Mental Health Guidance for Managing Anxiety
This page will include resources and tips for talking with children and older adults about what is happening in our community and globally.
Talking to Children
The Child Mind Institute has provided the following advice for talking with your children about the coronavirus. Below, you will find the tips summarized, but you can always visit the website for more information. The tips below are provided by Rachel Ehmke, managing editor at the Child Mind Institute.
- Don’t be afraid to discuss the coronavirus. Most children will have already heard about the virus or seen people wearing face masks, so parents shouldn’t avoid talking about it. Not talking about something can actually make kids worry more. Look at the conversation as an opportunity to convey the facts and set the emotional tone. “You take on the news and you’re the person who filters the news to your kid,” explains Janine Domingues, PhD, a child psychologist at the Child Mind Institute. Your goal is to help your children feel informed and get fact-based information that is likely more reassuring than whatever they’re hearing from their friends or on the news.
- Be developmentally appropriate. Don’t volunteer too much information, as this may be overwhelming. Instead, try to answer your child’s questions. Do your best to answer honestly and clearly. It’s okay if you can’t answer everything; being available to your child is what matters.
- Take your cues from your child. Invite your child to tell you anything they may have heard about the coronavirus, and how they feel. Give them ample opportunity to ask questions. You want to be prepared to answer (but not prompt) questions. Your goal is to avoid encouraging frightening fantasies.
- Deal with your own anxiety. “When you’re feeling most anxious or panicked, that isn’t the time to talk to your kids about what’s happening with the coronavirus,” warns Dr. Domingues. If you notice that you are feeling anxious, take some time to calm down before trying to have a conversation or answer your child’s questions.
- Be reassuring. Children are very egocentric, so hearing about the coronavirus on the news may be enough to make them seriously worry that they’ll catch it. It’s helpful to reassure your child about how rare the coronavirus actually is (the flu is much more common) and that kids actually seem to have milder symptoms.
- Focus on what you’re doing to stay safe. An important way to reassure kids is to emphasize the safety precautions that you are taking. Jamie Howard, PhD, a child psychologist at the Child Mind Institute, notes, “Kids feel empowered when they know what to do to keep themselves safe.” We know that the coronavirus is transmitted mostly by coughing and touching surfaces. The CDC recommends thoroughly washing your hands as the primary means of staying healthy. So remind kids that they are taking care of themselves by washing their hands with soap and water for 20 seconds (or the length of two “Happy Birthday” songs) when they come in from outside, before they eat, and after blowing their nose, coughing, sneezing or using the bathroom. If kids ask about face masks, explain that the experts at the CDC say they aren’t necessary for most people. If kids see people wearing face masks, explain that those people are being extra cautious.
- Stick to routine. “We don’t like uncertainty, so staying rooted in routines and predictability is going to be helpful right now,” advises Dr. Domingues. This is particularly important if your child’s school or daycare shuts down. Make sure you are taking care of the basics just like you would during a spring break or summer vacation. Structured days with regular mealtimes and bedtimes are an essential part of keeping kids happy and healthy.
- Keep talking. Tell kids that you will continue to keep them updated as you learn more. “Let them know that the lines of communication are going to be open,” says Dr. Domingues. “You can say, ‘Even though we don’t have the answers to everything right now, know that once we know more, mom or dad will let you know, too.’”
Caring for Older Adults
The National Council on Aging provided the following information on their website about how to care for older adults in response to the coronavirus. Check out their website for updates.
The situation around the novel coronavirus (COVID-19) is changing rapidly, and National Council on Aging (NCOA) is taking proactive steps to share the best information they have to protect the public’s health, especially among older adults. Now is the time to stay informed and follow basic tips to protect yourself and those around you.
Older Adults at Higher Risk
The CDC has identified older adults and people who have severe chronic medical conditions like heart, lung, or kidney disease at higher risk for more serious COVID-19 illness. According to the CDC, early data suggest older people are twice as likely to have serious COVID-19 illness.
This is likely because as people age, their immune systems change, making it harder for their body to fight off diseases and infection, and because many older adults are also more likely to have underlying health conditions that make it harder to cope with and recover from illness. Age increases the risk that the respiratory system or lungs will shut down when an older person has COVID-19 disease.
That’s why the CDC is recommending that people at higher risk take the following actions:
- Stock up on supplies.
