NIMH Expert Dr. Krystal Lewis Discusses Coping with the Pandemic and Re-Entry Stress
KRYSTAL LEWIS: Okay. All right. Hello, everyone, and thank you for joining. I am Dr. Krystal Lewis. I am a licensed clinical psychologist here at the National Institute of Mental Health or NIMH, which is a part of NIH or the National Institutes of Health. So back-to-school time, in general, can be stressful for students, parents, and teachers, whether in-person or virtually, let alone during a pandemic. There are so many uncertainties right now about COVID-19, in general. But we know that uncertainty can be a breeding ground for anxiety. So during the next 30 minutes or so together, I'm going to discuss some of the causes or triggers to stress and anxiety and share some coping techniques or some tools that we can use to help manage anxiety and this transition back to school. I'll also answer as many of your questions as I can during our time together-- before the end of our time together. So feel free, as I'm talking, to send your questions along, and we will try to get to as many questions as possible. It is important to note that I cannot provide specific medical advice or referrals. Please consult with a qualified health professional for diagnosis, treatment, and answers to your personal questions. It's important that you reach out to your individual provider. If you need help finding a provider, please visit www.nimh.nih.gov/findhelp.
KRYSTAL LEWIS: If you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK. That's 1-800-273-8255. If you're currently in crisis or you know someone in crisis, please reach out and utilize those resources. Okay. So when talking about stress, we know that stress is a completely normal experience. We've all had stress at one point or another in our lives. Everybody experiences stress in different ways. And so something that might stress me out might not be a stressor for you. Something that you find stressful might not be stressful for one of your friends. So when considering this back-to-school time, it's important to note that everyone might experience this transition a little bit differently and that a stressor for one of your children, which may be returning to school or having a new teacher, may not seem stressful for another one of your children. And so stress can lead to the experience of anxiety. And we know that there are similarities between stress and anxiety. However, they're not the same thing. So we're going to talk a little bit about that as well. So when talking about stress and anxiety, focusing on stress, first, we know that stress is a general response to an external cause or situation such as having to prepare for a major presentation or taking an exam, or in this case, the transition back to school could be a stressor for a lot of people. It typically goes away once the situation is resolved, and it can be positive or negative in terms of how it influences your behavior. So for example, if you have a deadline coming up on Friday at the end of the week, that stress could cause you to be a little bit more productive and it might motivate you to get done what you need to get done.
KRYSTAL LEWIS: However, someone else's experience of that stressor, it may actually impact their ability to sleep at night. It might cause them a lot of worry and a lot of angst where they're unable to concentrate on that particular project. And so it's the same external stressor, which is that deadline. However, it's affecting people differently. And so stress can be a positive thing in terms of it helps you or motivates you, like I just mentioned. However, for some, ongoing stress, it can impact their ability to manage in that situation, and it can also lead to anxiety. And so anxiety we know is more a response to something that's happening. It's an internal experience. Oftentimes, it's a reaction to a stressor. It's coming from your brain. And oftentimes, this anxiety, it's engaging our threat system, right? And so our threat system is activated and we feel anxious and that can be experienced in many different ways. But the difference here is that the anxiety sometimes can be persistent and chronic, and it may not go away. It doesn't go away once the actual stressor is removed. And so if there's no immediate threat around you, we can still experience that anxiety. We're often focused on the future, the what-ifs, what could happen. There's no immediate danger, but that anxiety continues to be there. And so again, similarities between the stress and anxiety, but a little bit different, and that's important to keep in mind. So we know, in general, that stress is a common, everyday part of life, like I mentioned, but sometimes these stressors can become chronic or they're continuous. So they happen over and over again. And many of you have heard of the term chronic stress. And when we're stressed, our bodies are stressed for long periods of time, we know that that can be detrimental to our brains and our bodies in the way that we respond.
