Given that teens with obsessive-compulsive disorder (OCD) and anxiety disorders crave control, repetitive daily routines, and certainty, COVID-19 and the disruptions caused by stay-at-home orders and school closings present some serious challenges. As a person with OCD myself, I can say I have had to adapt and put into place strategies that are specific to this situation.
Here are some coping strategies I developed for teens with OCD to use during the coronavirus shutdown.
Create a Calendar
Try to get them to switch from the phone to an old school planner they can write in. You can order one of these online – try to get one with the weekly view (seven days shown on two open pages.) That way, they will have enough room in each day to make lists, draw pictures, and, most importantly, cross out whatever they have achieved for that day. Now, you will probably get from your loving, empathetic, and responsive teen, “Why should I keep a calendar or make lists? I’m stuck here, and there is nowhere to go and nothing to do.” To which you reply, “Fine, (they use that word all the time, why can’t you?) This way, you can track the nothing.” Explain to your teen with OCD, “Look, what we are going through is hard for you because you have lost control, and a feeling of being out of control is tough for you. You are going to plan each day and then execute and cross off what you have done. It will give you a feeling of satisfaction and control even though, in the beginning, it will feel silly.”
Start With Simple Daily Events
Once the calendar comes in (or you create one with a ruler and some paper), start filling it out. Your teen will find out there are some things to put in it for the next day/week. Start with the obvious: wake up, breakfast, clean the dishes, dinner, meeting online with teachers, and whatever else has to happen. You will be writing down the most basic structure of the day: everyday occurrences that have not had to be planned or tracked before COVID. Waking up used to be at the same time because of school, now waking up can take place anytime. Going to sleep and waking up at different times is not good for teens (or adults) with a mental illness. This connection has been backed up by numerous studies, including this one from The Journal of Pediatrics.
You are going to impose a wake-up time. It will be a hard sell, but unhappy teens want to be happy. When they follow what I’m recommending for several days, they will be happy. Once they get happy, they will want to keep doing what makes them happy. Try to make activities occur at the time they used to even though the usual timeframes vanished when school closures and social distancing measures took effect. For example, if your teen always took the dog out after school, and that was at 3:30, have her write in the calendar, “take dog out at 3:30.” The dog will appreciate it as he is as befuddled by all this as we are.
Think about what they have lost and how the effect on them will be more pronounced
Think about it, teens with OCD, anxiety, or bipolar disorder have built their days around a structure that was imposed on them for years by school, sports, routine social activities, and other outside-of-the-home events. They got up at the same time, caught the bus, walked to school or carpooled at the same time; they sat in the same seat in the bus or car every morning; they used the same restroom and stall when they got to school, used the same locker, sat in the same seat in each class, and built rituals only they know about into their school day. Teens with OCD teens build structure into the world they expect to live in. We all do it; it’s a coping skill for the way we are wired. There was a sameness for your teen to every schoolday and weekend during the school year. Now that is suddenly all gone. And nobody knows when it is going to come back or if it will return in the same form.
The normalcy teens with mental illness fight so hard to achieve was taken from them
Getting your teen to use a daily list/calendar system is a way of restoring that normalcy and sense of accomplishment. When I was in high school, getting to school and in the right seat in the class, I was supposed to be in was quite an accomplishment. When I settled into my chair and made my nest, I actually felt like I had achieved something. Heck, I’m 55, and if I can go to Walmart and come home with the items my wife put on a list for me, I think I have won an Olympic victory. (And I get to cross that task off my list – oh, the joy.) There are none of these little daily victories for your locked-down teen with mental illness. The little things he was so proud of achieving have been suddenly taken away from him. Now you are going to create, with his help, new little things to achieve.
You and your teen are going to add a baseline structure – you are going to list mundane things to be achieved. Empty time is not good for those with anxiety disorders – we tend to think too much, and our brains get on to what my wife refers to as the “hamster wheel.” Being able to eat lunch at any time we want is confusing and disorienting if we have been eating lunch every day at 11:23 in the school cafeteria sitting in a blue chair in the same spot. The chairs are red and blue, but we like the blue ones so, if a red one is in our place when we arrive, we switch it.
You are going to work out what time breakfast, lunch, and dinner are going to be in “stay-at-home” mode, and your teen is going to eat it at that time (as well as help prepare the meal and clean up). Then you are going to add chores and tasks that regularly took place before COVID-19. Each time he achieves one of these small tasks, he gets to cross it off the list (we love crossing things out.)
Add something positive to look forward to
Once you get the daily basics filled in, start adding something to look forward to. The challenge is, the usual things to look forward to are off the table due to social distancing, school closures, and stay-at-home laws. During shutdown, little things need to become big things and put on the calendar. You used to get a shake at the drive-through when your teen was seven, and it was a big deal, if he knew it was going to happen he would inquire about this great adventure all day long. Now your OCD teen is not excited about the drive-through shake and will scoff at it when you put it down on his calendar. But now that he has been shut-in for weeks, the shake run is a big deal. He will not admit it, but on the day it is scheduled, he will wake up thinking about it and will be ready ten minutes before the appointed time. The only way the shake run idea could be any better is to make it happen on the same day at the same time every week… oh, the joy. By filling his day with events he can predict, take note of, write down in his calendar, and cross off, you have saved him from the anxiety empty and unstructured days can produce and given back a sense of control.
COVID social distancing: more time for social media and gaming addiction as well as the anxiety and depression that come with it
The link between social media addiction and depression and anxiety has been well established. But there is a way you can use the phone embedded in your teen’s hand to create structure: have her plan and implement social media meetings and write these upcoming meetings in her calendar. Watching YouTube videos for four hours straight is incredibly unhealthy for any teen and particularly teens with mood disorders. Meeting with all your friends on Zoom at 10:30 is great. Bingeing on five hours of “Stranger Things” in a dark room is bad. Scheduling a social media chat with your friends about “Stranger Things” at 11:00 on Thursday is good. The idea is to encourage your teen to use the phone or tablet to interact with others rather than just as an entertainment device. These interactions should be scheduled.
Teach your teen to create structure where there is none – use the calendar as a tool to make this happen
The idea is to implant structure into the current structurless existence. Your teen with OCD may not be able to do all the comforting things she is used to doing, but you are going to work with her to create new comforting rituals. To be comforting, activities need to happen at the same time and be “achievable.” Lying in bed, facing an empty and unstructured day, may be relaxing for many people but not for teens with OCD. Fill the day and use the calendar to fill it. Help your teen find new comfortable patterns during this time, and she will learn an even more important skill set she can use the rest of her life – the power to adapt to what she perceives to be a triggering event.
About the Author: Keith Deltano is an award-winning public educator, parent coach, and internationally touring educational comedian. He is the creator of the character education and anti-bullying curriculum CharacterVideo.org.
The opinions and views expressed in this guest blog do not necessarily reflect those of www.rtor.org or its sponsor, Laurel House, Inc. The author and www.rtor.org have no affiliations with any products or services mentioned in this article or linked to herein.
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