Recently, I have been thinking a lot about how to help my patients make decisions about "living their lives" as the COVID pandemic drags on into its third year.  This has been most relevant to me when working with anxious patients in their 20s/early 30s - patients who under different circumstances would be exploring career choices, dating, seeing friends, and pursuing varied interests.

While I have encouraged safety throughout the pandemic, always referring back to the most current scientific guidelines, I have wondered if some patients with anxiety have been using  COVID as an avoidance strategy.  Even when case rates were quite low, these patients were avoiding social interactions completely, not pursuing interests or hobbies outside of the home, and putting off making important decisions about their careers.  Not surprisingly, social anxiety seems to be the factor driving this avoidance.  

We are left with an interesting dialectic - COVID is still very much a threat requiring vigilance AND in order to move past social anxiety (and live a life of meaning and value), we must put ourselves into the exact situations that the COVID rules says we should avoid.  How can we hold both of these truths at the same time?  Here are some thoughts:

-Engage in "COVID-safe" exposures - For people with social anxiety, there are definitely exposures that can be accomplished while still being very safe with respect to COVID.  Here are some Ideas:

• Organize regular FaceTime/Zoom cocktails or coffee with friends
• Join an interest group (like a book or film club) or philanthropy that is still meeting on Zoom
• Take a class on Zoom (exercise, academic, etc) that offers some opportunity for social interaction
• Attend weekly religious services on Zoom (again, bonus if there is a casual meet-up before or after or a weekly Bible/Torah study discussion group)
• Meet up with friends or go on dates outdoors when COVID rates and weather allow
• Go on job interviews (virtual or in-person with masks).

-Perform a cost/benefit analysis - As parents, we have been performing cost-benefit analyses non-stop for the past two years.  The potential benefit of attending school has outweighed the risk of getting COVID (particularly since our district has always had a mask mandate and since the vast majority of kids in our community are vaccinated).  The potential benefit of playing an outdoor sport has seemed worth it, while playing an indoor sport with close contact seemed too risky.  A mostly outdoor summer holiday within driving distance happened - flying to a more exciting vacation locale has not.  To be honest, it gets exhausting to engage in these mental gymnastics but it is worthwhile.  Some questions that can help:

• is this a once in a lifetime event (like a family wedding) or something that will come around again (a regular night out with friends in the city where you live)
• is the passage of time a factor?  For example, if you desire a partner and family, putting off dating for several years might not make sense.  Similarly, if you are thinking about embarking on a long training program for a career you have dreamt about, putting off your education for several years might also not make sense.  
• how does this decision affect your mental health?  Some people are more comfortable and content being alone than others.  If loneliness triggers sadness/depression for you, seeing friends and dating might be important be worth the risk.  

-Engage in some healthy social comparison:  It is so hard to make decisions during the pandemic due to all the uncertainty associated with it.  There are no sure-fire ways to completely avoid getting COVID and there are also no ways to predict the future and see how the choices we are making today impact our lives in the future.  It can be helpful to take a look at what trusted friends are doing - friends who have a similar attitude about COVID, who might be of similar age and health status (for example, what are my friends doing who are double-vaxxed, boosted, and follow CDC guidelines for mask wearing and social distancing?).  Am I doing more than them, behaving in around the same way as them, or doing much less than them?  If the answer is the latter - it might be worth considering the impact your anxiety might be having - anxiety about COVID and/or anxiety about social interactions.  Gradual exposure can be used to test out your beliefs in both domains.  For example, plan several coffee dates with friends at a place with outdoor seating or distanced seating.  After each interaction, check out if your anxiety about getting COVID goes down AND if your social anxiety goes down - both should!

The winter break is almost upon us.  A time to get away to see family members, have some adventures, and take a rest from work and school.  But - well, there's COVID.  Still.

Many of my patients' families are traveling this winter break for the first time since pre-COVID.  They are flying, taking trains, and going on road trips - often to meet up with other family members for the holidays.  But this is causing kids (and their parents) a lot of anxiety.  Despite the availability of vaccines for kids ages five and up, and booster for those ages 16 and up, many of my patients are expressing concern about getting COVID and/or transmitting it to vulnerable relatives over the winter break.  And, I am also hearing worries about flying, being away from home, and being separated from parents (for example, when parents go out to a holiday party and leave kids home with a babysitter).  

