Tools for Achieving Menucha: Anxiety in Children and Adolescents with Dr. Oshra Cohen

00:00 Speaker 1 Hi, I'm Zalman Schneer. Welcome to the Everything Chinuch Podcast, brought to you by the Menachem Education Foundation. Here, you'll find farbrengens, workshops, live interviews and more, all to inspire you, the Chabad educator. We hope you enjoy today's episode.

00:20 Speaker 2 Thank you all for being here. I think there is something incredible about a bunch of educators coming together and learning and sharing and growing together. And what we're gonna talk about today in ve-very quickly, we're gonna try to wrap a lot of things into very little time, but what we'll talk about today is anxiety. So whenever I say that, there's usually a wave of anxiety that just spreads over the room, right? Just saying the word anxiety is anxiety-provoking. Let's take a breath. We're all good. The idea is gonna be for us to learn skills, tools that we can utilize ourselves, that we can teach our students. And, um, a, a quick word about me, as Chana said, I'm a psychologist in private practice. I also work in a school, and I'll be honest that I never planned to work in a school. That was definitely not part of the plan. Researcher, yes, and I spent years doing research. Clinician, yes, still doing that. School, no, not really. It was not part of the plan. In my final year of graduate school, one of the things you have to do is we have to do an internship, which means you get placed, and you see patients. And I was kinda like, you know, it's just something you have to get through 'cause I was really gonna do research for the rest of, of my career. So I work at this clinic, and it turns out I actually like seeing patients and talking to people, so that

01:44 Speaker 2 was nice to figure out. And I see woman after woman walking in with anxiety. And every time I ask her, "So when did this start?" Right? 'Cause we need to figure out what, what triggered this, when did this start? Inevitably, I get answers like, "In elementary school. I was nine years old. In high school." And I just started thinking, you know what? Maybe if we spoke in high school or in elementary school, you wouldn't need to be here. And that's sort of how I ended up in a high school because I wanna get them before they come to the office. And the truth is that we need guidance counselors right now. We need guidance counselors in schools, and we need teachers because one guidance counselor can't do it all, and being a teacher is more than just teaching. It's really about educating. We teach life skills. So I wanna give that to you. Hopefully, we're gonna learn it together. Every time I do this, I learn it all over again. We're gonna do this together so that you can go ahead and give this to your students. We'll see if I can work the tech, even though it seems pretty simple. All right, here we go. Let's talk about Chanie. Chanie is a seven-year-old. She's in second grade. She does really well academically. She gets good grades and is always participating in class and answering questions. Chanie loved being on Zoom. She was one of those kids. Her mom reports that she was happy and

03:12 Speaker 2 excited to log in. During recess and lunch, Chanie likes to hang out with the teacher and prefers to read during recess. Chanie's often sick during school trips or on days with activities. If you know Chanie, raise your hand. You have Chanie in your class? Okay, great. Let's talk about Rivkie. Rivkie is 11. She's in fifth grade. During class, Rivkie has a lot of questions and asks the teacher to repeat what was said because she wasn't able to write it all down. Rivkie rewrites her notes every night and often stays late after class to finish doing assignments. Her parents report crying spells during evenings when she needs to study for tests. Raise your hand if you have Rivkie in your class. Some more Rivkies. Okay. And one more. Miriam. Miriam is a junior in high school. Miriam has done very poorly academically. She's kind of failing because she doesn't study or do homework. If you want, she probably also doesn't show up for class. When confronted with her lack of participation, Miriam responds with a shrug and an, "I don't care about grades. I'm gonna fail anyway." Her parents report that she's often upset at home and gets easily irritable. Raise your hand if you know Miriam. Oh, we've got a lot of Miriams. Okay. So what do all three have in common? All three suffer from anxiety, but all three manifest very differently their anxiety because anxiety is not one thing. Anxiety is a conglomeration of symptoms and manifestations, but all three are anxiety. And

04:54 Speaker 2 in order for us to know that and understand that, it has to start with the initial paradigm shift. Friends, if you're gonna remember anything from what I'm gonna say, remember this, okay? Don't you love it when the teacher says to you, like, "This is gonna be on the test," so you just know what to write down? This is gonna be on the test. We often ask the question of, "How do I make this behavior stop? How do I get you to go to recess? How do I get you to stop asking a million questions? How do I get you to care?" That's not the question we need to ask. What we need to ask is, "What is motivating this behavior? What is going on for you that's making you react in this way, that's making you behave this way?" Because when we ask that question, we get to the correct answer, which is anxiety. And so the paradigm shift has to be from why, why are you doing this, to what, what is causing you to behave in this way? 'Cause then we, then we can start talking about, "Okay, so how can we help you?" Before we talk about anxiety, we need to understand that anxiety is really, uh, an extreme stress response. Now, we all experience stress. Stress is not a bad thing. Um, stress can be a very, very good thing. When we talk about stress, we think about stress as a bell curve. So think of it sort of like a

