Back to virtual school: 10 tips to help kids transition after summer break

By Dr. Sabrina Stutz, a pediatric psychologist at CHOC Children’s

As summer break comes to an end, kids and parents alike are faced with an uncertain transition back to school. While many children are starting the school year in a distance learning model, no one knows for sure what kinds of changes might take place in the future. We know that children and families alike can feel frustrated or scared about the transition and the uncertainty of this time. Here are 10 tips to help kids transition back to virtual school and prepare for the uncertainty of the future.

  1. Create a routine. In times of uncertainty, kids have a sense of safety and predictability in structure and routines.
    • Start by making clear bedtimes and wake times that will allow your child to get enough sleep – 9 to 12 hours, depending on their age.
    • Build a morning routine that is similar to the one they were used to with in-person Have your child wake up, eat breakfast, brush their teeth, put on clothes, and do any morning chores needed, such as feeding a pet. This will make sure your child is awake and alert in the mornings and ready for the school day. It also gives you valuable quality time with your child in the morning in which everyone is likely to be in a better mood. By following a morning routine, you are not only setting your child up for school success, but you are also modelling how to build and follow structure in a day.
    • Using your child’s school learning schedule as a guide, schedule out your child’s learning time, brain breaks, lunch, recess and homework time.
    • Schedule home and family time, dinner, active time, relaxation time and a bedtime routine. Be flexible with finding a routine that works for your family in these new circumstances.
    • If following routines is difficult for your child, consider adding in incentives to help them get used to them. For younger kids, a sticker chart and praise for following each step of the routine can be helpful. For older kids, points to earn screen time or allowance for following a new routine can also help motivate them.
    • If your child is distracted by other screens or devices, consider restricting device access until after the school day and homework are complete. In addition, for kids who will already have several hours of screen time during the day for school, support them in finding activities without a screen for their free time, such as playing outside, reading a book or cooking.
    • Build in fun activities into the routine as well, such as family walks or new weekend traditions. These traditions could be getting take-out from your favorite restaurant, playing outdoor games, cooking a new recipe together, or building something like a birdhouse.

2. Designate a learning space: When home and school occur in the same place, it can be easy for kids to get distracted by their favorite toys and activities, wanting to take a nap in their bed, seeing the TV screen, or wanting a snack from the kitchen. By finding and preparing a dedicated learning space for your child, it will help them stay focused on their school work and allow them to experience the separation between learning with play and relaxation time that they had when they were going to school in-person.

    • Locate a quiet space in your home with minimal distractions, good lighting, and sturdy seating. For kids who have a shorter attention span, scope out multiple potential appropriate spaces so that your child has different workstations to associate with different subjects. For example,  a seated location for writing, a comfortable space for reading or a higher countertop for standing while working.
    • Partner with your child to find comfortable positions that support their bodies. Put boxes under a tall chair to provide a footrest for a child whose feet do not hit the ground. If your child has a Zoom call, you can stack books under the laptop to bring the screen to eye level, avoiding neck strain. Just like at work, consider what will make a child’s body the most comfortable, without any strain.
    • If space is a concern in your home, be creative with different workspace solutions. For example, consider a foldable lap desk for couch sitting, or allow your child to kneel on the floor using an ottoman as a desk. Consider using low shelves or folding tables as workstations.
    • It is recommended to avoid bedrooms or lounge areas as learning spaces. Especially avoid having your child work on their bed, as this can disrupt a child’s association with their bed as a place for sleep and rest.

 3. Pre-plan organizational support: At school, teachers can monitor notebooks, desks, backpacks, planners and other things kids use to stay organized. In distance learning, parents can support children by ensuring they stay well-organized throughout the week.

    • If your teacher has recommended an organizational structure, help your child get whatever materials they need such as folders, school supplies or pencil cases. Low-cost alternatives to some popular organizational supplies could include plastic food storage  containers or reusing and decorating cardboard boxes.
    • If your teacher has not recommended an organizational structure, build one together with your child. Help them have a separate space to put their work for each subject, divided into completed work versus work that still needs to be done. For typed work, you can also help model for a child how to have different folders on their laptop for each subject.
    • Become familiar with your child’s virtual learning platform and support them in understanding how to integrate that platform with the physical organizational structure they have at home.
    • At the end of each school day, review with your child what they completed and what they still have left to do. Help them set up their workspace for the following day so that they can start the next day with success.

