Ask a Health Expert, Episode 5: Help With Back-to-School Anxiety During the COVID-19 Pandemic

 

 

Siobhan Goodwin

Hello, my name is Siobhan Goodwin, regional vice president of business-to-business strategy at Anthem. Welcome to our latest Ask a Health Expert podcast titled Help with Back-to-School Anxiety During the COVID 19 Pandemic.

I'll be your host today as I speak with Dr. Jessica Chaudhary, a psychiatrist who specializes in psychosomatic mind-body medicine. And Dr. Steven Korn, a child and adolescent psychiatrist. As well as Rebekah Stoll, a high school family and consumer science teacher for 14 years. There are so many mixed feelings among parents and kids about being back in school. Today, our experts will address some concerns parents are currently having as a result of the pandemic and the anxiety that their children are experiencing when moving back into the classroom. They'll share different tactics or approaches you can use to support your children as they go back to an in-person learning setting. And advice on how to cope with your own fears and anxieties. We'll hear from Rebekah Stoll and what teachers are seeing and get advice from doctors Chaudhary and Korn on what parents can do to help their children be productive, happy, and emotionally healthy during these times in the classroom and at home. Thanks for being here today.

Rebekah Stoll

Thank you. Happy to be here.

Dr. Steven Korn

Thanks for having us.

Dr. Jessica Chaudhary

Thank you. I'm looking forward to the conversation today.

Siobhan Goodwin

Let's start with you, Rebekah. You've been interacting directly with children since the pandemic began. From virtual teaching to the full-time classroom setting, what have you noticed in your students and how have they been handling the pandemic?

Rebekah Stoll

So, students are struggling with both academic and social anxiety this year. They were struggling with the social anxiety before the pandemic. They have been home for at least a year and a half, some of them almost two years, and they haven't had to have social interactions with their peers, so they're having a lot of difficulty making these connections. They also didn't have the same rigorous academic expectations last year, so coming back to school full time in-person with all their peers with regular academic pressures put on them — it is causing them a lot of anxiety, and it's really been a struggle.

Siobhan Goodwin

That sounds like the students are going through a lot. There must be a ton of stress going through their bodies, walking into that classroom. What are some of the tactics that you use to help students cope with anxiety?

Rebekah Stoll

So, I do a bunch of mind body type of activities. So, one thing I might do is check in with them on a mood meter. It's a way of students being able to verbalize what they're feeling at the moment so they can put words to the emotions that they're having. And if I notice that a lot of my students are having difficulties that day, I might take a few minutes to pause and talk to them about what's going on. Sometimes they just need a couple of minutes at the beginning of the period to debrief or de-stress about what's going on with their lives because school is not the most important thing in their lives, even though as a teacher, I believe that it should be. They are really social creatures, and sometimes they need time to process that information. So, I might take a few minutes to do that. I also talk to them about doing mantras. So, you take your fingers and you tap them against your thumb, each one of them, so there's four different beats. And they can come up with a phrase that helps them de-stress. So, it could be something like I-am-worth-while, and they can quietly just put their hand under their desk and tap and repeat that mantra in their head and it really calms them down a lot.

Siobhan Goodwin

That is really helpful. You know, having four children of my own, it's really hard when you know that your child is suffering from anxiety. It's difficult to get them up in the morning and out the door to school when I know that they're going into a situation that's really stressful for them.

Dr. Korn, is there anything that a parent can do to help their child before sending them off to school to help relieve some of that anxiousness?

Dr. Steven Korn

My general recommendation is to help the child focus on the here and now, turn their attention to what's going on in their immediate environment, in their immediate world. Simple breathing exercises also help to sort of bring the child back to the present. And then, of course, because anxiety is all about worrying too much about what's happening next, a simple, always effective strategy is to take the child through, pace by pace, what to expect. Getting on the bus. Getting off the bus. Walking into class. What they'll do at their desk and really help them sort of mentally prepare for what's to come and get some sense of mastery over that.

Siobhan Goodwin

That's great advice. If you don't mind, I'd like to dive a little bit further. Dr. Korn, you reference that maybe having the child do breathing exercises before they leave would be helpful. Could you tell me exactly how to do a breathing exercise as I'm not really sure I know how to do that myself?

