Emotional Wellbeing in Children and Youth

Why? Many children and teens struggle with feelings of stress, anxiety, and depression, particularly during the pandemic. These tools were created to promote the mental and emotional wellbeing of children and youth – during the COVID-19 crisis and beyond.

How? The National Academies of Sciences, Engineering, and Medicine (NASEM) made this project possible with funding from the Centers for Disease Control and Prevention (CDC). NASEM brought together a group of experts to develop ways to help children and youth with difficulties they face every day. Together with experts at ICF, they created tools, based on cognitive behavioral therapy (CBT), to help reduce stress, anxiety, and depression. The tools are meant for children and youth directly, and for parents to help children and youth with stress, anxiety, and depression. Teachers and other caregivers may also be able to use these resources.

More information about this project and the group of experts is available on the project webpage: https://www.nationalacademies.org/our-work/promoting-emotional-well-being-and-resilience.

Stress is a normal reaction to everyday pressures. Pressures may come from outside a person’s body (something that happens to you) or from the inside a person’s body (something you are feeling). Some stress can be helpful, like giving a person a boost of energy and feeling of urgency to study for a test. But having too much stress at once or having a lot of stress for a long time without enough breaks, can make life hard and cause problems with thinking and with doing day-today activities. When children or teens feel stressed, they may:

• Sweat
• Have a dry mouth
• Feel short of breath
• Have trouble sleeping
• Fidget
• Have a stomachache or headache
• Feel tense in the body
• Find it hard to think and finish tasks

Anxiety is an emotion of fear or worry about things that might happen in the future, or fear or worry about one’s safety, or the safety of others. Many children and teens have fears or worries, but some have so many fears and worries that they interfere with school, home, or play activities. When children or teens feel anxious, their muscles may tense, and their breathing and heartbeat may become more rapid. They might also have stomachaches, other body aches or pains, feel tired all the time, or have trouble sleeping. They might have upsetting thoughts that are hard to control. Sometimes, anxiety can make a child or teen irritable or angry. Some anxious children and teens keep their worries to themselves, or might not even be aware of them, and, thus, the symptoms can be missed. Examples of different types of anxiety that can cause difficulties with daily life include

• Being very afraid when away from parents (separation anxiety)
• Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias)
• Being very afraid of school and other places where there are people (social anxiety)
• Being very worried about the future and about bad things happening (general anxiety)
• Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)

Depression. Occasionally being sad or feeling hopeless is a part of every child and teen’s life. However, some children and teens feel sad or uninterested in things that they used to enjoy, or feel helpless or hopeless in situations they are able to change. When someone experiences depression, their eating and sleeping habits may change, they may feel tired and lack motivation to do things that they typically enjoy, feel bad about themselves, feel more irritable, and they might pull away from their friends and family. They might also have stomachaches or headaches. They might have trouble sleeping or may sleep too much.Some children and teens may not talk about their helpless and hopeless thoughts, and may not appear sad. Depression might also cause a child or teen to make trouble or act unmotivated, causing others not to notice that the child is depressed or to incorrectly label the child as a troublemaker or lazy. Examples of behaviors often seen in children and teens with depression include

• Feeling sad, hopeless, or irritable a lot of the time
• Not wanting to do or enjoy doing fun things
• Showing changes in eating patterns – eating a lot more or a lot less than usual
• Showing changes in sleep patterns – sleeping a lot more or a lot less than normal
• Showing changes in energy – being tired and sluggish or tense and restless a lot of the time
• Having a hard time paying attention
• Feeling worthless, useless, or guilty
• Showing self-injury and self-destructive behavior

Managing Symptoms. Although experiencing feelings of stress, anxiety, or depression may be difficult, it’s important to remember that these feelings can change, and there are tools that can help children and teens learn to manage feelings and help them cope.
Coping with these feelings can increase confidence and bring a greater sense of control. But sometimes children and teens can’t cope with these feelings on their own. When that happens, it is important to get help.

1. https://dictionary.apa.org/

Stress can be caused by a many things. Sometimes the cause is a specific situation that might be very difficult like…

• Having to do a difficult task,
• Feeling left out or lonely, or
• Feeling embarrassed in a social situation.

When stress is caused by events like this, the uncomfortable feelings can go away after the event is over. Many people also experience stress that lasts a long time without a break like…

• Living in a neighborhood where they don’t feel safe
• Having a parent who is sick and does not get better
• Feeling systemic racism or oppression at school

Thoughts, feelings, and behaviors can be difficult to manage when stressful factors like these feel outside of a person’s control. Cognitive behavioral therapy skills can help a person focus on what they can control.