Here are some tips -

Remember that we are out of practice - All of my patients understand the importance of regular exposure to feared situations, whether it be flying, being in public places where there might be germs, or being away from parents or away from home.  In the past almost two years, we have not had regular exposure to these situations.  Our brains need to be reminded that these situations are safe!  So, expect some anxiety -- but know that it will decrease as you practice.  For example, flights home are often easier than flights to our destination.  And, if parents have two holiday parties in a week, kids will likely have an easier time coping the second time after they see that they coped beautifully the first time.

Remember the science - The Omicron variant, right at the holidays, has thrown everyone for a bit of a loop!  It has given many people the feeling that they should cancel plans and retreat back into isolation.  But, think about where you are right now compared to this time last year or compared to March 2020 when COVID first hit.  Get vaccinated, get your booster if eligible, continue to don those masks (maybe get some fun holiday ones?), socially distance where possible, and try as often as possible to only go to crowded places where vaccines and masks are mandatory for all attendees or where the activity is outside.  Find some of the at-home COVID tests and give yourself a check before seeing grandparents.  Is there risk?  Yes.  There is.  But, with these precautions in place, the risk is significantly lessened.  

Balance COVID rules with rules dictated by anxiety - There is no doubt that masks and hand washing are important to ward off COVID.  But, for people prone to anxiety, that worry voice in your head can sneak in and start telling you to do EXTRA.  A patient this week told me that she is washing her hands anytime they feel dirty and germy.  This means she is listening to her anxiety, not to COVID rules.  It probably makes sense right now to wash our hands before eating and once we get home from being out in the world - but extra hand washing is not advisable and will only feed your anxiety.  

Put pleasure and fun back in your life - As I mentioned earlier, life is not without risk right now.  But, almost two years into this pandemic, it is essential to think about how we can all live a life of meaning and value despite COVID.  Have you missed seeing dear relatives or friends?  Find a way to have a safe visit.  Do you miss going to the movies or concerts?  Find events that require masks and vaccines and go have some fun!  Have you not been on a date night since March 2020?  Plan one - even if it involves putting the kids to bed and having a late dinner with wine and candlelight and nice music.  This pandemic has been so hard on mental health and now is the time to start injecting some happiness back into our lives.  

I am happy to offer a number of groups this Fall.  

• All groups will be held on ZOOM.
• Participants must commit to all group sessions.
• "Back to School Jitters" and the PAGES group do not require an assessment before participation.
• The 8-week treatment groups do require a thorough assessment prior to participation - this includes a parent only session (one hour) and a child session (one hour).  The total fee for these two sessions is $420.  A proper assessment is essential to make sure that patients are well suited to group treatment and to allow me to tailor each group to the cohort of kids enrolled.  
• Cost is $100 per group meeting (e.g., parent group is $400 total)

Back to School Jitters 
August 17 @1-2

This one session group, mostly geared to kids starting middle school, will cover typical back to school concerns - getting lost, figuring out lockers, and who to eat lunch with!  Kids are also welcome who have been out of school due to COVID or who are starting at a new school this Fall.

Teen OCD Group
8 Sessions, Date & Time to be decided (beginning Sept 2021)

This group, geared to 9-12th graders diagnosed with OCD, will begin with two sessions of psychoeducation.  We will learn what maintains OCD over time and what we need to do to change it.  Each participant will then be coached to build a hierarchy that will guide their treatment.  Subsequent sessions will involve exposure to feared situations, strategies for reducing compulsions, and discussions of how to live a meaningful life without OCD.  

Teen Anxiety Group
8 Sessions, Date & Time to be decided (beginning Sept 2021)

This group is geared to 9-12th graders diagnosed with anxiety disorders besides OCD.  This includes generalized anxiety (excessive worry), social anxiety, specific phobias, illness anxiety, and panic disorder.  The group is not suitable for kids whose main difficulty is trauma.  The group will begin with two sessions of psychoeducation.  We will learn what maintains anxiety over time and what we need to do to change it.  Each participant will then be coached to build a hierarchy that will guide their treatment.  Subsequent sessions will involve exposure to feared situations, strategies for reducing safety behaviors, and discussions of how to live a meaningful life without anxiety.  

*** For kids whose main difficulty is excessive perfectionism, Dr. Ledley will suggest joining either the teen OCD group or the teen anxiety group, depending on clinical presentation.  

