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
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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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Mindfulness and meditation: Practical tools to reduce stress during COVID19

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

As we adjust to many changes to our daily routine caused by the COVID-19 pandemic, many of us are experiencing an increase in stress, and looking for healthy ways to reduce stress during COVID-19.

Mindfulness and meditation have been scientifically proven to reduce stress, anxiety, impulsivity and other emotional challenges. Research also shows that mindfulness and meditation can improve attention, learning, and cognitive and academic performance. Many people have heard of mindfulness and meditation for stress reduction, but may not be sure what it means, where to start, or how to adapt it for children.

What’s the difference between mindfulness and meditation?

Mindfulness means intentionally bringing our awareness into the present moment, without judgements.

Meditation is the practice of using a technique to train our use of attention and awareness, intentionally.

This is an unprecedented time.  Our attention is being demanded and divided to solve many problems and address various concerns. In the wake of the COVID19 pandemic, we focus on whether we have enough groceries or toilet paper, how to adjust our family life and schedules to working or schooling from home, and how best to protect our families and loved ones from becoming ill. Now more than ever, our awareness and attention can become overwhelmed with what we know from the recent past in other countries who have also fought the virus, the present threat, and the future for ourselves and our communities.

Why practicing mindfulness is important

Being mindful and living in the present does not come naturally to most people. We have all had times in which we ruminate about the past— about what has already happened, whether it was fair, what we should have said or done differently or what we wish someone else would have said or done differently. Many times, when our thoughts get stuck in the past, we focus on negative things that happened. We can feel sad, mad, upset or scared all over again in the present, even though those past events might not be happening right now.

We have all had times in which we stress about the future— about what will become of us. What if we don’t learn as much in the homeschool environment and we don’t get into the college we want? What if something happens to us or our families that puts us in danger? What if we never reach our goals? What if scary things from the past happen again? When our thoughts get stuck thinking about the future, we can invent all sorts of scary scenarios and cause ourselves to worry unnecessarily.

Practicing mindfulness is a way to shift our thinking away from the past or future and live more fully in the present moment. The present can be an uncomfortable place, too, especially during the COVID-19 pandemic. Maybe you’re in pain, grieving, or you’re concerned about something happening right now. Even though the present may be stressful, it can never be as bad as all the negative events that happened in the past and all the terrible things that could happen in the future. Nothing is all bad, and we can miss out on some of the joys of living if we don’t pay attention to what is going on around us in the moment.

Bringing our awareness to the present moment takes practice. Here are a few ways to build mindfulness into your family’s everyday routine:

Mindful breathing

Conscious breathing is a simple way of training your attention and awareness toward the present moment by regulating your breaths.

Diaphragmatic or belly breathing

Diaphragmatic breathing, or belly breathing, is a kind of deep breathing that lowers heart rate and blood pressure, and helps our bodies and mind relax. Diaphragmatic breathing uses our diaphragms, a dome-shaped muscle under our lungs, to help get more air in our lungs and more oxygen to our bodies and brains.

  • First, sit in a comfortable position, or lie flat on your bed or on the floor. Relax your shoulders and soften your stomach muscles.
  • Place a hand on your chest and a hand on your belly. Imagine that your belly is a balloon. When you breathe in or inhale, you will fill that balloon with air and your belly will rise. Then when you breathe out or exhale, you will squeeze air out of the balloon with your stomach muscles and your belly will fall. The hand on your belly should move away from you when you inhale and move back in when you exhale. In this kind of breathing, the hand on your chest shouldn’t move much, while the hand on your belly should move out when you breathe in, and in when you breathe out.
  • If you’re lying flat, you can put something light on your stomach like a book or a stuffed animal and watch it move up and down with your breaths.

Practice this kind of breathing, 10 breaths at a time, several times a day, to build strength in your diaphragm and learn to consciously shift your awareness and focus to regulating your breathing.

Using props for young children

Young children can learn to regulate their breathing by using different items around the house to make it into a game. Here are a few ideas:

  • Blow bubbles to learn to take deep breaths. Make slow, controlled exhales to make the most bubbles or one big bubble.
  • Blow slowly into a pinwheel to make it move.
  • Rustle a feather by using your breath.
  • Blow gently next to a candle to make the flame flicker but not go out. Kids should only do this with parent supervision.

Five finger breathing

Stretch your hand out in front of you with your fingers stretched out like you’re about to give a high-five. Then take the pointer finger of your other hand and put it on the bottom of the outside of your thumb. When you inhale, trace up a finger, and when you exhale, trace down a finger. If your mind gets lost or your thoughts get loud, try to bring your attention back to the feeling of tracing your fingers and the sight of your hand.

Mindful grounding

In this activity, we use our senses to bring our attention to what we are experiencing right now, without judgement.

  • Name three things you see in your room or space.
  • Name three things you hear in your room or space. Even in a very quiet room you can usually hear the sounds of your own breathing, movement or some air flow.
  • Name three things you feel on your body or your skin. This could be texture, temperature, the weight of your body on a surface, etc.