- Take everyday precautions to keep space between yourself and others.
- When you go out in public, keep away from others who are sick, limit close contact, and wash your hands often.
- Avoid crowds as much as possible.
- Avoid cruise travel and non-essential air travel.
- During a COVID-19 outbreak in your community, stay home as much as possible to further reduce your risk of being exposed.
Anthony S. Fauci, M.D., Director of the National Institute of Allergy and Infectious Diseases, said that people with serious chronic conditions, especially the elderly, should think twice about traveling or going to crowded places. He advised that these individuals take the simple steps of “not putting yourself in a situation—whatever that might be—that might increase the risk given your situation.”
The CDC is urging individuals to stay calm and Share Facts, Not Fear. Among the CDC’s advice are these common-sense tips:
- Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Stay home when you are sick.
- Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
How to Support Older Adults
People of all ages can support older adults during this time. Many older adults depend on services and supports provided in their homes or in the community to maintain their health and independence. The CDC recommends that family members, neighbors, and caregivers:
- Know what medications your loved one is taking and see if you can help them have extra on hand.
- Monitor food and other medical supplies (oxygen, incontinence, dialysis, wound care) needed and create a back-up plan.
- Stock up on non-perishable food items to have on hand in your home to minimize trips to stores.
- If you care for a loved one living in a care facility, monitor the situation, ask about the health of the other residents frequently, and know the protocol if there is an outbreak.
Supporting a Loved One with Anxiety
Supporting a family member with anxiety requires special understanding of anxiety so that we do not inadvertently make anxiety worse for our loved one. Often, we want to relieve their anxiety so we do things to support them to relieve their anxiety. Unfortunately, anxiety loves it when people provide relief for it- but the outcome is that anxiety worsens in the long-term.
In response to the coronavirus, many people are experiencing a significant uptick in anxiety. For those living with anxiety disorders, a situation such as this provides a mixture of the right amount of uncertainty plus endless information flowing on social media and news outlets for anxiety to take over.
Below are some tips provided by Alice Boyes on her blog Seven Ways to Help Someone With Anxiety published in the Greater Good Magazine on July 25, 2018.
1. Understand differences in how anxiety manifests
Because of evolution, we’re wired to respond to fear by either fight, flight, or freeze. For different people, one of these responses will typically dominate. For instance, my spouse tends to freeze and will bury her head in the sand rather than deal with things that make her feel stressed and panicky. I tend more toward fighting, and will become irritable, excessively perfectionistic, or dogmatic if I feel stressed.
When you understand that anxiety is designed to put us into a mode of threat sensitivity, it’s easier to understand someone who is feeling scared (or stressed) and acting out by being irritable or defensive, and to find compassion for them. By paying attention to how anxiety manifests in the person you care about, you can learn their patterns and be in a better position to help.
2. Match your support to their preferences and attachment style
It’s best to ask someone what type of support they prefer rather than guess! However, we know from research that people who have an avoidant attachment style (typically those who’ve experienced rejecting caregiving or relationships in the past) are likely to respond best to strong displays of concrete practical support. That could include helping the anxious person break tasks down into manageable steps, or talking through specific options for how to deal with a difficult situation, like how to respond to an angry email, but still acknowledging their autonomy and independence while doing so.
Other people are more likely to prefer emotional support, especially those who are securely attached, or who have a “preoccupied” attachment style due to a fear of being abandoned or of their emotions being overwhelming to others. Folks like this respond well to statements emphasizing that they’re part of a tight team—for example, their supporter saying, “This is tough but we love each other and we’ll get through it together.”
Of course these are generalizations, and you need to tailor your support by observing what works in your particular situation. But when you have a very close relationship with someone, you can offer support based on intimately understanding your loved one’s anxiety patterns.
3. Find ways to make use of any insight they have into their anxiety
If your loved one has insight into their anxiety, you can help them spot when their anxiety-driven patterns are occurring. I find it helpful when my spouse notices that I’m expressing my anxiety about work by being irritable with her or by being too fussy. Because we know each other’s patterns so well and have a trusting relationship, we can point out each other’s habits. Not that this is always met with grace, but the message sinks in anyway.