KRYSTAL LEWIS: Over time, if we're constantly on edge, our brain is unable to-- our brain and body, unable to relax. This can lead to many physical symptoms such as experiencing headaches or stomachaches or even muscle aches, in general, and just a sense of not feeling well. And so the amount of stress that we're feeling can impact our overall well-being. And so it's important that you keep in mind when you're feeling these signs and symptoms of stress and anxiety so that you know at what point you should intervene and do something about it. And so when you're constantly having symptoms such as feeling irritated or experiencing a rapid heart rate, maybe losing focus and not really being able to concentrate, and you're constantly having these symptoms that's interfering in your daily life, then at that point, it's important to figure out, okay, what can I do about these symptoms, right? What can I do to help myself to refocus and to relax? So we're going to talk a little bit about relating this to the experience of back to school for parents and for children. But it is important to highlight the differences there between stress and anxiety and for you to be able to identify when you yourself are experiencing stress or signs and symptoms of anxiety. Okay. So over the course of the past year and a half or so, many people have been doing the best that they could do to manage during the pandemic. And we know, at this point, many people are tired of being at home, tired of being away from friends and family, not being able to enjoy the things, typically, that they've been enjoying. And so with this transition back to school, it's likely that it brings a lot of excitement, and rightfully so. It is an exciting time. However, it can also be stressful as we know that the back-to-school time period, in general, is stressful, let alone adding in the considerations that we have during this pandemic.
KRYSTAL LEWIS: Okay. So I'm just going to talk a little bit about some tips for parents, for caregivers to help manage this back-to-school stress. So the first thing I'll say is that it's important that you plan for the day. When your child's going back to school, you have the date and so it's important a week beforehand, several days beforehand, you think through what is that day going to look like? What time do your kids have to be to school? What's the morning routine, generally? You can talk this through as a family and prepare for what that might look like. What time we're getting up? How we're getting to school, whether that's a parent driving, who's driving them, or on the bus, what that might look like? In general, we recommend doing a run-through, right? And so as you start to prepare for back to school, we know that having your children go to bed a little bit earlier each night until you get to that bedtime that they should have during the school year is important. You can practice this before the actual night before school. And as you're doing that, prepare for what the morning may look like. So as you're planning it out, talk to your child about any concerns that they might be having about going back to school. You can talk through if they have a particular issue, who should they talk to? Who at school are they comfortable with? It might be a new school for a lot of kids, and so how do we help prepare them for that transition? So you can also try to reach out to a parent and plan a playdate if your child hasn't been around other kids or maybe they're transitioning to a new school. Planning out a playdate and giving your child time to socialize with another child, so maybe going into the school year, it's not as anxiety-provoking. They know someone. But really just knowing, okay, this is what the first couple of days might look like, here's our plan as a family, this is what we're going to do really helps to prepare not just you, but your child for what's to come.
KRYSTAL LEWIS: Another thing I'll say is it's important to ensure that you have a good schedule, in general. So as you're preparing for getting your child on a specific school schedule, that's going to be focused on sleep - what time will bedtime be? - and trying to be consistent with that. As well as when you wake in the morning, how much time do you need for that transition? Not for your child-- not just for your child, but also for yourself and your other children. So it's important to plan these things out and have a schedule or routine that everybody can go by, that everyone can follow. And so we know that this is helpful in that you need to take care of the essentials, making sure that you have food lined up, making sure that you know where your child's eating lunch at the school or are they bringing lunch. And when planning this out, you can help your child to remain excited about this transition by focusing on, okay, what do we have to look forward to? Maybe there is a special lunch that they want. Maybe you can help them focus on getting to see their friends that they haven't seen in a while. Talk about the transition to this new teacher, we're excited about who this teacher might be. Or being able to see our favorite teachers that we haven't seen in a long while. And so as you're doing the planning with your child, it's important to also focus on the positives and what can be exciting about this experience. Another thing I'll say is to listen to your child or your teen's concerns. And so we want to validate their experience, their emotions during this time period. It's easy for parents to invalidate their child because when they bring them a concern, as parents, we just want to make sure that they feel okay, that they're not anxious, that they're ready to go. And so if they come to you with a concern, we might say, "Well, you don't have to worry about that. That's a silly thing. Why are you even thinking about that?" And your goal is to help them to feel better, but in doing so, you're invalidating their experience of whatever it is that they're thinking about.