4. Test-drive the technology and review online safety: With more education occurring online, kids are using the internet more often to find resources for assignments, or to pass the time if distracted during the school day. Now is a great time to ensure you are familiar with the technology they are using and review internet safety.

    • Test out your child’s technology and see if they can maintain a good connection on their platforms in a variety of likely scenarios — another child in the home also has a Zoom call, or a parent needs to give a work presentation while the kids are engaged in distance learning.
    • Review your house rules on internet use and consequences for breaking those rules. Revisit your parental controls for screen time use and content.
    • Have a conversation with your child about common pitfalls of internet use including clicking on spam links, downloading content, cyberbullying and predators, and social media sharing.
    • Keep computers and laptops in common areas of the house so adults can monitor internet use.

5. Partner with your child’s teachers: While this transition to distance learning is an adjustment for families, it is also a major change for teachers! By collaborating and partnering with your child’s teacher, you can find creative ways to engage your child in learning and communicate successes and areas for problem solving.

    • Become familiar with the teacher’s expectations for your child’s progress and learning. Since children learn at different paces, it can be helpful to consult your teacher regarding options for additional enrichment or modifications that can support children with learning disabilities.
    • If you are concerned your child is spending all their free time on homework, having difficulty tolerating extended screen time, or struggling to understand the concepts provided, contact your teacher to see what suggestions they have.
    • If your child has a 504 plan or Individualized Education Program (IEP), stay connected to their special education teacher or case manager to help problem-solve how to make material more accessible for your child’s ability level in a distance learning format.

6. Make flexible back-up plans: Be prepared for something to go wrong in your distance learning plans, and stay flexible with changing the plan if it is not working for your family.

  • Create a plan with your family about what to do if technology fails, such as a power outage or device running out of battery . Will the child try to log back in on a different device? Or call in, instead? Who will communicate with the teacher to find the information the child needs to catch up?
  • Talk about plans for a child missing a live class.  Decide how the child will find out the necessary information for the class they missed, by contacting a friend for notes, emailing the teacher, asking for extra credit, or another way. Consider consequences for older children who miss live classes and help them problem-solve how to ensure attendance in the future.
  • Consider alternative childcare arrangements if a parent is unexpectedly called in to work on-site or needs to tend to another family member.

7. Find ways to enrich learning: Kids learn best through using a variety of learning approaches. Look for opportunities to enrich their learning at home and in your community.

  • Some kids benefit from hands-on learning. Get creative and partner with your teacher to find ways to use common household objects to help support your kid’s learning. This could look like breaking up crackers to teach fractions, using ice cube trays for sorting or teaching measurement through baking.
  • Find documentaries or educational programming that elaborate on what your child is learning about in school, or what they are interested in learning about.
  • Consider what kinds of physically distanced field trips you can incorporate into a child’s curriculum to help make their education come alive. Some ideas are: bringing art supplies to a local park and painting the clouds, collecting leaves or going to a local farm to pick fruit. You can also take virtual field trips to places like aquariums, zoos and planetariums.

8. Be creative about maintaining social connection: One of the aspects of in-person school that parents can supplement in distance learning is social connection and skills development.

  • Encourage regular virtual contact with other youth that the child knows from school or the neighborhood. Some children, even middle schoolers, are not yet experts in starting social relationships and may need their parents’ help with organizing virtual playdates or online communications.
  • Consider building social encounters that would normally happen in person into your child’s virtual schedule. Some teens might enjoy doing homework after school while on a video call with a friend.
  • Look for online groups or clubs put on by the school or community centers to capitalize on your child’s passions.
  • Although physical activities are still important, limit in-person time with other children and connect virtually if possible. Before engaging in any physically distant activities, ensure your child is up-to-date on well-child visits and immunizations. Parents should follow guidance from the Centers for Disease Control and Prevention regarding potential in-person playdates.
  1. Teach kids to cope with uncertainty: Many families do not know how long distance learning will be in place. Parents can support their children in developing resiliency to be able to tolerate unknowns about the future by focusing on the here and now.
    • Praise your child for all the bravery they are showing by trying a new way of schooling, for communicating their concerns to you, for problem-solving in a less-than-ideal situation, and for trying hard to adjust to distance learning. The more parents let kids know they are proud of them, the more the child will persevere and keep trying different solutions to find balance in theirs and their family’s lives.
    • Periodically, check in on your child’s mental health by asking how they feel and monitoring their sleep, appetite, motivation, and school performance. If you have concerns about your child’s mental wellbeing, contact your pediatrician or some of the resources listed below.
    • Here are additional tips from CHOC pediatric psychologists on:

 10. Ask for help: No one was given a manual on how to help their children cope with a global pandemic, all while coping with it themselves, managing their own work or finances, and supporting their kids’ education at home! It takes a village, and it is OK to ask for help or tap other resources to support you and your family through this time.

