Five coping skills to help manage anxiety and stress

National Stress Awareness Month, which is recognized annually in April, is an opportunity to raise awareness of the negative impact of stress, how to manage it, and where to go for help. Katharine Van de Putte, a social worker at the Behavioral Health Center at Children’s Hospital New Orleans, shares five coping skills to help children regulate their emotional responses to anxiety and stress.

Timmy worries about his mom. An hour passes, and she hasn’t come home from work. He imagines the worst case scenario, for no particular reason. When she finally comes home, Timmy can relax.

Imelda is scared to return to the classroom after a recent elementary school shooting. She is terrified that what happened to her beloved classmates and teachers could happen to her.

Johnny is nervous to go home. Nobody gets along. The conflict is too much for him to handle.

Children, like adults, can experience feelings of anxiety and stress from time to time. Anxiety is our natural response to a stressful or uncertain situation. When situations trigger fear and anxiety, our bodies go into a fight or flight response, prompting us to fight it out or flee from the situation.

Children can feel anxious for many reasons. Often times, anxiety can stem from traumatic events in a child’s life that can have long-term psychological impact. Family system issues, such as conflict or abuse in the home, can make a child feel unsafe and vulnerable. Academic performance in school can also increase anxiety and stress levels in children and teens. Some children feel anxious taking tests or speaking in front of their classmates while others get nervous about social interactions.

As a social worker in the Behavioral Health Center at Children’s Hospital New Orleans, I work with children and teens who have acute levels of anxiety. Unlike “normal” anxiety, patients with anxiety disorder have intense, excessive and persistent worry and fear about everyday situations. Most children who are admitted to us are in active crisis and have struggled with suicidal thoughts. When they first seek care, we create a safety plan for them. The first step in that safety plan is to develop coping skills to help these kids deal with their anxiety in a healthy and productive way.

The coping skills we share with patients at our Behavioral Health Center are things children and people of all ages, regardless of what they’re going through, can use to ease anxiety and stress.

Coping strategies to manage anxiety

Coping skills are helpful tools everybody can use to manage their anxiety. We teach patients new coping skills or reinforce the skills they already have, not necessarily to help them control their emotions, but to help them regulate their emotional responses. First, we will reassure them, “It’s okay to feel sad. It’s okay to feel stressed out. It’s okay to feel angry.” After talking about their feelings at that very moment, our team introduces them to different coping skills to help keep themselves at a safe level of emotional response when facing a situation that overwhelms them.

We teach children several internal and external coping skills including:

• Deep breathing exercises. Thiscanredirect your child’s anxious thoughts and bring them back to a calm, more relaxed state of mind. The younger kids call it belly breathing. Taking a slow, deep breath in like your belly is a balloon and taking a deep breath out like you are blowing on cookies that just came out of the oven. Counting can also be incorporated with breathing as well – inhale for a 4-count and exhale slowly. Some kids who are stressed out in class will count ceiling tiles. It distracts them from their source of stress at that moment.
• Positive affirmation can help children regain control of their anxious thoughts. Have your child recite a positive statement that they can repeat whenever they feel worried or scared. Things might not be great now, but there are also positive things your child can reset their mind towards. Another thing they can do is create a list of what they are grateful for.
• Visualization is a powerful technique that can help relieve symptoms of anxiety through the use of imagination. Often times, we’ll have patients visualize what their safe or happy place looks like. They will go through the details in their mind of a place that they feel safest or happiest and recognize why they feel that way. Visualization helps a child rest and relax their mind by focusing on calming imagery instead of dwelling on worrisome thoughts.

• Creative activities cangive children an outlet to express their anxiety in a creative way. Some children may find it easier to process their feelings through art rather than words. Others may prefer journaling or singing music to express their feelings. These creative tools can help calm and reset a restless mind so that your child can feel more relaxed.
• Physical activity can help clear your child’s head and lower their anxiety and stress levels. Exercise is a natural mood enhancer. Encourage your kids to engage in physical activity whether it’s participating in a sport they enjoy, taking a walk or going on a bike ride. Any sort of novel movement that will feel new to your body can help reduce anxiety. It could be lying on the floor and putting your feet up on the wall, which sounds silly, but it will help your child be present in that moment and it will help reset your child’s nervous system.

Our patients typically spend five to seven days with us at the Behavioral Health Center. From day one, they begin to learn and apply these coping skills to their daily life. By the time they are ready to leave, they feel empowered and better equipped to regulate their emotional responses. We also share these coping skills with the child’s parents or guardians at a family session. We encourage kids to ask their parents/guardians for support. For instance, a child might say, “When you notice I’m starting to get angry, can you remind me of my coping skill that helped me get through this?”

We like to encourage kids to feel their feelings. Often times, children will say, “I don’t feel safe or I don’t like talking about how I feel.” But it is important to encourage that exploration of emotions as it happens and give them time to process their feelings before it turns into a crisis response.

What if my child needs additional support?

In addition to coping skills, children may need extra channels of support to help them manage their anxiety and stress. When that happens, the next three steps in their safety plan would include:

• Talk to a trusted adult about how they are feeling, and ask for encouragement to use the coping skills. The hope is the trusted adult will be able to assess if further action is needed.
• Talk with a mental health professional to schedule regular outpatient therapy sessions to help your child work through their anxiety and stress and build up their coping skills.
• Call 988 (national suicide prevention hotline) or 911 if your child is in a mental crisis.

Patients and families can access additional behavioral health resources at Children’s Hospital New Orleans by visiting our website at Family Resources | Children's Hospital New Orleans (chnola.org)