What can we do when the going gets tough?

Dealing with heightened anxiety during COVID-19 with and without ARFID.

Dr Gillian Harris BA, MSc, PhD, Cert Ed.,AFBPsS, C.Psychol.

Dr Maddy Harris BA, MSc, PhD, DClin.Psy.

Cognitive behaviour therapy has long been the therapy of choice when dealing with anxiety: Anxious thoughts are challenged as being neither reasonable nor realistic. In times of crisis, however, this technique doesn’t work.

Psychologists luckily have other interventions to hand, and the approach that has been more widely discussed by the media and the social media in the last few weeks is that of Acceptance and Commitment Therapy. This approach acknowledges that the fears and anxieties are real and cannot be ’challenged’ away, but that by concentrating on our actions we can work past our fears. The approach is based upon Eastern philosophies and the suggestion that:“Pain is inevitable but suffering is optional.”

The basics of ACT are :

• Accept your reactions and be present

• Choose a valued direction

• Take action.

We have outlined a rough guide as to how this might be useful, below.

First things:

Take some time out to read this through and think about it.

It is difficult with the children at home, but short periods of time out are necessary.

Sit down somewhere quiet with a pen and paper.

1. Be aware of all of the worries and anxieties buzzing around your head.

It is okay to feel frightened, to be worried, to be sad and to be angry. Allow yourself these feelings. These worries are real, you can’t ‘challenge’ them; you are not being irrational. There are many things at the moment that you cannot control, and it is difficult to cope with the perfectly natural feelings of fear and anxiety.

You cannot control how you feel, but you can control what you do today, tomorrow and the next day.

2. Relax your body

Sit comfortably in your chair. Concentrate on calming your breathing and being aware of your body. Uncross your legs, settle your hands on your lap and sit up straight. Check through your body. Can you feel any tension? If so tighten and relax those muscles. Sit, relax and calm your body. When your body is calm, then you can start on calming your mind.

3. Think about what is going on in your head!

As if you were an outsider looking into your own brain, look at all that is buzzing around in there. We need to focus on what is under our control, and leave to one side anything that is out of our control.

Write all of these worries down under three headings:

a) This is terrifying but I can do nothing about it.

- Someone you know might get ill with COVID 19. - Your older relatives keep going out to the supermarket when they should stay at home. - What if this goes on for months, how will I cope? Will I get a summer holiday at all? - I might get ill, what will happen to the children?

Think carefully about these worries, they are general and vague, and not under your control at the moment.

Can you act on them in any way?

If not write everything down that you can do nothing about it.

AND THEN

Park the worries in your virtual car-park. They are going nowhere, leave them there. If you find yourself visiting them then walk away! This virtual car-park will be full of past worries that you could do nothing about because most of the things that you worried about didn’t happen.

b) I can do something about this – but not just now

- What will happen when I get back to work?

- How will my child handle going back to school?

- I will have to rebook all of the medical appointments.

You might be able to act on these worries, arranging appointments or preparing your child for school, but only when the time comes to do so. These go on your ‘worry later’ list – write everything down and put it somewhere safe to revisit in a few months’ time.

c) I can do something about this

This is the most important list – and the one that you should concentrate on.

Focus on what’s in your control.

Can you do anything about these worries?

Well, yes there are some things you can do.

- I am at home with (?) number of stressed out children, I am worried, and my partner is very annoying.

• Children become anxious when their routine changes; more stroppy and more avoidant in their eating.

• Be authoritative (the best parenting strategy; light control and love). Set up routines for every day, use visual timelines where necessary. Have Sunday as a pyjama day if necessary, otherwise, up and engage with the day in some way. This is difficult if you are working from home but you can alternate physical activity with quiet time, and yes it is okay to turn on the TV for an hour! The routines for the children should alternate structured activity with free play breaks – just like school (we are sure that you are all doing this anyway!)

• Use relaxation techniques both for yourself and your children. Mindfulness is not always the best technique when you are very worried and not skilled in this method. Instead, download deep muscle relaxation techniques with visualization. These techniques still the body, and ensure that, whilst visualizing, you have something to concentrate on. The visualization techniques can be used with some children as young as three years. Practice the relaxation for short periods throughout the week.

• It is also good to remember that behavioural techniques do work very well with most children if used properly*. Stars or points should be given immediately for the required action. These can then be traded in for the reward, chosen by the child, at the end of the week. This technique rarely fails. (Remember never to take a point away for unwanted behaviour and be consistent.)

• Set up a ‘time out space’, a room, a tent in the corner, where anyone can go (including you or your partner). Have your own’ green card’ system in place. When things get too much for your child, or one of your children then your child can hold up their green card and go to their time-out space, without question. Of course some canny children will start to use this to avoid completing their fractions worksheet, but this is where you start to use the behavioural techniques (stars and points).

• Use a change of pace and activity if your child is getting too anxious or stressed. Move to whatever soothes them; singing, hugging, jumping – the soothing activity will be specific to your child!

If it all gets too much, then access your feelings; you are allowed to feel stressed, worried and angry. Sit, calm yourself, acknowledge the feelings and then focus on what you can do. (Some people might have a glass of wine at this point! Hopefully not at 10 am in the morning).

My child is still not eating properly, but can you do anything about this now?

• Any time of high anxiety is not the time when your child is likely to move on and try new foods, but you might have more time to do food related activities.

• Sow vegetables.

• You might be able to cook more – and just get your child to look at the food you are preparing. Touch, smell and interact with foods. Even looking online at photos of food that you might be ordering from the supermarket is useful.

• Any sensory type of play is useful, not necessarily with foods, but with anything sticky, fluffy or soggy. Digging in the garden to look for worms would be ideal!

What if we run out of ‘safe’ foods?

• Download the letter from this website to supermarket managers, contact any outlet that you can, and ask to be allowed to stock pile.

• Keep in touch with your local community for help (We have just had a WhatsApp group shout for tomato ketchup for someone’s three year old. Three bottles of ketchup arrived on their doorstep within minutes).

What will happen if my child has to go to hospital?

Download the letter from this website so that you are prepared, and then ‘Park’ this worry.

To sum it up

• You will not always get it right – no-one can do that.

• You will lose your temper – that’s okay.

• Your children will misbehave – they are worried too.

• Your partner will blink too loudly!

• We will get out of this - and the sun will continue to shine!

Remember: if you feel anxious and stressed; calm, breathe, accept your worries, and then ask yourself - ‘What can I do right now?‘.

*Behavioural techniques may not work well with all children on the Autism spectrum, and some children who might be in foster care and have a disorganised attachment style.