Author: anxiety

Tips to Managing Stress and Anxiety Over the Holiday Season

By Hudi Kowalsky, LMHC

For many people, the Holiday season comes with mixed emotions.

Some of the pro’s include crisp winter mornings, holiday cheer, great retail sales, and festive spirit all around.

But the holidays can also create considerable tension, stress, and anxiety. First, holidays often come with a break from routine which can be disruptive and complicated to navigate. And for those who need to travel things can be even more complicated, and expensive. Second, there is family stress. While spending time with loved ones can be a great blessing, complicated dynamics often play out especially during the holiday season. And for some individuals spending time with family members can trigger unwanted memories, as well as habits which no longer serve us well. Third, is the vice of social comparison: Looking at images all over of other “happy” people can leave many wondering why they are feeling so sad, anxious, and alone. And for those who don’t have families to share the holidays with, such feelings can be even more compounded. It’s very easy to look around and see what others appear to have and be quick to judge ourselves harshly and curse our fate.

What are some tools that we can utilize to have a happy and NOT anxious holiday season? How can we maintain a sense of equilibrium and peace from late November through the start of January? To rephrase that question in the language of clinical science: What are the most effective ways to manage our emotions and increased vulnerability to anxiety during this season?

Here are our seven favorite ideas:

  • Keep up a healthy and regular routine as possible. If you need to travel or attend a family gathering or holiday party, try not to wake up or go to bed more than 60-90 minutes later than usual. The body has its own rhythm that needs to be maintained.
  • When you need a break from work, really take a break and let things wait until you’re back at work.
  • Keep up your fitness and try to stick to your regular diet/calorie intake as much as possible. If you miss a workout or overeat a bit here and there, just try to get back on track.
  • A drink here or there with friends and family is usually fine, unless your doctor has told you otherwise. But if you’re feeling sad or anxious be sure to go easy and not overdo it. Drowning away sorrows tends to bring them back with a vengeance down the road.
  • When you’re spending time with family that you care about, turn off your cell phone for at least part of the time together. When we’re not distracted by our phones a new world of curiosity and possibilities in relationships opens up.
  • If you’re in therapy, ask your therapist if you can contact him/her while you’re away as needed during the holiday season when things come up. And if you’re taking medication, make sure you have an adequate supply so you’re not running to a random pharmacy for a refill mid-Thanksgiving meal.
  • If you’re not in therapy, make sure you have a close friend you can call or lean on if things get tough. Sometimes, there is no greater medicine than having a shoulder to cry on.

Happy Holidays (seriously)!

Test and Exam Anxiety

By Mark Staum, LCSW

The months of October and November bring new weather patterns, new daylight schedules and new challenges for children. Exams, projects, and papers are back in full swing. Some children may experience some level of anxiety, in preparation for an exam or during an exam. Test Anxiety is a form of anxiety that can be anticipatory and/or performance related. In anticipatory test anxiety, a child may be anxious about the preparation necessary for an exam. When performance related, a child may experience anxiety during the exam itself.

Research shows that test anxiety is related strongly to time management and preparation. Even the most prepared/organized child may have some normal ‘jitters’ on the day of a big exam. However, generally speaking, children who prepare, plan ahead and studies for exams tend to feel more capable of handling any stressors that may arise on the day of the exam. By contrast, children who attempt to cram the night before tend to be more anxious. With that said, some children who study and know their material very well still get very anxious. Also, children with anticipatory exam anxiety may push off studying because doing so makes them think about their exams, which is unpleasant and anxiety-inducing, and as a result, they are less prepared, which begets even more anxiety.

To help children manage test and exam anxiety, teachers and parents should pay careful attention to children’s behaviors. Let’s look at three examples:

  1. A child tells you that before a Math exam, her body became ‘frozen’ and it felt like she was confused and disoriented.
  2. A child says that he reviewed the material for his History test an extra five times because he felt nervous that he really didn’t know the material well.
  3. A child mentions that before her most recent Science exam, she was so nervous that she could not study, and then during the exam, she felt very tired and had difficulty concentrating.

In all these cases, adults can assist children in navigating through these discomforts. In example #1, the child can take a practice test in advance of the exam, and then use breathing, relaxation, and light muscle exercises to relax the body directly prior to and during the exam. In example #2, we can help the child to recognize why it is that he is concerned about not doing well, and to be more accepting that sometimes we try our best and still don’t achieve what we want. In example #3, we can reinforce good study habits, especially when the child prepares for her test despite her anticipatory anxiety.

In all of these cases, feeling of anxiety can be worked through to build resilience and growth in your child. The above are sample strategies and professional assistance may be necessary. Typically, test and exam anxiety is highly treatable with evidence-based psychotherapy such as Cognitive Behavioral Therapy, and children can see benefits within just four to six weeks.

The Quiet Child: At What Point is Shyness… “Too Shy?”