Dr. Steven Korn

Sure, there are so many ways of doing this, and there's no right or wrong way. The whole purpose is to sort of help the child focus on their breathing, sort of turning their thoughts inward. So, for example, taking a breath and counting backwards to ten, or to five if it's a smaller child, and then letting it out at the same pace. Counting forwards, if they're counting backwards, something very simple that you don't have to think about, and that the whole purpose of it is to slow the child's breathing down and to get them thinking about taking a slow breath in and out.

Siobhan Goodwin

Thank you for that guidance. I think that would be helpful to anybody in a stressful situation, not just children. And as I think about stressful situations that we are all in now, social anxiety really floats to the top of my mind. We've all become used to being on camera and not having in-person interactions, which I think may prevent us from building relationships. I know when I'm uncomfortable, the first thing I do is pull out my phone and start texting or playing a game. Not the best thing to do. Rebekah, that must be something you see as a teacher. Is there anything to do to help children make that transition from video to in-person social situations to make them more comfortable?

Rebekah Stoll

Absolutely. So, I actually challenged a group of my students last week to not use their cell phones for an entire period, and when I challenged them to that, they totally freaked out. They were not at all OK with it. They're like, “What am I supposed to do? How am I going to make it through the period? What am I going to do with all of this time?” And I was happy to report the next time that I saw, I talked to them, they told me that they, more than half the class actually, completed the challenge and they loved it. And they were telling me how much more productive they were, how much more efficient they were at their work. And they were really surprised that, how much of a time suck their phones are. So, that was really interesting for them. One other thing I did at the beginning of the year is I teach fashion classes. I broke my kids up into groups and I teach mix levels nine through 12th graders, which can be a challenge in and of itself. So, I put them in groups and gave them a bunch of recycled items, and I challenged them to make an outfit from those items. And it was really silly, and they had a lot of fun with it. But I noticed that all of the groups I paired them with, all of those kids are still choosing to sit together and have become friends because of that activity. So, sometimes teachers need to force kids into doing group work in a way that makes them be able to relax a little bit that can help them build friendships with people they wouldn't necessarily be friends with otherwise.

Siobhan Goodwin

Oh, that's interesting. For parents who know that their child is having difficulty making those social connections, how do you recommend that they have that conversation with the teacher? Are there certain things that they should recommend for the teacher to do?

Rebekah Stoll

So, I wouldn't necessarily have the parents recommend situations for activities for the children to do because every classroom is very different. Every subject is very different. High school level, it's going to be different than elementary. A science is going to be different than in our classroom. But I do always encourage parents to have a line of communication with their student’s teachers. So, call them, email them, get in touch however you can, and let them know what's going on. Teachers want to do whatever they can to help the students be successful. And if you have any information that could help us with that, it's always wonderful. I always have the kids advocate for themselves as much as possible too and I tell the students when they get mad that their parents are contacting their teachers, that it's really okay to have more people caring about you.

Siobhan Goodwin

Thank you, Rebekah. Dr. Chaudhary, I know you have a young child at home. Are you seeing any of the same stresses that we've talked about with your child?

Dr. Jessica Chaudhary

Well, sure. I mean, children can have anxiety manifest in all kinds of different ways. And you know, as a parent, you have to really try to model some resilience, and I try to do that with varying degrees of success. But remember, resilience is really the ability to bounce back and take on difficult challenges and find meaning. And these skills can be learned. And if we can model this and teach this to our children, I think we can really help them face anxiety and any adversity they might be experiencing at school. So, I'll sort of give an example. If you're facing a difficult moment, use it as a teaching opportunity. It can be as simple as being stuck in traffic and explaining to the child, which I've done before, this traffic is making me so mad, but I'm going to take a few deep breaths and try to calm down. You want to try to keep things in perspective and maintain a positive outlook. Because when you feel anxiety, the children will feel the anxiety. And you also want to help children try to identify their emotions and what an appropriate response is because behind every behavior is really an emotion and recognizing, labeling, and understanding that can really help develop skills to respond to the emotions appropriately. For example, if you try to hold an ice cube that will help teach the difference between a feeling and a reaction. So those are some ways to try to teach kids resilience and dealing with adversity.

Siobhan Goodwin

Can you explain that a little bit more? What do you tell the child when they're holding the ice cube? What is it exactly that you're trying to teach them?

