Podcast: Helping Kids & Teens Manage Their Stress

Scott talks to Dr. Lisa Coyne about what stress looks like in kids and adolescents and how parents, educators, and providers can help address it. Lisa shares ways to identify stress in kids of all ages, explains common sources of stress both in and out of the home, and provides tips and tricks for lowering stress levels that all members of the family can benefit from.

Lisa W. Coyne, PhD, is an assistant professor of psychology in the Department of Psychiatry, part-time, at Harvard Medical School, and is a senior clinical consultant at the Child and Adolescent OCD Institute (OCDI Jr.) at McLean Hospital. Dr. Coyne has published numerous peer-reviewed articles and chapters on anxiety, OCD, and parenting.

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Episode Transcript

Jenn: Welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

Scott: Thanks everyone for joining us today, this morning, this afternoon, this evening, wherever you are. So my name is Scott O’Brien. I oversee McLean’s education outreach activities.

You know, the topic of stress is an incredibly important one and one that kind of touches us all. And we know that young people, you know, are experiencing higher levels of stress and anxiety, I think more than ever before, I think we can all agree on that.

And then, you know, for many young people, they’re not really skilled at managing their feelings or a lot of times not even able to express, you know, how they’re feeling or you know, what’s going through their heads or, you know, they’re not really in control. And I think this can be, same can be said for a lot, for adults as well.

So, you know, I think it’s really important that everyone who’s joining today, whether you’re a clinician, whether you’re a parent, an educator, anybody, you know, it’s really important that everyone understands stress and anxiety in young people and really in hopes of helping to be able to identify young people that are struggling and also to, you know, ‘cause you get them help if they need it, and to understand when they need help.

So today, Dr. Lisa Coyne is here to kind of walk us through this entire topic, stress and anxiety with young people. For those who don’t know Lisa, she’s an internationally known expert in this topic and I very much thank her for joining us today.

So Lisa, before we start taking questions, would you do me a favor? Would you talk to us just for a few minutes about stress and anxiety in young people, just kind of in general and the things that we all kind of need to know before we start this conversation?

Lisa: First of all, I guess I’ll start by saying that stress and anxiety are really normal human emotions. They are physical, emotional, and cognitive responses that we have to ongoing situations.

And I think one of the things that we do wrong as a culture is we think that they’re toxic, right? And we kind of try to run away from that. And it’s going to sound a little counterintuitive, right, but that’s actually not necessarily the most helpful thing to do.

So we’re going to talk today about what do we do with them when they do show up, right? I’m assuming that most of you guys don’t love feeling stressed and anxious, I know I don’t.

And you probably, if you are aware of the news and walking around in the world, you know that since the pandemic we’re starting to see huge increases in the numbers of, or you know, of stress in kids, of anxiety levels in kids.

We’re starting to see them struggling as they move back into school and start to kind of think about and wake up to what has been going on. And there are a number of contextual factors that are happening that are contributing to that, right?

The other issue that you’re probably noticing is that there’s a really big bottleneck in terms of like, if you notice that someone in your family who you love needs help, right, it’s very hard to find providers and that in and of itself is stressful.

So we’re going to focus today on what are the things that we can actually do in our families as parents, if we’re sufferers ourselves, right, because all of us at one point in our life are going to be visited by anxiety or stress, right?

One in three of us are actually going to struggle with an anxiety disorder, which simply means an intense level of anxiety that gets in the way of your functioning, right?

So that causes you intense distress or what we call functional impairment, which just simply means that you’re not performing maybe as well as you would wish, or that you’re capable of performing when that happens.

So I don’t know, is that a good enough start, Scott? Ask me if there’s anything specific, I’m happy to say more about it.

Scott: No, no, it’s a great start. The one thing I think would be really helpful to everyone to hear, as we’re getting started here, would be, would you be able to help us understand the difference between stress and anxiety?

And I ask this for a reason, one of those things that I always thought I knew until I started digging down deep into it and I was like, Oh, there’s a-

Lisa: Oh, that’s very interesting.

Scott: Yeah, exactly, so if you wouldn’t mind.

Lisa: Sure, of course. So stress is a response that we have when we are dealing with contextual stressors, right?

Stress can be acute or chronic, meaning that you can be stressed because you have to give a talk or webinar with Scott O’Brien or McLean, ha ha, just joking. No, it’s really lovely to see him actually, he’s like the opposite of stress for me, hanging out with him.

Or you can have chronic unremitting stress like we all experienced during the pandemic. So stress is a physiological reaction, right, where your body gears up towards a perceived threat and it’s exhausting, right?

And so with an acute, and your body’s supposed to do that, right, if you perceive there’s something threatening in your environment, you want to mobilize to deal with it. But if you are dealing with chronic stress that’s out of your control, like a lot of us did during the pandemic, we could become burned out.

And this is something that happens in work, it can happen in parenting, et cetera. And so I want to kind of keep this definition of stress as something that’s constrained to contextual factors.