06:16 Speaker 2 mountain that goes up and then goes down. If you're all the way on the edge where there is no stress, you're not getting anything done, okay? We all know those people are like, "No, it's gonna be fine." They never get anything done. If you're all the way on the other side where you're super stressed out, you never get anything done because it's so stressful, and there's so much to do, and I'm so overwhelmed that I just freeze. That space in the middle where I feel some stress but it's not debilitating is actually very, very functional. When a stress response goes wrong, when there is too much of it, here's what we see. We see somatic symptoms. These are things that happen in the body. For kids, stomachaches. When a kid comes to you day after day, "My stomach is hurting. My stomach is hurting," and you've taken them to the doctor, and you've taken them to the GI, and you've ruled out all the medical causes, wonder about anxiety. Headaches, muscle tension, not sleeping well. Um, with younger kids, sometimes we see they start grinding their teeth in their sleep. For adults, chest pain. We see that less for kids. There is an emotional response, so anxiety is one of those stress responses. Anger, yelling, screaming, tantrums. Feeling overwhelmed, that's often for adults 'cause adults can really articulate when we feel overwhelmed. You know when that-- when, like, someone comes to you, and they have one more thing they need you to do, and you're

07:36 Speaker 2 already done, and you're just like, "Oh my gosh, don't even talk to me"? It's like that. Lack of motivation and often sadness or depression. And the behavioral things we see are changes in appetite, and it can go in either direction, more or less. Anger outbursts, as we said. Substance use with high schoolers. Um, you wanna, you wanna wonder, right? What is going on? If you know, if you have a high schooler who is using substances, either drugs or alcohol, alcohol is a substance, um, you wanna wonder what is going on there for them. Social withdrawal, they're not hanging out with friends anymore. They're not socializing. And avoidance, and we will talk more about avoidance because avoidance is very, very important when it comes to anxiety. So, you can't help someone if you don't know what it is, so what is anxiety? I love this, um, I love this cartoon because I feel like this is what we tell our kids all the time, right? There are two birds, for anyone who can't see all the way in the back. There are two birds, and one of them is wearing a parachute, and the one bird says to the next, "Let's try it without the parachute." So kids come to you, and they're like, "Oh my gosh, I'm so nervous about this," and you kinda feel like it's not a big deal. Like, you really don't need a parachute for this. You're fine. But they're anxious, and they do feel like they need a parachute. Anxiety

09:00 Speaker 2 is normal. We all experience anxiety. I say this to people in the office all the time. If you walked in here and told me that you never feel anxious, I would be worried about you. Why? Why don't you ever feel anxious? There's something wrong. It's normal to feel anxiety, and anxiety is usually transient. It comes and goes. We all have our things. Everyone's got their stuff. The most interesting thing about anxiety is even though we all experience it, I only understand the anxieties I have. So if someone comes to me and says, "Oh my gosh, I'm so anxious. I need to host another five people for Shabbos," often our response will be like, "What's the big deal? Throw in some more chicken. Add water to the soup. Get a kugel. You're good to go. Not a big deal." And then you and her walk together to the elevator, and that's what stresses you out, and you feel like, "Oh my gosh, we're going up to the twentieth floor," and her response is, "What's the big deal? Two, four, six, it's all the same. The elevator is safe. You're gonna be okay." And the key is for us to really tap into not what it is that the individual is anxious about but that experience of anxiety. When anxiety becomes dysfunctional, when it becomes chronic, we worry about things all the time, we can't function with it, it leads to avoidance. Avoidance and anxiety are best friends. They always come together because the more anxious I

10:22 Speaker 2 am, the more likely I am to avoid, and the more I avoid, the more likely I am to be anxious. So it just keeps cycling again and again and again, and that's a cycle that we really need to help our students break. Ten to fifteen percent of kids between the ages of three to seventeen are diagnosed with an anxiety disorder. This is pre-COVID. Just think about what that means. These are staggering numbers. During COVID, the rates were thirty-five percent of kids were diagnosed with an anxiety disorder. So even if we were to go with a very conservative estimate of ten percent, don't, uh, don't, don't lose me. I know I'm s- math. Don't, don't shut down because we're doing a little math. Ten percent, that means that twenty out of twenty students in your classroom have a diagnosable anxiety disorder. That does not mean that there aren't more who don't meet criteria for a diagnosis. It just means that two out of ten really need help. So I want you to already be thinking about your classrooms, your schools. Who are those students? Let's start to identify them if we haven't already. So what are these kids anxious about? Number one cause of anxiety in kids and adolescents is school. That's what they say. Number one. And during COVID, kids who were on Zoom reported substantially lower levels of anxiety when it came to school 'cause they weren't in school, right? Now, obviously, the answer to this is not so they don't have to be