KRYSTAL LEWIS: So for example, your kid might come to you and they might say that they're worried about losing their lunchbox. And so for you, you're saying, "Well, that's not a big deal, right? We would just go buy another one," or that's not likely that that's going to happen. But if that's something that your child brings to you and they're concerned about it, it's important to validate how they feel about it and then come up with a plan or talk through what would actually happen if you did lose your lunchbox, right? "Oh, I can see how that would make you feel anxious. Let's come up with a plan for where you're going to put your lunchbox when you get to school or what happens if you do lose it. We can handle it." The biggest thing is when your children are bringing you concerns is you want to validate how they're feeling and say that you can understand why they would feel a certain way and it's okay to feel scared, it's okay to feel anxious, but this is what we're going to do about it. And so you don't want to feed into avoiding whatever it is they're afraid of. However, you do want to acknowledge how they're feeling and let them know it's okay to feel that way. And another thing I would say really is just knowing that it's important that as parents, you express your concerns as well. And that's okay. Let your child know that you feel anxious sometimes as well. "So I'm feeling pretty stressed about starting school next week too. Why don't we go for a walk?" So you're letting them know you're experiencing a similar emotion, and we're going to do something about this, right? So we're not going to, "Oh, let's pack our bags and run away. We're not going to school." It's like, "School's coming up and we know that we're going to school, but I'm nervous about it. I'm feeling stressed about it. I am as well." And so for you parents out there, there's a fine line between showing your kids that emotion about being nervous and then also modeling appropriate coping behaviors, but then also making sure that if you are feeling overly anxious about sending your kids out there in the world, that you're managing that yourself.
KRYSTAL LEWIS: And so you might need to take some time away, practice self-care, you might need to do something to manage that anxiety, not in front of your child. So there's that balance because we know that kids are always watching. And so the anxiety that you're feeling, you could transmit to your child when they're picking up on, "Oh, well, my parents are really nervous about this, right? They keep talking about it and they're talking about everything that could go wrong. Maybe I need to be nervous about this too." And so if they're expressing to you a concern, that's fine. And you can say, "Yeah. I thought about that too. It could be pretty scary. But here's what we're going to do." So it's important as a family that you have a plan for when you're transitioning to school, following the guidelines that are out there. What is the CDC saying? Are we following those guidelines? What is the school suggesting? And then you might modify that once your child actually goes to school. What is comfortable for you and your family? Having a plan of action and letting your child know, well, this is how we operate, so when you go to school, your child knows, okay, well, this is what I'm supposed to be doing. That can always be adjusted, but you can talk about it beforehand and plan for potentially what their experience might be like in school. The other side of that is that we're going to have to let them know, "Well, we may not know what's going to happen until you actually go to school, but we'll figure it out. It's okay. I know that you can handle this. It might be a little scary on that first day, but you've got this." And so the same language you want them to use with themselves, you can say that to them so they hear those words and let them know mom has confidence that I can handle this. "This is pretty scary. I'm hearing about COVID. I'm hearing all these words about keeping our mask on and what might happen. But my parents are sending me out here. They're telling me that I can do it. I can handle it." And so you want your child to have that same belief and efficacy in their own ability to handle this transition to school.