Now, on the other side of this kind of stress that we’re talking about, there’s also eustress, which actually is positive, right, it’s the stress that you might feel when you’re growing, when you’re trying something new, right?

When you are exploring new things or learning new skills and it’s a sign that you are doing things that are adaptive, you are learning from your environment and it’s just kind of a byproduct of that.

Think about the stress you might feel if you ask somebody out on a date, or you try a new, you do a performance or something like that. So those are the kinds of things that, you know, stress isn’t always bad, but it is a reflection that we’re being asked to do more than we’re normally doing in our baseline.

And to pull ourselves up a little bit bigger than maybe we have to do on a day-to-day basis on average, right? So now anxiety it’s, again, it’s got three components. So we, you know, it’s like a tripartite model.

So it has an emotional reaction of fear, has a physiological reaction, your sympathetic nervous system kicks in and it mobilizes you to flee, fight or freeze depending on the situation. And what happens is you’ll experience actually physiological things, right?

Like your heart might pound, you might have hot flashes, your hands might get sweaty, your stomach might be upset. Muscle tension is a big one of those and then the tiredness that happens after that, so all of those things are part of anxiety.

Anxiety also has a cognitive component, right? So sometimes people are really afraid of experiencing anxiety or it’s bad, or they dread, sorry, experiencing, I can’t even speak. They dread experiencing anxiety, which is associated with panic.

Or they’re hypervigilant to their bodies, checking, am I anxious, am I going to be anxious, am I going to have a panic attack? Right, so the tricky thing about anxiety is that it can, what are we anxious about, right?

Sometimes people feel what they call like free floating anxiety, I’m anxious, I don’t understand why I’m anxious, I’m just walking around and I just can’t wind down, right? Lots of times that’s because we are responding to stuff that’s going on in our heads that we’re not really like even noticing, you know?

So there might be a worried thought that happened just there, sense of uncertainty, existential threat, fear about something, worry about something, rumination about something, maybe you’ve done in the past that you didn’t do so well.

A mistake maybe that you’ve made, worry about things in the future that could happen, could possibly happen, right, so all of those things happen. Now, as I said earlier, anxiety, like stress, is a really normal part of the human experience.

And what I’m going to propose to you is that it’s not necessarily the experience of anxiety, right, that is the problem, granted, none of us like it, I don’t like it, I’m sure you don’t like it either, but it’s what we do about it that can lead us into functional impairment and greater distress, right?

So one of the things that goes hand in hand with anxiety is avoidance, right. Makes sense, right? Of course, like if I’m anxious about something, I don’t want to do that thing, I’m going to avoid it. And sometimes that’s exactly the right thing, right?

So like if there’s a poisonous spider on your desk, you’re going to avoid that spider, at least I would, right, ‘cause that’s a real threat, right? If there’s a fire alarm going off in your building, you’re going to get out of the building, that makes perfect sense and you’re going to feel really anxious while you do it.

It gets tricky when the perceived threat is a thought that you’re having, an imagined future, a past, right, that you maybe are negatively evaluating yourself on, right? And when we start to avoid those sorts of things, that’s what gets us into trouble, so I want to bring this into talking about kids, right?

One of the things that we’ve seen a huge increase in is school refusal post-pandemic, social anxiety. What is it like to be with actual humans in an actual space instead of Zoom world?

And so when little minds start to weave stories about how I’ll feel left out, no one will like me, I’ll look stupid, you know, I’m going to get rejected, they’re going to make fun of me, right? Well, if that’s the story you’re telling yourself about your day, you’re not going to want to go to school, right?

So if you think, “Oh gosh, you know, school’s just going to be overwhelming to me. I can’t get out of bed like, I’m so tired, and you know, there’s the work, I’m procrastinating on my work ‘cause I didn’t do it perfectly or it’s not done and the teacher’s going to yell at me,” and you’re not going to want to get out of bed, you’re going to want to stay at home, right?

And so there’s like a little decision point. So I want to like really break this down into two pieces with anxiety. So there’s anxiety, the emotional, cognitive, physiological experience, and then there’s the what do we do about that?

And the trick here really is being sensitive and responsive and noticing when is avoidance appropriate and when does it actually make things worse? So I’ll stop there, Scott. See if you have questions about that.

Scott: No, this is great. Thank you. You started talking about young people, which is fantastic.

How can you, how can especially parents, educators, people like that, in those roles, how, I should say providers as well, it’s probably good for them to hear, how can they tell when they’re looking at a child, when they’re, you know, kind of at that first glance evaluating them, how can they tell if a child is experiencing an, you know, stress beyond the norm, let’s put it that way.

Lisa: So I might reframe the question a little bit, right? Because if you are trying to, if you’re thinking about is this stress beyond the norm, some people are great, like responding to stress beyond the norm, other people are terrible at responding to stress that’s less than the norm.

So what I would want to ask really is, is this person stressed, right? What are they saying? How do they look in front of me? Do they appear anxious and fidgety or quiet and shut down? Are they saying they feel overwhelmed?