    • Reach out to your child’s teacher or school counselor if they are not adjusting well to distance learning or are struggling to keep up. To your comfort level, share with them any additional factors that might be contributing to your child’s needs – these could be family separations or disruptions in custody agreements, financial problems, an ill family member, lack of school supplies, a sibling who is distracting in the home. They may be able to help find creative solutions.
    • Be realistic about what kind of support you can or cannot provide during work hours. If you are concerned about engaging your child in distance-learning, consult your child’s teacher about schedules and other support. In pre-COVID times, grandparents or nannies were often a source of support to children while spending periods of time at home. The nature of the COVID-19 pandemic has made mixing households risky, and families may want to re-consider their typical avenues of support.
    • If you become concerned about your child’s mental health, contact your primary care physician. You can also call your insurance company for a list of in-network mental health professionals or search online. You can also contact any of the resources below.

Resources

  • CHOC’s mental health toolkit has resources for parents, kids and teens, and schools.
  • Helplines
    • Substance Abuse and Mental Health Services (SAMHSA) Disaster Distress Helpline
      • Toll-Free: 1-800-985-5990 (English and Español)
      • SMS: Text TalkWithUs to 66746
      • SMS (español): “Hablanos” al 66746
      • TTY: 1-800-846-8517
      • Website — English | Website — Español
    • National Suicide Prevention Lifeline: 1-800-273-8255
    • Crisis Text Line: Text HOME to 741-741
    • Orange County Crisis Assessment Team: 866-830-6011
  • Helpful apps
    • Woebot: a cognitive behavior therapy-based artificial intelligence self-care app designed by psychologists at Stanford University.
    • Headspace: A mindfulness app for everyday life
    • Calm: A sleep, meditation and relaxation app
Get more information on Coronavirus (COVID-19)

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7 ways to help kids cope with coronavirus (COVID-19) anxiety

If the ongoing spread of coronavirus (COVID-19) is causing anxiety, stress and uncertainty for grownups, consider how troubling it may be for children.

Depending on their age and media exposure, children may know more about the virus than grownups think. And even if unaware, children still might sense tension and anxiety from adults around them.

Here, CHOC Children’s pediatric psychologist Dr. Sabrina Stutz offers seven things parents can do to help reduce their children’s anxiety about COVID-19.

Meet children’s concerns with validation, compassion

  • Listen carefully to their concerns and learn where they heard their information. Validate their fears by saying something like, “It can be frightening when a new illness comes around, and we don’t know how long it will last.”
  • Gently correct any misconceptions they may have heard and encourage them to continue to ask questions.
  • Maintaining a routine can provide children a sense of security. Keeping a usual schedule – including schoolwork, activities and chores – will protect mental and physical health.

Stick to developmentally appropriate facts

  • ​Avoid having adult-level conversations about COVID-19 around children. Similarly, carefully monitor children’s exposure to media reports about the virus.
  • Answer questions with brief, developmentally appropriate explanations. For example, you might tell a young child, “Coronavirus is a new type of germ that can make some people very sick, and so it is important for us to wear masks around people other than our family, keep 6 feet away from people outside our family, wash our hands more, avoid touching our face, and spend time outside rather than in buildings to keep ourselves and others healthy.”
  • Remind children that doctors and other experts around the world are working hard to stop the virus and will let us know when it is safe to return to certain activities. This can help kids understand that smart, capable people are taking action.

Reassure kids by empowering them

  • Telling kids how they can help provides a sense of agency and can turn anxiety into an actionable goal.
  • Reassure children that they can protect themselves and others by wearing a mask, staying 6 feet away from others, practicing proper hand-washing and cough etiquette and taking other healthy steps.
  • Kids can also be included in other family-wide For example, if you are expecting to be staying at home for a while, ask the child what they might want to snack on or what activities they might enjoy. Be creative with helping your child choose activities that appeal to their passions or curiosities.