11:55 Speaker 2 in school. The answer is we need to figure out how to make school a little bit less anxiety-provoking. It is the most common emotional diagnosis in childhood, emotional disorder diagnosis, with symptoms emerging around the age of six. So it's really early. Six, they're little at six. And it often comes with other diagnoses such as ADHD, depression, obviously we said already substance abuse. And ladies, we win this one. Women are twice more likely to develop an anxiety disorder than men. Yay. Not yay. Now, of course, the question is why? Why are women more likely to develop an anxiety disorder? And the answer is we don't know. But also it seems that women's brains, girls' brains, are programmed differently in terms of processing emotional stimuli. We just absorb it differently, and that likely makes us a little bit more prone, not a little, twice as prone to anxiety, to depression. Maybe it's the hormones, maybe it's how we're socialized. We care a lot. But whatever it is, it results in more anxiety. Anxiety does vary over the lifespan. It goes up, it goes down. It can cause real impairment. And the earlier and sooner we catch it, the more likely we are to teach these skills, really good skills, so they don't need to actually carry this through the lifespan. So I want you to think about worry as not a bad thing. Worry is a good thing. If we never worried, we would never get anything done. If I didn't worry about this presentation, I'd stand

13:39 Speaker 2 here and have nothing to say to you, right? If we didn't worry about safety, we wouldn't look when we're crossing the street. If we didn't worry in relationship, no one would ever call anyone and say, "Hey, how are you doing? I've been worried about you." Worry is not a bad thing. I like to think of worry like salt. No worry, there's no flavor to life. Some worry gives flavor to life. It motivates us. It keeps us going. Too much worry, and now you have hypertension. All right. So just 'cause, you know, every presentation has to have the token chart, just so you know I'm, like, serious and real. Depression, anxiety, and dis-behavior disorders by age. You can see anxiety really spikes between six to eleven and really takes off between twelve to seventeen. So your high schoolers, they're probably anxious. Not all of them, but many of them. You wanna find them, you wanna help them. So let's talk about the how. Well, you can't help if you don't know what it looks like. So here are some symptoms of anxiety that we see in children and teens. The irritability, acting out tantrums. We tend to think of anxiety as worry, and that's the way it manifests in adults. Adults will come in and say, "I'm constantly worried. I can't stop thinking about it. I'm so stressed out." Kids don't say that. Kids come in and say, "I hate everything. I hate everyone. This is not working. I don't wanna be here." They'll act out.

15:19 Speaker 2 Difficulty separating, definitely for younger kids. These are the kids that really have a very hard time letting go. Insomnia and bad dreams. Bedwetting when it starts after it, it didn't. Meaning I'm not talking about bedwetting that has been going on throughout, but a resumption of bedwetting can be a sign of anxiety. Somatic symptoms, as we spoke about. With kids, we're seeing headaches and stomach aches. Unwillingness to try new things. Right, like, "I don't, I don't wanna go out. I don't wanna join the group. I don't wanna stand up and speak." Avoiding normal activities, school refusal, not coming to school. Anyone has kids who just don't show up? Raise your hand if you got kids who don't show up. Yeah, that's a lot. And specific fears. So these are fears, and we'll talk about that. Fears of needles, blood, um, fear of spiders, fear of clowns, and social fears. "I can't talk to anybody. I have no friends." So what are some types of anxiety? And this is obviously not an exhaustive list, but I wanted to give you a few ideas because these are the things that you're most likely to encounter at the-- at your schools. Test anxiety. Here's the thing: We all get anxious when we're tested, and if it's timed, we get even more anxious. This is true for everyone because any time we're evaluated, our adrenaline, our cortisol get released. These are hormones that get released in the body, and they cause rapid heart rate. They cause breathing that's more shallow.

17:02 Speaker 2 They shut down all non-essential elements in the body and get us super focused, and that's a good thing because when you're taking a test, you better be super focused. But when that goes haywire, we end up with test anxiety. The student can no longer function in an evaluative, um, situation. Social fears. It's the fear of being judged, the fear that other people are gonna make negative assumptions about you. Now, we like to think of this as like, oh, you know, kids have a hard time with this. But walk-- Did you walk into this lunchroom today and were thinking, "Where am I gonna sit? Who am I gonna sit with? Did someone save me a spot? I really hope somebody saved me a spot." That's normal. We all, we all feel this way. I, um, I spoke to a, a group of teachers once, and they were kinda like, "What's the big deal? Like, it's not a big deal. You walk into the lunchroom and, you know, what d-what difference does it matter? It doesn't matter who you sit with. Just sit anywhere." Right. And then the following week was the school dinner. And on the form of the school dinner, we have a line that says, "Where would you like to sit?" And everyone was writing things like, "Please put me with..." Or I'm sitting with. Don't wanna be alone. Right, 'cause it's hard. It's really, really hard, and what we need to remember is our kids are walking into a lot of unstructured time