Are they expressing kind of, you know, feeling like they are beyond their coping capacity, right? So I’d be curious about what’s their experience of stress? Are they experiencing it as overwhelming or something that they can’t cope with? That’s the first thing.

And then the second thing I would want to look for is how are they handling it? What are they doing with that?

‘Cause some people will be like, you know, here’s what you’d want to see, like an adaptive response to stress is, Scott, I’m really stressed, I’m just going to let you know that, it makes me feel a little vulnerable and I just also want to let you know, here are the things that I’m doing to take care of myself when I’m stressed.

I’m doing exercise, I’m eating well, I’m looking at my sleep, I’m keeping a good sleep schedule.

And sometimes when I feel like, you know what, I just need a break, I’m going to give myself permission to take that break and I’m not going to beat myself up about it because I’m human and I know I don’t have to be perfect, right, so I’m just role playing, Scott, a little bit none of these things are true, I’m terrible at dealing with stress, just kidding.

But it actually was a little bit of a role play. So the components of that are am I willing to express it or do I shut it down, avoid it, bottle it, the way a lot of us have been taught to do, especially men, watch out for that.

Am I mindful and thoughtful about what do I need when I’m stressed? And am I engaging in healthy behaviors? And you notice that the things that I mentioned are not magic, they are the basics. Are you sleeping enough? Are you eating well?

Limit alcohol consumption if you’re an adult, please, et cetera and are you filling your life with things that make you feel good, that make you feel full? Are you talking with friends would be another one. Do you have some social support? Are you seeking support?

And then the other one is, one of the hallmarks of burnout, right, is when people feel like they just have to keep going, they have to push themselves through, they don’t take time off, they have to do work perfectly.

And then pretty soon you live your way into an untenable situation. And so is this person in front of you okay giving themselves a little bit of a release of that pressure valve. And do they genuinely give themselves permission to do that?

Or are they feeling guilty and ashamed that they need a break? Does it mean they’re weak, right? Those are the things we want to look for in terms of coping with stress, right? Is that helpful?

Scott: It’s very helpful. You touched on it briefly, would you talk for just for a second, about like what are the kind of key things that we should be looking for?

You mentioned shutting down and being fidgety, things like that, like what are the actual, you can tell me what number there is, but for the average person, what are the things we should really be looking for in young people that we might not consider to be signs of excessive stress or anxiety?

Lisa: Yeah, right. Changes. Is there a change in behavior, that’s notable? Does this little person seem different than before? Do they fly off the handle more quickly? Are they irritable? That’s a big one.

You know, if you know your kiddo, like I have a 17-year-old at home and he plays his cards pretty close to the chest. And so it is very hard for me to tell, even as a psychologist, when he’s stressed because I don’t see huge variability in his behavior.

So in that case, what I want to do is I want to keep a tighter orbit, not an intrusive one, but just simply being present, noticing, checking in. And maybe if it’s a teenager, parents of teens, they probably won’t tell you much, that’s okay.

But I promise you just them knowing that you’re in their orbit is sometimes comfort enough, right, because remember, they’re developing autonomy, they’re individuating, they’re finding out who they are, but you want to communicate that you’ll be present.

So it can be hard to tell, right, when someone’s stressed or not. And you know, the simplest thing to do is to ask how are you doing, you know?

If you’re worried about them not telling you another thing that you can do that we don’t often do, especially if we’ve been socialized to avoid talking about emotion, talking about these harder, more negative emotions, right, is we can model, right?

I’ll show you mine, then will you show me yours? So like, I might open with something like, you know, I don’t know about you, but I been feeling so stressed lately, sometimes I can’t even tell when I’m stressed, like I just, I get these headaches sometimes or my neck hurts, do you ever feel that? You know, what’s it like for you, right?

So one of the number one ways that kids learn how to cope with emotions, and I’m mindful that Scott rightly pointed out that kids don’t necessarily know how to express their emotions or when or why or how effectively to do it, right?

One of the number one ways they learn is through seeing what we as parents do and when they’re a little older is seeing what their peers do. But when they’re a little, you know, even when they’re teens though, we do matter as parents, right?

And so flexibly being able to express instead of avoid or bottle what you’re feeling as a parent is really helpful. Now, one of the things sometimes parents say to me is, “Yeah, they don’t need to know I’m stressed. They don’t need to, it’s too much, right?”

But here’s the thing, right, who are you more willing to talk about stuff with, somebody who you feel like is like you, or somebody who you think is like always got their stuff together and like they’re never stressed, what are you talking about? I wouldn’t tell that person anything, right?

I’d be like, “Oh my gosh, I got to be perfect.” So our kids really do experience that sometimes, so just think about, do that little piece of perspective taking and think about your relationships that you have with people.

What are the things that those people who are closest to you do to make you feel safe and comfortable and willing to share what’s going on? Do that perspective-taking flip and then see if you can bring that into your conversations with your kids and see what happens.

Now on the, you know, part about, “Will my kids feel like I need to rescue me, I don’t want to show them I’m weak?”