KRYSTAL LEWIS: And so parents, when I say that these are the words you should say to your children, it's important that you say these words to yourself as well. Let yourself know that you can handle this. You may not have all the information. None of us do and that's okay. We'll adjust as needed and continue to kind of march forward, make sure that we're as safe as possible by following the guidelines, doing what is necessary for our family, what makes us feel comfortable, and then you go from there. So at this time, I think I'm just going to transition a little bit to some questions that we're receiving and address some issues that are more pertinent to our audience right now. Okay. So one of the questions here is asking about are there any wrong ways of coping with stress? That's a wonderful question. So we say we want you to figure out when you're feeling stressed. A lot of times, we know and we recognize the signs and symptoms and we do whatever we can to make them go away. But what we want to highlight is there are some things that we call unhealthy coping. You're still coping with it, but it's not the healthiest thing to do. For adults and parents, we say we want you to stay away from trying to utilize drugs and alcohol to calm yourself. We want you to focus more so on these healthy ways of coping. And when we say that, what does that mean? So it might be doing some meditation, doing some deep breathing. It might be going for a run. Something generally that's positive for your body, a positive for your brain, and brings you a sense of calm. Another thing that we say could be more of unhealthy ways of coping is avoiding the issue or just kind of not attending to things that need to get done.
KRYSTAL LEWIS: So as a parent, it might be easy when you feel overwhelmed and stressed that you're just not going to think about these things and you're going to go do your own thing, kind of ignore the issue. And that may not be the best thing for your family. That may not be the best thing for you because you're dropping the ball on certain things that need to get done. So can we find that balance of, "Okay, well, I know I have to do X, Y, and Z, but it's stressing me out. I'm overwhelmed. I don't even want to think about this." How do you get yourself to the point to be able to prepare your child for school or go into the school for a parent-teacher meeting? What can we do? How do you make sure that you're not avoiding important things? And so in general, we have to find what coping strategies work for yourself, but that are healthy for you and your family. And so anything that is harmful to yourself over time in terms of drugs and alcohol, it might be overeating. Some people find a sense of calm in eating their favorite foods, which might be filled with sugar and fats. Over time, that's not necessarily the best way to cope because it's not great for your health. For some, they might, "Oh, I just want to sleep." And this goes back to the avoiding piece of, "I'm just not going to think about it. I'm just going to sleep." What happens is we might tend to sleep more and more when we should actively be problem-solving or doing different things, and now we're dropping the ball. So it's really a balance of finding what works for you and it's not interfering with what you need to get done, it's not detrimental to your health and well-being in general. And I mentioned meditation. Another question here is meditation can be hard to focus, any tips? And so we know that meditation, in general, is super helpful for children in the classroom, for us at home just to help us to refocus. However, it can be hard to do.
KRYSTAL LEWIS: I would suggest practicing daily. And so there are so many different apps out there and guided meditation practices online. And so you can do this and set a timer to maybe just a few minutes each day. Maybe when you wake up, that's when you want to try it. The more that you do it, the more you practice it, the easier it becomes. But it's a process, so it's not just going to come to you, a lot of you, very naturally. It can be hard to focus during that time. So if you're saying, "Okay, I'm going to do this 30-minute meditation, sit here, put it on," and it's really hard for you to get through, you might have to start with a 5-minute meditation or even a 2-minute meditation and build yourself up to doing longer periods of time. And that's okay. And we say meditation is great for the family as well, and do family meditations. Maybe after dinner, you can say, "Okay, we're going to do this family meditation." And especially with younger kids, they're not going to be able-- they may not be able to sit for long periods, "So let's do a 5-minute meditation or a 3-minute meditation." The more you practice it, the easier it gets for you and the more helpful it can become. We have some other questions coming in here. So one of the questions is asking about the fight-or-flight response. So this will kind of relate back to when I was talking about the stress and anxiety that we might experience. Essentially, the fight-or-flight response is a threat response that occurs in our brains when we believe that we're in threatening situations. So this transition to school might elicit that response for a lot of kids. Once we're feeling anxious, our brain is activated, we're in a dangerous situation, we need to protect ourselves.