Look for kid-friendly methods

  • Make learning about hand-washing and other preventative measures fun. Help kids learn about germs by giving them some lotion and then sprinkling glitter on their hands. Tell them the glitter is like germs, and then ask the child to try to wipe it off with a paper towel or just water. They won’t get far! Then you can explain how soap and warm water removes the glitter – and germs – best.
  • Teach kids how long to wash hands for by singing a 20- to 30-second song together. “Happy Birthday” or the “ABCs” are classics. You can also be creative and estimate 20-to-30 seconds of any song the child likes.

Emphasize kindness

  • As always, it is helpful to teach kids to continue to be kind to all people, regardless of their country of origin or their appearance. Kindness is always possible – even when they feel afraid.
  • Educate children that most people who visit the doctor or wear a mask probably don’t have the virus.
  • It is important to remind children that we are all trying our best to stay healthy and it’s not anyone’s fault if they do get sick.

Remember to model positive behavior

  • Parents who show good coping skills can help reassure kids that they are safe. After all, kids learn from their parents how to react in new situations.
  • Remember that kids make mistakes. If your child accidentally does not wash their hands, gently remind them. Scaring children with the potential consequences of their mistakes is not helpful.
  • Adults should model self-care behaviors: Maintain activities and sleep schedules. Eat healthfully and practice hand hygiene and cough etiquette.
  • It’s also helpful for grownups to limit their own media consumption around coronavirus (COVID-19) and stick to a few trusted resources such as the Centers for Disease Control to prevent information overload and anxiety.

Watch for behavior changes

  • Changes in a child’s sleep, appetite, interest in being with friends or leaving the house, or levels of reassurance seeking, as well as excessive hand-washing can be signs that more help is needed.
  • If basic stress reduction techniques like deep breathing, distraction or guided imagery don’t help, reach out to your primary care provider for additional support.

This article was updated on August 18, 2020.

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Tips for making the most of your first mental health telehealth appointment

By Dr. Sabrina Stutz, pediatric psychologist at CHOC Children’s

Mental health services don’t always need to be carried out in person. Services can be delivered via a smartphone, tablet or computer. You and your child can engage in mental health services for telehealth from any private location with internet access.

If you are new to mental health telehealth services, here’s a guide for how you can prepare for your visit virtual appointment and what to expect, plus benefits of telehealth for mental health and answers to some commonly asked questions.

What happens before my first visit?

  • CHOC’s psychology team will email you a secure link for your virtual appointment. It is recommended that you practice signing onto the teleconference link prior to your visit.
  • We will also email a link to consent to mental health evaluation and treatment, for you to review and sign prior to your appointment.
  • We recommend that you find a place with stable internet service and good lighting in which you and/or your child can speak openly and freely with privacy.
  • Please ensure that a parent or adult caregiver will be physically present in the same location as the child at all times during telehealth mental health visits in case of emergency.

Who needs to be at the first telehealth mental health session?

Both a legal guardian and the child should be present at the beginning of the first session to go through the consenting process. It is recommended that the primary caregiver and the child be in the same physical location for the first appointment.

What will we talk about?

Your clinician will introduce themselves and confirm that a legal caregiver and child are present. They will review and confirm your contact information in the event of technology disruption or an emergency. Then, your clinician will review the consent process and answer any questions about using the teleconferencing software.

After the family consents to services, the clinician may wish to speak to the parent(s) and child separately. Your provider will review your concerns and your child’s history, and will offer feedback and recommendations/resources at the end of your visit. They will also answer any questions or concerns you may have about your child’s symptoms.

Is telehealth therapy as effective as in-person therapy?

Yes! Telehealth-delivered therapy techniques have been studied for over a decade. Many evidence-based therapies have research to prove that they are just as, if not more effective when delivered via telehealth. Cognitive behavior therapy (CBT), trauma-focused interventions, and parent-coaching models all have research to support their effectiveness when delivered online by a trained, licensed provider. Some minor adaptations can be made to ensure appropriate delivery of most evidence-based outpatient therapeutic interventions online.

What are the benefits of receiving mental health therapy via telehealth?