If you’re going to do this, it’s a good idea to have their permission first. Keep in mind that people who have insight into their anxiety often still feel compelled to “give in” to their anxious thoughts. For instance, a person with health anxiety might logically know that going to the doctor every week for multiple tests is unnecessary, but they can’t help themselves. If your loved one lacks insight into their anxiety or has trouble managing compulsions, it’s probably best to encourage them to see a clinical psychologist who specializes in the treatment of anxiety.
4. Help someone who is anxious to temper their thinking
You’ll be a more useful support person if you educate yourself about cognitive-behavioral models of anxiety, which you can do by reading or attending a therapy session with your loved one. But, in lieu of that, you might try using some techniques that can be helpful to people suffering from anxiety.
Typically, anxious people have a natural bias towards thinking about worst-case scenarios. To help them get some perspective on this, you can use a cognitive therapy technique where you ask them to consider three questions:
- What’s the worst that could happen?
- What’s the best that could happen?
- What’s most realistic or likely?
So, if your loved one is anxious that they were supposed to hear from their parents hours ago but haven’t, you can suggest they consider the worst, best, and most likely explanations for the lack of contact.
Take care not to overly reassure your loved one that their fears won’t come to pass. It’s more useful to emphasize their coping ability. For example, if they’re worried about having a panic attack on a plane, you could say, “That would be extremely unpleasant and scary, but you’d deal with it.” And, if your loved one is feeling anxious that someone else is angry with them or disappointed in them, it’s often useful to remind them that you can only ever choose your own actions and not completely control other people’s responses.
5. Offer support, but don’t take over
Avoidance is a core feature of anxiety, so sometimes we may feel pulled to “help out” by doing things for our avoidant loved ones and inadvertently feed their avoidance. For instance, if your anxious roommate finds making phone calls incredibly stressful and you end up doing this for them, they never push through their avoidance.
A good general principle to keep in mind is that support means helping someone to help themselves, not doing things for them, which includes virtually anything that stops short of actually doing it yourself. For example, you might offer to attend a first therapy session with your loved one if they set up the appointment. Or, if they’re not sure how to choose a therapist, you might brainstorm ways of doing that, but let them choose.
An exception might be when someone’s anxiety is accompanied by severe depression. If they can’t get themselves out of bed, they may be so shut down that they temporarily need people to do whatever is needed to help them stay alive. Also, sometimes loved ones are so gripped by an anxiety disorder that they’re in pure survival mode and need more hands-on help to get things done. In less extreme circumstances, however, it’s best to offer support without taking over or overdoing the reassurance.
6. If someone has a more serious anxiety problem, avoid stigmatizing them
What can we do for folks with more serious issues? People experiencing things like panic disorder, depression mixed with anxiety, post-traumatic stress, or obsessional thinking (including thoughts related to eating disorders) may fear that they’re literally going crazy. Helping them may feel beyond your ability.
You can still be supportive in many ways. When someone is experiencing significant anxiety, it’s helpful to reassure them that your overall perception of them hasn’t changed. They’re still the same person; they’re just suffering a temporary problem situation that has become out of control. They’re not broken and who they are hasn’t changed. To the extent possible, you can help the person stay connected to positive aspects of their identity by participating in or encouraging their interests and hobbies.
Sometimes, individuals who have chronic anxiety problems aren’t interested in changing. For example, you might be friends with someone who has agoraphobia or an eating disorder, but their condition is long-term and stable. In these cases, you can be accepting of that person so that they don’t feel isolated. Being matter-of-fact about their limitations without excessively shaming them or insisting they should pursue becoming “normal” is often the best strategy.
7. Take care of yourself, too
Recognize that your goal is to help, not to cure the person or relieve them from their anxiety. Taking too much responsibility is actually a symptom of anxiety, so make sure you’re not falling into that trap yourself.
Keep in mind that your support doesn’t need to be directly focused on anxiety. For example, exercise is extremely helpful for anxiety; so perhaps you could simply offer to go for a walk or attend a yoga class together. It’s also fine to put some limits on your support. A 20-minute de-stressing conversation while taking a walk is far more likely to be useful (and less exhausting) than a two-hour marathon discussion.
Helping someone with anxiety isn’t always easy and you may feel like you’re getting it wrong. But, if you remind yourself that you and your loved one are both doing your best, it can help you keep things in perspective. It’s important to remain compassionate and, as the saying goes, to put on your own oxygen mask first. That way, you’ll have a clearer head for figuring out what’s going on with your anxious loved one and how you can truly be of help.