“Don’t worry, be happy,” we tell each other. However, we all worry at some point or another. When does worrying become anxiety? Is it possible to overcome that anxiety? I have assembled a panel of experts on anxiety to share their insights and advice. As the director of SOS (Strategies for Optimum Success) I have seen children and adults struggling with anxiety. Michal Geffner (MG) is a social worker who has worked in schools and private practice in New Jersey and Ramat Beit Shemesh. Dr. Paul Foxman, PhD (PF) is the author of the acclaimed book Dancing with Fear and the founder and director of the Center for Anxiety Disorders, and Dr. Anonymous (DA) is a respected pediatrician in the Jewish community, and my personal health authority. Let’s hear what they have to say about anxiety.
My child seems a bit anxious. What is “normal” childhood anxiety and when would I have to be concerned with the anxiety being something more serious?
RS: Almost all anxiety is “normal.” It’s what you do with anxiety that makes it normal or not normal. In reality, everyone is going to become anxious about changes, new experiences, and risks, but the way different people deal with those anxieties is key. In my new children’s book My Friend, the Worrier, I write that anxiety is like a monster. If we say “yes” to it and think about it, it grows. If we say “no” to it, we are forcing it to shrink and disappear.
PF: The distinction between normal anxiety and a more serious anxiety disorder is the degree to which the anxiety interferes with the ability to function in daily life. For example, anxiety that interferes with sleep, eating or social interaction would be considered abnormal. Also, symptoms should not be considered severe unless they last more than two weeks in duration.
DA: Sudden onset of anxiety is usually PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). Normal childhood and teenage “worries” are not considered anxiety; however, long-term chronic generalized anxiety is a problem and needs therapy.
MG: Anxiety becomes something serious when your child is unable to function or takes an inordinate amount of time to perform normal every-day activities. For example, it might be serious if it takes your child hours to get dressed for school or hours to go to fall sleep. However, if you see anxiety starting up, it’s best to deal with the symptoms right away to avoid something more serious later on. Regardless, whether serious or not, anxiety is something that with the right tools can be overcome and controlled.
My 10-year-old is a hard-working student. While she knows much of the material, she makes many careless errors on tests because she is nervous and anxious. Do you have any advice I can give her to help make her test-taking a better experience?
RS: When you are under stress, your body releases the hormone adrenaline, which prepares your body for danger. Adrenaline gears up the body to either fight the threat or run away from the threat. This hormone causes the physical symptoms of anxiety, such as sweating, rapid heart rate, or hyperventilation. Like other anxiety disorders, test anxiety can produce a tortuous cycle. The more you think about the bad things that can happen, the strong the anxiety becomes. This makes you less able to concentrate on the material at hand and therefore more likely to do poorly on the test.
MG: It would be great if she can learn some breathing exercises and some self-relaxation techniques that she can do before the test to help calm her down. One such relaxation technique is to tense every part of the body and then relax part by part starting at the head and all the way down to the toes. It is also important to eat a good breakfast and get a good night’s sleep before the test.
My son is a wonderful boy who has some minor learning disabilities. While he is making great progress, he seems to grow quite agitated and even disruptive at family simchas and other social situations. Is this connected to his learning disability in any way?
RS: Research shows that many extreme cases of anxiety in children are linked to learning disabilities. Therefore, it is important to recognize that a highly anxious child is perhaps that way because he is struggling academically. It might be worth exploring your son’s learning disabilities because those might be at the root of his anxiety.
PF: My guess is that your son is exhibiting anxiety at family functions and social situations. His “disruptive” behavior is probably your son’s way of expressing his discomfort in social situations (psychologists view behavior as a form of emotional communication). Such anxiety may or may not be connected to his learning challenges. You may want to have your son evaluated at some point to sort out the basis of his agitation and disruptiveness.
MG: While there is no way to be certain if it his agitation at family simchas is connected to his learning disabilities, I don’t believe it is. He probably becomes overwhelmed by the noise, crowd, and forced socialization with family members. This, by the way, happens to adults too! The difference is that most adults have learned how to cope with this anxiety in various ways. It is important to talk to your son and ask him what it is that bothers him at these simchas. He may not know, but together you can brainstorm ways to make it easier for him. For instance, he might want to take breaks outside the room or bring a distraction such as a book or game he can use on the side when he becomes overwhelmed.
My daughter is in shidduchim. She is a wonderful outgoing girl who just “clams-up” during dates. I understand that she is a bit anxious when going out, but the shadchanim say that her being too quiet is becoming an issue. Is there a sensitive way I can be of help to my daughter during this crucial time in her life?
RS: A lot of young people are nervous when in the shidduch parsha because there is so much pressure on each individual interaction. My main suggestion for those in the shidduch parsha would be do to social skills training. Social skills training helps people work on verbal and nonverbal communication, such as eye contact, body language, and listening skills. While this sounds intuitive to a lot of us, there are people who need direct instruction to feel comfortable with these unwritten rules.
PF: It is normal to experience anxiety about dating, especially for a young person with little dating experience. One step that might prove helpful would be to make a list of questions that she might be asked on a date and practice answering them in advance. Likewise, preparing some questions that she can ask a date might also provide some structure to the “getting-to-know-you” communication process. In addition, anything you can do to help her develop self-esteem is likely to be helpful in reducing anxiety. Talents and skills are generally associated with high self-esteem.
Can you offer some tips to help control anxiety and nervousness in adults?
RS: Anxiety can be managed, but it is a constant endeavor to “shrink” the monster if you are inclined to anxiety. Some of the treatments for anxiety are cognitive behavior therapy, relaxation therapy, medication, and dietary or lifestyle changes. The first step is figuring out what is making you anxious and then moving from there to appropriate remediation.
PF: Anxiety is often associated with how we are thinking: if we worry, for example, we will feel anxiety. Therefore, practicing the positive alternatives of optimism, trust and faith, can help reduce anxiety.
MG: Exercise is one of the best things both adults and children can do to help control anxiety. While it is not a cure, it can really help. Exercising helps release hormones that promote relaxation. Some foods or vitamins that contain omega 3 can also really help. Of course, learning relaxation techniques can be very valuable as well.
DA: If there is a family history of anxiety, that can be a problem and needs therapy. Therefore, find out about your family history in order to help you treat the problem.