Telehealththerapy is a great way to access mental health services from the safety, comfort and convenience of your own home. Here are some of the other benefits of telehealth delivered therapy that families and clinicians have shared:

  • Families find it easier to attend sessions.
  • Families have flexibility in their schedule when cutting out commute time.
  • There are reduced childcare costs for untreated siblings.
  • Families save time, especially during high-traffic appointment times or when living far away.
  • Therapy is still accessible when on vacation within the state of California.
  • Children who might be nervous to do therapy feel more at ease using telehealth for a first session. Then, they are more likely to follow-up with telehealth mental health sessions afterwards.
  • Family members in separate locations can both attend a therapy session without having to be in the same location.
  • Parents at work can call in on their breaks to participate in family sessions.
  • Children and families are better able to remember and use coping skills when they have learned and practiced them in their own home environment.
  • Clinicians can see and live-coach families through difficult home-based situations like picky eating at mealtimes, setting behavioral limits such as a time out, or supporting a child in accepting a medical intervention such as  injections, pill-swallowing or nebulizers.
  • Clinicians have a richer and more nuanced understanding of families when they can see them in their home environment.
  • Clinicians can make more personalized and immediate recommendations. For example, “That looks like a great spot to put a reminder to check your blood sugar! Let’s create a reminder together and put it up during our session today.”

My child has trouble keeping their attention on the screen. What can you do for them?

The mental health community has created inventive and engaging ways to keep a child engaged over telehealth! Your clinician will talk with you and observe your child to assess their capacities for sustained attention, and can adapt interventions to fit their needs. For some children, we may ask parents to print out or set up certain activities before the therapy session to help facilitate. Other engagement strategies include share-screen therapeutic drawing and games such as Pictionary or Heads Up, gratitude scavenger hunts, “show and tell” topics, and parent-assisted relaxation exercises. If a child is unable to interact over telehealth, parent training models in which the therapist helps coach the parent to interact therapeutically with their child, are available.

How can I ensure my privacy?

 CHOC clinicians hold your confidentiality and privacy rights during telehealth sessions as seriously as they do when you come to the office. During a mental health telehealth appointment, your clinician will be in a private space where no one can see or hear them, and will be using secure, encrypted video conferencing software. We recommend that you access any mental health telehalthe services through your own password protected device on a password protected internet network to maximize your privacy. You may also wish to use headphones in order to have a more private conversation when sharing a home with others. For some very sensitive conversations, some families have chosen to step out to their cars or another more private location.

I have to work, but my child is home with another adult. Can we do a mental health visit via telehealth?

 For the first session, it is best if a legal guardian and their child can be together in the same location. Please contact your clinician for questions about special circumstances. For follow-up sessions, it will be up to you and your clinician to determine whether it is appropriate for the parent to call in from work while the child is at home with another trusted adult caregiver. Please talk to your clinician in advance of any adjustments that might need to be made for the supervision of your child during scheduled therapy sessions.

What if my child has very serious mental health symptoms?

If your clinician feels that your child’s mental health symptoms are too severe to manage over telehealth, they will review their recommendations and alternative options with you.

If you are concerned your child may be having a mental health emergency, do not wait for a telehealth mental health appointment. Instead, contact one of the crisis lines below, go to your nearest emergency department, or call 911.

  • National Suicide Prevention Lifeline: 1-800-273-8255
  • Crisis Text Line: Text HOME to 741-741
  • Orange County Crisis Assessment Team: 866-830-6011

If it becomes clear to a mental health clinician during the course of a telehealth session that your child is having a mental health emergency, the clinician will advise you to go to the nearest emergency room or call 911.

Learn more about mental health services at CHOC

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6 tips for coping in uncertain times

By Dr. Sabrina Stutz, pediatric psychologist at CHOC Children’s

We are living in an unprecedented time. Due to the COVID-19 pandemic, we have lost some control we previously felt we had over what will happen next— in our daily schedules, our children’s education, our careers and businesses, our health, our access to resources, and our relationship with loved ones and our community. For many of us, there is not a clear plan of when, how, and if life will return to how we knew it before. We know from previous research that worries and depression are often much higher when dealing with uncertainty. So, how can we cope in a time of such uncertainty? Here’s a guide to help you – and your children – learn the coping tips that will help with living in uncertain times.

What does tolerating uncertainty mean?

 Why are some people more affected by uncertainty than others? “Uncertainty tolerance” is our ability to cope with or accept uncertain or ambiguous situations. We cannot predict the future or control all outcomes, and so some uncertainty in life is inevitable.

Someone with high tolerance for uncertainty is better able to accept and adapt to outcomes they can’t predict or control. One study showed that people with a higher tolerance for uncertainty were more likely to cooperate with and trust other people. People with low tolerance for uncertainty, on the other hand, are more likely to experience anxiety and stress associated with the unknown.

