Alexandria, VA – Elisa Nebolsine is a Cognitive Behavioral Therapist, teacher, consultant, and author who practices in Alexandria, VA. Her new book, The Grit Workbook for Kids, is full of exercises, charts, and illustrations to help kids cultivate a growth mindset and build resilience. Nebolsine talked with The Zebra about helping ease anxiety as students return to school.
Some children are returning to a classroom for the first time in a year and a half. How has COVID impacted children’s mental health, and how can parents help ease back-to-school anxiety?
It has been a tough year, and this has been especially true for kids. Anxiety is the most common childhood disorder, and what I saw in my practice this year was that anxiety and COVID were a terrible combination. Anxiety seeks to make our world smaller. We avoid difficult and stressful situations and retreat into the comfort of our own safe spaces. And while this feels good at the time, this avoidance actually makes anxiety grow.
Exposure, in Cognitive Behavioral Therapy (CBT) work, is the act of slowly and deliberately facing your fears. One very wise eight-year-old I work with described exposure as the “your brain unlearning fear.” This is 100% accurate. Exposure work involves getting used to the discomfort of fear and learning that it actually is okay, the feeling does pass, and you can tolerate the experience. Of course, this is easier said than done. When even thinking about doing exposure work, your brain sends all kinds of alarm bells, letting you know that you are at risk, that what you are planning to do is not at all smart. But, once you start to face the fears, you get used to them, and you don’t have to feel as scared. Exposure is the gold standard of intervention for anxiety. Facing fears reduces them; avoiding fears strengthens them.
The example I use with kids of exposure therapy revolves around my fear of mice. I hate mice. I think they are horrible, gross, and dirty. And yet, if you gave me one and told me I had to hold it for two weeks, I would change how I felt about the mouse. At first, I would probably scrunch up my face and look away. I would think about how horrible the mouse was and how gross it was to be near it, but by the end of the second week, I would likely be introducing him (“this is Mr. Whiskers”) and talking about his favorite types of cheese. I would have unlearned the fear.
This is a long way of saying that to get kids back to school, we have to help them unlearn the fear response and begin exposure.
How do you recommend unlearning those fears and beginning exposure?
The first step might be to list the fears that they have about returning. Make the fears as specific as possible. Then, ask the following questions:
1. What is the worst thing that could happen? Go there. Go to the deep dark fear. For Harry Potter fans, this is like saying “Voldemort” out loud instead of muttering “he who cannot be named.” We have to name the fears to face them.
2. How likely is this (insert specific fear here) to happen?
3. If it happened, how would I cope?
Once you’ve identified the fears, you want to start practicing exposure. In CBT, we make a hierarchy of our fears, starting with 10 (the ABSOLUTE worst) and going down to 1 (not so bad). We rate the fears based on the 1-10 system, and we start with the easiest fear. Not the hardest, the easiest.
For school fears, this might involve going to the building and walking around. Maybe looking in some windows, getting familiar with an old or new space. The next step might be setting up playdates with friends the kids haven’t seen in a while. We want these initial steps to be successful, so a playdate might be more structured initially in this stage.
Tests are a worry I hear a lot about, and tests were very different last year. Exposure work can involve practice tests. You and your child can have fun setting up a “school” environment in your home, and even doing some visualization work to remember what the classroom felt like (tip: use your senses here to make it more real. Hardness of chair, smell of pencil shavings or cafeteria food, sound of bells for classes to switch, pledge of allegiance, etc). And then use a practice test (easy to find on the internet), and set up a time limit and structure around it.
Slowly start introducing your child to the things they fear in ways that are manageable and where the child feels they have a sense of control.
What other strategies do you recommend to help ensure a positive back-to-school experience?
Kids slept later during COVID. They wore their pajamas all day, they did class in their bedroom. It’s important for them to start getting used to getting back into the world. A clear structure of bed and wake time is an important first step. It’s not that long before school starts this year, and now is the time to start slowly switching back to school hours.
Make sure your child gets dressed every day and leaves the house for several hours. Practice interactions with other people, have more playdates, and decrease screen time. We all changed our habits and routines with COVID, and now is the time to begin changing back. It takes a while to get used to new routines, so don’t wait on this one.
Kids are generally resilient. I am hopeful that the fear of returning to school is the hardest part for kids, and the actual return will feel good. I saw that over and over with the private school kids I work with (who were in school during COVID), and when the public schools began to return in the spring. Initially, kids were very concerned about returning and had a great deal of anticipatory anxiety, but once they were back at school, they generally reported feeling relieved and happier to be around other people and more active.
How can you tell when a child’s anxiety level is normal for their age (especially during a pandemic!) and when parents should seek professional help?
The difference between regular anxiety and clinical anxiety has to do with the degree to which the anxiety gets in the way of regular life. In therapy, we talk about how much anxiety “interferes with daily functioning.” This means that anxiety is a problem when it limits what a person will do. For kids, this might mean refusing to play on a sports team or attend a birthday party. It might look like true panic and distress over a test or report, great difficulty sleeping because worries keep going around and around in your mind, or it might mean upset stomachs and headaches when in difficult situations. Pediatricians can help differentiate clinical versus “regular” anxiety, and they are a great first step if you have concerns.
In CBT, we think about anxiety as an overestimation of risk (seeing greater danger than actually exists), and an underestimation of resources (feeling that we are not capable of managing the danger). Clinical anxiety is different from “real” fears in that the risk is not truly as dangerous as it feels. This was and is a tricky balance with COVID. There is/was real risk to being exposed, and we had to retreat.
As we move back into the world, and for kids this means returning to school and activities, anxiety may try to make us believe that we are in serious danger all of the time- despite vaccinations, masks, and more. And there’s no getting around the fact that there is still risk out there. We can use the above tools to help kids to tolerate the discomfort of getting back into the world while still being safe and cautious.
Resources for Families
The Grit Workbook for Kids
by Elisa Nebolsine
Available on amazon.com
The Wise Family
Counseling, Assessment & Parent Coaching Offices in Alexandria, Arlington, Winchester, and Virtual
@wisefamilies on Facebook & Instagram thewisefamily.com
Virtual small groups for children ages 7-12, focused on managing anxiety and building confidence. wonderologie.com
Develops non-partisan, fact-based, age-appropriate content that kids, parents, and teachers can use as a tool to explain tough subjects. explanationkids.com