Q: What are you seeing in your practice among adolescents?
Stark: This past year, anxiety has been coming up more and more. We often think of uncertainty as one of the underlying things that breeds anxiety and when life is uncertain, it’s important for us to be able to sit with that uncertainty. And this year has been more uncertain than most.
There’s been no one typical reaction.
For some of the teens I’m working with, the pandemic has almost been like a relief. So for teens who have been having trouble going to school every day, interacting with peers, experiencing social anxiety, having panic attacks and feeling really nervous leaving the house, this has allowed them to avoid that anxiety more and stay home. In the short term, it feels great when you get to like sit in your bed and do class from there.
And for other kids who thrive on connection and on routine, the uncertainty and unpredictability of this year, being cut off from their friends, it’s been really devastating. They’ve experienced a lot of grieving and loss of the things that they expected to have this year: sports games, dances, things like that.
Q: How can parents help their kids who are feeling re-entry anxiety or may be a little reluctant to go back into the world?
Stark: The main idea is that anxiety tends to make us want to avoid things. It can feel so overwhelming and uncomfortable, like noticing your heartbeat quickening and some kids might feel sick to their stomach. It can feel more comfortable to be at home and really scary to be out in the world.
Step one is to notice the emotions that you’re feeling about re-entry anxiety. “I’m about to go back to school in person for the first time. What am I feeling in my body? What am I noticing? What thoughts are going on?
If you’re a parent, validate that emotion in your teen by saying, “It seems like you’re feeling really anxious right? Now, of course, it is the first day back to school. That makes total sense.” Help teenagers to make sense of their emotions.
Q: How do we avoid getting stuck in that feeling of re-entry anxiety?
Stark: What we know about anxiety is that the more we avoid something that we have to do, the scarier and harder it gets. And if I do go into school that day, and kind of face that fear, it’s going to be uncomfortable. I don’t want to mince words and act like it’s going to be butterflies and fantastic. It’ll probably feel really hard, and our brain learns that’s hard, and I can handle it.
Q: So should we be nudging them?
Stark: I typically recommend finding a step by step approach to overcome re-entry anxiety. For someone with mild to moderate levels of anxiety, ask the school district if they can come in to school one or two days a week or if they can come in for a study hall to start getting used to that feeling of being around other kids walking in the hallways.
For teens with school avoidance who have severe levels of anxiety, a first step might be actually driving to the school parking lot when school is not in session or walking into the school when other teens aren’t there. We call this exposure.
We want teens to be willing. I would never want to work with someone and say, “We’re going to drop you off and push you inside.” We need to find out what they’re willing to do in that moment. And I think that’s always a great question parents can ask their teens: What could you do to push yourself right now? Is it not doing homework in bed and sitting at a desk instead? Is it getting dressed in the morning? Getting up a little earlier? What can we do to start shifting back?
Q: How can we help kids think about these friendships and returning to them?
Stark: One of the things that can be helpful is opening up with curiosity. Ask them, “Are you excited to see your friends in person? What are you nervous about? What do you think might be different?” And then parents need to be able to kind of sit with it and say, “Yeah, it’s going to be different. It’s going to be hard. Let’s see what happens. And I’m here to support you.”
Q: How do we talk to our kids about the summer or the next several months?
Stark: The main idea I have here is trying to acknowledge the uncertainty and help kids sit with uncertainty, because uncertainty is definitely emphasized right now. And life just in general is uncertain. And it is such a beautiful tool of resilience to have to be able to sit with that feeling.
I’ll often sit down with some of the teens I’m working with and have them write down the things that they can control in their lives, like what time they wake up in the morning, or what they say to their friend by text, and the things that they can’t control. Because a lot of things — like what life will look like in June — we can’t control. But we still have the urges to worry about it and think about it a lot and attempt to control it. And that tends to make us feel more miserable. And so we try to parse apart what we can control. What can we make predictable and make into routines to make feel more structured right now? And what do we have to just accept and sit with?
Q: When we should seek help for our kids’ anxiety?
Stark: Are they able to do the things that they want to do in life? Or is anxiety, sadness, mood, emotion, getting in the way of like doing things they want to do? If a teen really wants to connect with friends, and it’s just feeling so overwhelmed that they’re lying in bed all day, to me that would signal we need some more coping skills. If someone is really interested in doing well in school, but they’re unable to get homework done or focus, that would be a signal to me.
And then secondly, if they are functioning or reaching their goals, but if you see your kid is shaking, having panic attacks, crying several times per week, seeming really down, are really anxious or dysregulated having a lot of outbursts at home, that to me would be would be a sign when that there is a level of distress.
Q: Any last words?
Stark: This past year has been such a challenging year nationally globally across the developmental spectrum for young kids, teens, and adults. At the same time, it’s brought mental health more into the conversation. We know how important it is to talk with our teens about this. The teens I work with have more knowledge about their own emotions, and schools seem to be emphasizing it more. I’m hoping we can kind of keep going. That means having this curiosity about our emotions and what coping skills we can use so we can come forward from this with some resilience. We know teens are really, really resilient and strong.