Anna Swan, PhD; Assistant Clinical Professor in UCSF Psychiatry Child and Adolescent Service (CAS) division
What: Strategies to help when feeling anxious.
Step 1: Notice that you are feeling anxious
Step 2: Identify worry thoughts, particularly thoughts that get stuck, increase anxiety, and are hard to control.
Step 3: Actions that help.
Structure and routine: Uncertainty feeds anxiety. To balance uncertainties about the future and the world, creating habits and routines can increase certainty about what you can control in your day, and decrease anxiety.
Relaxation strategies like deep, diaphragmatic breathing help the body to calm down.
Helpful thinking: When getting stuck on worries about the world, ask questions like “Whose job or responsibility is this? What is my role?” and focus on doing your part. When getting stuck on worries about bad things happening in the future, “look to the helpers” who are working to manage this pandemic.
Brave challenges: There may be situations unrelated to COVID that trigger anxiety (things like doing schoolwork, or socializing). Continue to challenge yourself to engage, rather than avoid, situations that make you feel anxious (turning in assignments, participating in google classroom, facetiming friends). Feeling more in control of these situations can help reduce overall anxiety.
Step 4: Results and rewards. Try these strategies out, and find the ones that work for you. Practice on a daily basis, even if you’re not feeling nervous so that it is easier to use skills when needed. Reward yourself (or have your parents help reward you!) for using these strategies to cope with anxiety during a very difficult time.
When: If you notice signs of increased anxiety, using these strategies a daily basis can help. If your anxiety feels overwhelming or is making it hard to do things you need or want to do, talk with your caregivers about seeing a licensed mental health professional.
Effectiveness: CBT for anxiety is an empirically supported treatment for child and adolescent anxiety 1, 2, 3. These above strategies are described in Kendall et al’s manualized treatments for the child (Coping Cat)4 and adolescent (C.A.T. project)5 anxiety disorders.
Hollon, S. & Beck, A. (2013). Cognitive and Cognitive-Behavioral Therapies. In Handbook of Psychotherapy and Behavior Change (M. J. Lambert, pp. 393-443). Hoboken, NJ, USA: John Wiley & Sons.
Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., ... & Iyengar, S. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753-2766.
Kendall, P. C., Swan, A. J., Carper, M. M., & Hoff, A. L. (2018). Anxiety disorders among children and adolescents.
Kendall, P. C. (1990). Coping cat manual. Ardmore, PA: Workbook.
Kendall, P. C., Choudhury, M., Hudson, J., & Webb, A. (2002). The CAT project therapist manual. Ardmore, PA: Workbook.