Well what if, right, what if actually expressing vulnerability is a strength, right, what if you could actually do all the things that you need to do while feeling vulnerable, right? What if you could strive forward and do all of those things?

Well that’s actually a demonstration of strength, isn’t it? Because you’re not pushed around by vulnerability. The more we feel like we have tied it, can it, minimize it, get rid of it, the more we are under its thumb, right?

So the more flexible we can be when it happens, the better off we are and that’s really modeling, you know, some people call it psychological flexibility. Susan Davis, who’s a Harvard Business School professor, talks about it as emotional agility, which I think is a great way to describe it too.

It’s not about not having anxiety or any other emotion, it’s about learning to have it well, it’s having it and living well and modeling that.

And what happens when you start to do that for yourself and modeling it for your kids is that you might have anxiety, you might experience that state or you might experience stress, but it doesn’t matter because there are bigger and more important things that you are interested in in your life.

Scott: It’s almost like you could read some of the notes I was scribbling because as I was writing things down, you started going into them, so this is wonderful. I love the fact that you talked about modeling and about flipping the way that you approach things.

So I can tell you personally, I have learned that is almost been invaluable in terms of having conversations with people in my own life. You brought up men and mental health before.

I can definitely say that I was a hundred percent raised, probably like most of the men in your life where everything’s fine, no matter how bad things are, you know, the house is on fire, everything’s fine, kind of a thing, like no matter how bad I’m feeling, it’s okay, I’m fine.

Lisa: So much pressure, yeah.

Scott: And it’s very difficult and of course, you know, you grow up that way and it’s very hard to get out that mindset even when you know better. That’s, I think, one of the hardest things is that kind of that battle that goes on between the, “I’m fine, I’m fine,” and then being like, “No, you know better than this, don’t do that.”

And I have to say the modeling part, I’m so glad you brought this up because I think it’s, honestly, I can’t tell you how amazing this has been to understand this, is when you ask people, how are you feeling?

Some people will open up, they feel comfortable disclosing, but a lot of people don’t. And I have found that when I lead and I say, “How are you feeling?” And they’re like, “Oh, I’m fine.” I’m like, “Oh, okay, well, you know,” and you start talking about something or you know, “I’ve been having a tough time recently,” whatever it is.

And you’re saying, “Have you ever felt this way?” You give people permission to open up and I can’t believe you brought that up, but like people feel like you will understand them in a way they typically do not feel like, everyone feels like they’re alone in their struggles, they feel like no one else gets it, no one, and also, you know, you brought up vulnerability is a very challenging thing.

It’s very difficult for most of us to open up about how we’re actually feeling. It’s difficult to admit things to ourselves, never mind to other people. And I think that’s an incredibly important part of this too.

And I was going to bring it up in the context, I do not have children, but I can also imagine as you’re talking, I started thinking about myself with my parents and if one of my parents said, “You know, I’ve been having a hard time with something, whatever.”

I’m like, I was the kind of kid that would’ve been like, “Well what’s going on?” I cared. You know? And I’d want to hear what was going on. And I can actually see that as potentially, and you know, you can tell me if this is right or wrong, but I can see that as actually kind of two things.

One, it’s kind of a bonding opportunity that you normally wouldn’t have. But the other thing is, I think it’s a way to potentially get a child to engage who typically may not engage in such a topic or it can actually be educational for them in that you are helping them understand.

I mean, I can, I’ll be honest with you, I didn’t understand my own emotions until I was in my thirties, like it just, and I didn’t because no one ever helped me understand how to process things, how to put things into words, things like that.

So I think of you as an adult and I think this could be, this could be a parent, but it could also be a teacher, it could be an administrator, it could be anybody. You know, having this kind of open conversation and helping young people like understand how to express themselves. I mean that’s invaluable.

I think, you know, I can’t speak for anybody else, but I can say like, there’s been a lot of times for me not to make this about me whatsoever, but you know, where you’re feeling a certain way and you can’t express, you can’t get it out and you know, you feel like you want to explode, but you don’t know what to do and you know that you don’t want to feel this way, but you do.

And I think being able to kind of put things into words it just ends up being so important, not just for, you know, for other people to hear, so they can get you help or help you kind of work through things, but for yourself to go, “Okay, I am feeling X.”

And being able to kind of put it into words and be able to put it out there successfully so other people can also understand what you’re experiencing and not just say like, “I don’t feel well, I don’t feel good,” or whatever it is, if you can even get to that point.

Lisa: Right, I think that’s so important. And think about like how much bandwidth we use. Like, so there’s a couple of pieces here that I want to kind of like pull out.

And one is in order for people to learn, for our kids to learn about their emotions, they can’t, if they’re taught, like, so first of all, they’re taught they’re not okay to have, if we as parents, one of the things we see quite a lot in families of anxious children is overprotection, right?

So parents jumping into rescue quickly, which I mean, come on, you know, you want to not have your child feel anxious. Me too. I get it, I totally get it. So let me just preface this by saying like, all behavior, all the things that we do make sense, right?