18:23 Speaker 2 at school: recess, lunch, any extracurricular activities, where we expect them to be able to just figure it out, and that can be very anxiety-provoking for some kids. Specific phobias. These are kids with very specific fears, things like arachnophobia, so fear of spiders, um, fear of animals. We have a lot of fear of dogs, I see in the office. F-fear of injections, fear of blood, claustrophobia. The number-one fear in the United States is fear of public speaking. The number-two fear in the United States is fear of dying, which means people would rather die than speak in public. And I'm always amazed when teachers come to talk to me before, um, before they need to give talks to parents or parent-teacher conferences, and they're nervous, and I keep... I say to them, "You public speak all day long. That's all you do. You walk into a classroom, and you present." And they say, "Oh, no. It's different. These are kids. These are adults, totally different." And finally, I have to say a word about math anxiety. Any math teachers in the room? No, math students, second grade. Math students, yes. Okay. Friends, here is the thing about math anxiety. First of all, twenty percent of all people, humans, never mind kids, suffer from math anxiety. Math is anxiety-provoking for a lot of people. And the thing about math anxiety is that people tend to think, "Well, I'm bad at math, and that's why I'm anxious." But the truth is that what the research shows is that you're

20:12 Speaker 2 anxious, and that's why you're bad at math. Because what anxiety does in the brain is anxiety floods us with hormones that impair working memory. What's working memory? Working memory is that piece of your brain that when you look at a problem, one plus two equals, that's the memory that holds one and the plus sign and the two and the equal sign. And when your brain gets flooded, it can't hold onto that. So you really are sitting there thinking, "One second. Was it a one? I don't know, but was it a plus or a minus?" That's why you're bad at math. And what we know is that when you gamify math, when you turn math into a game, anxiety goes down, 'cause games are fun and also not stressful. So for the math teachers in the room or for the principals of math teachers, gamify. It will reduce math anxiety. What is this gonna look like in your classroom? And here's why I think it's so, so, so important for you to recognize it, because you are the front line. In every school I'm in, there is one or two or three or four, at most, guidance counselors for a bazillion students. So the guidance counselor just can't get to everyone, right? We need teacher referral. We need a teacher to come to us and say, "Listen, I'm really concerned about Hani. I don't know. She seems off. She kind of seems anxious to me. I don't know. Can you check in on her?" You need

21:43 Speaker 2 to know what it is you're looking for. So you're looking for checking. These are the kids who constantly are checking for mistakes. "Did I do this right?" They're reviewing. They're checking for understanding. So you'll say something. They'll be like, "One second. So does this mean that I should write it down?" And you're like, "Yeah, I just said you should write it down." "Right. Okay, fine." And then you'll say, "Okay, guys, we're gonna go to lunch." "One second. So does this mean that we're going to lunch now?" "Yeah, it means we're going to lunch now." These are the kids who are checking all the time. It's very funny when I say it, so not funny when it's happening in your classroom. Incomplete work. These are the perfectionists. They always take forever. These are the kids who are constantly asking you for an extension. "I need one more day. I didn't finish. I'm almost done with the essay. I don't know. I still have three questions left." Constantly asking for extensions because they have to have it done perfectly. Repeating. These are the kids who will ask again and again and again, "Can you repeat that? Can you say that again? 'Cause I didn't write every single word." Incidentally, for, um, for incomplete work and for repeating, you know the kids that are taking a test, and time is up, and you walk over, and this happens all the time, right? And you're already holding on to the test. You're like, "Time is up. You gotta hand

23:09 Speaker 2 it in. They're the last ones in the room." And you're holding onto the test, and she's still writing as you're walking. She's still writing on the test because she just needed, like, five more minutes, except it's never five more minutes. You wanna keep that in mind. Is she struggling with anxiety? Reassurance seeking. These are the kids that come to you and are constantly saying things like, "But is this right? Is this okay? Did I do this right?" And self-criticism. These are the kids that say things like, "I'm so stupid. I can never do it. I always get it wrong. There's no point even trying." And I will say, self-criticism, to me, don't even bother trying to figure out anything else out. A kid who expresses a lot of self-criticism, send them to the guidance counselor or talk to someone about how to help them, because these become very core beliefs. These becomes ways we think about ourselves over the long term. So if they're saying it now, they're gonna hold onto that. They're gonna believe that about themselves as they become adults, and we wanna change that as quickly as possible. And yes, friends, there are more. Constant apologizing. "I'm so sorry. Is this okay? I'm so sorry. I'm so sorry." The kids who are avoiding social situations. They won't go out to recess. They won't come on field trips, school trips. Um, they'll sit alone at lunch. They'll find some corner. These are the kids who sometimes will sort of like, you'll find them