When we pay attention to our senses, there is not much time to think about the past or the future. In classic mindful meditation, we try to observe what we notice without judgement.

But what if your present isn’t very pleasant? What if what you saw was your bother messing up your room, or you heard an annoying TV show playing next door, or you felt pain on your body, and you became overwhelmed by paying attention to all of it?? In classic mindful meditation, we strive to observe what we notice without judgement. For example, we may recognize a sound, acknowledge it annoys us, but try not to place judgement on the sound itself or the source of it.

Positive attention adaptation

An adaptation of this exercise can be helpful in promoting awareness of positive aspects of an environment, even in stressful situations. You can choose to pick out three things you see that you like, three sounds you hear that you like, and three things you feel on your body that you like.

You can practice mindful grounding anywhere! While walking your dog you might notice a tall tree, hear the sound of birds, and feel the pavement under your feet. While you are doing the dishes, you might see light reflected off the water, hear the sounds of dishes clanking together, and feel the slickness of the soap on your fingertips.

Practice this exercise throughout your daily life to train your mind to come back to the present. Try to practice even when you are not distressed, to teach your body to recognize when it is thinking in the past or future, and how to choose to live more fully in the present.

Mindful noticing

In mindful noticing, we try to bring our awareness and presence fully into a specific object or activity.

Know your penny

Many people find that when they try to notice every thing they can about a common object that they are able to stay more present-minded. For this activity, you will need a penny or another coin.

First, bring your attention to what your penny looks like. What markings does it have on the front? What words or numbers are there? Is your penny shiny or dull? How does the light reflect off your penny? Does it change if you tilt it around? Are there smudges, nicks, or other identifying features on your penny? Take a moment to really get to know your penny. Look at the edges of your penny. What do you notice about those? Flip your penny over and notice everything you can about the back of your penny. What is written? What pictures are there? How does the light move off your penny?

Now, bring your attention to what your penny feels like. How heavy is your penny? Is it warm or cold? Does its temperature change depending where you hold it? Are the edges smooth or grooved? What does your penny feel like between your finger and your thumb? Notice all the ways your penny feels in your hand. Know what is special about your penny so well that if you were to drop it in a bucket of pennies, you could pick out which penny was yours.

You can use these techniques with other senses, too:

  • Listen to a song you love but try to notice all the things you haven’t noticed before. Listen for when the singer takes a breath, listen to a particular instrument throughout the song, or to the beat or bass.
  • Try mindful eating, noticing all the different flavors and textures of a bite of food and how it tastes different on different parts of your tongue.
  • Focus on how your muscles feel when doing yoga to help build movement into your routine.

Loving-kindness meditation

While mindfulness meditation helps us bring our awareness to the present moment, with acceptance and without judgement, loving-kindness meditation seeks to grow warmness, kindness and authenticity in how we feel about ourselves and others. Research has shown that daily practice of a loving-kindness meditation can reduce self-criticism, pain and grief, and can increase tolerance of annoying behaviors, foster social connectedness, and cultivate compassion for oneself and others.

First, repeat these four sentences, either out loud or to yourself:

  • May I be safe.
  • May I be healthy and strong.
  • May I be happy.
  • May I be peaceful and at ease.

Next, direct these wishes to someone you value, love, respect or feel positively toward.

Then, direct these wishes to someone you find challenging, or whose behavior you don’t like.

Finally, direct these wishes to the world and all beings.

Mindful mantra meditation

A mantra is a sound or phrase that is meaningful to a person. Mantra meditation includes repeating a sound or phrase and allowing your awareness to explore what that means for you in the present moment.

Helpful mantras for kids include:

  • I can handle this.
  • I am safe.
  • Let it go.
  • I am thankful.

You can set aside times of the day to practice mindfulness and meditation or find ways to build these skills and thought practices into your everyday activities. We all need practice to become experts, so be sure to practice mindfulness and meditation regularly — in times of peace as well as times of stress. Soon, you will be able to harness the ability to move your awareness to the present and cultivate compassion at will.

To explore mindfulness and meditation further, check out the following resources:

Headspace — A mindfulness app for everyday life.

Calm — A sleep, meditation and relaxation app.

Left Brain Buddha — A website for modern mindfulness.

Cosmic Kids Yoga — Guided meditation and yoga for kids.

“The Mindful Teen” by Dzung X. Vo, a mindfulness-based stress reduction workbook for teens.

“The Mindful Dragon” by Steve Herman, a children’s book that teaches mindfulness, for ages 4-8.

“The Ultimate Mindfulness Activity Book” by Christian Bergstrom, featuring 150 playful mindful activities for kids, teens and grown-ups.

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Siete maneras para ayudar a los niños sobrellevar la ansiedad debido al coronavirus (COVID-19)

Si la propagación continua del coronavirus (COVID-19) le causa a los adultos ansiedad, estrés e incertidumbre, considere lo difícil que debe ser para los niños.