 How do I know if I have trouble coping with uncertainty?

 Some common behaviors people exhibit when they struggle with tolerating uncertainty are:

  • Excessive reassurance seeking from others or constantly asking questions
  • Checking and double-checking news outlets, social media or emails
  • Checking-in multiple times daily with friends or loved ones
  • Not allowing others to help out of fear it will not be done right unless they do it themselves
  • Avoiding and procrasting tasks or situations that provoke anxiety or a sense of uncertain outcomes
  • Distraction or keeping oneself overly busy to avoidhaving to think about uncertainty
  • Engaging in unhealthy coping such as excessive drinking or risky behaviors

How can I get better at coping with uncertainty?

The good news is that the skill of tolerating uncertainty is like a muscle. If we train and practice coping with uncertain situations, we can grow stronger and improve at doing so. Here are some tips for coping with uncertainty:

  1. Practice mindfulness

We can better cope with uncertainty if we can develop a willingness to experience the discomfort of it, without trying to change or eliminate it. Being mindful means intentionally bringing our awareness into the present moment, without judgement. We can focus on what we know is happening right now, without thinking about what might happen in the future. Mindfulness exercises help us learn to observe our present thoughts, feelings and environment as they are, without attempting to alter them. We can practice being mindful about uncertainty and our discomfort with it, so we can be more willing to experience it without additional stress. Check out tips and tricks for using mindfulness and meditation here.

2. Work through the stressful thoughts

When we are faced with uncertainty, we can experience automatic negative thoughts that pop into our minds unintentionally. If we can identify and challenge those thoughts, we will be better able to cope with them. Here are some common thoughts associated with uncertainty and ways to work through them:

  • Shoulds/musts: Thinking that things should or must be a certain way sets us up to have expectations that can let us down. Try to catch thoughts framed in this way, and rephrase them as, “I’d like for things to be this way, but I may not have as much control over the outcome as I would like.”
  • Predicting the future: No one can predict the future. But often our thoughts try to do this in order to guide our current behaviors. As humans, we like to be able to plan, thus we often try to anticipate the future. Unfortunately, our future prediction thoughts can often be catastrophic and stressful. Try to focus on the present, remember that you are doing your best to create the future you want, and that is all you can do.
  • What-ifs: Sometimes, we can overanalyze a situation by considering all the possible angles and outcomes, all the “what-ifs.” When we are stressed, “what if” thoughts can paralyze us and stop us from taking any action at all. Try answering your “what-ifs” to make them hold less power over you. For example, if you were to answer the question, “What if I get negative feedback from a teacher or supervisor?” you might say, “Well, I would feel upset, ashamed and I’d call my friend or loved one to talk it through. I’d probably do some self-soothing, and then try to improve my performance next time.”

3. Shore up your resiliency

Anxiety is caused by overestimating risk and underestimating one’s ability to cope with that risk. While you can help to manage thoughts that overestimate risk by trying some of the strategies above, you can also intentionally strengthen your coping toolbox and build resiliency. Resilience is the ability to bounce back from difficulties. Find more strategies for building resilience here so you can feel more prepared to cope with any outcome that might occur.

 4. Do the opposite

We can practice tolerating uncertainty by doing the opposite of any behaviors we typically do to control the discomfort. For example, if you find yourself repeatedly seeking reassurance, try to sit with the discomfort and not ask reassuring questions. If you tend to check and double-check your newsfeeds, lists or emails, try to turn off notifications or limit yourself to just one check per day. If you are not comfortable delegating tasks to others, do it anyway, and practice coping with the feeling of uncertainty. While it may feel uncomfortable at first, your mind will adjust with time, and you will prove to yourself that uncertainty may not be as bad as you once feared.

5. Focus on things you can control

Make a list of things that concern or worry you, and divide them up into things you can control and things you cannot control. For example, we cannot control the global response to COVID-19, but we can practice good hand hygiene and appropriate physical distancing. We cannot personally stock store shelves with more paper towels, but we can consider alternative ways to conserve household resources. We cannot control when schools reopen, but we can come up with ways for our families to balance the needs of parents and children, even if that balance does not look the same as it did before school closures. We cannot control how our loved ones feel about quarantine, but we can support them with resources and ideas for coping with it. (Here’s activity ideas for kids during stay at home orders, and tips for helping kids cope with COVID-19 stress.) By taking a more solution-oriented approach, we are able to accept the things we cannot change, while taking action on those we can.