Cognitive behavioral therapy (CBT) works by helping a person notice how their thoughts affect how they feel and behave. CBT helps them turn unhelpful thoughts around to more helpful thoughts so they feel better. Experts tell us that CBT is the gold standard of therapy for children, teens, and adults who are experiencing stress, anxiety, and depression.

The word “cognitive” refers to what we think, and the word “behavioral” to what we do. CBT can help children and teens…

• “Catch” thoughts that are not helpful, “check” them, and “change” them to feel better. 
• Learn to notice and do the things that help them feel better.
• Learn helpful skills like deep belly breathing and mindfulness.

CBT won’t be able to fix all the things that make someone feel stressed, anxious, or depressed, but it can help them cope with those feelings and feel better. 

These tools don’t teach every part of CBT, only some of the most tested and easy-to-use skills. Although these tools can’t take the place of a mental health provider, they can help children and teens learn how to better cope with everyday stress and anxiety.

NOTE: It takes time to learn a new habit, usually 30 to 60 days, so it’s important for children and teens to keep practicing these skills regularly. They will not only benefit today, but will build resilience and help manage future stress throughout life’s journey.

The CBT skills we teach here can help children and teens deal with stress, anxiety, and depression, and can provide parents, teachers, and other caregivers with tools to help children and teens learn new ways of coping. Here are some of the CBT skills we cover in these tools:

• Deep belly breathing involves slowing down breathing as a strategy to stay calm and relax. This skill is taught in the Belly Breathing or Deep Breathing scenarios.
• Mindfulness is all about learning how to stay fully in the present moment and being aware of one’s thoughts and feelings without feeling bad about them. This skill is taught in the Calming Your Mind scenarios.
• Doing activitiesthat make children and teens feel better - even when they feel down, that can help reduce stress, and give them more energy. This skill is taught in the Doing Fun Activities or Increasing Favorite Activities scenarios.
• Catching, checking, and changing your thoughts means learning to “catch” thoughts that are not helpful, “check” them, and “change” them to feel better. When we are feeling stressed, anxious, or depressed, we often fall into thinking traps, or patterns of unhelpful thoughts that are based on incomplete information. Here are a couple of the most common thinking traps that are addressed in these tools:
• Labeling is when someone attaches a negative description to themselves. For example, when someone makes a mistake, they might say “I’m such a failure,” rather than recognizing that making mistakes is normal. Learning how to get out of this thinking trap is taught in the Catch, Check, and Change Your Thoughts – Part 1 scenarios.
• All-or-nothing thinking often involves the use of absolute terms, such as never or always. For example, if someone tries out for a basketball team and don’t make it, they might think, “I’ll never be a basketball player!” In reality, when they focus on their feeling of failure, they might not remember that they can try out for a different team or practice and try again next year. Learning how to get out of this thinking trap is taught in the Catch, Check, and Change Your Thoughts – Part 2 scenarios.

There are other thinking traps too. Examples include “self-blame,” or thinking things are always their own fault even when those things are outside of their control; “mind reading,” or thinking that they know other people are thinking negatively about them; “should statements” or telling themselves they should or must do something that they might not be able to do; and “catastrophic thinking,” or focusing on the worst possible outcomes of something.

The language we use to describe people and experiences is important. It signifies how we express ourselves and how other people see us. Many times, in English or Spanish, we use different forms of nouns, pronouns, or adjectives that are based on assumptions about a person’s gender. Many people may not view this as a problem. But, for some people, assumptions about gender are not accurate, and can be harmful. Gender inclusive language is used throughout the modules to ensure that all children and teens can connect to our scenarios. They, them, and theirs are pronouns frequently used to refer to a single person when we are not aware of the person’s gender, and/or when a person does not identify as a boy/man or a girl/woman. For example, if a person notices that someone left an item in a classroom but the person does not know who it belongs to, the person might say “Oh no, someone left their water bottle” using “their” as a gender neutral pronoun. In Spanish, gender inclusive language is sometimes created using an –e, rather than a feminine –a or a masculine –o.

If you or your child or teen are in need of immediate support, the Lifeline network is available 24/7 across the United States. You can call (800) 273-8255 or text 741741.

If you are looking to find a provider who can support you or your child’s mental health, you can visit the Substance Abuse and Mental Health Services Administration and Mental Health America treatment locators. Cognitive behavioral therapists can be found on the Association for Behavioral and Cognitive Therapies website. The American Psychological Association also has a resource page dedicated to COVID-19.

To learn more about the COVID-19 pandemic, visit the websites for the CDC or the NIH.

For additional help, visit our Resources page.