Dr. Jessica Chaudhary

When you hold the ice cube, you immediately feel the cold and you react and you might want to drop the ice cube. But if you hold it for a second and you process what you're feeling. Well, I feel the cold. Can I do something to mitigate that feeling or make it better? Can I maybe put the ice cube in a paper towel and that'll help this coldness that I'm feeling? It's the same type of behavior that formulates reactions to the difficult experiences that we feel. We may want to have a knee jerk reaction to something. But if you take a moment and process and filter, there could be ways to really deal and cope with that difficult situation.

Siobhan Goodwin

Oh, that's really interesting. And it's such a great way of showing a child, or even an adult, that they may have more control than they think over their feelings once they understand them. Dr. Korn, how do you recommend getting teenage children, who may not do a lot of talking, to articulate their feelings or to understand the difference between their emotions and their reactions? I know some of my children, not all of them, but some of them, would never sit down and have a conversation with me about how they're feeling. What are some of the techniques that I could use to have a conversation with them?

Dr. Steven Korn

One of the techniques that I've found helpful is having them, or asking them about a friend or somebody they know – a classmate, a teacher, a friend, even a sibling, and how that person is feeling. How they're coping with the stress of, let's say, returning to school or having a family member ill with COVID, how they're feeling about it and how they know how they're feeling about it. So, this will get them to pay attention to the person's expressions or their behavior or their actions or activities. And by asking them to talk about somebody else that they know, it may feel safer for them and whether or not they're revealing something about themselves, it may at least give them the opportunity. And then, of course, you can always ask, you know, is that something you felt or is that something they told you? Or is that how did you know that? And I think that will help them get to the point of being able to talk about these things, but not necessarily just talking to you about themselves directly.

Siobhan Goodwin

I don't know if you've ever heard children say this, but I know I've heard my children say it over and over again, and it breaks my heart when they do. And what they say is, “I don't have any friends.” And so, I might ask them, “Well, who'd you eat lunch with and who’d you talk with today?” And they would say, “Oh, I didn't really talk to anybody. I don't have any friends.” I don't know if it's true or not, but it really makes me anxious that they're feeling so lonely. Is there anything that you would recommend to address that loneliness?

Dr. Steven Korn

One of the things that I find is that everybody values helping kids become kind and practice kindness. And so, one of the things you can do to sort of explore that is asking your child who in their lives needs more kindness, whether it's somebody at school, their teacher, the bus driver, the person working in the school lunchroom, or one of their classmates. And if so, how do they know that person needs more kindness? What are they showing that they got that conclusion from? And then helping them with ways of practicing kindness; for more sociable kids, this may be actually saying or doing kind things. And for less sociable kids, it may be more easy to give them a kindness rock or to give them a handmade card or something. And then hearing back about that, so asking the child to kind of tell you, maybe at the end of the day or at dinner, what they did that was kind that day and what specific who they were kind to, why they were kind to that person, and sort of building on that.

Siobhan Goodwin

I love that, because it teaches them to be kind, but also to reach out to people and establish a relationship with them. Rebekah, what do you do when a child appears to be lonely or secluded in the classroom?

Rebekah Stoll

So, I try to get them included in whatever we're doing. Participating with me can sometimes build a conversation with some of their other peers. I also have a women's empowerment club where we try to build up the positivity of the entire building, so we do activities that make everybody feel good and included. So, doing different things or encouraging students to join other extracurriculars, so even being in an after-school chorus or we have a cultural diversity club, anywhere that they will feel accepted. They might not know that these things exist, so giving them the information can really help them find a niche in their school.

Siobhan Goodwin

So, Dr. Chaudhary, do you have advice for a parent or a caregiver that would help their child in the morning before leaving for school, when you know that they're full of anxiety?

Dr. Jessica Chaudhary

Sure. So, you really want to not only validate what they're feeling but help them face their fears. So, you want to help them relax through things like breathing exercises or guided imagery or visualization. And this helps build confidence. So, with guided imagery, you visualize a place where you feel safe and confident, and you can close your eyes for a minute and take your mind to that place that's peaceful and quiet. You can play in your mind how you might respond to a difficult situation and how you can react differently than what you might be feeling. And there's also a wonderful, mindful hand awareness exercise where you can grasp your hands tightly for five seconds and then release and notice how your hands feel while you pay attention to the feeling for as long as you can. Because this is a real, wonderful way for getting out of your head and into your physical awareness. With the breathing exercises, there's something called one minute breathing, which is a real anxiety buster and can be done anywhere at any time, standing up or sitting down. You start by breathing in and out slowly. And after a few seconds, you practice what's called the 4-4-4, which is inhale for a count of four, hold for a count of four, and then exhale for a count of four. Let the breath flow in and out effortlessly and repeat this four times.