KRYSTAL LEWIS: So an easy example would be on that first day of school and maybe the child doesn't know anyone in the classroom. So walking in, they might, all of a sudden, feel their heart racing and they might feel butterflies in their stomach and they're feeling really scared. And there's no immediate threat in their environment, right? But what they're thinking is, "I don't know anyone. I don't know who I'm going to sit next to, who am I going to talk to, mom's going to leave me," all these anxious thoughts that are occurring. And when our fight-or-flight response is activated, our body is preparing itself to fight, get out of this situation, to flee, to fight, and sometimes we just might freeze up. These are physical responses that occur generally in the amygdala part of our brain. It's the word we use with the kids. But it's activated, and so what we need to do is how do you calm that system down? This is where we say it's important to engage in some deep breathing, doing something like closing your eyes and thinking of a calm place. That might be the beach you went to over the summer. It might be your room at home for some of your kids. But picturing a nice calm place, closing your eyes, doing some deep breathing, in through your nose, out through your mouth. Taking a couple of deep breaths helps to disengage the fight-or-flight response once it's activated. And once your body is feeling a little calmer, you're able to use the prefrontal part of your brain and think through, okay, helpful thoughts in this situation, problem-solving, decision-making. The fight-or-flight response, once activated, can make it hard to access that part of the brain. So with anxiety, in general, that's where we help kids to utilize some sort of coping strategy that helps bring them down a little bit, and then we can think through or problem-solve having helpful thinking in the moment versus the anxiety thoughts or the worry thoughts about worst-case scenario.
KRYSTAL LEWIS: All right. So here's another great question. How can I approach the conversation of stress with a child who always isn't comfortable with sharing those things? So a lot of times, you'll find that kids will keep in their worries, right, or they get uncomfortable talking about the emotions that are uncomfortable for them in terms of anxiety and worry or even if they're angry. They have a hard time expressing these concerns. This particular question is asking about, well, a child who doesn't seem comfortable talking about those things. What I would say is if you know your child well enough to know what stresses them out is to gently approach the conversation, "Hey, we have school starting." "Hey, school's starting. I know generally this is a stressful period of time. Let's talk a little bit about that." And even if your child's not doing much talking, again, this goes back to as a parent, you can model, "I'm feeling a little worried about this. Let's talk about what it might look like. Are you feeling worried? Do you have any concerns?" If they're having a really hard time communicating that with you, and depending on their age, sometimes we like for kids to write out what's going on, journal a little bit. So each day they could track their thoughts or their feelings about something, and then you could have a conversation developed off of what they're writing down if it's hard for them to verbally communicate that with you. We recommend that kids have a comfortable conversation with a parent. It might be a sibling they feel more comfortable just starting that conversation. But I would say as a parent, navigating, okay, my child's feeling a little concerned about this, but it's hard for them to verbalize it to me. And so you can have the conversation with them and throw out there, "It seems like you may be worried about this. What are your thoughts on riding the bus?" Or, "This is a new school for you. It seems like this might be a big challenge. What are you thinking about this?" Or, "We're super excited about you starting this new school. How do you feel about it?"
KRYSTAL LEWIS: And so just engaging them in the conversation is helpful. And if you find that they're really struggling, then you can provide some ideas of how you think they might feel and see if they'll go with that or suggest writing things out. All right. Another one is are we taking note of the psychological impact of masks on children and their social-emotional learning? I think that's a good question. And I think there's a lot of great research going on right now about the impact of COVID and the pandemic on children, in general, as we transition back into school and being in person where most of the kids are going to be wearing masks. We'll be able to see more of the impact, and we probably won't know the full impact for years about how this is affecting our children. But we do know that this is a change from how it's been. For some kids who might have more difficulties with reading facial expressions, now, we have them wearing masks, which will make it even harder for these kids potentially to read how their peers are responding to them or what's going on, what their teacher is thinking in the moment. And this may impact their learning, their ability to focus in the classroom. Socially engaging with peers, it may make it more challenging for them. So I do think that this is something that we're considering, not just researchers, but teachers in the classroom and parents in figuring out, okay, well, how do we make this a little more comfortable for our kids? We're still following the guidelines and wearing mask as the recommendations say to do. Can we make this a little easier for our kids with this in mind? Okay. All right. So just checking for some more questions.