6. Make progress on a skill or hobby

With stay at home orders still in effect, life can seem stagnant or unmoving. Without knowing a concrete timeline for things returning to normal, it can help us cope with uncertainty when we create progress and forward movement in other areas of our lives. Try an activity or hobby in which you can see progress and improvement:

  • Start a garden
  • Learn to cook
  • Make some artwork
  • Exercise
  • Yoga and meditation
  • Learn a new language
  • Rearrange the furniture in your room
  • Take an online class

By practicing the above tips and tricks, we can increase our ability to cope in times of uncertainty and feel strong enough to manage any outcome!

Additional resources for coping with uncertainty:

Articles:

Helpline:

  • Substance Abuse and Mental Health Services (SAMHSA) Disaster Distress Helpline
    • Toll-Free: 1-800-985-5990 (English and español)
    • SMS: Text TalkWithUs to 66746
    • SMS (español): “Hablanos” al 66746
    • TTY: 1-800-846-8517
    • Website — English | Website — Español

Helpful apps:

  • Woebot: Your Self-Care Expert App, a cognitive behavior therapy-based artificial intelligence self-care app designed by psychologists at Stanford University
  • Headspace: A mindfulness app for everyday life
  • Calm: A sleep, meditation and relaxation app
Get more information on Coronavirus (COVID-19)

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How cognitive behavior therapy (CBT) can help reduce COVID-19 stress

By Dr. Sabrina A. Stutz, pediatric psychologist at CHOC Children’s

As the COVID-19 pandemic crisis and stay-at-home orders continue, many parents may notice changes in their own— or their child’s — mood, health habits, motivation and relationship with others. It can be stressful adjusting to this new experience and tolerating the uncertainty of this time. If you or a family member are experiencing significant mood or behavior changes related to COVID-19, cognitive behavior therapy (CBT) can help!

What is CBT?

CBT is a type of evidence-based treatment to reduce distress and unpleasant psychological symptoms. It is based on the idea that what we do is rooted in our thoughts, our feelings and our behaviors and that by changing them, we can improve our mood and wellbeing.

For example, if we get a good grade or performance report, we feel proud, we think “I can do this!” and we behave by sharing the good news with our family and friends. However, if someone bumps into or rushes past us, we might feel alarmed, we may think “How rude!” and we may respond with behaviors like shouting at them or complaining to someone, which makes us experience that cycle all over again.

For many of us, the thought-feeling-behavior cycle works on autopilot, and we simply react to the situation in front of us. However, when we identify and challenge unhelpful thought patterns and introduce healthier behaviors, we can change how we feel. CBT is designed to help us adjust our own thoughts, feelings and behaviors through mastering coping and problem-solving skills, in order to ultimately find a better sense of wellness.

How does it work?

CBT is a special type of talk-therapy provided by a trained mental health professional that is structured and time-limited, usually occurring for around 12-20 sessions. Sessions are spent on reviewing recent mood states and thoughts, learning and practicing coping skills, and problem-solving how to make these skills part of your daily life. CBT is highly focused on what is happening right now, and less focused on lengthy processing of your childhood or life history. Although your therapist may ask you questions about the past to get a better sense of what has contributed to your current thoughts, feelings and behaviors, most sessions will focus on what you can practically do about how you are thinking and feeling now, and how to create a brighter future.

CBT is the most rigorously researched type of psychotherapy, and studies have shown that it tends to work better and faster than other types of talk therapy to address a variety of psychological concerns. Many therapists consider CBT a gold-standard and first line of treatment. A variety of CBT approaches for specific populations have been found to be effective in reducing symptoms associated with depression, anxiety, post-traumatic stress, panic attacks, social anxiety, disordered eating, insomnia, headaches, psychosis, pain and more. Research shows that adaptations of CBT are effective for people of all ages including young children, school-aged youth, teens and adults.

What does it look like?

A CBT therapist can work with you to create a personalized CBT treatment plan and tailor it to your goals and lifestyle. Possible session topics may include, but are not limited to:

  • Emotion identification
  • Mind-body awareness
  • Mood/thought tracking
  • How the thought-feeling-behavior cycle affects you
  • Relaxation skills
  • Behavior activation (building in enjoyable activities and noticing your mood before/after)
  • Regulating strong emotions
  • Changing unhelpful thoughts
  • Challenging unhelpful beliefs
  • Problem-solving
  • Communication strategies
  • Identifying unhelpful thoughts or automatic thoughts

Below is a sample topic that is a staple of most CBT therapies — automatic thoughts.

