Sage Thrive Today Blog Mental Health Intervention PODCAST EPISODE 9: Coping with Fear & Anxiety

PODCAST EPISODE 9: Coping with Fear & Anxiety

Welcome to our podcast: Conversations About Student Mental Health.

I’m Chris Leonard, Clinical Social Worker working with adolescents for over 25 years. In this podcast, I talk with school administrators, educators, clinicians, and parents to open a dialogue that will help the growing number of students struggling with mental illness.

Chris:

Who is not feeling fearful or anxious today? COVID-19 has us all hunkering down at home. We’re worried about running out of food, worried about finances, worried about running out of toilet paper. We’re worried that we will get the virus, and more worried about our loved ones, who are most vulnerable due to age or medical fragility. We’re all just plain worried. We wash our hands, we wash again, we try to adjust to news and updates that seem to change hourly.

Today, we’re going to talk about anxiety. What it is, what to do about it, and what not to do about it. We’ll also discuss how to talk to young people and help them cope during this time of tremendous uncertainty.

I’m pleased to welcome John Reilly to the podcast today. John is a clinical social worker, and certified psychoanalyst with 30 years of experience working with adolescents and adults. He also provides intensive clinical supervision to many clinicians and regularly writes about anxiety and treatment techniques. Welcome to the podcast, John!

John:

Hey, thanks, Chris. I was listening to that intro and I didn’t even know until about 6 weeks ago that I had the anxiety phobia of the loss of toilet paper! That’s something we’re all having to contend with now, and it’s been quite a thing to watch people navigate over the last several weeks.

Chris:

Yeah, it’s a good point, because you know, we have felt that anxiety’s been an epidemic for some time now. People constantly talk about the epidemic of anxiety in the country. But things that we’re anxious about now were never things that gave us pause before.

John:

There are a lot of things to try to control. You know, thinking about this toilet paper hoarding, with all the stuff that’s out of control, people try to control something in their life. So sometimes things can be as simple as trying to control how much toilet paper you have in your house, milk you have in your house. You see that before snowstorms, you see that before other kinds of storms, people hoarding things that, really, they’re not going to have any problem getting. The hoarding causes a run on things and a panic and more anxiety, so it’s kind of a self-fulfilling prophecy in some ways.

Chris:

Oh, definitely, definitely. Well, I think that’s going to play a role in some of what we’re going to talk about today, that idea of a self-fulfilling prophecy. To that point, can you talk a little bit about your understanding of what anxiety is and what purpose it serves?

John:

Well, before I get to that, I want to talk about that word “epidemic” for anxiety. Those of us that are in the mental health field, are you know, I’m not sure we’re seeing it as an epidemic because we’ve always seen it. I think there is more awareness over anxiety and its manifestations than ever before, and people willing to get some help and to talk about it. There’s some that say going to therapy and going on medication is less stigmatized, than it’s been in the past, so I think that’s an overall good thing.

There are certainly other parts of our daily lives and culture that I think are contributing to anxiety, obviously our current pandemic, but aside from that, be it the 24-7 news cycle, people being glued to social media, busy lives, not getting enough sleep, it all contributes to levels of anxiety. Even prior to this pandemic, people didn’t have enough down time. We’re starting to see people disengage a little bit, everyone’s brains are always engaged in doing something and being busy. Sometimes when I’m driving my car, and as soon as people stop at a stoplight, they’re looking down at their phone. People are always engaged, there’s no time to just think and meditate. So I think, and the lack of sleep and all that contributes to intense anxiety.

So about anxiety: you know, anxiety gets a bad rap. It’s really a very uncomfortable feeling of worry, nervousness, and unease, disease. It lies on a continuum between mild to severe, like panic attacks. People with panic attacks or claustrophobia would be a real intense sort of anxiety; one would feel panic, shortness of breath, desperation. Sometimes people can connect to what’s causing anxiety, but more often than not, people have no idea why they’re feeling anxious, and there’s this kind of free floating anxiety that people have.

