quote that just popped up in front of me here, “It demystifies mental health emotional issues. I learned so much about myself and others. I find it’s helpful at building empathy when you hear about all the people’s troubles and stories.”

So, not only did people increase their compassion towards themselves, they increased their empathy for others, and that’s important too that when we increase our self-compassion for ourselves, then we also have empathy for others, because that’s what will make you a happy, healthy human being, is being able to love yourself and to love others.

Moore: Thank you both. I am so pleased to be able to talk to you about this because to have podcasts for mental health validated in this way is really important. The sense of connection they bring, the demystification that goes on, that the kind of discussion around the margins of what you might hear in a therapy appointment or an appointment with a professional. The fact that you can broaden your understanding by listening to a range of experiences is so valuable and it’s a genuinely fascinating piece of work. Thank you both so much for doing it and for being willing to join me to talk about it.

Lambert: Thank you, James.

Ó Caoilte: Thanks so much for having us on.

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MIA Reports are supported, in part, by a grant from The Thomas Jobe Fund.