Colman Noctor: Responding to the fourth wave of anxiety in our young people

I have been struck by how many young people do not talk about the presence of sadness -  instead, it's the absence of happiness or joy

Picture: iStock 

There are different metrics to measure the impact of Covid-19 on our lives. For many, it is daily case numbers, hospital admissions, occupied ICU beds or deaths; for me, it is the number of referrals arriving in my email inbox. I saw a big peak in queries in January 2021, and it seemed like the whole country was struggling with mental health problems. But a week into January 2022, and I have almost as many queries as I did in the whole month last year.

As spring of 2021 sprung and the schools reopened, we all smiled again as we queued for our vaccine and our hope reserves began to refill. However, as autumn came around and the clocks changed, things became considerably darker. The new Omicron variant and the return of restrictions brought a wave of frustration, upset and disillusionment. The spike in cases in primary schools, the ramping up of in-class tests in secondary schools began in earnest. As the fourth surge of anxiety began, the young people of Ireland began to struggle once again.

No child is immune to stress

About 60% of the referrals I currently get relate to anxiety, some 30% contain themes of low mood or low motivation, and the other 10% tend to be eating problems. The age span is evenly spread with equal numbers of four-year-olds and 24-year-olds. Socioeconomic background does not seem to be a protection or risk factor, suggesting no child is immune to psychological stress and emotional problems relating to pandemic life.

It is heart-breaking to decline to take on young people who have significant needs, many of whom I believe I could help, but there are not enough hours in the day. Of the young people I have been able to see, I have been struck by how many do not talk about the presence of sadness -  instead, it's the absence of happiness or joy. 

Traditionally working with young people is really exciting. Their colourful worlds of friendships, puberty, growing up, betrayal and fervent support are usually so vibrant and have this wonderful theme of youthful exuberance and naivete. But this is different now. Feelings of hopelessness, resignation and repeated claims of ‘what’s the point’ are pervasive, and the colour in their lives seems considerably duller.

The conversations are different to the pre-pandemic topics. There were far fewer interpersonal disputes with friends, less betrayal of loyalties and thankfully fewer accounts of bullying. But what is most noticeable is this air of nothingness or numbness that is affecting young people’s wellbeing.

Air of despair and hopelessness 

The young people I talk to seem to have a sense of suspiciousness. It’s like nothing in their lives is reliable, and when they look to the grown-ups for advice, it tends to be wishy-washy, uncertain, or what they promise does not materialise. In many ways, it appears that the adults in their lives have ‘lost the room’. Like many of us, they feel let down by the false promises of an end to the pandemic.

 This air of despair and hopelessness is challenging to watch and increasingly difficult to treat. I repeatedly asked during the first lockdown the benign mental health question, ‘have you tried going for a walk?’. Now here I am, 23 months down the line offering promises of ‘better things to come’, which is being met with a similar sense of dismissal or series of eye-rolls.

With no obvious solution, we can become overwhelmed by circumstances we have no control over. This lack of control can be displaced onto something we feel we can influence, something more tangible. It can manifest in stringent restriction of eating patterns or becoming more obsessive about certain aspects of our lives.

A common displaced obsessive worry I have witnessed since the pandemic is a fear of vomiting.

The child’s brain tells them that in order not to vomit, they must take certain precautions, like not eating any foods that might make them sick. They become acutely vigilant of their diet and gastro sensations. This can evolve into avoiding school or any public places where you might pick up germs. They may also engage in excessive handwashing.

Parents typically become concerned because they see their child eating less, or becoming obsessed with cleanliness or maybe not wanting to fall asleep at night for fear that they will vomit in their sleep and a search for professional help ensues.

When a young person arrives to see me with these experiences, I will often say that I don’t believe that the vomiting is the problem. Instead, it is the child’s belief that these behaviours are the ‘answer’ to their problem. These precautionary behaviours offer the young person a short term feeling of control. They know that if they wash their hands, avoid certain foods and monitor any feelings in their stomachs, they are controlling the risk of vomiting and, by extension, feel more in control of an aspect of their lives.

However, in the long-term these reassurance-seeking behaviours are futile. Their stress originates elsewhere, like the overwhelming uncertainty of growing up in a pandemic, but this is something they can do nothing about. These behaviours provide an illusionary short-term feeling of control and autonomy, which is exactly what they crave when they feel overwhelmed.

Therapy involves supporting the child or young person to tolerate the uncertainty of their lives and teaches them alternative ways to cope and respond to the anxiety other than irrational worries. Although this is easier said than done. 

Acknowledge the reality 

When children are anxious they tend to ‘overestimate the challenge and underestimate their ability’. Those who support them try to put the challenge in perspective and reassure the person of their own ability. This can be done by acknowledging that growing up in a pandemic is really difficult but reassuring them that it will not last forever, and there are still experiences open to them that may well offer psychological and emotional nourishment.

Not every anxious child needs to see a child psychotherapist, and there is a lot parents can do to help. The most important role parents play in supporting someone with anxiety is to use every opportunity to nurture their self-worth, self-value and self-belief. Rather than glibly promising that everything will be OK, we need to remind them of their qualities, strengths and inherent value. 

Try to get them to trust in their own ability to ride out the Covid storm and offer authentic support to help them get through it. It may seem futile and we may need to repeat this process many times, but remember just because it does not have an obvious impact is not proof that it is not working. It can be difficult to measure mental health progress, so persist even when your approach does not seem to be having the desired effect. Providing anxious children with evidence to bolster their self-worth will help them persevere despite the Covid storm.