24:44 Speaker 2 in some, like, godforsaken corner, and they're all alone. You're like, "Oh, why don't you join whatever?" Like, "Yeah, okay." And two minutes later, you'll go back, and they're still there 'cause they're never gonna do it. Poor concentration. Can't focus. They seem to be all over the place. Now, obviously, we worry about ADHD with poor concentration, but we should also think anxiety. It's not always an impulse control disorder. Often, it's kids who are so flooded with anxiety, they just can't think. And truancy. they don't show up for school. I wanna spend a minute talking about truancy because it's the kinda thing that we have to catch it early, and we have to address it early. The longer a kid doesn't show up for school, the harder it is to get them back in the building. So I can tell you that a couple years ago, I had a student who transferred into our school. Um, she was having a very hard time, and we had to... She couldn't make it. She could not make it into school, and we worked with Mom to get her into the car. And then for the better part of a week, I spent every day going out to the car, sitting in the car with her, step by step, helping her just, "Let's keep the door open to the car. You are not going in." And then, "Let's stand in the parking lot. We're not going in. We're just standing in the parking lot." And then coming through the front

26:01 Speaker 2 door, and, "We're not going into class. We're just at the front door." And building up her ability to actually make it into the building until she was able to go into class. Because if we don't, it gets very, very difficult to get these kids back on track, not just academically, but psychologically. So if you have a case like this, if you have a kid who is struggling, get on it early. And this is not about yelling at them, "You have to come into school." It's really about working with them to address that anxiety. So, we have to start with, um, you know, Sur Merav Asatov. So we gotta talk about what's not helpful. Humpty Dumpty sitting there with the therapist who says, "Visualize yourself not falling off the wall." I will respectfully disagree with this therapist. That's not what I would've said to Humpty Dumpty. When we treat anxiety, we say, "Visualize yourself falling off the wall and not breaking," 'cause everyone falls off the wall sometimes. Also, note that the therapist is holding glue as they're saying, "Visualize yourself not breaking." Here's what's not helpful. Eye rolling. Ugh, this is so ridiculous, right? This is so silly. It's obviously... I don't, I don't know if that's helpful to anything ever, but definitely not helpful for anxiety. Saying things like, "I'm sure that's not the reason." Right? A child comes in and they say, "I'm so nervous. Nobody wants to be friends with me." "I, I'm sure that's not the reason you're nervous. Everyone wants

27:36 Speaker 2 to be friends with you." Saying things like, "Look, I understand you're anxious, but you gotta get it done." So we like to call that tough love. I'm not sure how much love is in that statement, but it's definitely tough. When kids can do, they do, and if they can't, we have to teach them how to be able to. But this idea that kids are just not motivated. Everyone wants to feel successful. Everyone wants to feel like they, they're capable, and when they don't, we need to help them feel that way. Now, often, it will end with them having to do it, but we need to bring them to a point where they believe they could be successful. Saying things like, "Listen, if you just tried harder, you'd be successful." That's not necessarily true. There are kids who try really, really hard, and they just don't make it, and we need to figure out what is standing in the way of their success, not just send them back to try harder. And, "Look, I know you feel this way, but really don't let emotions control you." Sure. None of us should let emotions control us, except all of us are controlled by emotions. There's a lot of incredible research about elections and how they're really decided by feelings. Even though people justify their choices, we are all motivated by emotion, as are kids. It's just more obvious with kids. So what, what can we do that would be helpful? No, you do not need to be

29:09 Speaker 2 a therapist to be helpful. We all teach life skills, and that's really what this boils down to. You're gonna teach life skills in your classroom. You already do. You're just gonna be more overt about it, a little bit more obvious about it. We wanna start off with problem solving. A kid comes to you and says, "I didn't get a chance to write it all down. You were going so fast." So you could tell them what to do, or you can ask them, "Okay. So how do you think you can solve this problem? What do you think you could do? Because I'm not gonna repeat the whole lesson right now, right? So, but you still need the notes. So what do you think you could do?" Help them get to a point where they generate the response. "I can borrow the notes. I can maybe be okay with not having all of the notes." Help them problem solve. What might you do? And that's a question that we need to ask. We wanna create what we call thought challenges. Kids come in all the time, and they say, "I just can't do it." And I always say, "I just can't do it, yet." Yet is a very, very important word. Um, in one of the schools that I was consulting, I was consulting at, there was a teacher who would walk into class every day and write on the board, "yet." And every time a student would make a statement like that, "I can't do it,"