They don’t always work the way we think they do, but they all make sense, right? And so helping, but the message that that sends is you are not big enough to handle your own anxiety, I will do it for you.

And that’s great when kids are little or when there’s a real threat, but what if they’re transitioning to college and they’ve had a lifetime of that? What skillset will they have for coping with adversity, right?

So a lot of parents, I mean, and just step back and think about this, right? Like a lot of parents might feel, “But my job’s to keep them safe, right, to protect them?” Sometimes.

What if the bigger long-term goal of parenting really is how to teach them to live, how to teach them to adapt, how to teach them to recognize and call upon their own strengths.

How to teach them that strengths develop by interacting with things that are sometimes hard, right? That’s really important. And so that’s another piece. But I want to go back to this piece.

You reminded me of something, Scott, just a story I was telling recently about like really not even knowing what emotions you’re having and like I didn’t have lots of people around me expressing emotion in ways that were asking me actually about emotions.

And I remember I used to ride horses when I was little, I ride them now again for the first time in like a long time and it’s been really fun. And I would say this little horse that I ride is like my dharma teacher, he’s just fabulous.

Talk about teaching you how to pay attention, he likes to buck me off when I’m not paying attention, so pretty good teacher. But I remember when I was about 13, right?

I was in the car going to the stable, my mom was driving me and I had this feeling, I didn’t know what it was, but my stomach was upset and I felt really wound up and antsy and I didn’t like the feeling, I felt like I was sort of buzzing with electricity.

And I was like, “What is this?” I didn’t know what it was. It was anxiety. I don’t even know why I felt it. But all of a sudden that’s about the time when anxiety disorders can start to show up in kids, right?

They can happen at any age, but they do like lots of times they start to show up when you’re a teenager. I didn’t have the, I remember what it was like, not knowing what that was. Now of course I could teach a course on it, but like back then I was like, and I didn’t talk about it to anyone, I just had it and I didn’t like it.

I remember thinking, “I don’t like this feeling that I’m having on the way to go to the horses,” you know? And so it’s such a gift that you can give your kids and the cost of it really too and I think this is not a small thing is you have to be willing to feel and be curious about and open to what you’re feeling.

So I mean if you’re busy like me, you know, I think all of us can get stuck in, sort of like we’re just, not now I don’t have time to deal with that now, I’m like pushing it down and we’re just going to get through the day and you know, days and days and days of that, though, pretty unhelpful, that’s when burnout happens, when we’re really disconnected with what we need, with what we want. How could you even know what you need if you suppress?

‘Cause the thing is, when you try to not feel stuff or if you push away anxiety or any other negative emotion that you don’t want, you suppress everything else too. You start losing contact with joy, with gratitude, with comfort, love and you know, just enjoying things out in the world.

And I think that that’s a really important piece. So again, what if, what if, right, we could actually be walking around in the world as fully experiencing human beings and we treat emotions just like they’re information, right?

Not that they are things we need to be, they’re toxic that will hurt us or that we don’t want or that too much of is bad. What if it’s just an experience you’re having and guess what, like everything else, it’s impermanent.

It’s going to come and it’s going to go. And the less control you try to exert over it, the more freely it will come and it will go and the less it will push you around, you have all that bandwidth to do other stuff that’s important to you.

Scott: That’s great. Thank you. Really great question just came in. I think I’m looking forward to hearing your answer to this.

Lisa: I probably don’t have an answer, I’m just kidding.

Scott: No, no, no. I think you’re actually, you’re the perfect person to ask this question to, that’s why I’m looking forward to it.

How does sharing how you’re feeling in order to allow children or adolescents to share how they’re feeling, translate in a clinical setting? As a therapist, do you or should you disclose how you are feeling in order to have a child open up to you?

Lisa: That is a beautiful question and I love that there are some therapists and also parents here, ‘cause now you’re going to hear what clinical psychologists think about when we see your kids, yay.

So when I think about this, when I am working with kids and teens, and this is what I, we train, I have a large staff, we’re constantly training everybody from practicum students to postdocs.

The first thing is we think of ourselves as the context, part of the context in which this young person is going to learn.

And the whole goal of treatment is how do I set up this situation such that I can encourage this young person to be flexible, to be curious about their own emotions, to feel held, to feel like they’re welcomed.

Like they can say anything that they want to say and that’s great, there’s space for all of it. So that’s kind of the main goal. And that’s kind of underneath all of the evidence-based practices that we do.

We often forget that piece and we go straight to what are the strategies that they have to do to get rid of anxiety? We don’t get rid of anxiety, by the way, but that’s what people think. So the next thing I would say is I’m strategic in my self-disclosures.

I never ever want to just say, “Oh, I’m feeling this today” for no reason or to take up too much space in the session. But if I have a story that I feel like could help that young person lean, lean out, get curious, I might try it.

