Anxiety is the most commonly diagnosed psychiatric disorder among youth. Anxiety disorders are characterized by excessive fears and worries about the anticipation of a future threat while fear is the response to a real/perceived threat in the moment. There are different types of anxiety disorders, depending on how long the symptoms persist, what situations the symptoms occur, and how it affects functioning. Obsessive-Compulsive Disorders are another type of anxiety disorder that includes either obsessive/intrusive thoughts or repetitive behaviors or mental acts in an attempt to reduce distress (in a response to the intrusive thoughts).
The most effective treatment for Anxiety and OCD is exposure treatment- that is, facing your fears. There are two specific treatments that are most effective including, Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (EX/RP). As a parent with a child in treatment, you may have noticed that your child’s symptoms were improving, that your child was facing their fears and building their way up on the exposure hierarchy. And then COVID happened. You may actually see that your child is feeling relief in their anxiety symptoms- however, this might actually be a treatment setback.
Let me give you a personal example- with spiders.
Here’s what would happen if a coronavirus-like-event occurred in the middle of my spider phobia treatment.
Imagine that I am working towards overcoming my fear of spiders. I am exposing myself to pictures of spiders, videos of spiders, and finally, I am in the same room as a spider. I am about to hold the spider in my next exposure when I learn that across the world, spiders are now deemed dangerous. We are being told to wear bug spray every time before leaving the house, that spiders are now 5 feet tall and that spiders can be extremely dangerous.
We all might have a slightly different reaction. But for most people who have anxiety disorders, we may actually be initially relieved. “PHEW! Now everyone is on the same page as me; I was right all along. Spiders are scary and dangerous.”
A month later, however, we are told that those spiders were killed and that spiders are no longer as dangerous, that you don’t need to wear bug spray all the time (but in some situations you should) and that camping is a totally fun activity that you can do with spiders.
While relief initially ensued, it may be even more difficult for me to buy-in to the process of facing my fears. I may not let go of my strong viewpoint that spiders are dangerous. The difficult part here is that I convinced myself that my “anxiety was right”.
Expect a similar situation with your child, especially if they have social anxiety or OCD. Because your child is no longer facing their fears (and instead they are avoiding), it makes complete sense they feel relieved.
For kids (or adults) with fear of contamination OCD, they usually engage in excessive hand washing, wear gloves and masks, and engage in behaviors to reduce the likelihood that they will experience contamination. To some extent, these kids may feel as though their OCD was right all along. While we are taking more precautions to be safe during COVID-19, there are still behaviors outside of normative precautions that can be escalating anxiety.
Here are tips on how to help your child control their anxiety/OCD during COVID-19.
1. Continue virtual therapy and do lower-level exposures
This may not be the time for your child to continue with their exposure therapy they were doing two weeks ago. Rubbing your hands on a dirty bathroom floor, without handwashing (yes, this is part of exposure treatment) is not indicated right now. However, your child can still move forward in treatment such as looking at pictures of contaminated surfaces & touching a toilet in their own bathroom and not washing their hands for 10 minutes. Social anxiety exposures may include FaceTiming their friends or asking their teachers questions during virtual class. Exposures can still be done, with assistance from your child’s psychologist.
2. Distinguish between OCD/Anxiety and justified pandemic fears
It is important for your child to distinguish between COVID-19 and their anxiety. It would make sense that your child’s brain may automatically conclude that their OCD was “right” all along. Ask your child questions, be curious, and ask them to differentiate between guidelines set forth for COVID-19 during this time vs. what will be different in a few months from now when we are not in a pandemic (i.e., wearing gloves is a precaution necessary for some people now, but it will not always be a necessity).
3. Normalize your child’s reactions
There are thousands of ways your child can be reacting to this pandemic. Normalize their reaction. Find the kernel of truth in how they are reacting and tell them it makes sense. This is such an unusual time for the entire world and I think most reactions can make sense. As a parent, find ways to normalize their fears that are justified, given the current status of the pandemic.
Your child may experience treatment setbacks and psychologists expect this to happen during the pandemic. If your child has a stall in their exposures or in their treatment there are ways to adapt their treatment. Therapists around the world are conducting video therapy sessions and your child’s treatment can be adjusted to be the most effective and safe.