30:32 Speaker 2 um, "I will never get it," she would just point to it and say, "Now you say it again." "I can't do it," "yet." "I'm never gonna get it," "yet." Doesn't work as well. But she would still make them do it. The kids were very cute. At the end of the year, they made her a poster with her name and yet on it and hung it up on her wall. Yet is an incredibly powerful word because the implication of yet is there's room for growth. There's room for change. You're gonna get there. Give that to them. Even if it's not in this moment, they'll get there. Don't make promises you can't keep. We like to say, "Listen, it's gonna be okay. Why don't you go join that group? I'm sure they're gonna be happy to have you." Really? You're sure? Because they might really just be so mean to her that they're not gonna be happy to have her. So we need to say the things that we really know for a fact. "Why don't you go join this group? I think you can handle. I think you can cope being there, even if they're not so friendly." But they might be. They might be friendly. We wanna validate kids' fears in a way that shows understanding, but without reassurance providing. And look, this is hard, right? Because the instinct when a kid comes to us and says they're having a hard time, "I'm so worried about this," the instinct is to say, "I definitely hear

31:54 Speaker 2 that, but you're gonna be okay." Right? Immediately we put in, "But, but it's gonna be okay." "But" is a diminishing statement. If you think of a sentence, the first half of the sentence and the second half of the sentence, if they are combined with the word "but," what you've done now is you've diminished from the first half. So if I say, "This was really fun, but I could have used more time," what I really said is, "This was kind of fun." We wanna use the word "and." "This was really fun, and I could have used more time." Because now I've gave validity to both halves of the sentence. When a kid comes and says, "I am feeling anxious," I totally hear that this is really hard for you, and I really believe you could cope. It's both. And we wanna, of course, model ways of dealing with anxiety. So I know it's hard to do, but there's nothing more powerful than a teacher standing in a classroom and saying, "You know, when I worry... sometimes I worry. Sometimes I think, like, this is gonna be really hard, and then I try to remind myself that it's okay, or maybe I go and talk to someone about it." When a teacher says that, that becomes a message to a student that it's okay, that you too can do this. I give you permission to struggle, and I give you permission to problem solve and move forward. What else? Well, you gotta be present. So what does

33:30 Speaker 2 that mean? Eye contact. We gotta look at the kids. It's amazing how often students misinterpret our behavior. So I have students walk into the office all the time saying things like, "Teacher hates me." "Teacher hates you? Why would she hate you?" "I don't know. Every time I come over to her, she doesn't even look at me." Teacher was busy writing. Teacher was, you know, occupied with a paper in front of her. "No, she hates me. She doesn't even look at me." Now, of course, the second half of that is, "Teacher hates me." "Why would teacher hate you?" "She's always looking at me." There's no way to win, friends. Let's be honest. But we do wanna make eye contact. We do wanna make sure that then when they're talking to us and sharing fears and concerns, that we're there, we're present. We put aside the pen. We put aside the paper. We spend a minute to say, "Okay. Look, I'm with you. I'm hearing." We wanna make sure that we reflect back. A lot of times we think we understand, but we don't. So reflecting back is a really useful tool to make sure you got it right. So I will say to a student or to a patient, I will say, "So what I'm hearing is that you're really nervous about going on this trip because you're not sure you're gonna have who to sit with on the bus." Right. Sometimes they'll say, "No, that's not, it's not at all about the bus. I'm just

34:53 Speaker 2 nervous because we're gonna go boating, and I'm scared of water." "Oh, okay. So glad you explained it to me. I didn't get it the first time." Reflect back and reflect what you see. A lot of times students don't have awareness of their own behaviors. It means saying things like, "You know, I notice you've been pacing a lot in the back of the classroom," or, "I notice that you keep twiddling with your pen, and it keeps falling on the floor." I know it's very easy to get annoyed at those things 'cause, like, "Oh my gosh. Could you just put the pen down?" But if we take a minute to think again, what is motivating this behavior? Maybe the student is bored. Maybe the student is anxious. Maybe they just need to not use the pen. But by asking, you get the answer to that. You wanna show understanding. Acknowledge the difficulty, right? We wanna say things like, "This is hard. I think anyone in your position would really struggle. It's okay that this is hard." And of course, we wanna share the vulnerability. It's okay to say that, "You know, this is very difficult, and sometimes I struggle, too." So pop quiz: Which of the following is the cause of test anxiety? Fear of failure, lack of preparation, poor test-taking skills, high pressure, perfectionism. And the answer is all of the above. Test anxiety can be caused not just if you don't know the material. Sometimes it can be caused if you know the material, but