By Sara Berlin, LMSW

It is common for people, especially children, to struggle with transitioning to the fall season. At the start of each school year, many children present as shy and struggle to interact with peers and teachers. While the majority of such children will “open up” over the first month of school, some children remain sheepish such that their parents and teachers become concerned. At what point is shyness “too shy”?

Intense shyness that lasts beyond the typical 1-month adjustment period to school may be a sign of Social Anxiety Disorder, an anxiety disorder that affects 4-9% of children and adolescents, or approximately 1 in 10-20 children. While feelings of anxiety in social situations are a normal part of life (and even healthy in some cases!), Social Anxiety Disorder is characterized by persistent and excessive fears about being negatively evaluated by others, which causes notable distress or impairment in everyday life. Children with Social Anxiety Disorder often struggle to attend school, perform as required, and/or socialize with peers, since they tend to be overly quiet and avoid activities that may draw attention to themselves.

In other cases, children may show signs of Selective Mutism, another anxiety disorder in which children refuse to speak in situations where talking is expected or necessary. Children with Selective Mutism may turn their heads away when others approach them or chew/twirl their hair in order to avoid eye contact. They may also stand motionless and expressionless or withdraw into a corner to avoid talking. Interestingly, children with Selective Mutism can be talkative and display normal behaviors at home or other places where they feel comfortable, such that parents are sometimes surprised to learn from a teacher that their child refuses to speak at school.

Here are some practical tips for parents with children who are struggling with social anxiety or selective mutism:

 Understand Your Child’s Intentions

Know that socially anxious or selectively mute children are not trying to be troublesome by ignoring friends and teachers. In fact, such children are usually highly compliant, since they are afraid of being judged or evaluated negatively by others. Avoidance of social situations or speaking are simply (maladaptive) ways of not feeling distressing feelings of anxiety. Almost all socially anxious children would do anything to stop being so anxious and “difficult!” So, be compassionate and validate their feelings of anxiety and fear.

 Give Praise (even) for Small Social Interactions!

Overcoming social anxiety and selective mutism involves a child gradually facing their fears and interacting more with others over time. As such, give your child praise right away whenever they try to interact with or communicate to others (verbally or even non-verbally). Any baby steps your child takes towards overcoming their anxiety should be reinforced. So, when you see your child struggling to speak in spite of their fear, make sure to praise them right away! And needless to say, refrain from making negative comments when you see them struggling. Punishing good behavior (trying to interact with others) can make things much worse, since socially anxious kids tend to be very sensitive to criticism. In addition, it is very important to identify and “label” your child’s specific behavior as you praise them. For example, if you see your child struggling to speak, instead of giving a generic praise such as “great job” you can say something like “I can see how hard it is to speak to these unfamiliar people in your class, and I’m proud of how you made sure to ask the entire question.” In sum, (1) praise your child ASAP after they do something hard, (2) be as specific as possible when praising, and (3) do it often.

 Don’t Probe, Validate

Parents naturally want to ask children questions about their fears (probe) when they start noticing them getting tense in certain social settings. Believe it or not, asking questions to children to alleviate anxiety can actually have the opposite effect, since it directs a child’s thoughts even deeper into their anxiety. Instead of probing, ignore the negativity and focus on praising positive behavior. With that said, it’s important to validate your child’s anxiety, especially if he feels overwhelmed. For example, note that they are overcoming an emotional challenge when they resist the urge to avoid. For example, you can say, “I know that speaking with your classmate was really hard for you today and I am proud that you are practicing your bravery.”

 Resist the Urge to Speak for Your Child

When you see that your child is feeling uncomfortable and anxious, it’s common to want to intervene and speak on their behalf. After all, what parent wants to see their child in distress?! However, saving your child from anxiety will make it harder for them to learn how to speak – if you communicate for them when they are anxious they will never learn to manage their anxiety! Instead, try to encourage them to speak or, if they are really struggling, you can tell guests that your child is working on bravely talking and he’ll try again in a minute or two. Just make sure you do in fact come back to it a minute or two later, though! If you don’t, and you simply “save” your child from speaking, it will reinforce their silence by preventing them from ever having to learn to speak for themselves.

 Make Talking Fun!

There are some games you can play that encourage continued speech, like Go Fish, Battleship, Surveys of “Favorites,” Hangman, Spot It, and Tell Tale. Be patient and positive as your child finds new ways to cope! Secure attachment and strong social support are huge protective factors for all children, particularly those experiencing anxiety disorders. Continue to provide a warm, safe, loving, and fun environment for your child!

 Seek Help

Finally, and perhaps most importantly, childhood anxiety disorders are easily treated and many families can benefit from consulting a mental health professional. A therapist can help assess, diagnose, and treat the anxiety disorder and help you create a plan to help your child cope and overcome their fears. Cognitive-behavior therapy (CBT) is the gold standard to treat childhood anxiety disorders as it helps children learn new ways to think in anxiety provoking situations, and teaches them concrete techniques to manage and tolerate their anxiety. If you are concerned about your child’s anxiety, seek help from a trained professional who can help you and your child.