Middle School Social Anxiety Group
8 Sessions, Date & Time to be decided (beginning Sept 2021)

This group is geared to 6-8th graders diagnosed with social anxiety.  We will learn what maintains anxiety over time and what we need to do to change it.  Each participant will be coached to build a hierarchy that will guide their treatment.  Subsequent sessions will involve exposure to feared situations, strategies for reducing safety behaviors, and discussions of how to live a meaningful life without anxiety.  We will have many important discussions about topics like where to find friends and what makes a good friend and how to initiate and maintain conversations, 

Parent Anxiety Group: Education and Support (PAGES GROUP)
4 Sessions
Runs on a rolling basis, next session to start on Sept 15th @ 10am 

This four-week group, held on Zoom, offers parents the opportunity to learn about why anxiety is maintained over time and what they can do at home to start to change it.  Weeks One and Two were primarily "education" with tons of learning packed into two hours!  Weeks Three and Four were tailored to "support" group members' unique needs.  You ask, I answer!  Topics covered in prior groups have included anger/difficult temperament; social anxiety; perfectionism; raising independent, resilient kids; and sleep challenges. 

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We are just finishing up our first four week Parent Anxiety Group: Education and Support (PAGES group). It's been a great success!  This four-week group, held on Zoom, offered parents the opportunity to learn about why anxiety is maintained over time and what they can do at home to start to change it.  Weeks One and Two were primarily "education" with tons of learning packed into two hours!  Weeks Three and Four were tailored to support the group members' unique needs.  This group included parents of kids from first to tenth grade.  Although this felt slightly daunting at the get-go, we immediately observed many commonalities and I was able to tailor the lessons to the groups' needs with tips specific to both younger kids and teens.  During Week Three, we focused on anxiety and sleep, as well as anxiety and anger/bad behavior.  During Week Four, we will be focusing on perfectionism.  Parents have had ample opportunity to ask questions and receive helpful tips from me.

The next session of the PAGES group will begin on May 3, for four Mondays @10 am.  You can read more details in the flyer below.  If you would like to join, please email me ASAP at [email protected].  I'd love to have you!

The past year has been unprecedented (I know, I know…that word!), as has our teens’ screen time.  For interest’s sake, I just pulled up my calendar from this week, 2020.  There is barely an empty hour between competition jazz band commitments, religious school, music and sports lessons, high school extra-curriculars, and get-togethers with friends.  I see virtually no blank space on our family calendar – and my kids have never been as “programmed” as their peers!  With so little free time (once you add in schoolwork, which both my kids take seriously), screen time was not a huge issue in our house.  The kids texted with friends, followed some Instagram accounts, and my son played an hour of video games per day on weekends only.
 
Fast forward to COVID times.  How many times have YOU said to your kids – “Get off your screens” or “Can’t you find anything else to do that does not involve in a screen?” It sure feels like a problem – so I turned to my screens and asked fellow parents of teens whether they are struggling with screens in their homes too.  I also asked what their teens are keeping busy with that does not involve an electronic device.  Here are some take-aways:
 
-We are all in this together – “All screens.  All the time,” “Screens, all the time,” “Definitely a lot of screen time.”  Basically, every parent who I heard from admitted to way too much screen time in their homes.
 
-Sports have been helpful – in some areas, organized sports have continued throughout COVID.  Parents remarked that team sports and individual lessons in sports like tennis have been a godsend for their kids.  Although we have been extremely cautious throughout the pandemic, we did allow our son to play Little League baseball this summer and it truly was a blessing.  He got to be with other boys, got a lot of fresh air and exercise, and felt some of the team spirit he usually experiences at his beloved overnight camp.  Parents also wrote about how their kids have embraced the family exercise equipment.  My daughter has been joining me for Peloton yoga classes and we are loving the together time and the laughs when we can’t quite master the poses!
 
-Weather is a factor – Parents remarked that their kids were much better at getting outside for exercise and socially distant visits with friends when the weather was warmer and there was no snow or ice on the ground.  So many friends invested in firepits and heaters before the winter – but when it is 10 degrees outside, no teenager is going to sit in the backyard!  Bad weather = more screen time.  For all of us. 
 