Siobhan Goodwin

Thank you so much. Dr. Korn, are there other things a parent can do before sending their child off to school, something that they can do to help them as well?

Dr. Steven Korn

One of the best antidotes to anxiety that I know of is emphasizing and reminding the child of their strengths and their capabilities. The things that they do well, I think sometimes is to kind of remind them about who they are by asking them what's going to happen. For example, this day where they know that they're going to be able to handle it and do a good job and really be able to get through it well and turning the focus onto that as opposed to asking them things that they may be concerned or worried about. So really reviewing what they're already good at, what they know they can do well and what they know that they're going to accomplish.

Siobhan Goodwin

That's really important, especially as I think about some of the parents who have talked to me about their children slipping academically. While they've done very well in school previously, once COVID hit, some of the parents said, at least that I've talked to, that they noticed that their children weren't handing in homework assignments and weren't doing as well in the classroom as they had before. Dr. Chaudhary, why do you think that’s happened and what advice can you give to parents to help turn that around?

Dr. Jessica Chaudhary

Well, there’s a couple of different things I think you really need to pay attention to as a parent. One, you really want to look for a change in what's normal for that, for your child, for that particular child. And if you're noticing changes in sleep or appetite or less interest in activities or less engagement with friends or being generally more isolative — anything that's really a significant change in what's normal for the child could be a sign of something like a depression or an anxiety. And you want to try to understand that and offer interventions or support or help if it's needed. If parents can recognize some of the signs, then they can offer some help. But I will say broadly speaking, children and adults alike are adapting to change due to COVID. And one of the things that you can really do as a parent, something I try to do again with varying degrees of success, is try to embrace change and keep things in perspective. And if you can project that positive outlook, then that can also really help to relieve some of the fears that children might be feeling.

Siobhan Goodwin

That’s very helpful, Dr. Chaudhary. Rebekah, I'd like to also send that question your way. I'm sure you've seen many times where a child was top of their class and then COVID hit, and all of a sudden, these children aren't handing in assignments or they're falling behind. What do you recommend parents do with a student at home? And what are you doing in the classroom to try and address the same issue?

Rebekah Stoll

So, motivation and not turning in work was a huge issue when the students were virtual, and it's still spilling into this year as well. Anything that you can help with your child with prioritizing or making lists of when assignments are due and what's most important. They often are not sure about their time-management skills, and they waste a lot of time doing things that are not nearly as important as some other things. So, coming up with a schedule of what you need to do after school from this hour to this hour, you need homework. And going through each of your assignments and saying, “Okay, this one is due tomorrow, but this one's not due till three weeks, I need to do the one that's due tomorrow first.” So, anything with time management and prioritizing is huge. I've had to talk to my students a lot about motivation and trying to figure out what they can do to help themselves get motivated because that really is an intrinsic thing. They need to find out what they can do that will help motivate them, and it's really been a struggle for them this year.

Siobhan Goodwin

Thank you, Rebekah. One of the things that we've seen issues with young children and teenagers is resiliency. Dr. Korn, can you teach somebody how to be resilient?

Dr. Steven Korn

Resilience, that I understand, is sort of a protection against anxiety and uncertainty. It's the ability to handle things that are unexpected or that don't go well or that you're disappointed in and how not to be too strongly affected by them. So, it really is a form of armor or protection that every child needs to develop.

Siobhan Goodwin

Thank you. And so, Dr. Chaudhary, how do you recommend helping a child develop resiliency?

Dr. Jessica Chaudhary

You first have to start by appreciating your own innate resilience. Most people have quite a bit of resilience, even though they don't know it, or they may not feel like they do. But there are things that build resilience and increase hopefulness. Things like giving back and finding ways to use your strengths and talents to help others. We become more grateful when we become a giver rather than a receiver. When you think about some of the most difficult things that you've been through, you can think about that in a way that makes you feel grateful that you made it through. And you also want to watch your language and the language that you use, and you want to teach this to your children because grateful people use thankful words. Words like gifts and blessings and fortune and abundance. And less grateful people are preoccupied with burdens and curses and deprivations. So, you tell yourself and your children that you get to do this rather than you have to do this. This also helps to build resilience.