One thing that people are starting to realize is that it can manifest in various different ways that are not directly felt as anxiety. It could be like a slight tightness in the chest, headaches, stomach aches, back problems, some of those somatic ways. Sometimes people don’t even realize those somatic symptoms are due to anxiety, and when there is a connection made, it’s often very helpful because one of the things that helps with anxiety is knowing it’s there, and then understanding what the anxiety is signaling. So it’s anxiety as a signal for some kind of underlying difficulty or problem.

Chris:

Yeah, that aligns with my view. You know, anxiety serves as a survival purpose to us. When we were hunter-gatherers and we were living alongside saber-toothed tigers, if you saw a saber-toothed tiger, it was a good thing to get anxious because you had to figure out what you were going to do to survive. Were you going to stand and square off with it with your spear, were you going to run, what were you going to do to keep yourself alive that day?

And a lot of times, people experience anxiety in this kind of fight-or-flight, life-or-death situation, and it seems to me that people kind of cultivate a habit. Out of necessity, often because they’ve had childhood experiences, something has happened in their life, where they have felt that they have been in danger. And they get very accustomed to that sense of being in danger. It sets up a pattern in their life, where they are constantly defending themselves against impending danger. And that becomes the story of their life that they tell themselves to survive. It outlasts its usefulness for people.

John:

I have some thoughts about that, especially regarding trauma, and we can talk about that a little bit later.

But I have an example of a somatic complaint the patient came in with the other day. She came in with a headache, and she’s been prone to have headaches when something stressful was going on. So knowing that, I was asking her to tell me what’s been going on in her life. And it wasn’t immediately obvious, but there’s this thought in psychotherapy that the unconscious always pushes for expression, so if you ask the right questions and listen, somehow it’ll pop up.

So she was talking about her son who is an essential worker, and he has to go out there into the world on a daily basis, and come home to her. You know, as she talked about it, I noticed her voice changed. And I said, I wonder if in some way, your headaches are caused by the worry for your son, and the worry for yourself, about him bringing home the virus to you. And she said wow, I didn’t really realize that, but that’s exactly what I was stressed about. She didn’t want to realize how scared she was for her son, how scared she was for herself. So she kind of suppressed it, but it did cause some tension in her mind, and as often happens in therapy, if you make the connection it helps someone kind of bring it into the consciousness. It does help begin to calm down. It may be an urgent situation going on; she still has to be very aware of what’s going on in her life and her son’s life. But at least she’s aware that it was causing her a tremendous amount of stress, coming out in headaches.

Chris:

Well, that makes me think that generally people think of anxiety as something they have to avoid at all costs, or something that they’ve got to get rid of. When something manifests as a headache, when a feeling like that manifests as a headache, it’s not a conscious decision. “I don’t want to worry about my son, so let me get a headache.” It plays out that way though, but when you bring it to consciousness, the headache no longer becomes a necessary or seemingly necessary means of coping.

John:

It’s a language, you know, when we repress things. Somatic complaints are a kind of language. You kind of know, if you are a therapist, if someone is prone to that. You know to look for stress or depression or something underneath it. So it’s not a bad thing, it’s functional. It can lead us to take action when we’re in danger. It can lead us to take action on something not too dangerous. If you have financial problems, anxiety over money may cause you to set a budget, get a job, think more consciously of your financial situation, rather than just deny it and ignore it.

The kind of anxiety that’s a problem is the intense and preoccupied anxiety. When you hear someone’s being neurotic, having neurotic anxiety, it doesn’t have a biological base. It can be a preoccupation, nervousness, obsessive compulsiveness, and just an obsessive manner. That may be caused by a conflict, something like being repressed or suppressed, like we talked about before, causing anxiety.

I like to see it as the check engine light on a car. But once you check it, the light goes out. Once you know something’s wrong, you can keep driving it, you can keep riding it, but sooner or later, it’s gonna get to a point where you need to pay attention to it. If a patient comes into my office and is feeling anxious or even depressed about something, and not clear on what it is, we trace it back to what the cause of it is. You know, it can be a signal that something’s not right and that there’s something unconsciously preoccupying them.