KRYSTAL LEWIS: We have a question a little-- okay. We have a question about ADHD, kids with ADHD. It's a little broad. And I would say just in terms of back to school, some of the things I mentioned could be equally as helpful for kids who do have ADHD, especially focusing on the organization piece and the planning and the scheduling. It'll be important to do walk-throughs with your kids about what the school day may look like, help them to get organized with their school materials as well as throughout the day what their schedule and routine might look like, where we're keeping those extra masks, where the hand sanitizer is. So if you're focusing on the health-related concerns, making sure you have an idea that, okay, this is what they'll have with them, this is where it is, helping them to stay organized in that way. As far as learning in the classroom, it's going to be the same thing of making sure that if your child does have a diagnosis of ADHD, this may be communicated to the teacher, so you can come up with a plan for how we're going to manage this in the classroom. And you might already be thinking about, okay, well, how is this impacting them at home as well? So when it's time to do homework and the transitions, which might be a little difficult, what are some ways that we can help our kids in these situations to minimize the anxiety that they might feel about this? We have another question here. What coping strategies we can adapt to-- okay. And so this question really is asking about strategies for kids who have anxiety, how we adapt some of the coping strategies that we have for children. And I think here, I've touched on this a little bit. For our kids with anxiety, it will be very important to help them feel efficacious, help them feel like they can handle this transition to school and the stressors that pop up.
KRYSTAL LEWIS: So the first thing I would say is helping them to manage any physical anxiety they might experience. So when they know that their tummy hurts or they're feeling like I'm getting headaches, my heart's racing when I have to go to school or engage with certain peers, what can they do about that? I would suggest teaching them some strategies like deep breathing, telling them when is a good time to use the breathing. Okay. So before they're getting out the car you know, generally, your child's feeling a little anxious, let's say five deep breaths and focus on what you're excited about for the day, right? Help them to shift their thinking a little bit, helping them to not necessarily attend so much to the anxious thoughts. And when they are having them or expressing them to you, what they're worried about, what they're concerned about, again, validating their experience. "I can see how that would make you feel worried. Let's talk a little bit about that. Coming up with, okay, well, how are we going to handle this?" We're not avoiding. The biggest thing is not letting your child stay home if they tell you they're really anxious and they're upset, and behaviorally, you might see them acting out. But we don't want to reinforce that fear. We want to talk to them about it and come up with a plan for how we're going to manage it. And that could be the deep breathing strategies, that would be the helpful thoughts. So helping them recognize when they're having anxious, unhelpful thoughts, "That sounds like your worry brain right now. That sounds like an anxious thought. Let's focus on something a little more helpful in this situation." Not necessarily all positive, but what's just helpful in this moment.
KRYSTAL LEWIS: I think it's also important to encourage kids to write out their worries. That can be a strategy. So if they are feeling anxious throughout the day, you can tell them to write in their little journal, give them a book to bring to school where they can write things down, or if it's at home, it might be easy for them to access their tablet or if they want to write as well, and just track those thoughts, write them out, get the anxiety out, the worry thoughts out, and then plan through, okay, how do we address these different things? There are many different coping strategies out there for kids. And as we close in our time together, what I will say is that you can go to our website at www.nimh.nih.gov/covid19. To learn more about stress and anxiety, you can go to www.nimh.nih.gov/stressandanxiety. We have a bunch of resources on our websites that can help you and your children. And we also have a lot of active studies on stress and anxiety in many different areas for those who might want to participate. So feel free to check out our website and our resources. And again, the biggest thing will be to follow the CDC guidelines that are out there. We really appreciate you joining us today. Thank you for joining, and best wishes for the new school year.