April 21, 2022
Cindy Lopez:
Welcome. My name is Cindy Lopez, the host of this CHC podcast, Voices of Compassion. We hope you find a little courage, feel connected and experience compassion every time you listen. Anxiety is a healthy emotion, except when it’s not. Experiencing anxiety can sometimes be just what we need to finish a task or project or to deal with an uncomfortable situation, but it could also be overwhelming and create more disorder in our kids’ lives. Today I’m talking with CHC experts, Jessica Shankman, doctoral psychology intern, and Christa Johnson, clinical psychologist about what’s typical and what’s not with anxiety. We’ll talk about times when kids are more prone to anxiety and signs of anxiety you might be seeing in your child. It’s a timely and important topic. Welcome Jessica and Christa.
Christa Johnson, PsyD:
Thank you, Cindy, it’s wonderful to be here. Hello to everyone listening. My name is Crista Johnson. I’m a clinical psychologist here with Children’s Health Council, and I specialize in the treatment of obsessive compulsive disorder. Much of my experience since I was licensed about six years ago has been working with teens, transitional aged youths and adults utilizing cognitive behavioral approaches and dialectical behavioral approaches in outpatient settings.
Jessica-Shankman, MA:
Hello everyone. My name is Jessica Shankman. I am a doctoral psychology intern that is with Children’s Health Council for a period of time as part of my residency, and so I’m in a clinical psychology PhD program and I’m in a child track. I’ve really been most interested in working with teens and children, just really focusing on a range of emotional difficulties that they can have, especially depression and anxiety, and I’ve noticed that can really show up with so many other disorders that teens face at this age. And so, I really am excited to talk more about that today.
Cindy Lopez:
So Jessica, anxiety is a normal, healthy emotion, but sometimes it’s not. So when is it not healthy?
Jessica-Shankman, MA:
Yeah. So, I think that a lot of people when they first hear it they’re going to think to themselves about some really unpleasant feelings, maybe it’s in your body, maybe it’s the thoughts that you’re having. A lot of times we’re thinking about how can we stop that anxiety from happening. What can we do to get rid of that? We don’t like the way it feels, and the reality is, is that anxiety is part of the normal human emotions, it’s there for a reason. It’s really designed to help protect us in a lot of ways. Originally, we might’ve had it when we were, you know, cave men and facing a big bear that was approaching the cave, and it’s signaling our body to move and get out of that situation, but when we think about our daily experiences, we’re not facing those types of threats all the time, and so thinking about when is the anxiety just too big for the situation? The situation is just not that threatening. It’s not posing the amount of stress that our body is telling us that we should be feeling or telling us to respond to. So, that’s often a sign that it’s just too much you know because regular stressors are designed to be part of our life and anxiety should be there for a lot of situations.
Cindy Lopez:
So, Christa, what is the difference between stress and anxiety?
Christa Johnson, PsyD:
That’s a really good question, and I think many times we can kind of use those terms, maybe interchangeably. I think that again, like anxiety, stress is part of life and there’s a lot of things that happen in the course of our lives that bring about these uncomfortable feelings. One of the differences between stress and anxiety, I think they both really lead to experiencing physiological symptoms like increased heart rate, sweating, and they’re both characterized by those types of symptoms when we’re experiencing them. I think the difference between the two is that stress is something that we experience in response to some kind of external trigger or stressor or cause and when that stressor has passed, the stress goes away. It’s a little bit different for anxiety because anxiety doesn’t necessarily stop once that stressor has passed, and I think that has to do with you know, we describe anxiety as this persistent experience of apprehension, of dread. And after a stressful situation has passed, if somebody is struggling with anxiety they might be wondering about whether they said the right thing, did the right thing, questioning a lot of what they did or didn’t do. So it doesn’t necessarily stop after that stressor has passed.
Cindy Lopez:
So I’m wondering, does anxiety show up differently in different ages?