Automatic thoughts

Thoughts are like the background music to our outward actions and attitudes. Automatic thoughts are like old songs that get stuck in our heads. They pop up unexpectedly, and we may not notice that the song is playing on loop, how it is affecting our mood, or even that we could be starting to hum some of it out loud. Automatic thoughts are instant, nonconscious, and often repeated thoughts to which our bodies and brains respond on autopilot based on our experiences and beliefs. We often don’t even notice that we are having an automatic thought unless we are paying specific attention to it, so we don’t assess whether or not it is a true or helpful thought. We don’t often challenge where we learned the belief behind the thought, whether that was a reputable source, or notice how it affects our mood or behavior. Rather, our minds sub-consciously accept the automatic thought at face value and act accordingly.

However, automatic negative thoughts (or ANTs) often pop up in our minds and cause distress or unhelpful behaviors. Automatic negative thoughts can be about yourself, someone else, or the future. Just like actual ants, automatic negative thoughts (ANTs) can arrive one after another, and soon our minds might be swarming with negative thoughts that can leave us feeling overwhelmed and stressed.

Common ANTs include:

  • I’m not good enough. (Or pretty enough, smart enough, _______ enough)
  • I’m a failure.
  • Nobody likes/loves me.
  • This will never end. I am going to feel this way forever.
  • What if _____ happens? (e.g., imagining the worst-case scenario)
  • I shouldn’t feel this way.

In CBT, a therapist can help you learn to identify these automatic negative thoughts when they are happening and take a closer look at whether they are accurate or helpful. Then, you can learn ways to change or adjust those thoughts when you notice them interrupting your mood and behaviors. Some CBT-based activities to change automatic negative thoughts might include:

  • Learning about common types or flavors of unhelpful thoughts
  • Finding evidence for and against a thought or belief
  • Increasing positive self-talk, as if you were talking to a best friend
  • Adjusting the language of your thought to be more realistic
  • Asking others what they think about it
  • Testing your “what if” theories

How do I get started?

Now more than ever, many therapists are offering sessions via telehealth. Research has shown that CBT delivered by telehealth can be just as effective as in person sessions. Contact your primary care provider, insurance company, or local mental health board for referrals to a local therapist. When you are choosing a therapist, be sure to ask whether they have had specific training in CBT and feel comfortable using it as a therapy model. CBT is best delivered weekly at first, in order to learn and practice skills, build momentum, and ensure an appropriate treatment plan to reduce symptoms as soon as possible.

While true CBT is done in consultation with a CBT-trained therapist, the principles underlying the approach can help anyone. If you are looking for self-help strategies, start by tracking your mood and thoughts. This can help you stay more in tune with your emotions and notice trends that affect your well-being. Then, build relaxation strategies into your schedule to help your body calm down and reduce unpleasant thoughts and behaviors. You can find other self-help CBT-based coping skills in these resources:

For kids

  • “Tiger-Tiger, Is It True? 4 Questions to Make You Smile Again” by Byron Katie
  • “How to Get Unstuck from the Negative Muck: A Kid’s Guide to Getting Rid of Negative Thinking” by Lake Sullivan, PhD
  • “CBT Workbook for Kids: 40+ Fun Exercises and Activities for Help Children Overcome Anxiety & Face Their Fears at Home, at School and Out in the World” by Heather Davidson, PsyD

For teens

  • Moodnotes —a teen-friendly app for tracking mood, thoughts and identifying negative thinking traps
  • Mindshift CBT — a CBT-based self-help app developed by Anxiety Canada
  • “The Relaxation and Stress Reduction Workbook for Teens: CBT Skills to Help You Deal with Worry and Anxiety” by Michael A. Tompkins et al.
  • “Conquer Negative Thinking for Teens: A Workbook to Break the Nine Thought Habits That Are Holding You Back” by Mary K. Alvord, PhD, and Anne McGrath,

For adults

  • Woebot — a CBT-based artificial intelligence self-care app designed by psychologists at Stanford University.
  • “Mind Over Mood: Change How You Feel by Changing the Way You Think” by Dennis Greenberger, PhD, et al. — a CBT-based self-help workbook for adults
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