That happened to me one time, several years ago, I had this feeling of just anxiousness, and a little bit of dread. I think I was actually talking to you, Chris, about it. This was probably six or seven years ago, and you knew that my son Jesse was going away to camp for the first time. And you having been in the camp business years ago, you kind of know that’s a big deal for parents. And you mentioned to me, I wonder if this has anything to do with your son going to camp in another week or two. And that was exactly it. It was something he was excited about, and I was having to deal with it for my first time, with my son going away for 7-8 weeks. Again, an exciting time, but something that caused some discomfort for me that I didn’t really want to deal with. Again in that case, I think it was you that brought that to my attention. And after that it was like, ok, I could really embrace the feelings I was having. But also kind of being excited about him leaving and being aware of those conflicting feelings that can go on for somebody.

Chris:

So we have an openness to kind of explore what this is about. What might be going on for me right now? What might be happening here?

How can we help people, because people do all sorts of things to avoid their anxiety. You know, liquor sales are probably at an all time high. People drink, people smoke, people gamble, people obsess, people do all sorts of things to not deal with the anxiety that’s presenting to themselves. How do you help people get past those avoidance strategies?

John:

Well, you know, I think now in this pandemic, it’s been a really interesting shift in the work. At least the first several weeks, it was kind of having to take everyone’s temperature on my own. We’re all going through this with everyone else. We have to kind of see how we’re feeling about things. What can I do, during this time, to stay calm, amid the pandemic?

And I think that basic needs are important. You have to make sure you have your food and essentials and loved ones are all taken care of the best you can. Finances are being disrupted, like so many people’s finances are being disrupted, you know, really got to plan for that the best you can. Some people that would never think of themselves going to the government for help, but there are programs out there to get help. So put pride aside and realize that this is not of your own making. This is something that just came out of left field, and surprised the whole world, so take care of yourself in that way, take care of your health.

Like you were saying Chris, when some people are stressed, or things are out of control, they overeat, drink too much, and while that may feel good in the moment, it really won’t help. Try to set up some healthy habits. I notice people, who never worked out before, working out. I notice people that never walked, walking outside. Walking several times. I see people’s dogs tired, they don’t want to go on another walk with their owners, because their owners are going out for walks all the time. And that’s been a good thing. There are also many options online for working out; people are posting videos on Youtube, of how to do at-home workouts, so that’s a helpful thing.

Try to establish some sort of routine, if you’re a person who needs structure. Set an alarm, make your bed, shower. If you’re working at home, try to set up a place to work that’s comfortable for you, and maybe put on some type of work clothes. It can be fun doing all these meetings online with videos. You know, I was in one the other day, and I saw somebody dressed pretty impressively: he had a shirt and a tie on. And I was like wow, that’s pretty great for a video meeting. I was on with a bunch of people, and the person had to get up , and they got up, and they were wearing their underwear, and a dress shirt!

So be comfortable at home, but also be aware of being too comfortable. So that was a little comic relief, throughout all of this seriousness that we’re going through. The other advice (and I’m sure you’re saying this to your clients too, Chris) is to limit your time watching news.

Chris:

Oh yeah.

John:

And social media. I mean, it’s 24-7 of negativity, emergency. You know, I remember thinking about this the other day… how we got news in the 1980s, for those of you that were aware of news in 1980. We had the 5 o’clock and 6 o’clock news. You checked it one time a day, got the information that you needed, and then shut it off.

Things are changing rapidly, but usually not that rapidly. So, if you can get updates every 12 or 24 hours that can be helpful. On social media, we all have the doomsayers in our friend group; they’re either all politics or all pandemic all the time. There’s a great option, I think on Facebook, that you can mute somebody for 30 days. It might be somebody you want in your life overall, but maybe not during these sort of times because too much of them is not good for you. That’s one of the important things, to really limit your exposure to the negativity.