Jessica-Shankman, MA:
Yeah I think that with kids maybe partially because they’re just learning different ways to express themselves and to understand the emotions that they feel. We might see that they are presenting with more of what we call somatic complaints. So those are things that are happening in your body physically. So they might say, “I have a tummy ache. I have a headache.” They might show up to the nurse more frequently than is typical, and so that tends to be a way that it could signal to a parent or a teacher that this is a child who’s struggling with some level of anxiety or worry and could be something to explore. And then, they might also say that they’re scared. There might be those times where they’re sharing, “I feel very frightened or I feel very afraid of something.”
And then, for teens, I think that there can be this transition into being able to articulate a bit differently what they’re feeling, but for many teens that can be hard to share when the anxiety is getting very big, so you can see that those sorts of physical signs might show up for teens to where they’re noticing that they’re feeling more sick than usual. They might not be aware that it’s really the anxiety, and same goes for kids, but the other way that you might see it is that they are wanting to avoid school more often, that they are sharing that they are feeling very worried about going to certain places. They might be more attached to a parent then is typical or might show signs kind of physically that they are tearful or shaking. So some of these things really do cross over across the lifespan, but I think that teens might be able to understand it in a different way, but all important to notice as a parent or an adult.
Cindy Lopez:
As a parent or a caregiver, you’re probably looking at your kids going, is this typical is this not, like when should I be worried about it? I also know that there’s many types of anxiety disorders. So can you talk about some of those?
Jessica Shankman, MA:
Yeah, so anxiety can show up in a lot of different ways, and when you notice that it’s kind of centered around a specific experience or a set of situations, then it might be under a specific heading. And so there’s kind of what we would consider a generalized anxiety disorder, where you’re noticing that you’re afraid of lots of different situations. There are lots of things that kind of give you that low level stress, and you’re noticing that you’re feeling more uptight and worrying about lots of different things. It could be anything from friends, families, school situations. That’s more of generalized anxiety, but then there’s also more specific experiences people can have. So for example, some people might experience very, very intense and sometimes debilitating fear about a specific situation or person or animal; we call these phobias. And I think a lot of times people might think about, you know, dog phobias or phobias about flights.
So I think that this has kind of infused into our everyday understanding of anxiety, but it’s really when that fear just goes above and beyond. It’s no longer fitting the situation, you start to want to avoid it in ways that are impacting your life. And then a specific type of phobia within that is a social anxiety or social phobia and that’s when people feel very afraid of being evaluated and any sort of judgment in social situations. This one’s tricky in adolescents because you can think back to your own adolescent experience, if you’re an adult listening to this you might remember feeling more aware of social situations and other people’s feelings or beliefs about you. And so this can be tough, you have to think about ,it as beyond a worry that you would feel about a presentation, kind of that typical experience in adolescence and into adulthood. It would be more to the point where maybe you’re avoiding social situations above and beyond, and really wanting to stay home a lot more, experiencing a significant anxiety and then panic attacks can kind of go along with a lot of these experiences, but that’s when you kind of have this sudden intense anxiety that you might feel like you’re dying or losing control. It can be very scary, and it brings people to the emergency room all the time because they’re not sure what’s happening for them, and you might find that those experiences are happening once and you’re not worrying about them again, or it can kind of get in the way of your life. Christa I know that you specialize in OCD and so I thought I’d kick it to you to elaborate on that.
Christa Johnson, PsyD:
So, individuals with obsessive compulsive disorder or OCD, they experience what we call recurring unwanted thoughts, images, ideas or even sensations. And we refer to those experiences as obsessions, and these obsessions make individuals feel compelled to perform certain behaviors or actions repeatedly. Those actions or behaviors we call those compulsions. So some examples of some compulsions might include hand-washing, checking things multiple times, counting. It could even be mentally analyzing things or even avoidance and these compulsions can really significantly impact the person’s ability to function, and I’ve heard it a lot at talks and in conversations with my clients where they call it really a disease of doubt. It makes people doubt everything, and it’s so hard to navigate the world with all of this doubt and questioning around the things that they’re doing or not doing. One thing that I think is important to highlight with OCD is that, as I’m saying this, you might be thinking, well, I’ve had unwanted thoughts, and I do things repetitively. And
Cindy Lopez:
Exactly what I was thinking.
