Sheltering in place and remote learning are the new way of life for many Tri-Valley residents, and local mental health experts have recently stepped up to help parents and children better understand and recognize the potential risks and signs of anxiety related to long-term isolation during the COVID-19 pandemic.
As residents pass the half-year mark since schools and many office buildings first closed to stop the spread of COVID-19, Dr. Jennifer Penney of Axis Community Health in Pleasanton told the Weekly that she has observed an increase in the need for mental health and counseling services.
"Usually depression and anxiety are the most common reason people come to counseling at Axis in particular, but we've seen such an uptick ... because of the pandemic taxing everybody's resources and ability to cope," Penney said. "We're seeing that people who have never experienced depression before are now experiencing it, just due to the difficulty coping right now."
According to the American Psychological Association, anxiety is "an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure." The disorder affects an estimated one in three youths and can manifest itself in many ways.
Local family therapist Vanessa Varrelman, who works mostly with elementary-age students, also reported seeing more young clients with anxiety in recent months.
"I would definitely say anxiety has increased," Varrelman said. "I definitely think that anxiety has increased around the pandemic but also just having their routine disrupted. It stands to reason that anxiety would be increased because routines are disrupted."
Anxiety appears in both young and older people, as well as depression, but experts said the conditions can present differently in children.
"For kids, it's sometimes hard for them to articulate what's going on. They have difficulty putting words to their feelings and experiences," Penney said.
It's not uncommon for parents to notice changes in their child such as acting out, an increase in aggression or irritability, somatic complaints about headaches or stomach aches, difficulty sleeping, nightmares, bed-wetting or not paying attention in class.
With many potential distractions at home while trying to learn via virtual platform, though, Penney said it's important for parents to remember "it's more that (the child's) maybe not comprehending the material, such as a kid that was learning normally and now they're spacing out during class or not watching their video for school."
Parents can and are encouraged to help their child avoid too much screen time outside of online schooling but have struggled with finding the right amount. Many want their child to still socialize with their friends over Zoom and feel connected but also interact with their real surroundings.
"There needs to be a limit on screen time, but right now families are in a space where they're trying to balance the kids' need to be on screens more," Varrelman said. "We're all in the same space together trying to navigate it, figure it out. We can only go on what best practices are, and trial and error."
Mannie Nimmo -- one of the co-founders of the Pleasanton-based Z-Cares Foundation, which specializes in mental health first aid training and public education about youth anxiety and depression -- said parents ask her "a lot" now how much screen time during a pandemic is too much.
"They spend extra time in their room, but they have to because of schooling. So it's, 'where does that excess come into play and what are the differences?' That's one of the questions that I get asked a lot," Nimmo said.
Structuring screen time is important, so Penney said "it's important to schedule in time for talks with friends since they can only do it virtually right now" and just try to find the right balance between virtual and real world activities instead.
"It's a very individual issue for families, so the most important thing is for families to sit down and talk about it directly," Penney said. "I see black-and-white extremes oftentimes. Some families have open ended and no structure, or the flipside is the parents are very stringent and have very limited hours, which stresses out the parents and kids with trying to keep it at a minimum."
By checking in with themselves about how they're also feeling, parents can help their children better cope with remote learning and isolation, according to Varrelman.
"Kids' success is a direct correlation with how the adults around them are handling it," Varrelman said. "It's equally as important for parents to be mindful and take care of themselves so that they can be a better support to the student. The thoughts and feelings (kids) have are directly related to the thoughts and feelings that parents are having about (COVID-19)."
Many of Samantha Nimmo's peers in college are grappling with a daily case of deja vu: "It's good to have routine but at the same time, if you're doing the exact same thing at the exact same time, every single day, that's going to get really repetitive," she said. "I've had a lot of people tell me they feel like they're living the same day over and over and over again, and they're bored."
To stave off some of the monotony that can contribute to anxiety, Samantha Nimmo suggests "doing the same things you do every day but in different places" like a set amount of time for taking a walk or painting every day.
"Something different that you don't usually do -- it's just a little change, but even that little change can really flip your whole day around," Samantha Nimmo said.
Sometimes a specialist is needed, however, and whether for a child or grownup, finding professional help during a global health crisis is more difficult but not impossible. Steve Nimmo said Z-Cares recently revamped their mental health first aid training system to respond accordingly during the pandemic.
"The National Council of Behavioral Health, who certifies us, they came up with a Zoom solution to the training, so we were able to get that turned back on. We're now again conducting mental health first aid trainings virtually on Zoom," Steve Nimmo said.
"You miss a lot of nonverbal cues when you're on virtual versus non-virtual," Steve Nimmo said. "We can see from the shoulders up but we might not see the fidgeting hands or feet wiggling around ... so I think you miss some of that."
Virtual counseling doesn't work for all patients, but Mannie Nimmo said it's resonating with a lot of kids who have anxiety: "People with social anxiety, you're not in a room with people, so you're in your own home, your own space, you're in a more comfortable environment, which can be helpful."
"It's been a mixed bag. On one hand, we have kids or adults who are either fearful to go out in public because of the pandemic or have agoraphobia and are just afraid of going out," Penney said. "Some have chosen to put counseling on hold until they can be seen in person."
Steve Nimmo recounted the recent successes of a Chicago therapist that he knows counseling patients over the internet.
"He did say a lot of the kids will like to go jump on Zoom and they do it from their own room, and they feel super comfortable about it," Steve Nimmo said. "They might have a hard time even getting up and going into the office but it's not so hard for them to open their computer in their room and have a conversation with them. That's certainly the positive side of it, that they're working in a comfortable space."
Many experts agreed that they are likely to continue offering telehealth services after the pandemics, though Penney and Varrelman said some patients need or prefer in-person therapy, such as play therapy for small children.
Varrelman has offered some in-person treatment including play therapy for children during the pandemic, but under strict safety guidelines like wearing a face mask, practicing social distancing and disinfecting all toys as well as laminating or printing single-use worksheets.
Axis also switched to telehealth services within a week of sheltering starting; since spring, 17 licensed clinicians have conducted counseling sessions via video or phone. "That's been the case since March and will continue until it's determined to be safe to be indoors without masks," Penney said.
For more information and resources about anxiety, depression and other mental health disorders, visit www.zcares.org or www.axishealth.org.