Try a new hobby, or an interest, many people certainly have the time now. I don’t have as much time as I thought I was going to have, I do have to work on that. But you can read a book, you can write a book, you can, you know, watch old movies…there are so many things one could do. We’re not going to have this chance, this time again, when we’re hunkered down at home for weeks at a time. I’m sure you are too, Chris, I know how you approach life… you try to make the most of this difficult situation. So I think this is a great time to do that.

Chris:

Yeah, I’m really trying to. Look, it’s sad, it’s tragic, you and I both know people who have died. It’s worrisome, for all of us, but I try to balance that with the opportunity that’s available. And it’s interesting, you listed a ton of great strategies for people to cope with anxiety, and the one that really resonated with me was learning something new.

John:

Right.

Chris:

Because when you learn something new, you’re literally rewiring your brain. And when you’re rewiring your brain and creating new neural pathways, your brain is going to respond differently to everything.

John:

That’s a good point.

Chris:

So learning something new, whether it’s sitting down to meditate or whether it’s playing chess, where you’re focused on something and trying something that you haven’t tried before, it really is an opportunity for you to kind of reshape your brain a little bit.

John:

You know, one of the things that I’ve noticed, and it’s certainly happening in my life and I’m noticing it around my neighborhood, is families are spending more time together. People are going out for bike rides. I’m having great conversations with my kids. They’re spending a lot of time on x-box and all that, but there’s really quality time, sitting down having dinners together. It really has slowed the pace of life down tremendously. It’s certainly going to make me reevaluate. I don’t want to go back to normal, really. I don’t want my normal to be what it was. I never had this opportunity to reflect on it until it was stopped and you really have to stop and look at it, so I think there’s some silver linings here.

You talked about learning something new, learning to change. We’ve all had to, you know, really adapt and change, pretty quickly, to some very difficult situations. And I’m always amazed by the resilience of human beings. Takes a lot to break people. People do find ways to adjust. Some quicker than others, we all have different capacities. Some people do it easily, some people have a real challenge to do it. I see that some people have difficulty not being in control, with loss of control. And our jobs are all about helping people let go of some of the control, and to work on being more flexible and resilient. And this pandemic has been a crash course in this.

Usually when we look to make adjustments in life, it’s something we plan for and we take time and we talk about it. We didn’t have that chance, this time. It was just thrust upon us. With our Sage Day schools, one of the things we had to do was switch over to being a traditional school, and then, within a week or two, switch over to do everything online. And doing therapy online. You know, it’s been amazing to watch the students, the teachers, the creativity that comes up and the commitment to the great work that’s been going on. If we would’ve tried to design it prior to this emergency, we probably would’ve taken 1-2 years to roll out such an initiative, just like most public schools. Everyone really had to be resilient, and get up to speed, so I think this has been really a real great opportunity for people that need control and planning, to learn to be more resilient.

I’m working on that a lot with my own patients. People that really had to have routines and have it their way, this has really been turned upside down. And you know, remarkably, they’re doing it. A lot of talking, a lot of feelings about it. I don’t know if you’ve seen the same thing, Chris, but it’s been a really neat opportunity as a therapist to go through something myself at the same time as my patients are adjusting to it and watching how we all have to work this through. Because we are all in this together.

Chris:

Yeah. I certainly have seen people struggling with control, people who are used to feeling, “I can pretty much dictate, I’m the captain of my own ship, I can control what happens in my life, I’ve got a great workout routine, I do this, I do that.”

You know, I’m thinking of one person in particular who had really turned his life around and had been able to go from really being a shut in to becoming involved and getting into intense exercise. This required a real high-end gym to do, and he was being more social, and getting out there and moving forward with his academic life. All sorts of these things were all happening, after a period of really being stuck. He’s still struggling with being so angry at how his life has just been shut down. How he’s now been forced back to his previous comfort zone, which is no longer a comfort zone, because his life became much more about control and achievement. It’s going to be a while, working this through. In some sense it’s an opportunity to rework through some leftover stuff. Because being shut in was all about control in a different way, right?

