Dealing With Anxiety Upon Re-Entry: Know the 3 A’s!

I’m writing to offer simple information about different types of anxiety that could emerge as you and your loved ones transition from COVID life and begin to re-enter more “normal” expectations for daily living.  

As a family therapist in Washington DC, I often help parents support their children in coping with anxiety as a roadblock toward their goals or happiness.  First, we work on first identifying what kind of anxiety they are dealing with. There are many kinds of anxiety that extend beyond just normal, fleeting worries or fears.

Generalized Anxiety: excessive worry across situations.

Social Anxiety: fear of situations that involve interacting with or in front of others that could be embarrassing or humiliating.

Separation Anxiety: anxiety about separating from home or caregivers–exceeds what is normal for age/situation.

Panic: intense physical reactions when in a state of fear, with or without a trigger.

Phobia: fear of a specific object or situation. 

Agoraphobia: avoiding activities or places due to fear of panic attack.

Obsessions: recurring, uncontrollable thoughts.

Compulsions: recurring, uncontrollable actions in attempt to rid oneself of obsessive thoughts or anxiety.

Because COVID living has nurtured certain kinds of fears more than others, we are going to focus on the first three types of anxiety–generalized, social and separation anxiety.  It’s also important to recognize that fear is a natural feeling to experience when we feel unsafe or scared about something as significant as a pandemic.  Fear is present-focused and generally expected when there is a real threat. Anxiety is not. Anxiety is often future-focused and irrational.  Anxiety occurs in our minds and often shows itself as worry. Worry is a mental habit, and anxiety is an overall experience of fear in our minds, our bodies, and our lives when not managed well.  In my sessions with clients, we work on understanding the difference between fear, anxiety and worry.  

Next, we also identify what coping style or “go to” action tendencies, which have been created in response to this anxiety.  I refer to these anxiety coping styles  as the 3 A’s of Anxiety:  Approach, Avoid, Attack. When we are calm and not anxious, we can Approach (or in Brene’ Brown’s words, “Turn Toward”) our fear more easily to solve our problems. When we are overwhelmed with anxiety, we often either Avoid (Turn Away or Turn Inward as outlined by Dr. Brene Brown) or Attack (Turn Against by fighting, arguing, pursuing or excessive problem solving) as a way to cope with feeling too much or too little.  [Adapted from Dr. Sue Johnson and Dr. Brene’ Brown’s materials]. 

Then, we create a stepwise plan for getting more comfortable Approaching these feelings and situations–I call this The Ladder Activity. We draw a ladder and rate situations/feelings/thoughts on a scale of 0 (not disturbing at all) to 10 (most distressing)  We then create a plan for gradually Approaching these anxious situations. Step by step, we work through this ladder in order to help decrease the anxiety and unhook the anxious reaction from the associated cues/triggers/reactions (i.e. anxious feeling, disturbing thought, physical distress, phobic behavior, etc.).  In doing so, we have to be sure to try different strategies and be sure that our goal is to teach the basic messages—You are okay~You are safe~Your feelings can pass~You can survive your feelings and thoughts~Your thoughts are not FACT, etc. We do this through a myriad of techniques including relaxation, distraction, and exposure while being careful to avoid crutches and avoidant tendencies.  

How can this process help you help your children/teens cope with their anxieties about returning to more normal routines?  Here are my tips.

1. 1. Start early.  Make a list of what activities make them nervous or anxious, Write down what they think, what they feel, and what they avoid, and what they are willing to try for each activity.  Some experts say it can take on average 9+weeks to automate a new positive behavior—That time period is longer than most summer breaks!! 
   2. Take baby steps.  Try small actions on their list of willing activities regularly, and gradually increase the challenge for them to try more difficult activities that challenge them emotionally.  
   3. Encourage them often. Let them know that you are here seeing and hearing them.~That you get it~That their feelings matter~That they belong back with their friends and teachers, etc~And that they can do it. These are the primary messages that promote security in our kids!!! 
   4. Don’t refute their feelings or thoughts. Be sure to reflect their feelings–feel it and say it back. It will be tempting to debate or disprove the worries – stick with the feelings instead. Get in there with them and feel it as much as you can. It will help you join with how hard this feels for them. 

• Still give strong pushes forward.  Try to be kind and firm as you encourage them to push them through their uncomfortable feelings.  These feelings will not break them.  

1. Check your own ambivalence.  If your own feelings are creating unrest or uncertainty, try to own your feelings, work on them, and then use them to demonstrate to your kids that both of you can do hard things together.  
2. Plan to just show up.  Try letting go of most all other expectations when your kids are entering back onsite or re-joining school/activities again.  Take the stance—All we have to do is try and just show up.  You can also try, “Just 20 minutes” for social events. 
3. Address the anxiety in the body.  If you child/teen is experiencing so much anxiety that s/he is not sleeping, eating, or feeling well, then consider what interventions you can try for the body (i.e. natural remedies, big body playtime/movement,  exercise, a protein filled snack, melatonin for sleep, etc.). 
4. Try Transitional Comfort Objects. For children/teens who are struggling to be away from home, consider some comfort strategies to help calm their bodies.  (i.e. fleecy soft shirt or sweatshirt in place of their plush COVID blanket, flexible water bottle spout  for stress chewing, cool stone in the pocket or favorite scrunchy on the wrist for soothing fiddle time, etc.).  
5. Prep Your Professionals.  If you’re worried that your child/teen will panic or deteriorate as she/he transitions back, be sure to be in touch with your family helpers to get their input and prepare them for what you all might need as a family. Those professionals could include favorite teachers, tutors, babysitters, pediatricians, other doctors, therapists, speech/occupational therapists, etc.  These people are pros at managing transitions with kids, so lean on them ahead of time and during this change.