-Kids have adjusted to doing all sorts of things online – in my house, we do online trumpet lessons, clarinet lessons, and piano lessons.  I have learned to knit online with my best friend in Canada.  Of course, many, many kids are doing therapy online (I’ve never been busier).  Things that seemed impossible before COVID seem pretty normal now.  Yes, I recognize that these online activities technically involve a screen, but if it means kids are learning and growing, we will have to accept it for now.  
 
-Crafts can be cool – one mom wrote that she is taking 2-3 trips to craft stores per month.  Many parents wrote about their kids drawing, painting, knitting, crocheting, baking and cooking.  I do have to say these interests seemed to trend slightly to the tween/early teen age group as opposed to high school kids. One of my college age students knits and crochets the COOLEST clothes and bags – I feel like if my daughter and her friends could see her stuff, they would all want to pick up knitting.  But if I suggest it – no way.  
 
-Pets – many people have acquired pandemic puppies and these too have been very helpful for kids.  They get kids outside and exercising and are of course good for mental health and for learning responsibility.  Don’t have your own pet?  Maybe your child can help out walking a neighbor’s dog!
 
-Reading – some parents wrote that they have kids who are naturally avid readers and these kids have loved the gift of reading time that COVID has afforded.  
 
To summarize – the good news is that our kids have kept up with old hobbies and interests and have developed some new ones despite COVID.  The bad news – there is an awful lot of aimless screen time, and a lot of the activities described above actually still involve screens.  
 
SO, SHOULD WE BE WORRIED?
 
 As a psychologist, I encourage you to ask yourselves this –
 
What is the function of the screen time?
 
Some positive functions –
 
-Social time – if your kid is on Facetime with friends, playing video games with other kids, or watching silly videos with a friend, remind yourself – this is all they’ve got right now.  Particularly in the winter, it is really hard to get together in any meaningful way.  For kids who are in school, social time is very limited.  Generally, kids cannot choose who to eat lunch with and during lunch cannot even face a peer and talk while they eat.  Kids are telling me that school leaves them feeling really empty.  They need to fill their tank somehow.
 
-Learning – Obviously, our kids are going to be on screens for school and for completing schoolwork.  During these odd times, we also have to accept that they will be on screens to take their music and dance lessons, do some of their sports coaching, watch videos about crafts and baking, and so on.  At these times where kids are having so few shared experiences, it is also important for kids to have things to connect about – and this might be the latest sports scores or the newest Netflix series.  For kids who are watching a lot of sports or shows/movies, suggest they get on Facetime and watch with a friend or watch a really interesting series and virtually meet to discuss each episode with friends (like a book club – but for TV!) 
 
-A healthy escape – This year has been a nightmare between COVID, political and social unrest, and for many kids, losing loved ones, economic security, etc.  Think about what YOU do at the end of a hard day.  Most people turn on the TV and zone out.  Let your kids do that too.  Not for hours, but do remember that they need a brain break too.
 
And the not so positive –
 
-Escape from aversive feelings – If your child is spending hours on screens, to the exclusion of COVID-safe social time, other hobbies, spending time with family, etc., it is worth asking if they are using screens to escape from aversive feelings of anxiety and sadness.  Screen time would likely not be the only sign of a problem.  Has your child’s eating or sleep habits changed?  Do they seem particularly critical of themselves or more worried than usual?  Have they lost interest in things they used to like and that they still could do during COVID?  If you are seeing some of these changes with increased screen time, check in with your child.  If you are concerned about their mental health, speak to your pediatrician or school counselor.  
 
 
 
 
 
 
 

Happy New Year! Here’s hoping that 2021 brings many positive changes to our world after an incredibly difficult 2020. With New Year’s here, many people will be tempted to get “out with the old” and establish new, healthier habits.
HERE ARE SOME TIPS FOR CREATING AND STICKING TO YOUR RESOLUTIONS THIS YEAR:

• Be realistic and be kind to yourself – We are coming off a really challenging year (are you glad I didn’t use the word “unprecedented”?!). To cope with COVID-19, many people have gained weight and consumed more substances than they typically would. Concurrently, we have been unable to engage in healthy behaviors like going to the gym or exercising with supportive groups of friends. After such a rough year, it would be unfair to tell yourself to lose your “COVID-20” in a month, to stop drinking alcohol completely, or to start working out every day. Be realistic. How about restricting your evening alcoholic beverage to weekend nights only? Perhaps working out three times per week? Maybe having a small dessert after dinner, but not after lunch? When we set reasonable goals, we are more likely to succeed.
• Don’t feel tied to January 1 – There is a lot of pressure to set resolutions on the first of the year. For some people though, other times of transition during the year mean more to them – maybe a birthday, or the start of the school year, for example. If these milestones speak more loudly to you as the time to make behavior changes, go with it. January 1st is just another day and there is no need to change everything about your life by January 2nd!
• Be concrete – It can be very hard to meet goals if we don’t define them concretely. What does it mean to “get healthier” or to “get in shape”? Give some thought to what your goal is so that you know how to/whether you have met your goal. For example, a goal for one person who wants to “get healthier” might be to cook at home every night and only order in/eat out one night per week. A goal for another person might be to cut their drinking down to a specified amount (one drink per evening or only on the weekends).
• Be consistent – There is an adage in psychology that it takes three weeks to establish a new behavior. For example, if you can wake up fifteen minutes early and do some morning yoga every day for 21 days, that routine will be established in your behavioral repertoire. Print out a calendar page and check off each day that you meet your goal. A visual reminder of how well you are doing is very motivating. And, reward yourself. Perhaps after a week of success, treat yourself to a manicure or a piece of really good chocolate.
• Remember that a blip is different from a “relapse.” – We’ve all had a bad day from time to time (perhaps more often than usual during 2020!) and might throw up our hands and say, “what the heck”. We might have that extra drink or slice of cake to soothe our nerves. That’s okay. It’s what we say to ourselves about that “what the heck” experience that matters. It is just a blip. We can get right back on track the next day. It does not mean that we should throw the whole goal-setting challenge out the window! Re-set that 21-day habit clock and try again.
• Figure out healthy replacement behaviors – And while we are on the subject of blips, if you are trying to get rid of an unhealthy behavior, consider what you can do at high-risk times that is inconsistent with the risky behavior. If you are prone to indulge in the evenings (in either food or alcohol), chew some sugarless gum; take a nice hot shower or bath; or hang out in a room in your house where you would not eat or drink (e.g., get into bed with a great book if you don’t eat in bed).
• Remember that food deprivation generally does not work – Setting a goal to never eat chocolate again won’t work – trust me! When we deprive ourselves, we tend to rebound and actually overindulge when we have access to the desired item. A better goal is to learn to eat everything in moderation. Set a goal of eating a small piece of chocolate each night rather than a whole bar, or one cookie rather than five. As I just mentioned, think about the behaviors that impact overindulgence. If you sit down in front of the TV with a box of cookies, you are likely to eat them all. Instead, bring one cookie into the TV room on a nice plate and really savor that cookie. Make sure the rest of the cookies are put away and the kitchen lights are turned off to deter the urge to go back for more.
• Make new behaviors rewarding – To encourage yourself to engage in a goal behavior, figure out ways to make that behavior rewarding. If you set a goal to exercise more, make plans to exercise with a friend you really like to spend time with. Want to do more yoga? Make sure to invest in a really nice mat or maybe, after a few successful weeks, treat yourself to some new yoga wear. Trying to eat more healthfully?  Purchase a beautiful new cookbook or find some creative food blogs that inspire you. And, following from the previous bullet point, putting one really delicious cookie on a pretty plate will be a nicer experience than gobbling a whole box of cheap cookies by the kitchen pantry.
• Use visual reminders – I am a real believer in visual reminders. If you are trying not to snack between meals, tape an inspiring note to your pantry and fridge. Trying to get better about flossing? Leave the dental floss out on the bathroom counter and, again, put a note on the bathroom mirror to remind you to floss each night. Want to do that morning yoga? Leave your mat unfurled next to your bed so you see it as soon as you open your eyes in the morning.
• Find your cheerleaders – Who can you rely on to check in with you about your goals? Ask the most supportive people in your life to periodically ask you how things are going, or update them knowing that you will get a supportive text or emoji back from them. Some people love to post progress with weight loss or exercise on social media – it gives you accountability and again, cheerleading from your friends. Or, if you are a really social animal, get a group together all working toward the same goals, and cheer each other on.

Best of luck with your New Year’s resolutions!  And here’s wishing you a happy, healthy and calm 2021.

Originally published on https://lifespeak.com/blog/​