And the next thing that’s really important is really noticing how did it work when you did that? Did it lead to that young person telling you something, sharing something more personal? If so, great, great job. If it didn’t, then you have your data, not like that. And so part of it is really being present and really noticing like, how is what I’m doing working?

And you know, there’s small self-disclosures. I was just talking about this earlier with one of my trainees where she was asking me how do I know what to say to a 10-year-old that comes into my session?

And I said, “What were you like when you were 10 years old?” You know, imagine you’re 10 and you walked in, your mom dragged you to a doctor, like for your heart or your mind like oh my gosh, that would be terrifying, right? Maybe, maybe not, right?

But thinking about like if things are quiet in a session and you’re not really sure, saying something like, “Well you know, if I were you, if I were 10, I might be really scared to sit across from someone. I don’t know if that’s what it’s like for you. What’s it like for you?”

You know, or I wouldn’t want to say a word, I wouldn’t say anything at all. I’d be like, screw you. So those are little self-disclosures that you can do, they’re not boundary violating in any way.

The other thing that comes up when clinicians ask me about this is, if you share some vulnerability, like can you cry with your clients? That’s a big one that comes up and you know, “Sure,” is my answer, if you model what to do with that, right?

You don’t want to fall apart in your session. But I mean to show that you’re moved by a sad story that your client is telling you and to like kind of be with them in it, that’s an incredibly powerful experience and there’s no rescuing needed here, right?

The best way to help with that is when clients show you sadness or anxiety, it’s to stay and witness and let them feel seen without fixing, right? To hold that experience with them, that’s really important.

So I guess the short answer in that is to be strategic, to be mindful and thoughtful and if you do share, think carefully about why you’re sharing. Does it have a good reason? Think carefully about boundaries. Are you crossing any?

And you know, most importantly pay attention to did that help move the session in a way that was useful to that client, yes or no?

Scott: A couple of people have written in with a question, so I was wondering about this a little bit before when we were talking about parents and talking about being able to share a little bit.

How do you share without leaving a young person feeling responsible in any kind of way, both responsible for this, maybe the stressful situation that the parent might find themselves in, responsible for you feeling that way?

Essentially, yeah, you know where I’m going with this, how do you have those conversations without leaving that young person more stressed or anxious than they already were?

Lisa: Well let’s assume that they do feel responsible, right? You might conceptualize that as a skills deficit because here’s the thing, we’re not actually responsible for each other’s emotions. We’re responsible for our own.

And so you can think of that as a great place to do some learning or some teaching, right? So if I’m trying to think of a specific example and none are coming to mind at the moment, but it’s not out of the realm of possibility that when my clients tell me sad stories for example, I tear up, I’m just like that, ‘cause I’m like feeling it for them, I’m with them.

And if they, my clients almost never, I don’t think they’ve ever felt like, “Oh, I’m so sorry I made you cry.” And I think that the reason is that I don’t treat it like it’s something that needs to be fixed, right?

I don’t move them away from sadness when they experience it. So often we get it wrong as clinicians and we think like we might get like trapped and I want to make my client feel better, when you want to make them feel period, help them to feel and help them ride out and make a space for all of those big emotions that they’re having.

And really it’s through modeling, you know, is the answer to that question. It’s like, yeah, I feel sad and you know what, it’s okay, sometimes I feel sad it’s part of life, you know, or this is a very natural response to hearing a sad story or having a sad event happen, you know?

And so it’s watching someone and being with someone when they’re really experiencing a lot of emotions and really helping them feel like you’re really there and that there’s nothing to be fixed. It’s just magnificent. It’s amazing, right?

That’s flexibility because the ability to really experience all the things that are going on inside you without defense and knowing at any moment you can choose to do whatever you want, like that’s such a gift. And that’s what we mean when we say psychological flexibility, right?

So when we teach exposure, which is the evidence-based treatment we use in our clinic for anxiety, OCD, all of those things, we’re shaping a number of skills. Curiosity about when you try something new, what will happen.

Willingness to experience all of your thoughts and feelings that are happening without defense, you know, and noticing, you don’t have to like them or love them and again, who likes anxiety, right?

And you know, focusing your efforts on doing the things that you care about in your life, the things that really matter. ‘Cause a lot of times when people come to us and they are struggling with anxiety or OCD or something like that, they see themselves as a problem and the only thing in their focus is I just got to get rid of this anxiety, this OCD, that’s it.

And their experience of themselves as human is really limited. And so whether you do straight up like we’re going to do exposure and response prevention or we’re going to do something a little bit more flexible, that involves a lot of exposure and response prevention, what happens is they start to experience themselves differently.

And they start to recognize these beautiful latent strengths that were there all along but they just hadn’t been using and maybe had atrophied a little bit through lack of use.

Scott: We were talking a little bit earlier about the modeling and trying to use that to maybe engage with young people that may be a little closed off.

Any other tips for parents, educators, I mean, really I guess even clinicians, anybody who’s in this position, where you’ve got a young person who is closed off, who doesn’t want to open up about anything, any tips or things that you’ve learned over the years that you’re like, you have found to be beneficial that other people could benefit from?