Christa Johnson, PsyD:
You’re thinking, well, somebody told me that I was, you know, why do I do this so much, but I think that’s not to say that somebody without OCD doesn’t have these experiences, and it’s like, what Jessica was sharing with the anxiety pieces. So some of the stuff on a base level these are things that all of us experience. It’s about how big they are in your world.
So for an individual with OCD, these distressing thoughts are in many cases present all the time. So it’s not just before maybe it’s a wedding or a formal or something like that. It can be really quite ever present and the repetitive behaviors or compulsions can take up a very large portion of a person’s day and can get in the way of other areas of functioning and can be quite taxing for the person.
Mike:
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Cindy Lopez:
So, anxiety and depression, Jessica, do they go together? How are they alike? How are they different? Maybe even talk about when children might be more prone to anxiety or depression.
Jessica-Shankman, MA:
Yeah. I think that anxiety and depression often do go hand in hand. There’s even been questions at times of where are the lines given that we see them go together so often. And what I think you can really see as the difference is that for many people who are having depression that can show up with anxiety where you’re feeling like you have lower mood, you have lower energy or excitement about things that used to make you feel happy.
It kind of is like a dulling effect across a lot of different areas and can really get in the way of social activities, school, and being able to kind of interact with your world. And so the depressed mood can or cannot show up with anxiety. And I think, a lot of times when people are experiencing so much anxiety that is exceeding what is typical or manageable it can make them feel down. It can make them feel sad, but whether or not those go hand in hand or if one better explains it versus the other is often kind of, you know, is this person having those worries that are in a specific category or across lots of domains? Are we seeing that show up? And some of the symptoms that do look the same though, are, you know, social withdrawal. So really pulling away from your social situations, and all of the impacts on different life activities. As well as, you know, tummy aches and headaches and physical symptoms.
Jessica-Shankman, MA:
So, those are just some of the ways that anxiety and depression can go together, and I wonder if Christa, if you want to add a bit about what you know when kids and teens are more prone to developing these disorders.
Christa Johnson, PsyD:
That’s a great question because whenever there are any challenges or problems or obstacles, we always want to figure out what caused this so that we can work towards prevention. When we’re talking about anxiety and depression there’s a lot of factors that can play a role in a child or a teen developing these conditions.
And that includes biology, you know could include their temperament. Another thing that I think is really important to note is that experience that we have throughout the course of our lives can play a large role and whether or not anxiety or depression is developed. So for example, if a child or a teen has a history of trauma of maltreatment, peer rejection and bullying in particular, that can certainly lead to a greater risk for developing depression and anxiety later on.
Cindy Lopez:
So Christa, say I’m one of our listeners right now. I’m a parent, I’m a caregiver, even an educator. What questions should I be considering if I’m wondering whether or not my kid’s anxiety is something I need to pay attention to?
Christa Johnson, PsyD:
I think the questions that parents would be asking are going to be related to what it is that they’re observing. So I think in an example where a parent might be noticing that their child doesn’t want to go to school as much anymore. They’re wanting to stay home, that could warrant questions around what are some of the barriers there, and is there something going on at school that is difficult for them, asking about the peer relationships, how things are going with friends. And also asking about experiences in the class, do they feel restless or uncomfortable or scared when they’re there? Are they having any trouble focusing or getting homework done? It might even be something like, maybe they’re having trouble sleeping, maybe they’re having trouble sleeping because they’re worrying about things at night. And so that makes it hard to get up in the morning. Of course it depends upon the age of the child, but for a parent who perhaps has a younger kiddo who is coming to them talking a lot more in the recent past about stomach aches or headaches, kind of talking with them about what that felt when they started to feel it, do they feel them more at school? Did they feel them more when they’re thinking about school and kind of starting that conversation to get a better understanding about what’s going on for them?