John:

I was wondering, as you were talking about this person, did he or she have a trauma history? Because I’m noticing that some people have had trauma. When we say trauma, I’m talking about a continuing trauma, a divorce, a loss of a parent. I’m talking about early traumas, abuse of various sorts, alcoholism of various sorts. There are various kinds of trauma issues. They all about having to face issues of control, loss of freedom, life changing on a dime, not knowing too much. It’s all the things that we’re contending with now. That’s all stuff that happens for someone that’s been traumatized.

For some, this initially sent them into a panic, a reaction of some sort. And I’ve noticed that, knowing their history, they were kind of reliving the trauma from the past in a sense, but not knowing it. When we were able to make that connection, it actually gave us an opportunity to work, like you said, at a deeper level.

A lot of times people who have lived through trauma and don’t really remember or repress it, or haven’t worked it through, they’re expecting something bad to happen in the future. Now something bad is always going to happen in the future, that’s what life is, but it’s not necessarily what they think it is. The bad has already happened. They have already lived through it. So we get them to work through what the bad was, put it into words, talk about it with somebody, and this will give us an opportunity to work through the trauma and be better able to respond to future crises so it doesn’t have to set them back into a trauma reaction. Does that make sense? Have you seen that in your work?

Chris:

Yeah, it definitely does. That particular person, I wouldn’t say there was a history of trauma, but I do have some other people that I work with for whom trauma was present, such as childhood abuse. What I see, what I’ve seen with one person in particular, is the story they tell themselves. He tells himself that people in charge are bad. And people in charge are incompetent. And people in charge are going to lead us into danger. And so, he always is, whether it’s at work, whether it’s at home, wherever it is, in the political realm, there’s always somebody who’s screwing it up. And they are going to make it bad, and make it worse. And so the story that he tells himself is that you always have to be ready for it to get worse. I always have to be ready for the thing that’s going to be the last straw. And what we’re trying to look at is, when you live that way, when you live as if the impending bad thing is always going to happen, you’re always living as if it already has, and as you’ve said, for people who’ve experienced trauma the bad things have already happened.

John:

Yeah.

Chris:

But to live in that constant state of arousal, that constant state of waiting for the axe to fall, you’re living as if axes are falling all the time.

John:

Right, it really robs you of living in the moment. Yes, you may be prepared, like all those people that were doomsdayers, right, they were prepared for the pandemic, but they’ve been living like this for the past 20 years. They’re all hunkered down, being paranoid all the time. So I think that’s a good example.

The other thing I’m noticing with people who’ve had trauma is that they might not have had any huge reaction to this, but they’re talking about their trauma from the past. It’s happened with a couple of patients, that they’ve brought in material that we’ve never really talked about before, or only talked about in a superficial way, and it’s just coming up with more depth and helping move the therapy along.

So this has really been something that you couldn’t design as a therapist, but it’s pushing people to contend with things. We stay very busy in life, we stay busy busy busy, all the time, and part of that is just the business of life, but often it gives us a way to not deal with certain things. So when that’s taken away, things come up. You may begin to deal with things that you’ve been trying not to deal with.

Chris:

I think we can both say that if there’s one tip that we were going to give people who are struggling with anxiety at this time is, if you’re not in therapy, get therapy. Find somebody to talk to. Because there’s really no better way to understand what’s going on for you.

John:

Yup.

Chris:

And figure out how to cope more effectively.

John:

There’s another change that’s happened, Chris, with people going to therapy. Some people say “I don’t have the time,” but now therapists are doing therapy online. And I think a lot of therapists may just continue to do therapy online. Patients may say, “I don’t want to have to go to an office every week, because it takes me 2-3 hours to go for a 45-50 minute session, with travel time.” So now, there’s never been an easier time to have therapy. People are doing telemedicine now, which is really great. I’ve been doing some varied version of it for years, but now I’m doing it 100% until we get out of this, and it’s been tremendous. People enjoy working this way, and I think it offers the ability, with the right therapist, for quality treatment via video.

Chris:

Good point. Well now let’s shift gears. Parents are really struggling with how to explain everything that’s going on to children. So what would you suggest to parents about how to talk to their kids about this crisis?