36:20 Speaker 2 because of lots of other things. So here's what I recommend for test anxiety. I always tell the students, have a snack before the test. Let's boost up your sugar levels. It's gonna help you think. Start with questions that are easiest to build confidence. Don't go for the things that are hard. Look through the whole test and answer what you know. Go through the whole test before stopping. Don't get stuck on one question. You'll go back. And no what if games. What if I fail this test? Then I'm gonna fail the class, then I'm gonna fail high school, then I'll be homeless, my life will be over. No what if tests. They roll very quickly. We wanna be armed for anxiety. This is what we do as guidance counselors in the office with students. We talk about acceptance of feelings. We reframe behaviors. We modify some behaviors. We need to change what they do. We evaluate the risk. You're not gonna fail high school because you failed one math test, and we decide to act instead of avoid. But what do you need to do? The dos and don'ts of helping your students. Do break tasks down. Kids get overwhelmed. If there is an essay, break it down to pieces. If there is a huge project, give them multiple deadlines. Focus on the positive. "You're doing great on the quizzes. Okay, the test was rough, but you did really well on the quizzes." Help students reframe. This is not the end of the world. I say

37:54 Speaker 2 this all the time. The only thing that's the end of the world is the end of the world. Nothing else is. Encourage coping statements: I can do it, I can overcome, I can learn. And encourage students to seek support from guidance, from parents, from you. Don't encourage students to start with the small stuff, even though it's very tempting, but the truth is, it becomes just a way to avoid the big, overwhelming things. Don't focus on physical symptoms. "Why is your breathing like this? Why are you jittery?" The more focused you are on physical symptoms, the higher their anxiety is gonna be. Don't endorse negative cognitions: I can't do it, I'm, I'm not capable. And the other two, provide reassurance and encourage avoidance, those are the kind of things that you wanna work on with the guidance counselor because sometimes we'll do that, and sometimes we won't. To wrap up, on a bigger level, on a school level, here are some things that a school can do to provide students with anxiety with support. We can accommodate lateness on a short-term basis. Students who really struggle to get in the door, give them an allowance that they can come late as we're working to get them into the building. We can have shorter days for children with separation anxiety. We can allow extra time between transitions. This kid is anxious. They're gonna-- It's gonna take them time to wrap up before, between classes. It's okay. We're not gonna hold them accountable if they're a couple of

39:29 Speaker 2 minutes late. We can create a safe place for them. Principals, I love you. You're amazing. I'm not always sure that your office is the safest place for this, but it might be. If it isn't, then find another space. And we can create a coping plan. What are you gonna do when you feel panicky? Where are you gonna go? Who are you gonna talk to? How are you gonna work through this? And finally, when do I refer out? Therapy is not a bad word, and it's okay to need to talk to someone, and a lot of times, your job will be to help parents understand that because there's a lot of stigma around therapy, and there's a lot of fear of, "What does this mean about my child?" And all it means is that your kid needs a little more support, that your kid's in n- needs a little bit higher level of care. So I will say... I tend to say err on the side of referring. If they need it, they should get it. But certainly, if a child cannot function in the classroom, if the child cannot function in the school... I had a student who spent his days sitting in the hallway crying. That's a kid who should be referred to therapy. If a child is really struggling academically and can't make any ground, that's a student that should be referred. And, and if a child is having overt outbursts, right? Anger outbursts, um, crying spells, these are kids who are not

41:01 Speaker 2 functioning well who really need a much higher level of support. To end, there are a lot of resources about anxiety that you can access. There's a lot of information online. Anxiety is really the number one thing that we're talking about right now post-pandemic, and we do expect to see the numbers, unfortunately, rise, but the good news is, we have really, really good treatments for anxiety. So parents should know that a child with anxiety can learn and can grow and can acquire skills that are really gonna help them function very, very well in life. I'm happy to take any questions, but I appreciate your attention and your time, and thank you for being here. Um, Hannah, do we have a minute for questions? We have a minute. Please.

41:51 Speaker 3 Whichever.

41:53 Speaker 2 So when is it different, "I'm nervous," to "It's an anxiety"? Right. So it's, it's always on a continuum, right? Think of it, if this is not-- there's no discrete line. We're all on a continuum. Think of it as everyone is anxious, and it's just a matter of where you are on the line. So as long as you are functioning, as long as you can get through it, you're still okay. Once it becomes pushing you to avoid, once it becomes you're not functioning, things are falling by the wayside, then it's an issue. When a child is exhibiting symptoms of panic, so hyperventilation, they can't calm themselves down, that's anxiety. But it really is a subjective experience.

42:35 Speaker 3 So when-- but what if th- this child knows the term anxiety?

42:40 Speaker 2 Right. So-

42:44 Speaker 3 I, I only say from experience 'cause we have this in my house.

42:47 Speaker 2 Right.