Cindy Lopez:
Yeah, we’ve all been living with COVID for the past couple of years, and we know we’ve heard all data and statistics about increase of mental health issues. So if I’m seeing some of these things in my kids, where there’s school avoidance, like I can’t get them to go to school, they’re complaining about stomach ache or headache or whatever, they’re socially not in the same place that they were like they’re not able to concentrate like they were pre pandemic, how much of this could be attributed to the pandemic. And if so, even though we can say, well, that’s part of the pandemic, is it still something we need to pay attention to?
Jessica-Shankman, MA:
I think that this is something that all of us are kind of still figuring out when many of us have not lived through something as globally impactful as this pandemic has been, just in terms of how many kids and teens have experienced the same sort of stressor, right? You know, there can be individual stressors that people experience, but on top of this seeing this widespread pandemic. I think that there will be research years from now to figure out what was the impact when there’s a global trauma in this sense. And so I think that right now, what you can be noticing and recognizing is that there is a degree of kind of normal anxiety that people would likely be having, especially teens. Their life was disrupted in a way that many of them didn’t fully understand and for kids as well that there might be just kind of catching up, in terms of what all happened to have been home for a period of time and for this to be ongoing, where we are waxing and waning in our anxiety response to the situation. And so, we would expect that there would be a certain degree of stress or anxiety, but you know, it has been a couple of years. And so thinking about, has this now kind of reached into other categories? Are we seeing it show up about things above and beyond, pandemic situations, it might have kind of added to the baseline of anxiety and now you know, it’s kind of like a magnet when you’ve got some added stress at the baseline. Then there might be kind of the opening for other anxieties to develop, and so I think that the answer to this is if you’re noticing that this is something that’s impacting your child there can be skills and tools that you can learn in a therapy setting that could be helpful even for you know, what is an understandable response to something very hard and very ongoing and prolonged.
Cindy Lopez:
So, Christa and Jessica, as we wrap it up, I’m just wondering if you have any additional things that you want to share with our listeners.
Christa Johnson, PsyD:
Well I do think that it would be important to also add here while anxiety is a part of the human experience and in certain situations with certain individuals, it can certainly feel overwhelming and unmanageable without help. Help and treatment is available. And so, there are a variety of evidence-based treatments to help parents if they are struggling themselves or children or teens. So there’s hope out there, there’s providers, there’s lots of resources. And one way potentially to get a little bit more information about that is to contact your insurance company, or maybe speaking with friends and family about ways that they’ve obtained support so that you can seek out that support as well if you want to, or it feels like it’s needed.
Jessica-Shankman, MA:
I would just add that with all of the discomfort and stress and difficulty that anxiety can bring, I think that a lot of times there can be this feeling of like, I just want it to poof disappear, and I think that on that message of hope for treatment, a lot of times it’s building up skills and ways to approach those anxiety provoking situations because life can throw curve balls. And, if we didn’t have anxiety that would be problematic. It would actually, we really need it and so, to understand, you know, how can I hit that kind of optimal level of stress to be able to be motivated, to get things accomplished, to meet my goals, to respond if there’s a stressful situation in a way that’s healthy and helpful, but also, it can just become so big and especially for teens and kids, this is a really wonderful time to introduce those skills early on and they’re life skills ultimately, and so, just to normalize and continue on that, thought of hope.
Cindy Lopez:
Yeah. Thank you so much. For our listeners, just want you to know that you can reach out to us at CHC. We have a host of folks, just like Jessica and Christa, who can help you and your children. You can reach us at careteam@chconline.org or you can call us at (650) 688-3625. So again, Jessica and Christa, thank you so much for sharing your expertise and your experience with us today and to our listeners thank you for joining us, and we hope that you’ll listen in again next week.
Jessica-Shankman, MA:
Thank you so much.
Christa Johnson, PsyD:
Thank you for having us.
Cindy Lopez: Visit us online at podcast.chconline.org. Make sure to subscribe to Voices of Compassion so you never miss an episode and we’d love it if you’d leave us a rating and review. Have a question? Send us an email or a voice memo at podcasts@chconline.org. We’re here for you when you need us.