Lisa: Yeah. Yeah. So one thing you can do is with the closed-off kids, asking lots of questions is going to push them further away, right, so things that don’t require a response are very helpful.

“Hey, just letting you know I’m here. I know you probably don’t need anything but I’m here,” right, so that’s thing one. Keep giving those little bits. Small things, like small thoughtful things, are really meaningful.

Like if you are imagining that they’re struggling but they’re not telling you, bring them a cup of hot chocolate to their room. Be like, “Hey, I don’t want to bother you, but here’s a snack, I’ll see you later.” That’s it, small things, like little, “Hey, I’m here, I love you.” “Hey, I’m here. I love you.”

Model yourself, really that’s a good thing. Like you probably like, just talk about your own emotions. You can even do this with little kids.

When I used to work with kids and parents, Parents of kids who were like three to five years old and we would talk about how do you do emotion modeling with things like anger, ‘cause little kids that age are just learning what that is and how to not hit their friends when they were playing in the block corner with them.

So one of my favorites was when you have your little passive audience or your captive audience in the back in the car seat and you’re in Boston driving in traffic model road rage and also model like having that and not doing anything with your hands or rear-ending the car in front of you, right? Little things like that.

Third thing, humor. Use humor, right? Poke fun at yourself, poke fun, don’t poke fun at them necessarily. You know your audience, I hope, so think about that, how you might use that mindfully.

And one of the things is it’s, you know, treat emotions like it’s not necessarily a big deal to have them, like it’s not the be all and the end all, we don’t need to rush in if you’re sad and we don’t need to rush in if you’re angry and we don’t need to like fix it, but like, yeah, I’m sad, yeah, you know, I don’t love this and yeah, no, I’m happy to talk about it.

So not in a dismissive way, but just to kind of model that you can have these things and it’s okay. Tell stories, you know, that’s another thing sometimes when kids won’t talk to you, you can certainly talk to them.

You know, when I was your age and probably this is irrelevant, maybe you think I’m a stupid parent for saying this story, but this is a thing, you know, and tell them a little story, let them make fun of you, don’t take it personally, right?

So I think the most important thing is if you keep trying something and it’s not working, stop doing whatever that is and try something different, right? And I think sometimes kids can feel coerced into saying things and we don’t want that either.

We want an invitation kind of a feel to whatever it is that you’re going to do, right? They don’t have to take you up on it.

And that might make you feel sad and it might make you feel like, “Oh gosh, I wish you would tell me you’re frustrated.” And those are all things to make space for in you as you try to kind of open up for them.

Scott: One of the things you put out there was that, you know, saying to a young person, like, “Hey, I’m here if you need to talk.” That kind of a thing and how impactful that can be. Coming back to before when you were talking about treatment and like sharing a story or you’re sharing how you’re feeling, things like that.

And you said, if it works great and if it doesn’t make note of it. Have you ever put something like that out there to a young person who’s closed off in terms of helping to kind of build that bond a little bit and then had it pay off 1, 2, 3, 4 sessions later.

Lisa: You were asking me a question and the last thing I heard was, does it sometimes pay off three or four sessions later?

And the answer to that is yes and it always surprises me and it’s the funny thing is it’s often something that I’m like, I can’t even remember I’ve said and it stood out in their mind. I’m like, oh that was the thing, huh?

Yeah, so I think, yeah like sometimes just putting stuff out there and then noticing later. And then the other thing too is like I am very behavioral in my approach. I don’t know if this is useful to probably the parents, but maybe the clinicians who are listening.

You know, I try to evoke and reinforce the different behavior that I’m interested in seeing. So like if someone shares with me an emotion, I want to try and do a thing that’s going to help that continue, right?

And then asking a question is a good way to evoke something, either avoidance or expression of emotion, there are other ways to do that too, so I think about it like that.

Scott: That’s great. Thank you. We got a couple questions about this. Any tips on teens managing stress around exams and college?

Lisa: Oh gosh, they asked knowing that this is like the early action deadline for that, oh my gosh. So those parents who are out there in the middle of this, I feel you. Yes, so every teen is different and what they need is going to be different.

What I would say is take their lead, right? So it can be hard, ‘cause you might want to, if you are wanting them to be successful and seeing parts where there, might maybe aren’t, you know, they’re falling down or you can help them a little bit more. Just remember this is their life, you can guide, but they’re going to do the thing.

And then if they, you know, I mean there’s so many ways you could go with this, like if you have the disorganized, I can’t get all my stuff together and I’m not really noticing deadlines, you might have to be in the short term and very stressed out sort of like traffic cop and help them organize with that executive functioning stuff, you know, and just help them out as best you can.

But I think the biggest thing that you could do really is to let them know, like, I don’t know if you parents remember what it was like when you applied to college or when you had a test that you thought was really important, but I was thinking a lot about this week watching my son do this and looking like, now 2020, I’m like, I guess that stuff didn’t matter as much as I thought it all did.