42:48 Speaker 3 Okay? So I've only said it 'cause it's in my house. And one of my kids, uh, she's not a kid anymore. She grown. "I'm having an anxiety attack." And I see what you guys saying. "Are you nervous?" To which she looks at me, she goes, "Mom, I told you. I'm having an anxiety attack."

43:04 Speaker 2 Right. So, look, I think-

43:06 Speaker 3 When you talk about it-

43:08 Speaker 2 I think we all see this all the time. I have students coming in and being like, "Oh my gosh, I have, like, PTSD from this." I'm like, "No, you don't." You just don't. Like, the fact that, you know, your teacher said, "No," you don't have PTSD from your teacher saying no. Like, the kids today, they really do, they know the terms, they don't know what they mean. They'll say like, "I'm so OCD about this." No, you're not. But they know the terms, and it's okay. This is where we kind of do this assessment of, what are you trying to tell me? Are you trying to tell me that you're nervous? Are you trying to tell me that you legitimately have an anxiety disorder? Um, I often tell students, I'm like, "You don't get to diagnose yourself with an anxiety disorder. You gotta talk to someone else in order to diagnose that." Final question, go ahead.

43:50 Speaker 4 How do you help two types of students? One, the student who absolutely does not listen to the parents, anybody, anything, and they, and they need serious help, and intervention, and evaluation, and, and support emotionally and relate, and the type of student that is just, just doesn't wanna do anything, doesn't wanna participate in activities. Truancy is an issue. Just doesn't want to.

44:14 Speaker 2 Okay. Oh, sure. The question was, how do you help two types of student? One is the one who does not listen to the parents, is not at all connected to them, and yet needs limits and boundaries, if I understood correctly. And you see, watch me reflecting. And the second one is, how do you help the student that doesn't wanna do anything, right? Okay. So this is like a Hillel question of, like, the whole Torah kulah al regel achat. So I don't know if we can do that, but I'm gonna throw a few ideas. Look, this is, when I've said this before, I will say it again. One of my favorite Rashis in all of Tanakh, my favorite Rashi, I think it's so beautiful, is the Rashi about Yosef HaTzadik, right? So Yosef HaTzadik is in the house of Potiphar, and he's gonna sin. Seems pretty clear from the pesukim it's not going well, right? He's gonna sin. And this is Yosef HaTzadik, let's just remember, right? This is a, we call him HaTzadik for a reason. And Rashi there says, so why didn't he sin? How was he able to resist temptation? Rashi there says, "Ra d'yikno shel aviv," he saw his father's image. Now, let's think about this for a minute. It doesn't say he remembered all the Halakha he learned about how wrong this is, and it doesn't say he was afraid of Hashem. He wasn't even thinking about Hashem. What does it say? He saw his father's image. The relationship is what

45:38 Speaker 2 held him back. So in the case of this first child that you're describing, we're talking about a missing relationship, right? Something there is not working. Okay, that's something that they need to work on in therapy. But what we as a school can do is we can foster a relationship with this child, so that maybe it won't be the image of his father, but there's something incredibly powerful about the image of a teacher. You know, I hear this all the time from alumni who come back and say, "You know, I was in a situation, and there was gonna be a situation, and I don't know, I kind of like was thinking of my teacher, and I just feel like she would've been so disappointed in me, so I just left." Right, exactly. Because the relationship is incredibly, incredibly powerful, and that's what we want for that kid. We want relationships that are gonna be meaningful, that are gonna be sustaining, because they don't have it anywhere else. It's not an answer, but it's something.

46:30 Speaker 4 Right.

46:30 Speaker 2 Okay. And in terms of the kid who's just not motivated, I have to go back to the basics of that paradigm. No child is born unmotivated, right? There's no baby that comes into the world and is kind of like, "You know what? Not in the mood to crawl, not doing it." Not motivated, and like, you're like, "How do I motivate my child to crawl?" No, no one ever comes into the world unmotivated. We call things unmotivated when we don't know what the cause is, right? When we don't know why someone is not doing something, we're like, "Well, they're not motivated." Maybe. Or maybe there's something else going on. And we go back to that paradigm shift of asking, what is going on for you that you are so entrenched in this need to not participate, so entrenched in this need to not put forth effort? Are you scared that you might fail? Are you scared that no one's gonna like you? Are, what is the fear underlying this behavior? And look, it's tough. I'm not gonna say, I c- I get to stand here and say like, "Here's what we should do," and then you need to go and do all the hard work, and it's tough. But if we come in with this paradigm shift, every conversation we're gonna have with the student will sound different, because it's no longer gonna be about mesorah and like, "No, you didn't do it." It's really gonna be about, "I'm here to help you. Tell me how

47:43 Speaker 2 I can help you." If you have any questions, please feel free to find me. Thank you for your time and for your attention, and thank you, Chana. Thank you for listening. Wishing you much hatzlacha in your vital shlichus.