John:

You know, by and large what I’m noticing is that a lot of kids are handling this better than we expected. I do find that if kids have a stable household, and parents are keeping calm, and taking care of the basic needs, wifi is good in the house, so they can stay connected with their teachers and their friends, kids are handling this pretty well.

You don’t want to give false promises, but we can tell young people that we’re going to get through this, that everything is going to get back to normal at a certain point. We can’t say that no one’s going to get sick, but if someone gets sick we’re going to do what we need to do to get better. So try to give some reasonable assurances but don’t try to guard them from every reality of the situation, because they know. They know. They watch news.

Ask them to talk about anything that they’re worried about. And if they’re not overly worried, don’t look for the over worry. Watch for signs: are they sleeping? Are they eating, are they having nightmares? Do they seem preoccupied, is there a personality change? If some of that stuff is going on, you want to really assess how they’re handling the situation, but let’s not assume that every kid is struggling with this.

I think parents are handling it well, but look, a lot of families are under stress right now. A lot of people have lost jobs, people are having to adjust their whole work life. Some families have everyone at home, working together and they haven’t lived like that before. Try to set up a really stable home environment. Try to have some family dinners. Try to have family time together. In World War II, the kids that stayed with their parents during the blitz fared much better than the kids that were sent out to orphanages in the country. Because they were detached from their families. So that’s something: be with your kids, be calm and open up a dialogue and talk about things. Don’t necessarily assume that they’re struggling, but look for those signs that I talked about before, as a sign that your son or daughter, may be struggling in some way.

Chris:

Excellent, yeah. It always makes me think of an example I use with people in terms of helping children. A child is riding their bicycle and they fall and skin their knee. If you run over to them and wail, “Oh my god, what happened, this is terrible,” then they think it’s terrible. If you go over to them and say calmly, “Oh you have a boo-boo, let’s go wash that off, we’re going to make it feel better,” then they feel reassured. So when we remain centered and calm, our children will feel more centered and calm. And when our children ask us difficult questions, the best thing to do is to answer the question as simply and honestly as possible.

John:

Yeah, yes.

Chris:

Because, a lot of the time, they’re not asking anything quite as complex as we think. It can just be a very simple answer.

John:

One of the things that people ask me is, what do I do to get rid of my anxiety? I had a prospective new patient come in the other day and say, “I don’t want any anxiety anymore.” I said, “If that’s your goal you should try a different therapist, because I will not be able to help you completely get rid of all your anxiety. But what I can promise you is that we’ll try to understand it, and we’ll try to lessen it, and make it be something that doesn’t have such a big part in your life anymore.”

Life does have its anxieties, and like we said earlier, there’s some good reason for anxiety. It’s a signal, so the idea of having an anxiety-free life is not possible. But less neurotic anxiety in your life, that’s certainly possible. There’s certainly a lot of people who are there to help. So I encourage anyone that’s leading a life with a lot of anxiety, it doesn’t have to be part of your life on a daily basis in such an intense way. It’s something that, just like anything, you’ll have and you just contend with to some degree. Even Chris and I, we have a degree of it, right? So knowing it, and helping people to better understand it as a part of life. We all love being happy, but we can’t just be happy all the time. Sometimes there’s sadness and anxiety that comes into our life, and having a place to talk about that is helpful.

Chris:

I can’t think of a better way to end this podcast than with the point that anxiety really is part of life. So we’ve come full circle. We talked about people trying to get rid of anxiety, and it’s not something that we entirely get rid of. It’s something that we learn to have a much more healthy relationship with.

So, listeners, I want to thank you for joining us today. I hope you and your families are staying safe and well. Please do join us soon again for another in our series about student mental health. Take care everyone.

Conversations About Student Mental Health is brought to you by Sage Thrive, partners in school-based mental wellness.

You can find the show notes on our website at www.sagethrivetoday.com. You can also suggest topics for upcoming episodes of the podcast; we’d love to know what issues related to student mental health you want to hear more about.

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