It’s just a test or I mean if you don’t get into the college of your choice, you can transfer later, or you can try again. And also, I mean, you know, there’s other things to do, maybe a gap year, maybe the college you got into turns out to be the right place, who knows.

But we so often have these stories like if I don’t do this one thing, all of my life is ruined. And so my advice to you would be to undermine that story. And so one of the things I said to my guy was, “You know what, you’re going to do the best you can and maybe you’ll get in and maybe you won’t. And either way it’s going to be okay.”

You know, if you have something that you want to do in your life, you will get there and you will figure out how to do it one way or the other. There’s a whole bunch of different ways to be successful, right and some of you probably have kids who that really don’t know what they want and you know what, that’s really okay.

How amazing to not have a direction and the opportunity to try different things and learn through doing, not through thinking.

Some thinking is good and some planning is good, but through putting themselves in situations where they might learn and experience, what are those things that kind of light them on fire, you know, or to just be willing to try something for a while and see is you know, maybe I go to school for a while and see if this is for me or maybe it isn’t.

Or maybe I take a gap year, right? So I think helping them think flexibly and not getting too attached to the outcome, right? But instead using sort of the metric of did I do my best at this, am I satisfied with what I did? Yes, great. Awesome. And after that, it’s up to chance, we see what happens.

Scott: Any suggestions for speaking with a teacher or school administrator about a student’s stress level?

And I imagine this could be from a parent or it could be from a provider as well who needs to come to a school to talk about, “Hey, you know, we’ve got a kid who’s struggling a bit.”

Lisa: Yeah and so this is a longer conversation ‘cause there’s lots of different ways you could go with this.

And my answer is going to, the very short answer is going to be, it depends on what your goal is, right? If you want to engage the support of the school community around your kiddo, you might share information, you might connect them with your child’s therapist if they have one.

But you have to be careful also because remember that sometimes having anxiety and learning to face it and move through it is better than having lots and lots of accommodations where it’s okay to be anxious and kids start to think of themselves as I am anxious, right, and you know, I can’t handle things.

I would not want to give a child that message. I would want the message to be, I experience a lot of anxiety and sometimes it overwhelms me, but I’m working on it, right, and I know I can develop the tools I need to handle it.

So I would think about that as a more adaptive, helpful message than I’m anxious and I just can’t, right, because that is going to constrain them and it’s also going to like prevent them from being curious about what strengths they might have and find, right, to cope with that, so that’s really important.

So think about it, think about like what would sharing with the school do? What’s your goal? What kind of help do you want? And sometimes like loosening things up is the right answer, right?

Like if we can kind of, like, get some training wheels on before we learn to ride the bike without them, that’s never a bad thing, right? So we work with a lot of kids who are transitioning from residential care to lower levels of care and our message is, “Yeah, let them come for an hour a day. Great, that’s awesome.”

And that’s a huge accommodation, right? But with an eye towards so that they can then do a couple of hours and then they could do a whole morning and then they could do a little bit longer and that they can grow, right? So it’s just kind of like making those first steps smaller so they can make it up the stairs.

Scott: One last question for you and then I promise I’ll let you go.

Lisa: Okay.

Scott: A young person is struggling in the moment. What can we do to help them cope in the moment?

You know, I hate using the word relax because that to me is like a, using that word in front of someone who’s struggling is like the last thing you should probably do. But what can you help them do to kind of, to feel better quickly?

And I’m sorry and I know there’s no magic bullet for this, but you know, there’s got to be something that we can do or something that you can say that’ll tell us absolutely don’t do in that moment.

Lisa: I think the number one thing I would say is to empathize, I see how hard this is and you know what, I may not know what to do, but I’m right here with you.

That is the number one, helping that young person feel seen, right, and staying and you know, there’s a whole host of other things that we can do depending on the situation.

You know, sometimes helping kids, there’s DBT kinds of things, if kids are really genuinely having issues where they, you know, shut down the experience of anxiety.

All sorts of things that we can do, like ice dives and sort of just slowing down, noticing is another one, grounding yourself is another one where you’re kind of usually anxiety lives in the future, in the past, when we’re worried about things that might happen or stuff we did that we’re going over, that we’re ruminating about.

So helping them sort of ground themself in the present moment, but mostly I think the number one thing I would do is, “Wow, you look really anxious. What do you need right now? What can I do for you?”

You know? And just being with them, I think and seeing what it is that they need. That would be my preferred response above all else, especially for parents.

Scott: I love it. So Lisa, thank you so much for being with us today. I think everyone really appreciates it. We’ve got a lot of great questions and engagement. And then a sincere thank you to everyone who joined us today.

just love when people come out to help, you know, support the young people in their lives, their communities, and their families, et cetera. So I genuinely appreciate that. Thanks everyone. Take care.

Lisa: Bye.

Jenn: Thanks for tuning in to Mindful Things! Please subscribe to us and rate us on iTunes, Spotify, or wherever you listen to podcasts.

Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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