Siobhan Goodwin

Thank you so much. And Dr. Korn, I'd like to ask you the same question, how would you recommend building resiliency with adolescents?

Dr. Steven Korn

Sure. So as Dr. Chaudhary mentioned, modeling this is very important basically sort of showing a kid or a teenager how you cope with challenging events and disappointments and sometimes even sort of verbally or sort of saying what you're kind of doing automatically to help them learn how you do it. And secondly, of course, is to help them to identify resilience and strengths in others from their perspective. So, for example, again, going back to a friend or a teacher or a coach and something that happened to them that, you know, could have really thrown them off in the way that they kind of handled this, the way they coped in helping to sort of identify this in other people is a good way of helping people develop themselves.

Siobhan Goodwin

So said another way, and I'm wondering if this would be helpful and if I'm understanding what you're saying correctly; if I were to sit down with my children at the dinner table, maybe sharing stories of where I'd failed in the past, whether it be something that happened during my day or something that happened at work or how I be bounced back from that, is that kind of a form of resiliency or how you can show your child that it's OK to fail?

Dr. Steven Korn

Yes, that's exactly what I'm talking about. For example, relating from your own day-to-day life something or an event that happened at work or among your friends or family members. What it was that happened that disappointed you or that upset you, how you handled it, how you felt about it, if you handled it well. How you think you could have handled it better if you didn't feel, if you didn't feel like you handled it well. So basically, just serving examples from yourself as a way of how you think about these things and how you handle these things, not necessarily judging whether another person, what another person did, but basically using yourself as an example.

Siobhan Goodwin

That's very insightful. Dr. Korn, thank you so much. There's a part of me that can't help but wonder if that feeling of fear of failure is what's driving a lot of anxiety that our children and adolescents are facing. So, for instance, are they not handing in homework assignments because they're afraid they won't get 100 or 95? Are they not reaching out to other people who are in the same setting as them because they're fearful of being rejected and trying to establish a relationship with another person? And so with that, I'd like to ask Rebekah, what are your thoughts on that and what are some of the things that you can do in a classroom to help children who might have a fear of failure?

Rebekah Stoll

So, I definitely think there is a fear of failure from some of our students. Some of it, I think, is they're just disorganized. They don't know how to keep track of all of their different assignments. And in high school, some of my students have completely full schedules without lunches, so they have nine different classes that they're managing work for. Last year the rigor level was not nearly as high, so trying to go back into regular schooling without any sort of transition has been a challenge for these students. I also think that students are having way too much screen time. Too many of their assignments are on the computers, and it's hard when you don't have something physical to stay organized sometimes. So, it really I think it's affecting how they process the information, and I think that it's going to be a struggle for the next several years.

Siobhan Goodwin

That's really interesting, Rebekah. And not to oversimplify what you're saying, but do you think it would be beneficial for parents to buy their children planners and sit down and help them organize their day and their priorities?

Rebekah Stoll

I think planners are a fantastic idea. I know that that sort of organization doesn't work for people, but it's a pretty cheap thing that you can try. And if it works, it works. If it doesn't, it doesn't. A lot of my students will set reminders in their cell phones to remind them to hand things in, if that's what works for them, that's amazing as well. So, you really need to kind of do a trial and error and figure out what is going to work best for your child and what works best for the way that their brains work.

Siobhan Goodwin

Do you see or do you recommend that there are ways children can organize their day that are more successful than others?

Rebekah Stoll

I think any student that tries to organize is going to be better than the students that kind of just wing it. So, any time you can put everything in one place to see what you have, some of my students use Google Classroom as their whole organizational philosophy. Some of my students do still carry around paper planners, so just trying to put everything in one place so you can see everything is very beneficial.

Siobhan Goodwin

I'd like to thank Rebekah for giving us such valuable insight into what you're seeing firsthand from an educator’s perspective. And Dr. Chaudhary and Dr. Korn, I very much appreciate you taking the time to weigh in on how we can help our children and parents who continue to deal with so much as a result of COVID. No doubt the three of you have covered information that many parents can relate to, and I'm sure they'll find our discussion very helpful.

We have additional resources for both parents and children, and they're available on our website at anthem.com/ca. And as always, we are all intentionally involved in improving the health of humanity. And we hope you'll join us soon for another episode of Ask a Health Expert.