Dependiendo de la edad y su exposición a los medios de comunicación, los niños pueden saber más de lo que los adultos piensan. Aún si no saben, los niños pueden sentir la tensión y la ansiedad de los adultos a su alrededor.

A continuación, la sicóloga pediátrica de CHOC Children’s Dra. Sabrina Stutz ofrece 7 recomendaciones que los padres pueden usar para reducir la ansiedad de sus niños acerca del COVID-19.

Responda a las preocupaciones de los niños con compasión y validación

  • Escuche con atención sus preocupaciones y averigüe de donde escucharon la información. Validar sus temores al decir lo siguiente “Puede ser miedoso cuando se presenta una enfermedad que no conocemos completamente”.
  • Corrija cualquier concepto erróneo que hayan escuchado y anímelos a continuar hacer preguntas.
  • Mantener una rutina les ofrece a los niños sensación de seguridad. Continuar con un horario usual que incluye escuela, actividades y tareas protegerá la salud mental y física.

Mantenga los hechos apropiados de acuerdo con su desarrollo

  • ​Evite tener conversaciones adultas sobre COVID-19 alrededor de los niños. Al igual, vigile cuidadosamente la exposición de sus niños a los medios de comunicación sobre el COVID-19.
  • Conteste preguntas con explicaciones breves apropiadas para su desarrollo. Por ejemplo:  puede decirle a un niño pequeño, “coronavirus es un tipo nuevo de gripe y resfriado que para estar sanos es muy importante que nos lavemos más seguido las manos y estornudemos en el codo.”
  • Recuérdeles a los niños que los doctores y otros expertos alrededor del mundo están trabajando fuertemente para parar el virus. Esto puede ayudar a que los niños entiendan que personas inteligentes y capacitadas están tomando acción.

Tranquilice a los niños otorgándoles poder

  • Decirles a los niños la manera como pueden ayudar convierte la ansiedad en una meta que se puede lograr.
  • Asegúreles a los niños que se pueden proteger a sí mismos y a otros practicando la manera apropiada de lavarse las manos, de toser y tomar otros pasos sanos.
  • Los niños también pueden incluirse en otras preparaciones familiares. Por ejemplo, si usted se está preparando para la posibilidad de tener que permanecer en casa por un tiempo, pregúntele al niño lo que desea para comer o que actividades le gustaría durante ese tiempo.

 Busque métodos para niños

  • Haga que sea divertido el aprender a lavarse las manos y tomar otras medidas preventivas. Ayude a que los niños aprendan sobre los gérmenes dándoles una loción y luego rociar “diamantina” en sus manos. Dígale que la diamantina es como los gérmenes y luego pídale al niño que trate de quitárselos con una toalla de papel o con tan solo agua. ¡No lo lograran!  Luego puede explicarle como el jabón y el agua tibia puede lavar mejor la diamantina y los gérmenes.
  • Enséñeles a los niños por cuanto tiempo se lavan las manos cantando juntos una canción de 20 a 30 segundos. Canciones de “Feliz cumpleaños” o el “ABC” son clásicas.  Usted puede ser creativo y estimar los 20 a 30 segundos de una canción que le guste a su niño.

Enfatice la bondad

  • Como siempre, ayude a enseñarle a los niños continuar siendo bondadosos con todas las personas independientemente del país de origen o su apariencia. Aunque ellos sientan temor, siempre es posible la bondad.
  • Para ayudar a que los niños realísticamente consideren el riesgo, enséñeles que la mayoría de las personas que visitan a un médico o que usan una mascarilla probablemente no tienen el virus.
  • Es importante acordarles a los niños que todos estamos haciendo lo mejor para estar sanos y que nadie es culpable si se llegan a enfermar.

Recuerde demostrar un comportamiento positivo

  • Los padres que demuestran buenas habilidades de afrontamiento pueden ayudar a darle la tranquilidad a los niños de sentirse seguros. De todas maneras, los niños aprenden de sus padres cómo reaccionar en situaciones nuevas.
  • Recuerde que los niños cometen errores. Si su niño accidentalmente no se lava las manos o no estornuda en su codo, recuérdeselo cariñosamente. No ayuda asustar a los niños por los errores con consecuencias potenciales.
  • Los adultos deben demostrar comportamientos para cuidarse a sí mismos: Mantener los horarios de las actividades y del sueño. Comer de manera sana y practicar etiqueta para lavarse las manos y toser.
  • También ayuda que los adultos limiten su atención a los medios de comunicación sobre el coronavirus (COVID-19) y más bien sigan a los recursos de confianza tales como el Centro para control de enfermedades para prevenir tanta información y la ansiedad.

Observe cambios en el comportamiento

  • Cambios en el sueño del niño, el apetito, su interés en querer estar con amigos o de salir de la casa, o maneras de buscar seguridad, al igual que lavarse en exceso las manos pueden ser señales que es necesario más ayuda.
  • Si no ayudan las técnicas básicas para la reducción del estrés tales como respiración honda, distracción o imaginería guiada, comuníquese con su médico primario para apoyo adicional.
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